The Acute Effects of 2 Different Intensities of Resistance Exercise on Autonomic Function in Heart Failure Patients: A Randomized Controlled Trial.

BACKGROUND: Although a wide spectrum of resistance exercise intensities was recommended in the guidelines, none of them investigated the acute effects of different intensities of the resistance exercise on cardiac autonomic function in patients with chronic heart failure. This study aimed to investigate the acute effects of the low and high intensities of the resistance exercise on heart rate variability in chronic heart failure. METHODS: This randomized controlled trial was performed between October 2019 and December 2020. Fifty-seven patients with chronic heart failure (New York Heart Association class II and class III) underwent hemodynamic, functional capacity, and heart rate variability (time and frequency domains) assessments. They were randomly divided into R1, R2, and control groups. The intervention consisted of performing a short aerobic exercise including 15 minutes of walking at an intensity of 50% reserved heart rate for all 3 groups and additional resistance exercise with the intensity of 50% 1-repetition maximum and 75% 1-repetition maximum for R1 and R2 groups, respectively. RESULTS: The standard deviation of normal to normal intervals and standard deviation of average NN intervals became significantly lower in R2 (P =.031), and both high-frequency power and low-frequency power were significantly higher in R1 (P =.039 and P =.004, respectively) after the intervention. No significant changes were observed in the control group. Between-group changes were not significant for hemodynamics and functional capacity after treatment. The between-group comparison demonstrated a significant increase in root mean square of successive differences of the NN intervals in R1 in comparison to the control (P =.035). CONCLUSIONS: These findings indicate that resistance exercise in 50% 1-repetition maximum in comparison to 75% 1-repetition maximum had more favorable effects on the heart rate variability in chronic heart failure.

Validation study of the Persian version of the subjective exercise experiences scale (SEES) in Iranian adult individuals.

BACKGROUND: Subjective exercise experiences scale (SEES) is a 12-item questionnaire assessing global psychological responses to exercise, with three constructs including positive well-Being (PWB), psychological distress (PD), and fatigue (FAT). The present study aimed to assess the reliability and validity of the SEES questionnaire in the Iranian population. METHOD: This cross-sectional psychometric study was conducted on 138 adults immediately after 30 min of walking. The internal consistency of the questionnaire was evaluated with Cronbach's alpha coefficient. To assess the test-retest reliability, 38 of the participants were requested to fill in the questionnaire again after a week. The test-retest reliability was analyzed using the intra-class correlation coefficient (ICC). The concurrent validity was examined through the correlation matrix between the domains of SEES and SF12. Principle component analysis was performed to determine the factor loading of the measured variables. IBM SPSS statistics 24 was used for all calculations. RESULTS: Cronbach's alpha was 0.82, 0.82, and 0.81 for the PWB, PD, and FAT, respectively. The ICC value was acceptable for all subscales (ICC for PWB, PD, and FAT were 0.83, 0.88, and 0.74 respectively). There was a weak to moderate correlation between the SEES and SF-12 subclasses. Factor analysis confirmed the three-factor structure of the instrument, explaining 67.21% of the observed variance. Item 3 didn't fit in well with the three constructs and was deleted from the Persian version of the SEES. CONCLUSIONS: The Persian version of the SEES is a valid and reliable instrument to evaluate the psychological response to the exercise stimulus.

Association of Opium Consumption and Coronary Artery Ectasia: A Propensity Score-Matched Study.

BACKGROUND: Opium consumption is associated with increased risk of atherosclerosis and a hyper-inflammatory state which are suggested as contributing factors to the development of coronary artery ectasia (CAE). We aimed to determine if opium consumption is an independent risk factor of CAE. This study aimed to explore the relationship between opium consumption and CAE. METHODS: In this propensity score-matched study, we enrolled patients who underwent elective coronary angiography between September 2004 and March 2017 in Tehran Heart Center. We studied patients with CAE and without coronary artery disease (CAD) as cases. The control group, patients with normal coronary angiograms, were selected after applying the propensity score matching to match for age, sex, diabetes mellitus, hypertension, hyperlipidemia, family history of coronary artery disease, and cigarette smoking. RESULTS: We studied 242 patients with pure CAE and selected 968 control patients. The prevalence of opium consumption was not significantly different across these groups: 17 (7.5%) in the pure CAE group compared to 76 (8.6%) in the control group (Odds ratio: 0.81; P=0.455). Amongst the patients with pure CAE, Markis scores were not significantly different between opium consumers and non-consumers (P=0.136). CONCLUSION: We found no significant difference regarding opium consumption between patients with pure CAE and those with normal coronary angiograms. In addition, there was no correlation between opium consumption and Markis scores in patients with pure CAE.

Data integration in cardiac electrophysiology ablation toward achieving proper interoperability in health information systems.

