Predicting outcomes in patients with low ejection fraction undergoing coronary artery bypass graft.

Introduction: Reduced left ventricular ejection fraction (LVEF) is a well-known predictor of adverse events after cardiac surgery. We aimed to assess the outcomes in patients with low LVEF undergoing coronary artery bypass graft. Methods: In this retrospective cohort, we included all patients with left ventricular ejection fraction ≤ 40 who underwent coronary artery bypass grafting between March 2007 and March 2016 (with a median follow-up of nine years) at Tehran Heart Center. Demographics and clinical characteristics were extracted from the data registry. Akaike information criterion (AIC) was used. The univariate Cox regression was performed. We investigated the predictors of mortality and major adverse cardiac and cerebrovascular events (MACCE) using Cox multivariable regression. Results: In total, 5,532 cases (79 % male) with a mean age of 65.58 were included in the study. The nine-year overall survival was calculated at 68 %, and more than half of the patients had MACCE (55 %). In adjusted multivariable Cox regression analysis, moderate to severe mitral valve regurgitation, glomerular filtration rate ≤ 60, mild right ventricular dysfunction, and valvular heart disease independently predicted higher mortality. The abovementioned predictors and peripheral vascular disease significantly increased MACCE. Conclusion: Our study indicates the clinical significance of mitral regurgitation, valvular heart disease, and renal function in patients with low ejection fraction treated by coronary artery bypass grafting surgery. Identifying predictors of adverse events can help with clinical decision-making and risk stratification, ultimately improving patient outcomes.

Prediabetes and major adverse cardiac events after acute coronary syndrome: An overestimated concept.

BACKGROUND: Unlike diabetes, the effect of prediabetes on outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) is not much investigated. We investigated the association between fasting glycemic status and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ACS undergoing PCI and had mid to long-term follow-up after coronary stenting. METHODS: Registry-based retrospective cohort study included ACS patients who underwent PCI at the Tehran Heart Center from 2015 to 2021 with a median follow-up of 378 days. Patients were allocated into normoglycemic, prediabetic, and diabetic groups. The primary and secondary outcomes were MACCE and its components, respectively. Unadjusted and adjusted Cox models were used to evaluate the association between glycemic status and outcomes. RESULTS: Among 13 682 patients, 3151 (23%) were prediabetic, and 5834 (42.6%) were diabetic. MACCE risk was significantly higher for diabetic versus normoglycemic (adjusted hazard ratio [aHR]: 1.22, 95% confidence interval [CI]: 1.06-1.41), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 0.95, 95% CI: 0.78-1.10). All-cause mortality risk was significantly higher in diabetic versus normoglycemic (aHR: 1.42, 95% CI: 1.08-1.86), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 1.15, 95% CI: 0.84-1.59). Among other components of MACCE, only coronary artery bypass grafting was significantly higher in diabetic patients, and not prediabetic, compared with normoglycemic. CONCLUSIONS: Prediabetic ACS patients undergoing PCI, unlike diabetics, are not at increased risk of MACCE and all-cause mortality. While prediabetic patients could be regarded as having the same risk as nondiabetics, careful consideration to provide more intensive pre- and post-PCI care in diabetic patients is mandatory.

Comparative analysis of treatment options for chronic heart failure and depression: a systematic review and Bayesian network meta-analysis.

Different interventions have been evaluated for the treatment of depression in heart failure (HF) patients. However, clear and established recommendations are lacking. PubMed, Scopus, and Web of Science databases were systematically searched for randomized controlled trials (RCT) evaluating the effect of various treatment options on depression scores in heart failure patients. The primary outcome was a change in depression scores presented as standardized mean difference (SMD). A Bayesian network for meta-analysis was constructed. Twenty-five RCTs were included, randomizing 6014 patients with confirmed heart failure and depression between 2003 and 2022. Compared to treatment as usual (TAU), only cognitive behavioral therapy (CBT) (SMD - 0.60, CI95% [- 1.0, - 0.17]) leads to a significant reduction in depression scores. Other interventions did not improve depression scores significantly. Our results show that for patients with HF and depression, CBT can significantly improve measures of depression, being the most efficacious treatment.

