Abstract Background The presence of cardiac myxoma in the right atrium (RA) is rare. There is limited knowledge regarding the clinical symptoms and diagnosis of RA myxoma. This systematic review aimed to provide a summary of the clinical and laboratory characteristics, electrocardiogram (ECG) findings, and outcome previous cases with RA myxoma. Methods A comprehensive search was conducted in PubMed, Web of Science, and Scopus to identify relevant studies. Inclusion criteria were case reports and case series written in English that provided sufficient data on the manifestation of RA myxoma. Descriptive statistics were used for quantitative analysis. Results The search identified 619 patients from 480 eligible studies. The patient’s mean age was 45.7 ± 17.6 years, and 55.4% of cases were female. The most common clinical manifestations of RA myxoma were cardiac, systemic, and neurologic manifestations which reported in 77.0%, 34.8%, and 21.1% of cases, respectively. Besides, 11.7% of RA myxoma were asymptomatic. ECG findings revealed normal in 39.4% reported cases. The ECG abnormalities included tall or peaked P-wave, RA and LA enlargement (19.2%), abnormal T-wave (14.0%), sinus tachycardia (11.8%), and incomplete or complete RBBB (11.2%). Echocardiography remained the diagnostic method in a majority of the cases. The mortality rate of RA myxoma was low (9.2%) during the follow-up. Conclusions This systematic review provides a comprehensive summary of the clinical and laboratory manifestations and outcomes of RA myxoma, contributing to the existing knowledge on this rare cardiac tumor.

Abstract Background Cardiac rehabilitation (CR) is crucial for addressing cardiovascular diseases globally, with a specific emphasis on gender differences. Despite its demonstrated benefits for women, there's limited acceptance globally, especially in low- and middle-income countries. The program aims to optimize risk factors and improve overall patient well-being. Methods A cohort study was performed on those who were candidates for CR programs during 2001–2019. Assessments were performed within one week before and one week after the 8-week CR program. Age, sex, smoking status, clinical data, resting systolic and diastolic blood pressure (SBP and DBP, respectively), echocardiography and laboratory data were obtained. Functional capacity was evaluated using the international physical activity questionnaire, and a treadmill exercise test. Anxiety, depression, general quality of life (QoL), and health-related QoL were selected for psychological status. Then statistical analysis was performed on data. Result In this study, the number of male patients was 1526 (73.69%). The average age of patients in the female group was higher than that of males (58.66 ± 9.08 vs. 56.18 ± 9.94), according to the crude model results, the changes in emotional, social and physical scores were significant (P-value:0.028, 0.018, 0.030), as well as the differences in Mets and smoking were significant (P-value for both < 0.001) in the adjusted model, the emotional variables and Mets changes were significant in two groups, so that the emotional score in the female group was higher than that of the male group, and the female Mets score was significantly lower than that of the male group. Conclusion The CR program can improve cardiovascular outcomes, but the greatest impact was on the quality of life, patient METs and smoking behavers. Also the number of female participants in the CR program was less than the number of males.

Background: Atherosclerosis is the main process in coronary artery stenosis, which is exacerbated by vitamin D deficiency. This study aims to investigate the relationship between vitamin D deficiency treatment, lipid profile, and C-reactive protein (CRP) in ischemic heart disease (IHD). Materials and Methods: This is a double-blind, randomized clinical trial involving 44 IHD patients with hypovitaminosis, aged 40–65 years, who were referred to Chamran Specialty Heart Hospital, Isfahan, Iran. Participants were randomly divided into two groups: The intervention group received weekly doses of 50,000 units of vitamin D3 for 5 weeks, while the placebo group received a control substance. CRP and serum lipid profiles, including total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were assessed before and after the intervention. Trial registration number: IRCT20200905048622N1. Results: The mean age of the IHD patients was 57.84 ± 9.66 years, and among all 44 patients, 40 patients (91%) were male In the intervention group receiving vitamin D3, serum levels of HDL (P = 0.048) and 25-hydroxyvitamin D (25(OH)D) (P < 0.001) increased, while serum level of TG (P = 0.008) decreased significantly. In the placebo group, HDL level (P = 0.007) was increased and alanine transaminase (ALT) (P = 0.05) was significantly decreased. The results showed that the correlation between serum 25(OH)D treatment and CRP level was not significant. Conclusion: Vitamin D supplementation in IHD patients led to notable improvements in lipid profiles, including increased HDL-C levels and decreased TG levels. These findings hold potential clinical implications for healthcare professionals in managing risk factors in IHD patients.

