Tehran University Medical Journal

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A cross-sectional study was conducted on type II diabetic patients during 1991-1996 in Isfahan. By systemic sampling, 715 patients were enrolled. Variables studied, include: age, gender, duration of diabetes, body mass index (BMI), literacy, smoking habits, hypertension, lipid profiles, fasting blood glucose (FBS), retinopathy, ischaemic heart disease (IHD), proteinuria and type of treatment of diabetes. Prevalence of IHD in males (37.4%) was more than females (32.6%). Logistic regression analysis revealed a direct association between IHD prevalence with age, BMI, hypertension, proteinuria, diabetic retinopathy and type of treatment. Conclusions: 1) The factors mentiond are good predictors of IHD, but genetic influences may also contribute to the risk of IHD. 2) As obesity and BMI are prone to medical manipulation, control of these risk factors may decrease prevalence of IHD.

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Prosthetic valve re-operation has greater mortality and morbidity than primary valve replacement. By recognition of factors influencing on causes of redo operation and preoperative survival, one can select appropriate prosthesis at primary valve replacement and when operation performed at appropriate time, surgical risk can be reduced.
Methods and Materials: Two hundred patients that underwent prosthetic valve re-operation from October 1991 through November 2001 were included in this study. There were 68 men and 132 women with the mean age of 42:tl 1.8 years. Structural failure was the commonest cause of bio-prosthesis replacement (93%). Valve thrombosis was the common cause of mechanical valve replacement (32%). Age younger Than 50 (P= 0.01) and interval after the first implantation more than 10 years (P= 0.01) affected bio-prosthesis degeneration.
Results: Atrial fibrillation (P<0.01), Older age especially more than 40 (P<0.05) and mitral position (P<0.01) affected mechanical valve thrombosis. Cross clamp time (P= 0.005), Tricuspid insufficiency (P = 0.001), NYHA IV (P = 0.005) and emergent operation (P= 0.001) were independent determinants of hospital mortality.
Conclusion: In conclusion, in patients with more than 10-years life expectancy and age younger than 50, mechanical valve can be selected for primary valve replacement. If operation performed before patients reach deteriorated condition, preoperative survival would be excellent.

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Background: The purpose of this study was to compare electronic fetal heart rate monitoring (EFM) characteristics between Appropriate for Gestational Age (AGA ) and Small for Gestational Age (SGA) fetuses and to determine whether SGA fetuses have specific abnormalities.

Materials and Methods: Among children born from Apr 2002 to Mar 2003 in Arash hospital, we identified 300 singleton infants born after 36 weeks' gestation of uncomplicated pregnancies in whom second-trimester (24-27 weeks' gestation) EFM records were obtained. Individual components of fetal heart rate (FHR) pattern baseline rate, baseline FHR variability, presence of acceleration and periodic and episodic deceleration , and birth characteristics were compared between AGA and SGA infants or between pregnancies with or without second-trimester decelerations. Statistical analysis was performed using Student t, Chi square and Fisher exact test.

Results: Among 300 infants, 261 (87%) were AGA and 39 (13%) were SGA 65 had and 235 did not have second-trimester decelerations. Baseline FHR variability, second- trimester decelerations and intrapartum FHR decelerations were significantly higher in SGA fetuses than in AGA fetuses (P<0.05). Birth weight and gestational age were significantly lower in SGA fetuses than in AGA fetuses (P<0.05). There were no significant differences in baseline rate and acceleration ,maternal age and parity, Apgar score in 1 minute, meconium staining, mode of delivery, NICU admission, between SGA and AGA infants. Small for Gestational Age infants were more frequent in pregnancies with second-trimester decelerations compared with those without second-trimester deceleration (P<0.05). Baseline FHR variability in pregnancies with second-trimester decelerations was significantly higher than in pregnancies without second-trimester deceleration (P<0.05).

Conclusion: Periodic or episodic decelerations and increased FHR variability during late second-trimester EFM were associated with an increased risk of SGA infant