Heart surgery over two decades: what we have learned about results and changing risks.

OBJECTIVES: Using the cardiac surgery database is of high importance in referral centers and can lead to a better quality of care for patients. Tehran Heart Center (THC) is a cardiovascular referral center that was inaugurated in 2001. In this report, we aimed to present the third report of trends in patients' cardiovascular risk factors and surgical procedures from 2002 to 2021 that have been gathered for all THC patients. METHODS: This serial cross-sectional study was conducted at Tehran Heart Center from 2002 to 2021. All patients undergoing cardiac surgeries were eligible to enter the study (N = 63,974). Those with miscellaneous types of surgeries were excluded (N = 9556). The distribution of cardiac surgeries (including isolated coronary artery bypass graft (CABG), isolated valve, and CABG + valve surgeries) and their respective in-hospital mortality were recorded. Furthermore, 20-year trends in the prevalence of various cardiovascular risk factors (CVRFs) among the following groups were evaluated: a) isolated CABG, b) aortic valve replacement/repair for aortic stenosis (AS/AVR/r), and c) isolated other valve surgeries (IVS). RESULTS: A total of 54,418 patients (male: 70.7%, age: 62.7 ± 10.8 years) comprised the final study population, with 84.5% prevalence of isolated CABG. Overall, the AS/AVR/r group was in between the CABG and IVS groups concerning CVRFs distribution. Excluding some exceptions for the AS/AVR/r group (in which the small sample size (N = 909) precluded observing a clear trend), all studied CVRFs demonstrated an overall rising trend from 2002 to 2021 in all three groups. Regarding in-hospital mortality, the highest rate was recorded as 4.0% in 2020, while the lowest rate was 2.0% in 2001. CONCLUSIONS: Isolated CABG remained the most frequent procedure in THC. Notable, increasing trends in CVRFs were observed during this 20-year period and across various types of cardiac surgeries, which highlights the clinical and policy-making implications of our findings.

Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis.

Introduction: Detection of paroxysmal atrial fibrillation (PAF) is crucial for secondary prevention in patients with recent strokes of unknown etiology. This systematic review and meta-analysis assess the predictive power of available risk scores for detecting new PAF after acute ischemic stroke (AIS). Methods: PubMed, Embase, Scopus, and Web of Science databases were searched until September 2023 to identify relevant studies. A bivariate random effects meta-analysis model pooled data on sensitivity, specificity, and area under the curve (AUC) for each score. The QUADAS-2 tool was used for the quality assessment. Results: Eventually, 21 studies with 18 original risk scores were identified. Age, left atrial enlargement, and NIHSS score were the most common predictive factors, respectively. Seven risk scores were meta-analyzed, with iPAB showing the highest pooled sensitivity and AUC (sensitivity: 89.4%, specificity: 74.2%, AUC: 0.83), and HAVOC having the highest pooled specificity (sensitivity: 46.3%, specificity: 82.0%, AUC: 0.82). Altogether, seven risk scores displayed good discriminatory power (AUC ≥0.80) with four of them (HAVOC, iPAB, Fujii, and MVP scores) being externally validated. Conclusion: Available risk scores demonstrate moderate to good predictive accuracy and can help identify patients who would benefit from extended cardiac monitoring after AIS. External validation is essential before widespread clinical adoption.

Serum levels of trimethylamine N-oxide and kynurenine novel biomarkers are associated with adult metabolic syndrome and its components: a case-control study from the TEC cohort.