There are many sex-specific factors affecting myocardial infarction (MI) outcomes in males and females. This study aimed to evaluate the relationship between reproductive factors and cardiovascular outcomes in women after ST-elevation MI. This retrospective cohort study was initiated in 2016–2017 at Chamran Hospital, Isfahan, Iran. One hundred eighty women with a diagnosis of ST-elevation MI were followed up for 3 years, and any occurrence of cardiovascular events (CVs) was recorded. All information regarding reproductive factors was recorded via questionnaire. This information was compared between women with cardiovascular events and women without adverse events using a sample t test, chi-square test, and multiple backward logistic regression analysis. SPSS version 24 was used to conduct all analyses. Sixty-four women with a mean age of 65.81 ± 13.14 years experienced CV events, and 116 women with a mean age of 65.51 ± 10.88 years did not experience CV events. A history of ischemic heart disease and diabetes mellitus were more prevalent in women with CV events (P = 0.024 and P = 0.019). After adjusting for ischemic heart disease and diabetes mellitus, oral contraceptive pill (OCP) usage was more prevalent in women with CV events than in women without CV events (60.9

Abstract Introduction The purpose of this study is to investigate the trends of the burden of ischemic heart disease (IHD) in the Eastern Mediterranean Region (EMR) countries from 1990 to 2019. Method Prevalence, disability-adjusted life years (DALYs), death, DALYs attribution risk factors, healthcare access and quality index (HAQ), and universal health care (UHC) were extracted from the database of the Global Burden of Disease study (GBD) for the EMR countries. Data stratification is based on the social demographic index (SDI). Cardiac rehabilitation data was obtained from the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and other information was e obtained by an advanced search of individualized countries’ data. Result IHD age-standardized prevalence increased from 4.96% to 5.31% in the EMR from 1990-2019 while it decreased at the global level. In the EMR, the trend of age-standardized IHD death and DALYs rates decreased by 11.39% and 15.36% between 1990 and 2019 respectively, however, both rates were higher than the global rates. The burden of IHD in males was higher than females. The highest decrease of IHD age-standardized prevalence, death and DALYs rate in the EMR countries occurred in Bahrain (-3.72%, -64.95%and-69.08%, respectively). However, the most increase of prevalence happened in Oman with a change of 14.40% and for death and DALY rates was in Pakistan (29.62% and 31.93%, respectively) in the studied period. The top three attributed risk factor to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particular matter pollution. The 29-year trend of an attributed risk factor to IHD DALYs in the EMR (1990-2019) showed that the two factors of high fasting plasma glucose (64.03%) and high BMI (23.39%) had an increasing trend, respectively. Conclusion Our results showed an increased trend of the prevalence of IHD in the EMR that requires well planned prevention and treatment strategies. Developing and implementing programs to address the risk factors through health promotion and education, preventive programs, and medical care should be a priority for countries in this region.