INTRODUCTION: Providing information exchange and collaboration between isolated information systems (ISs) is essential in the health-care environments. In this context, we aimed to develop a communication protocol to facilitate better interoperability among electrophysiology study (EPS)-related ISs in order to allow exchange unified reporting in EPS ablation. MATERIALS AND METHODS: This study was an applied-descriptive research that was conducted in 2019. To determine the information content of agreed cardiac EPS Minimum Data Set (MDS) in Iran, the medical record of patients undergoing EPS ablation procedure in the Tehran Heart Center (THC) hospital was reviewed by a checklist. Then, an information model based on Health Level Seven, Clinical Document Architecture (HL7 CDA) standard framework for structural interoperability has been developed. In this framework, using NPEX online browser and MindMaple software, a set of terminology mapping rules was used for consistent transfer of data between various ISs. RESULTS: The information content of each data field was introduced into the heading and body sections of HL7 CDA document using Systematized Nomenclature of Medicine - Clinical Terminology names and codes. Then, the ontology alignment was designed in the form of thesaurus mapping routes. CONCLUSION: The sensitive, complex, and multidimensional nature of cardiovascular conditions requires special attention to the interoperability of ISs. Designing customized communication protocols plays an important role in improving the interoperability, and they are compatible with the needs of future Iranian health information exchange.

Development of a minimum data set for cardiac electrophysiology study ablation.

BACKGROUND: At present, there is no established national minimum data set (MDS) for electrophysiology study (EPS) ablation, which has led to a lack of standardization and variable assessment criteria in this context. OBJECTIVE: The objective of this paper was to develop a MDS of EPS ablation as means of establishing an information management system or clinical registry in this field. METHODS: In this cross-sectional and descriptive study, national and international cardiovascular scientific literature were studied to establish an initial set of data elements. In order to its validity, the population study composed of 15 cardiac electrophysiologists who asked to review the proposed data elements and score them in order of importance using a five-point Likert scale. The items scored as important or highly important by at least 60% of the experts (average score of 3 and higher) were included in the final list of MDS. RESULTS: An MDS of cardiac EPS ablation was created with nine data classes, including administrative data, past medical history, sign and symptoms, physical examinations, laboratory tests, presenting status of heart conduction system, catheter ablation, postprocedure complications, and discharge outcomes. For each category, required variables data and possible respondents were determined. CONCLUSIONS: Consensus was reached on a set of core data elements to standardize data collection for cardiac EPS ablation in order to achieve quality improvement and effectiveness indicators for the management of care process and health outcomes.

Developing a Minimum Data Set (MDS) for Cardiac Electronic Implantable Devices Implantation.

BACKGROUND: There is no established minimum data set (MDS) for cardiovascular implantable electronic devices (CIEDs), which have led to a lack of standardized assessment criteria in this field to ensure access to a reliable and coherent set of data. OBJECTIVE: To establish the minimum data set of CIEDs implantation that enables consistency in data gathering, uniform data reporting and data exchange in clinical and research information systems. METHODS: This descriptive and cross-sectional study was conducted in 2018. That comprised a literature review to provide an overview of cardiovascular documents, registries, guidelines and medical record forms to extract an initial draft of potential data elements then asked from experts to review the initial draft of variables to score the items according to the importance perceived by them based on a five-point Likert scale. The items scored as important or highly important by at least 75% of the experts were included in the final list of minimum data set. RESULTS: Initial dataset were refined by experts and essential data elements was selected in eight data classes including administrative data, past medical history, sign and symptoms, physical examinations, laboratory results, procedure session, post procedure complications and discharge outcomes. For each category required variables and possible respondents where determined. CONCLUSIONS: The minimum dataset will facilitate standardized and effective data management of CIEDs implantation; and presents a platform for meaningful comparison across contexts.

Asymptomatic Interrupted Aortic Arch, Severe Tricuspid Regurgitation, and Bicuspid Aortic Valve in a 76-Year-Old Woman.

Interrupted aortic arch is a rare congenital abnormality with a high infancy mortality rate. The principal finding is loss of luminal continuity between the ascending and descending portions of the aorta. Because of the high mortality rate in infancy, interrupted aortic arch is very rare among adults. In this report, we describe the case of a 76-year-old woman with asymptomatic interrupted aortic arch, severe tricuspid regurgitation, and bicuspid aortic valve. To our knowledge, she is the oldest patient ever reported with this possibly unique combination of pathologic conditions. In addition to reporting her case, we review the relevant medical literature.

Factors Associated with Outcome in Patients with Acute Upper Gastrointestinal Bleeding in a Tertiary Referral Center in Northern Iran.

BACKGROUND Upper gastrointestinal bleeding (UGIB) is a major healthcare problem and is the most frequent gastrointestinal reason for admission to hospital. We aimed to investigate the prognosis of patients with UGIB referred to a referral hospital in northern Iran in 2013. METHODS All patients with UGIB who admitted to Sayyad Shirazi Hospital, in Gorgan, northern Iran, in 2013 were enrolled. The patients' demographic data as well as data about admission, diseases, drug history, and patients' prognosis were collected by structured questionnaire using information in hospital files. The relationships between different factors with the proportion of mortality and recurrence were assessed using Chi-square test. RESULTS In total, 168 patients were enrolled of whom 109 (64.9%) were male. The mean (SD) age of the patients was 59.4 (18.2) years. Mortality and recurrence occurred in 23.2% and 34.5% of the subjects, respectively. We found significant relationships between older age and diagnosis of malignancy with mortality (p =0.03 and p <0.01) and recurrence (p<0.01 and p <0.01). CONCLUSION We found relatively high rates of mortality and recurrence among patients with UGIB. Our results suggested older age and diagnosis of malignancy as the most important indicators of mortality and recurrence in such patients. Considering these factors in clinical settings may result in better and more effective management of patients with UGIB.