Background: Epidemiologic research suggests that gut microbiota alteration (dysbiosis) may play a role in the pathogenesis of metabolic syndrome (MetS). Dysbiosis can influence Trimethylamine N-oxide (TMAO) a gut microbiota-derived metabolite, as well as kynurenine pathways (KP), which are known as a new marker for an early predictor of chronic diseases. Hence, the current study aimed to investigate the association between KYN and TMAO with MetS and its components. Methods: This case-control study was conducted on 250 adults aged 18 years or over of Tehran University of Medical Sciences (TUMS) Employee's Cohort study (TEC) in the baseline phase. Data on the dietary intakes were collected using a validated dish-based food frequency questionnaire (FFQ) and dietary intakes of nitrite and nitrate were estimated using FFQ with 144 items. MetS was defined according to the NCEP ATP criteria. Serum profiles TMAO and KYN were measured by standard protocol. Result: The mean level of TMAO and KYN in subjects with MetS was 51.49 pg/mL and 417.56 nmol/l. High levels of TMAO (≥30.39 pg/mL) with MetS were directly correlated, after adjusting for confounding factors, the odds of MetS in individuals 2.37 times increased (OR: 2.37, 95% CI: 1.31-4.28, P-value = 0.004), also, high levels of KYN (≥297.18 nmol/L) increased odds of Mets+ 1.48 times, which is statistically significant (OR: 1.48, 95% CI: 0.83-2.63, P-value = 0.04). High levels of TMAO compared with the reference group increased the odds of hypertriglyceridemia and low HDL in crude and adjusted models (P < 0.05). Additionally, there was a statistically significant high level of KYN increased odds of abdominal obesity (P < 0.05). Conclusion: Our study revealed a positive association between serum TMAO and KYN levels and MetS and some of its components. For underlying mechanisms and possible clinical implications of the differences. Prospective studies in healthy individuals are necessary.

Risk assessment for mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A retrospective cohort study.

Background and Aims: Primary percutaneous coronary intervention (PCI) is the treatment of choice in ST-elevation myocardial infarction (STEMI) patients. This study aims to evaluate predictors of in-hospital and long-term mortality among patients with STEMI undergoing primary PCI. Methods: In this registry-based study, we retrospectively analyzed patients with STEMI undergoing primary PCI enrolled in the primary angioplasty registry of Sina Hospital. Independent predictors of in-hospital and long-term mortality were determined using multivariate logistic regression and Cox regression analyses, respectively. Results: A total of 1123 consecutive patients with STEMI were entered into the study. The mean age was 59.37 ± 12.15 years old, and women constituted 17.1% of the study population. The in-hospital mortality rate was 5.0%. Multivariate analyses revealed that older age (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.02-1.10), lower ejection fraction (OR: 0.97, 95% CI: 0.92-0.99), lower mean arterial pressure (OR: 0.95, 95% CI: 0.93-0.98), and higher white blood cells (OR: 1.17, 95% CI: 1.06-1.29) as independent risk predictors for in-hospital mortality. Also, 875 patients were followed for a median time of 21.8 months. Multivariate Cox regression demonstrated older age (hazard ratio [HR] = 1.04, 95% CI: 1.02-1.06), lower mean arterial pressure (HR = 0.98, 95% CI: 0.97-1.00), and higher blood urea (HR = 1.01, 95% CI: 1.00-1.02) as independent predictors of long-term mortality. Conclusion: We found that older age and lower mean arterial pressure were significantly associated with the increased risk of in-hospital and long-term mortality in STEMI patients undergoing primary PCI. Our results indicate a necessity for more precise care and monitoring during hospitalization for such high-risk patients.

Association between dietary intakes of Nitrate and Nitrite with Angina and atherogenic index in adults: A cross-sectional study from Tehran University of Medical Sciences employees` cohort (TEC) study.