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Background: Oral clefts are among the most common congenital anomalies. Infants with oral clefts often have other associated congenital defects, especially congenital heart defects. The reported incidences and the types of associated malformations and congenital heart defects vary between different studies. The purpose of this study was to assess the incidence of associated congenital heart defects in children with oral clefts.
Methods: All infants with cleft lip and palate referred to the Children's Medical Center and Bahramy the teaching Hospitals of the Tehran University of Medical Sciences from 1991 to 2005 were prospectively enrolled in this study group. All patients were examined and noted by an academic cleft team contain a pediatrician and a pediatric surgeon, and received cardiac consultation and echocardiography by a pediatric cardiologist. non cardiac associated anomalies, still born and patients without echocardiography were excluded from the study. Data including age, gender, exposure to contagions and high risk elements ,consanguinity and familial history of oral cleft, type of oral cleft, results of cardiac consultation and echocardiography and associated cardiac anomalies were cumulated and analyzed by SSPS version 13.5
Results: Among the 284 infants with oral clefts, 162 were male (57%) and 122 were female (43%). Seventy-nine patients (27.8%) had cleft lip, 84 (29.5%) had cleft palate and 121 (42.6%) had both cleft lip and palate. Of all the patients, 21.1% had congenital heart defects. the most common type Of these congenital heart defects(28.3%) was atrial septal defect.
Conclusions: For patients with cleft lip and palate, we recommend preoperative cardiac consultation, careful examination and routine echocardiography for associated cardiac anomalies, as well as appropriate management and prophylactic antibiotic therapy for those with associated congenital heart anomaly.

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Background: The presence of increased numbers of nucleated red blood cell (NRBC) in the umbilical cord blood has been associated with states of relative hypoxia. Nucleated red blood cell counts are a potentially useful tool in estimating the degree and timing of intrauterine hypoxia. This may have important implication in determining causality in case of compromised infant. Cord blood NRBC counts may be obtained noninvasively from an otherwise discarded specimen and analyzed by personnel on equipment readily available in most hospital laboratories. Since the aim of monitoring of fetal heart is early diagnosis of hypoxia, we studied the relationship between abnormal fetal heart rate with the number of nucleated red blood cells (NRBC) in the umbilical cord blood.

Methods: We performed this research at Hazrat Zeynab Hospital on 130 full-term newborns (65 cases of fetal distress and 65 normal cases) between July 2005 and July 2006. The NRBC counts of newborns with abnormal fetal heart rate were compared with those of normal newborns and correlations with other parameters including Apgar score, hemoglobin level, condition of newborns in the first 24 hours of the birth and birth weight.

Results: The mean NRBC count in the fetal distress group was 9.45 ± 8.75 and that of the normal group was 9.17 ± 8.76 per 100 white cells (p=0.89). The mean duration between diagnosis of fetal distress to birth was equal to 1.2± 0.77 hours. Furthermore, there was no meaningful correlation between number of NRBC and Apgar score, hemoglobin, birth weight and condition of newborns in the first 24 hours.

Conclusion: If the fetus is born a short time after the diagnosis of distress with no risk factors for hypoxia, the NRBC count for cord blood is not elevated.

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Background: The relationship between coping styles and psychological adaptation during the recovery process was investigated in a sample of coronary heart disease (CHD) patients.

Methods: One hundred and fifty patients from Shahid Rajaee Heart Center, Tehran, Iran, were included in this study at intake and forty five patients (27 men, 18 women) participated in the follow-up study. All participants were asked to complete the Tehran Coping Styles Scale (TCSS) and Mental Health Inventory (MHI). The Recovery Process Questionnaire (RPQ) was completed using each patient's medical file and clinical examinations by cardiologists. Styles of coping with stress were categorized as problem-focused, positive emotional-focused and negative emotional-focused. Psychological adaptation included psychological well-being and psychological distress.

Results: Objective recovery status showed no significant correlation with either coping styles or psychological adaptation. Perceived recovery revealed a significant positive association with negative emotional-focused coping (p<0.05), but no significant correlation with other coping and psychological adaptation variables. Perceived recovery revealed a significant negative association with psychological distress (p<0.05), but showed no significant correlation with psychological well-being.

Conclusions: Perceived recovery in CHD patients is positively influenced by negative emotional-focused coping styles. Results and implications are discussed specifically in terms of the possible reasons for the positive relationship between perceived recovery and negative emotional-focused coping.

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Background: Although metabolic syndrome (METs) is receiving attention from physicians, data on the syndrome's association with coronary heart disease (CHD) in the Iranian population are limited. This study was designed to determine the association of different definitions of METs and its components with CHD.

Methods: Logistic regression analysis was used to analyze data from 5981 subjects aged ≥30 years. METs definitions by the International Diabetes Federation (IDF), the Adult Treatment Panel (ATP III) and the WHO for CHD were used in three models: model 1 an age adjusted model, model 2 adjusted for age, smoking status, premature history of CHD and LDL-cholesterol and model 3 adjusted for the mentioned variables plus the METs components.

Results: METs as delineated by all three definitions was associated with CHD in models 1 and 2. In model 2, METs was most closely associated with CHD in men, as defined by the WHO [2.3 (1.8-3)] and in women by the ATP III definition [1.6 (1.3-2)]. In model 3, METs lost its association with CHD. However, in men high fasting plasma glucose and high blood pressure plus obesity (by the WHO definition) and in women high blood pressure plus high waist circumference (by the ATP III definition), obesity and glucose domain (by the WHO definition) remained associated with CHD.