It has been estimated that in the next decade, IHD prevalence, DALYs and deaths will increase more significantly in EMR than in any other region of the world. This study aims to provide a comprehensive description of the trends in the burden of ischemic heart disease (IHD) across the countries of the Eastern Mediterranean Region (EMR) from 1990 to 2019. Data on IHD prevalence, disability-adjusted life years (DALYs), mortality, DALYs attributable to risk factors, healthcare access and quality index (HAQ), and universal health coverage (UHC) were extracted from the Global Burden of Disease (GBD) database for EMR countries. The data were stratified based on the social demographic index (SDI). Information on cardiac rehabilitation was obtained from publications by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), and additional country-specific data were obtained through advanced search methods. Age standardization was performed using the direct method, applying the estimated age structure of the global population from 2019. Uncertainty intervals were calculated through 1000 iterations, and the 2.5th and 97.5th percentiles were derived from these calculations. The age-standardized prevalence of IHD in the EMR increased from 5.0% to 5.5% between 1990 and 2019, while it decreased at the global level. In the EMR, the age-standardized rates of IHD mortality and DALYs decreased by 11.4% and 15.4%, respectively, during the study period, although both rates remained higher than the global rates. The burden of IHD was found to be higher in males compared to females. Bahrain exhibited the highest decrease in age-standardized prevalence (-3.7%), mortality (-65.0%), and DALYs (-69.1%) rates among the EMR countries. Conversely, Oman experienced the highest increase in prevalence (14.5%), while Pakistan had the greatest increase in mortality (30.0%) and DALYs (32.0%) rates. The top three risk factors contributing to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particulate matter pollution. The trend analysis over the 29-year period (1990–2019) revealed that high fasting plasma glucose (64.0%) and high body mass index (23.4%) exhibited increasing trends as attributed risk factors for IHD DALYs in the EMR. Our findings indicate an increasing trend in the prevalence of IHD and a decrease in mortality and DALYs in the EMR. These results emphasize the need for well-planned prevention and treatment strategies to address the risk factors associated with IHD. It is crucial for the countries in this region to prioritize the development and implementation of programs focused on health promotion, education, prevention, and medical care.

Background: The burden of stroke is high worldwide, especially in low-middle income countries. We aim to explore the temporal trends of the incidence rate (IR) of stroke over 14 years in Iran’s central areas. Methods: Stroke registry as part of cardiovascular disease (CVD) registry in Isfahan that focused on hospitalized patients (≥15 years) with first or recurrent stroke from 2001 to 2015. Factors included date of symptoms, demographics, management, survival at 28 days, date of admission, history of stroke, and other CVD and clinical diagnosis according to Computer Tomography Scan. We calculated age-, sex, and place-of-residence-adjusted IR based on multiple reference populations. Data were analyzed by bootstrap robust zero-truncated negative binomial regression models using R Statistical Software. Results: From 19,174 registered patients with stroke assessed by ICD-10; 18,010 (93.93%) cases were identified based on WHO-MONICA. Approximately 51% of hospitalized stroke patients were women. The average annual increase in stroke incidence based on ICD-10 ranged from 1.56% (95% CI, 0.14, 2.97) to 2.67% (95% CI, 1.25, 4.09) for different reference populations. In addition, a similar trend was also observed for stroke IR based on WHO-MONICA during the study period for the whole reference population, with an average annual change of 2.5% (95% CI, 1.28, 3.72) to 3.64 % (95% CI, 2.47, 4.82). Conclusion: Given that temporal trends of stroke have increased in both sexes, especially in Iran’s urban areas, prevention programs are needed for public awareness and physician motivation in order to identify risk factors as well as primary and secondary prevention.

BACKGROUND: Depression is common in patients with cardiovascular disease (CVD). Home-based cardiac rehabilitation (HBCR) is a program that alleviates depression. This study aimed to determine and compare HBCR programs and usual care (UC) effects on depression control in patients with ischemic heart disease (IHD). METHODS: This clinical trial study was performed on 259 patients with IHD that were randomly allocated to the HBCR and UC groups for stress management. Data were collected using the Beck Depression Inventory (BDI) at baseline and 6 and 12 months. Generalized estimating equation (GEE) models were applied to examine the associations between times of the groups and changes in outcomes over the study times. Data analysis was done in SPSS softwareat the significance level of 0.05. RESULTS: A total of 247 participants with a mean age of 55.22 ± 7.40 years participated in this study, and 209 (84.6%) of the study participants were men. Among patients, 128 patients in the UC program and 119 patients in the HBCR program attended at least one of the pre-determined visits (months 6 and 12). The patterns of change of the depression parameter were similar through the course of the study between the two groups (P = 0.04). In the HBCR group, the depression reduced continuously from baseline to 6 months, baseline to 12 months, and 6 to 12 months (P < 0.05). In the UC group, depression was significantly reduced from baseline to 6 months and from baseline to 12 months. CONCLUSION: HBCR was effective in continuous reducing of depression scores in long-term follow-up of patients with IHD. These findings suggest that HBCR can alleviate depression in patients who do not participate in hospital-based cardiac rehabilitation (CR).