BACKGROUND: Previous studies have shown that the intake of nitrate and nitrite may be associated with cardiovascular disease. Therefore, this study sought to investigate the association between dietary intakes of nitrate and nitrite with the odds of angina and atherogenic index in adults. METHODS: The study analyzed 1182 adults aged 20+ in the Tehran University of Medical Sciences (TUMS) Employee's Cohort study (TEC), focusing on dietary intakes, angina, and atherogenic indexes, using a validated food frequency questionnaire (FFQ) and the Rose Angina Questionnaire (RAQ). RESULT: The study found a significant inverse relationship between nitrate intake and odds of grade 2 angina. The highest dietary nitrate was associated with 29 % lower odds of grade 1 angina and also, 46 % lower odds of angina possible (P<0.05). Adults with the highest nitrate intake had 29 % lower odds of grade 1 angina and 46 % lower odds of angina possible. Adherence to nitrate reduced CRI, Atherogenic index of plasma, and TyG in participants, but no significant association was found with other factors. CONCLUSION: The study suggests that high nitrate and nitrite intake can alter angina risk, and a reverse association was found between dietary nitrate intake and various atherogenic indices.

The Association between Acute Cardiac Injury and Outcomes of Hospitalized Patients with COVID-19: Long-Term Follow-up Results from the Sina Hospital COVID-19 Registry, Iran.

Background: The present study aimed to investigate the association between acute cardiac injury (ACI) and outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran. Methods: The current cohort study enrolled all consecutive hospitalized patients with COVID-19 (≥ 18 y) who had serum high-sensitivity cardiac troponin-I (hs-cTnT) measurements on admission between March 2020 and March 2021. ACI was determined as hs-cTnT levels exceeding the 99th percentile of normal values. Data on demographics, comorbidities, clinical and laboratory characteristics, and outcomes were collected from Web-based electronic health records. Results: The study population consisted of 1413 hospitalized patients with COVID-19, of whom 319 patients (22.58%) presented with ACI. The patients with ACI had a significantly higher mortality rate than those without ACI (48.28% vs 15.63%; P<0.001) within a mean follow-up of 218.86 days from symptom onset. ACI on admission was independently associated with mortality (HR, 1.44; P=0.018). In multivariable logistic regression, age (OR, 1.034; P<0.001), preexisting cardiac disease (OR, 1.49; P=0.035), preexisting malignancy (OR, 2.01; P=0.030), oxygen saturation reduced to less than 90% (OR, 2.15; P<0.001), leukocytosis (OR, 1.45; P=0.043), lymphopenia (OR, 1.49; P=0.020), reduced estimated glomerular filtration rates (eGFRs) (OR, 0.99; P=0.008), and treatment with intravenous immunoglobulin during hospitalization (OR, 4.03; P=0.006) were independently associated with ACI development. Conclusion: ACI occurrence on admission was associated with long-term mortality in our hospitalized patients with COVID-19. The finding further underscores the significance of evaluating ACI occurrence on admission, particularly in individuals more prone to ACI, including older individuals and those with preexisting comorbidities, reduced oxygen saturation, and increased inflammatory responses.

Blood Pressure Control Following Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: Insights from a Triple-Blind, Randomized, Clinical Trial.

Data on substituting one antihypertensive medication with the proper dose of another antihypertensive medication, in certain medical conditions, are scarce. Herein, we present the results of replacing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) with the calcium channel blocker (CCB) amlodipine, with or without the alpha- and beta-blocker carvedilol, to control high blood pressure in patients with coronavirus disease 2019 (COVID-19). Iranian hypertensive patients with COVID-19 and a history of taking ACEI or ARB were randomized to "continue" and "change" groups. The continue group comprised patients who continued using their previous antihypertensive medication regimen as normal, whereas patients in the change group had their antihypertensive drugs changed to the CCB amlodipine, with or without the alpha- and beta-blocker carvedilol, based on their response to amlodipine. Patients' blood pressures were measured for 8 days following their recruitment. A total of 31 and 33 patients were randomly allocated to the ACEI/ARB continue and ACEI/ARB change groups, respectively. No significant deviations were seen in patients' systolic blood pressure by substituting an ACEI/ARB agent with the CCB amlodipine, with or without the alpha- and beta-blocker carvedilol. Moreover, the change group had a more balanced systolic blood pressure (ie, 110-130 mmHg) compared with the continue group (ie, 111.5-140.0 mmHg) throughout their hospitalization period. During their hospitalization, the blood pressure of the change group was well controlled with the proposed equivalent doses. Further investigations of the proposed equivalent doses in larger randomized clinical trials, populations other than Iranian COVID-19 patients, and extended duration are encouraged (clinical trial registration ID: IRCT20151113025025N3).