Conclusions: In Iranian men and women, all three definitions of METs were associated with CHD when considering the conventional risk factors. After further adjustments for the components of METs, none of these definitions showed an association with CHD and only high blood pressure correlated with CHD in both sexes for all definitions.

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Background: Previous studies have suggested the presence of a relationship between the increase of NRBC and the duration and intensity of asphyxia. The purpose of this study was to evaluate the relationship of fetal heart rate pattern and the number of NRBC's in umbilical cord blood sample at birth.

Methods: We enrolled 322 pregnant women with healthy, term fetuses who referred to Mirza Kouchak Khan Hospital for pregnancy termination in 2005 in a case-control study. All patients underwent continuous FHR monitoring and based on their FHR pattern, they were divided into two groups with normal FHR pattern and at least one abnormality in FHR pattern (including absence of beat to beat variability absence of proper acceleration and early, late, variable and prolonged deceleration). Samples of umbilical cord blood were evaluated for NRBC count and pH immediately after birth. The variables were compared in these two groups.

Results: The mean NRBC count was significantly higher in patients with any kind of deceleration (late, variable, early or prolonged) in comparison with controls (respectively 11.88±4.406, 8.32±4.64, 10.58±5.366, and 4.11±4.913 vs. 0.93±1.790 in controls). Furthermore the mean NRBC count was significantly higher in patients with absence of acceleration or beat to beat variability (10.73±5.07 and 13.73±3.58 vs. 1.47±2.50). There was a negative correlation between 5^th minute Apgar score and umbilical cord blood sample with mean NRBC count of umbilical cord blood sample.

Conclusion: Any abnormality in FHR pattern is associated with a significant increase in mean NRBC count of umbilical cord blood sample. There is also a significant relationship between the 5^th minute Apgar score and umbilical cord blood sample pH, and mean NRBC count in umbilical cord blood sample.

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Background: It is generally accepted that the selective adenosine triphosphate-dependent potassium channel openers (KATP openers) have a dramatic role in the treatment of some cardiovascular disorders. The aim of this study was to investigate the effects of diazoxide, a potent ATP-related potassium channel opener, on spontaneously beating isolated rat atria to achieve more accurate approaches to treat cardiovascular diseases, such as atrial related disorders including atrial arrhythmias.
Methods: After induction of anesthesia, we exsected the heart and isolated the atria of 48 male Wistar rats. Later, we recorded the beating and contractile force of the atria by a physiograph. Subsequently, we studied the effects of diazoxide (2 to 100 µg/mL) on beating and contractile force of the isolated atria 5, 10, 15 and 20 minutes after applying the drug onto the atria.
Results: Diazoxide administration (2 to 100 µg/mL) showed a significant decrease (7% to 49% depending on concentration) in atrial beatings (P≤0.001) and in contractile force (1.5% to 67% depending on concentration), (P≤0.001). The effects began several minutes after applying the drug onto the tissues.
Conclusion: This study revealed that diazoxide has a direct concentration-dependent effect on cardiac performance and leads to reduction in beating rates and contractile force of the heart. This effect seems to be related to the activation of mitochondrial or sarcolemmal KATP channels. Since the inhibitory action of diazoxide on the heart was very remarkable and prompt, this agent may also exhibit antiarrhythmic properties.

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Background: Balloon atrial septostomy is an emergent procedure in pediatric cardiology. Nowadays, most patients in need of the procedure have acceptable outcomes after surgical repair. Thus, it is important to perform this procedure as safe as possible. By performing early arterial switch operation and prostaglandin infusion, the rate of balloon atrial septostomy has markedly decreased. However, not all centers performing early arterial switch repairs have abandoned atrial septostomy, even in patients who respond favorably to prostaglandin infusion.
Case presentation: In total, eight 1- to 15-day old term neonates admitted in Shahid Rajaee Heart Center in Tehran, Iran from October 2009 to February 2011, with congenital heart diseases were scheduled for balloon atrial septostomy. In six cases the procedure was done exclusively under echocardiographic guidance and in two cases with the help of fluoroscopy. Success was defined as the creation of an atrial septal defect with a diameter equal to or more than 5 mm and ample mobility of its margins.
Results: Male sex was predominant (87%) and the mean age of the neonates was six days. The diagnosis in all cases was simple transposition of great arteries. The procedure was successful in all patients with any cardiovascular complication.
Conclusion: Balloon atrial septostomy is an emergent procedure that can be done safely and effectively under echocardiographic guidance. According to the feasibility of this technique it could be performed fast, safe and effective at bedside, avoiding patient transportation to hemodynamic laboratory or referral center.