Background: Mortality of ST-elevation myocardial infarction (STEMI) patients is increasing in world. This study defines predictors of mortality in patients who have STEMI. Materials and Methods: This study was a part of the ST-elevated myocardial infarction cohort study in Isfahan conducted on 876 acute myocardial infarction (MI) followed for 2 years that 781 patient entered. The effect of predictors of mortality includes demographic, physiological, and clinical characterizes compared in two groups alive and died patients. MACE was defined as nonfatal MI, nonfatal stroke, and atherosclerosis cardiovascular disease-related death was recorded. Univariate and multiple logistic regression analyses were performed. All analyses performed using SPSS 20.0. P < 0.05 considered statistically significant. Results: A total 781 patients, 117 (13%) that 72 (8.5%) was in-hospital died. The mean (standard deviation) age of the patients was 60.92 (12.77) years and 705 (81.3%) patients were males. Significant factors that affected mortality on analysis of demographic and physiological parameters were age (P < 0.001), sex (P = 0.004), transfusion (P = 0.010), STEMI type (P < 0.001), number epicardial territories >50% (P = 0.001), ventilation options (P < 0.001), smoker (P = 0.003), and diabetes (P = 0.026). Significant clinical factors affected mortality were ejection fraction (EF) (P < 0.001), creatinine (P < 0.001), hemoglobin (P < 0.001), low-density lipoprotein-cholesterol (LDL-C) (P = 0.019), and systolic blood pressure (P < 0.001). Multiple logistics regression model definition significant predictors for mortality were age (P < 0.001), heart rate (HR) (P = 0.007), EF (0.039), LDL-C (P = 0.002), and preangia (P = 0.022). Conclusion: The set of factors can increase or decrease mortality in these patients. Significant predictors of mortality STEMI patients by 2-year follow up were age, HR, EF, LDL-C, and preangia. It seems that more articles need to be done in different parts of Iran to confirm the results.

Background. This study aimed to investigate readmission risk factors after ST-elevation myocardial infarction (STEMI) during a 3-year follow-up. Methods: This study is a secondary analysis of the STEMI Cohort Study (SEMI-CI) in Isfahan, Iran, with 867 patients. A trained nurse gathered the demographic, medical history, laboratory, and clinical data at discharge. Then the patients were followed up annually for 3 years by telephone and invitation for in-person visits with a cardiologist concerning readmission status. Cardiovascular readmission was defined as MI, unstable angina, stent thrombosis, stroke, and heart failure. Adjusted and unadjusted binary logistic regression analyses were applied. Results: Of 773 patients with complete information, 234 patients (30.27%) experienced 3-year readmission. The mean age of the patients was 60.92±12.77 years, and 705 patients (81.3%) were males. The unadjusted results showed that smokers were 21% more likely to be readmitted than nonsmokers (OR, 1.21; P=0.015). Readmitted patients had a 26% lower shock index (OR, 0.26; P=0.047), and ejection fraction had a conservative effect (OR, 0.97; P<0.05). The creatinine level was 68% higher in patients with readmission. An adjusted model based on age and sex showed that the creatinine level (OR, 1.73), the shock index (OR, 0.26), heart failure (OR, 1.78), and ejection fraction (OR, 0.97) were significantly different between the 2 groups. Conclusion: Patients at risk of readmission should be identified and carefully visited by specialists to help improve timely treatment and reduce readmissions. Therefore, it is recommended to pay special attention to factors affecting readmission in the routine visits of STEMI patients.