Epidemiology and prevalence of tobacco use in Tehran; a report from the recruitment phase of Tehran cohort study.

INTRODUCTION: Tobacco use is a major health concern worldwide, especially in low/middle-income countries. We aimed to assess the prevalence of cigarette smoking, waterpipe, and pipe use in Tehran, Iran. METHODS: We used data from 8272 participants of the Tehran Cohort Study recruitment phase. Tobacco use was defined as a positive answer to using cigarettes, waterpipes, or pipes. Participants who did not report tobacco use during the interview but had a previous smoking history were categorized as former users. Age- and sex-weighted prevalence rates were calculated based on the national census data, and characteristics of current and former tobacco users were analyzed. RESULTS: Age- and sex-weighted prevalence of current tobacco users, cigarette smokers, waterpipe, and pipe users in Tehran was 19.8%, 14.9%, 6.1%, and 0.5%, respectively. Current tobacco use was higher in younger individuals (35-45 years: 23.4% vs. ≥ 75 years: 10.4%, P < 0.001) and men compared to women (32.9% vs. 7.7% P < 0.001). The prevalence of tobacco use increased with more years of education (> 12 years: 19.3% vs. illiterate: 9.7%, P < 0.001), lower body mass index (< 20 kg/m2: 31.3% vs. ≥ 35 kg/m2: 13.8%, P < 0.001), higher physical activity (high: 23.0% vs. low: 16.4%, P < 0.001), opium (user: 66.6% vs. non-user: 16.5%, P < 0.001), and alcohol use (drinker: 57.5% vs. non-drinker: 15.4%, P < 0.001). Waterpipe users were younger (46.1 vs. 53.2 years) and had a narrower gender gap in prevalence than cigarette smokers (male/female ratio in waterpipe users: 2.39 vs. cigarette smokers: 5.47). Opium (OR = 5.557, P < 0.001) and alcohol consumption (OR = 4.737, P < 0.001) were strongly associated with tobacco use. Hypertension was negatively associated with tobacco use (OR = 0.774, P = 0.005). CONCLUSION: The concerning prevalence of tobacco use in Tehran and its large gender gap for cigarette and waterpipe use warrant tailored preventive policies.

Predicting factors of echocardiographic super-response to cardiac resynchronization therapy.

PURPOSE: To investigate the clinical and echocardiographic predictors of echocardiographic super-response to cardiac resynchronization therapy (CRT) in heart failure patients. METHODS: We retrospectively collected data from 97 patients, who underwent CRT and were followed up (median time = 20.33 months). All had left ventricular ejection fraction (LVEF) ≤35%, New-York-Heart-Association class 3 or 4, and Q wave, R wave and S wave (QRS) duration >120 ms. Time-to-peak systolic velocity was measured for individual LV segments by tissue Doppler imaging prior to CRT. Two-dimensional echocardiography was carried out before and at follow-up, and ≥12.5% increase in LVEF was defined as super-response. RESULTS: From the 97 patients, 23 (23.7%) were super-responders. Super-responders were more frequently female (52.2% vs. 24.3%, respectively; p value = 0.012). Among super-responders, the mean of LV end-diastolic and end-systolic volumes were significantly lower. According to dyssynchrony indices, time delay between anteroseptal and posterior wall and SD of all LV segments timing showed significantly higher values in super-responders. By multivariate analysis, LV end-systolic volume and anteroseptal-to-posterior wall delay remained independently associated with echocardiographic super-response to CRT. CONCLUSION: About one-fourth of our patients with CRT were super-responder in that they had ≥12.5% increase in LVEF by echocardiography. Among all the clinical and echocardiographic measures, only lower LV end-systolic volume and higher anteroseptal-to-posterior wall delay predicted super-response.

ACC/AHA/HFSA 2022 and ESC 2021 guidelines on heart failure comparison.

The 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) and the 2021 European Society of Cardiology (ESC) both provide evidence-based guides for the diagnosis and treatment of heart failure (HF). In this review, we aimed to compare recommendations suggested by these guidelines highlighting the differences and latest evidence mentioned in each of the guidelines. While the staging of HF depends on left ventricular ejection fraction, the Universal Definition of HF, suggested in 2021, is described in 2022 ACC/AHA/HFSA guidelines. Both guidelines recommend invasive and non-invasive tests to diagnose. Despite being identical in the backbone, some differences exist in medical therapy and devices, which can be partially attributed to the recent trials published that are presented in the American guidelines. The recommendation of implantable cardioverter defibrillator for prevention in HF with reduced ejection fraction (HFrEF) patients, made by ACC/AHA/HFSA guidelines, is among the bold differences. It seems that ACC/AHA/HFSA guidelines emphasize the quality of life, cost-effectiveness, and optimization of care given to patients. On the other hand, the ESC guidelines provide recommendations for certain comorbidities. This comparison can guide clinicians in choosing the proper approach for their own settings and the writing committees in addressing the differences in order to have better consistency in future guidelines.

Association of lipid accumulation product with type 2 diabetes mellitus, hypertension, and mortality: a systematic review and meta-analysis.

Purpose: Novel anthropometric measures are simple, applicable, and inexpensive tools for cardiovascular risk assessment. This study evaluates the association of lipid accumulation product (LAP) with hypertension, type 2 diabetes mellitus (T2DM), and all-cause mortality, and compares it with other anthropometric measures. Methods: PubMed, Web of Science, EMBASE, and Scopus were systematically searched for articles published until May 15, 2021. We included all the studies that had measured LAP predictability for T2DM, all-cause mortality, and hypertension with no limitation in comorbidities and follow-up duration. We assessed the predictability measures of LAP for the aforementioned outcomes. We also performed a meta-analysis on four articles on mortality using an inverse variance method by the "meta" package in R software. Results: Twenty-nine studies were included in the review after applying the eligibility criteria. The hazard ratio for all-cause mortality per one standard deviation increment of LAP was 1.24 (95% confidence interval [CI]: 1.00-1.53; P = 0.0463) in females, and 1.07 (95% CI: 0.74-1.57; P = 0.709) in males. All included studies found a direct association between LAP with T2DM and hypertension. However, studies used different cut-off points for LAP. Most studies found that LAP was superior in predicting T2DM and hypertension compared to conventional indices, e.g., body mass index and waist circumference. We found that LAP may have higher prognostic significance in females compared to males. Conclusion: LAP is an inexpensive method to evaluate the risk of all-cause mortality, T2DM, and hypertension, and could outperform conventional anthropometric indices in this regard. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01114-z.

Improved Right Ventricular Systolic Function After Cardiac Resynchronization Therapy in Patients With Heart Failure.

BACKGROUND: Since the introduction of cardiac resynchronization therapy (CRT) to improve left ventricular function, the effect of CRT on the right ventricle in patients with heart failure has not been well described. METHODS: We evaluated the effect of CRT on right ventricular systolic function in 20 patients (80% men; mean [SD] age, 58.5 [9.8] y) with cardiomyopathy and right ventricular systolic dysfunction (New York Heart Association class III or IV, left ventricular ejection fraction ≤35%, and QRS interval ≥120 ms). The median follow-up time was 15 months. Right ventricular systolic function, defined as a tricuspid annular plane systolic excursion (TAPSE) index of 16 mm or less, was evaluated in patients before and after CRT. RESULTS: Twelve (60%) patients had ischemic cardiomyopathy, and 12 (60%) patients had left bundle branch block detected using surface electrocardiogram. The mean (SD) QRS duration was 160.5 (24.4) ms. From before CRT to the time of follow-up after CRT, the mean (SD) ejection fraction increased significantly from 22.5% (5.6%) to 29.4% (7.4%) (P < .001). The mean (SD) TAPSE index also increased significantly from 13.70 (1.78) mm to 16.50 (4.77) mm (P = .018). Eleven (55%) patients showed improved right ventricular systolic function (TAPSE ≥16 mm) after CRT. Patients with a favorable right ventricular response to CRT were significantly older (64.6 [8.2] y vs 53.6 [8.4] y, respectively) and more likely to have nonischemic origin of cardiomyopathy than were patients with unimproved right ventricular function (66.7% vs 18.2%, respectively). CONCLUSION: Our findings indicate that CRT is associated with improved right ventricular systolic function in patients with heart failure and right ventricular systolic dysfunction. Patients with nonischemic heart disease more often show improved right ventricular function after CRT.