Background and aims: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system. The impact of the number of attacks on the disease is undeniable. The aim of this study was to analyze the number of attacks in these patients. Methods: In this descriptive-analytical study, the registered data of 1840 MS patients referred to the MS clinic of Ayatollah Kashani hospital in Isfahan were used. The number of attacks during the treatment period was defined as the response variable, age at diagnosis, sex, employment, level of education, marital status, family history, course of disease, and expanded disability as the explanatory variables. The analysis was performed using zero-inflated negative binomial model via Bayesian framework in OpenBUGS software. Results: Age at diagnosis (CI: -0.04, -0.20), marital status (CI: -0.56, 0.002), level of education (CI: -0.81, -0.26), Job (CIHousewives vs Employee=[0.04, 0.64], CIUnemployee vs Employee=[-1.10,0.008])), and course of disease (CI: -0.51, -0.08) had a significant effect on the number of attacks. In relapsing-remitting patients, the number of attacks was partial significantly affected by expanded disability status scale (EDSS) (CI: -0.019, 0.16). Conclusion: Aging, being single (never married), high education, and not having a job decrease the number of attacks; therefore, lower age, being married, primary education, and being a housewife increase the number of attacks. An interventional or educational program is suggested in order to prevent the occurrence of further attacks in high-risk groups of patients and to increase their chances of recovery.

Vaseghi, Golnaz PhD; Jamalin, Marjan MSc; Arabi, Sina MD; Kheiri, Soleiman PhD; Hajian, Shabnam MSc; Sarrafzadegan, Nizal MD Author Information

Background: Breast cancer, as the most frequent cancer diagnosed in women worldwide, is affected by different regulatory mechanisms and cellular processes such as microRNAs (miRNAs) and autophagy, which influence tumor cell progression. MiRNAs play a crucial role in cancer progression. Aberrant miRNA expression has been described in various human cancers. Growing evidence proposes that miRNAs have a considerable role in tumor development and may constitute robust biomarkers for cancer diagnosis and prognosis. Objectives: The aim of this study was to evaluate miRNA-638 (miR-638) expression level in breast cancer patients and its bioinformatics analysis. Methods: In this case-control study, miR-638 expression was examined in fresh breast tissues of 47 patients with breast cancer using real time polymerase chain reaction (PCR). Then the role of miR-638 in various signaling pathways was studied using Target Scan, the MicroRNA-Target Interactions (miRTarBase) database, miRWalk2.0 and the database for annotation, visualization and integrated discovery (DAVID). Results: The miR-638 expression level showed a significant decrease in breast cancer patients. Also, this miRNA might be involved in apoptosis, angiogenesis, and autophagy. Conclusions: According to the results, miR-638 can be used as a potential prognostic biomarker for cancer growth, and its low expression is thought to increase cancer progression by disrupting cell death and autophagy, which are considered as important pathways in breast cancer.

Background: Treatment has a major effect on attacks in patients with multiple sclerosis (MS). This study aimed to determine the effect of the type of used drug on occurrence and number of attacks in patients with multiple sclerosis. Methods: In this cross-sectional study, 1815 patients with multiple sclerosis referred to Ayatollah Kashani hospital in Isfahan, Iran, whose information was recorded in iMED software and followed at least for 34 months, were included. The effect of the type of drug on occurrence and number of attacks was determined using Negative Binomial Hurdle model by R software. Findings: The type of drug had a significant effect on the occurrence of attack; so that, compared to interferon beta-1a (muscle), interferon beta-1a (subcutaneous), fingolimod, glatiramer acetate and azathioprine were less effective, especially for relapsing-remitting types. Interferon beta-1b and glatiramer acetate had more and less effective on the occurrence of the attack in women and men, respectively. In women, fingolimod drugs, glatiramer acetate, and azathioprine had less effect on the number of attacks, respectively. The effect of age was significant on the occurrence and number of attacks in men and women, and both the recurrence and progressive clinical course. Conclusion: Younger patients had more occurrences of attacks. Interferon beta-1a (muscle) has a better performance than other drugs in reducing occurrence of attacks. In women, patients taking interferon beta-1b had fewer attacks compared to patients taking interferon beta-1a (muscle). In men, patients taking interferon beta-1a (muscle) had fewer attacks than those taking glatiramer acetate. © 2018, Isfahan University of Medical Sciences(IUMS). All rights reserved.