Association of zinc serum level with metabolic syndrome in iranian children and adolescents: The CASPIAN-V study.

Introduction: Metabolic syndrome comprises a set of metabolic risk factors associated with cardiovascular disease and type 2 diabetes. Zinc plays an essential role in numerous enzyme functions that may be associated with metabolic dysfunctions. The relationship between serum zinc levels and metabolic syndrome in adolescents has not been specifically studied. Therefore, this study was performed to determine the relationship between serum zinc levels and metabolic syndrome in Iranian children and adolescents. Materials and methods: This cross-sectional study was performed using data collected in the CASPIAN-V study. In this project, data were collected using interviews, examinations, biochemical assessments, anthropometric studies, and the nutritional status of participants. The variables considered in this study included serum zinc levels, triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting blood sugar, height, weight, abdominal circumference, and systolic and diastolic blood pressure. Results: A total of 1371 participants were included in this study, with a mean age of 12.24 ± 3.23 years. In total, 12.40% (n = 170) of the study population had metabolic syndrome, of which 55.7% were boys and 44.3% were girls. Mean zinc levels (µg/dL) in patients with and without metabolic syndrome were 107.03 and 110.6, respectively (p-value = 0.211) and 111.8 for boys and 109.10 for girls (p-value = 0.677). Conclusion: This cross-sectional study showed no association between serum zinc levels and metabolic syndrome in children. Further similar studies and cohort studies with large sample sizes are needed to reveal the exact relationship between serum zinc levels and metabolic syndrome.

The outcomes of marginal donor hearts compared with ideal donors: a single-center experience in Iran.

Background: Heart transplantation has been considered the gold-standard treatment for patients with end-stage heart failure. This study assessed the survival outcomes of marginal donor hearts compared with ideal donor hearts in Iran. Methods: This retrospective study is based on the follow-up data of heart donors and recipients in the Sina Hospital Organ Procurement Unit. Among the 93 participants, 75 were categorized as ideal donors (group A) and 18 as marginal donors (group B). Group C included heart recipients who received a standard organ, and group D included heart recipients who received a marginal one. To analyze differences in patient characteristics among the groups, posttransplant heart survival was assessed in all groups. All data were obtained from the hospital records. Results: The mean age of the donors was 26.27±11.44 years (median age, 28 years). The marginal age showed a significant association with donor age. The age of recipients had a significant effect on survival days in the ideal group. Most patients survived for at least 1 year, with a median of 645 days in recipients from marginal donors and 689 days in recipients from ideal donors. Conclusions: Considering the lack of organ availability in Iran, it may be possible to use marginal donors for marginal recipients, therefore reducing the number of people on the waitlist. We also recommend establishing a national marginal donor system specifically for Iranian patients to extend the donor pool.

COVID-19 in Iran: clinical presentations and outcomes in three different surges of COVID-19 infection.

BACKGROUND: A few studies compared the characteristics and outcomes of COVID-19 patients during the first and second surges of the disease. We aimed to describe the clinical features and outcomes of COVID-19 patients across the first, second, and third surges of the disease in Tehran, Iran. METHOD: We conducted a retrospective cohort study of patients with COVID-19 admitted to Sina hospital in Tehran, Iran, during three surges of COVID-19 from February 16 to October 28, 2020. RESULT: Surge 1 patients were younger with more prevalence of hypertension. They also presented with significantly higher oxygen saturation, systolic blood pressure, and respiratory rate on admission. Patients had higher levels of neutrophil to lymphocyte ratio, Urea, CRP, and ESR, in surge 2. The incidence of dyspnea, chest pain, and neurological manifestations followed a significant increasing trend from surge 1 to surge 3. There was no difference in severity and in-hospital mortality between the surges. However, the length of hospital stays and acute cardiac injury (ACI) was less in surge 1 and acute respiratory distress syndrome (ARDS) in surge 2 than in other surges. CONCLUSION: Patients did not significantly differ in disease severity, ICU admission, and mortality between surges; however, length of hospital stay and ACI increased during surges, and the number of patients developing ARDS was significantly less in surge 2 compared to other peaks.

Prognostic significance of CHADS2 and CHA2DS2-VASc scores to predict unfavorable outcomes in hospitalized patients with COVID-19.

Introduction: Owing to the imposed burden of the coronavirus disease 2019 (COVID-19),the need for stratifying the prognosis of patients has never been timelier. Hence, we aimed to ascertain the value of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-M (one point for male instead of female) scores to predict unfavorable outcomes in COVID-19 patients. Methods: We enrolled consecutive patients above 18 years of age with confirmed COVID-19,who were admitted between February 16 and November 1, 2020. The primary endpoint of this study was three-month all-cause mortality. The secondary endpoints were considered four major in-hospital clinical features, including acute respiratory distress syndrome, cardiac injury,acute kidney injury, and mechanical ventilation. Results: A total of 1,406 hospitalized COVID-19 patients were studied, among which 301(21.40%) patients died during the follow-up period. Regarding the risk scores, CHADS 2≥1,CHA2DS2-VASc≥2, and CHA2DS2-VASc-M≥2 were significantly associated with mortality. The performance of all risk scores for predicting mortality was satisfactory (area under the curve:0.668, 0.668, and 0.681, respectively). Appraising secondary endpoints, we found that all three risk scores were associated with increased risk of acute respiratory distress syndrome, cardiac injury, acute kidney injury, and mechanical ventilation. Lastly, we revealed that all risk scores were significantly correlated with serum levels of laboratory biomarkers. Conclusion: Our analysis illustrated that the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-Mscores could aid prognostication of unfavorable outcomes in COVID-19 patients. Therefore,these easily calculable methods could be integrated into the overall therapeutic strategy to guide the COVID-19 management more accurately.

Efficacy of Date Palm Pollen in the Male Sexual Dysfunction after Coronary Artery Bypass Graft: A Randomized, Double-Blind, Clinical Trial.

Background: Bypass graft surgery of the coronary artery has a significant effect on the creation and development of sexual dysfunction among male patients. The previous studies have demonstrated that date palm pollen (DPP) increases the count and quality of sperm. Additionally, it has been shown that DPP has a protective effect against myocardial infarction and cardiac remodeling. Therefore, this is the first study investigating the impact of DPP (Phoenix dactylifera L.) on managing male sexual dysfunction after coronary artery bypass graft. Methods: This randomized, double-blind, placebo-controlled clinical trial was conducted on 60 patients (DPP group n = 30, control group n = 30) of Iranian men after coronary artery bypass graft. Two parallel groups were randomly generated from the study participants. The intervention group was prescribed 3 grams of the powder of DPP twice a day (9 AM and 9 PM) for two months, while the control group received the same prescription of the placebo powder. Results: The DPP consumption significantly increased the International Index of Erectile Function (IIEF) (from 23.21 to 46.57) and the Hurlbert Index of Sexual Desire (HISD) (from 59.39 to 64.45) scores over time in the intervention group. However, there were no significant changes in the control group. Conclusion: Daily intake of 6 g DPP for two months exhibited beneficial effects on the symptoms of male sexual dysfunction in patients who have undergone coronary artery bypass graft (CABG).