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Background: Vasoactive intestinal peptide (VIP) plays an important role in modulating coronary blood flow and heart rate. The purpose of the present study was to investigate the effect of eight weeks of low intensity aerobic exercise on plasma levels of VIP hormone, blood pressure and heart rate in healthy elderly men and women, and patients with coronary artery disease (CAD).
Methods: In this study, 15 healthy women and 15 healthy men and 15 female and 15 male with CAD disease were randomly chosen as the experimental and control groups. Subjects did aerobic exercises tree days/week, for eight weeks, with the heart rate of 10010 beats per minute. Blood samples were taken from each subject in three stages, (before, immediately after and 24 hours after the 8 weeks of exercising).
Results: The results showed that there was a significant difference among plasma VIP levels in the four groups. Moreover, a significant difference was observed between the systolic blood pressure in the four groups (P=0.01) and the systolic blood pressure in male patients and healthy women (P=0.03) while there was no meaningful difference the systolic blood pressure in the two other groups. There was also a significant difference in the heart rate of the three rounds of sampling in the three of groups (P=0.002) but no significant difference was observed in healthy men.
Conclusion: According to the above results, it seems that the duration and intensity of each workout should be considered to reach the VIP stimulation threshold. It may bring about considerable changes in VIP levels.

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Background: Advanced glycation end-products (AGEs) came up with the recent researches regarding new biomarkers for the diagnosis of heart failure. AGEs are the end products of non-enzymatic glycation and oxidation of proteins, lipids and nucleotides during Maillard biochemical reaction. Although it has been known that AGEs have a role in the pathogenesis of chronic heart failure (CHF), information regarding its role and its pathogenetic mechanism is very limited. The aim of this study was to find any relationship between AGEs with the etiology and severity of chronic heart failure.
Methods: This study is a prospective cross sectional study that enrolled 85 patients with chronic heart failure. Measurement of left ventricle ejection fraction (LVEF) was done by echocardiography. Blood samples were collected for measuring AGEs just before or after echocardiography assessment (in the same session). Measurement of AGEs was done by the enzyme-linked immunosorbent assay (ELISA) method. The relationship between AGEs with the severity of CHF and as well as the etiology of CHF were evaluated via SPSS-15.
Results: Of 85 patients 48 (56.5%) patients were male and 37 (43.5%) were female Mean±SD of their ages was 55.8±13.4 years old (ranges from 27 to 84 years). Correlation coefficient between LVEF and AGEs was 0.269 (P=0.013). Mean of AGEs in patients with and without ischemic etiology of their heart failure were 16.8±9.8µg/ml and 11.6±7.3 µg/ml, respectively. Although trend was in favor of ischemic heart failure, the difference between two groups was not statistically significant (P= 0.141).
Conclusion: According to this study the rate of AGES could be helpful in the diagnosis and assessment of severity of CHF. Based on our findings, higher blood levels of AGEs in the ischemic CHF cases, also it could be concluded that in the future this marker may be used for etiologic differentiation of heart failure syndrome.

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Background: Androgenetic alopecia (AGA) is the most common type of progressive balding that appears with early loss of hair, chiefly from the vertex. There has been significant relationship between AGA with coronary artery disease and related risk factors, such as hypertension in some studies. The aim of this study is to investigate the association between androgenetic alopecia with hyperlipidemia.
Methods: This cross-sectional study was performed on 112 patients with vertex type AGA (in male grade 3 or higher Hamilton- Norwood scale, and in female grade 2 or higher Ludwig scale) (study group) and 115 persons age and sex matched, with normal hair status (Normal group). None of participants had diabetes mellitus, hypothyroidism, liver disease, kidney disease and none of them had history of smoking and using drugs with effect on serum lipids. They were 20-35 years old and their body mass index were 20-30. Blood samples were obtained following 12 hours fasting status and serum levels of triglyceride (TG), cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were determined using standard laboratory methods. Total cholesterol greater than 240 or TG greater than 200 or LDL greater than 160 or HDL less than 40 in men or HDL less than 50 in women were considered hyperlipidemia.
Results: In androgenetic alopecia group 46.4% and 47% of normal group were female. Mean (±SE) of total cholesterol (172.4±3.1, 148.8±3.1, P< 0.001), TG (133.6±5.5, 88.3±4.3, P< 0.001), LDL (96.4±2.9, 84.9±2.7, P= 0.004) and HDL (54.9±2.0, 45.5±0.9, P< 0.001) in AGA patients were higher than normal group. %46.4 of patients and %52.2 of controls had hyperlipidemia. Relationship between AGA with hyperlipidemia was not significant (P> 0.05).
Conclusion: The findings showed that there is no relationship between AGA and hyperlipidemia. Regarding to high levels of total cholesterol, LDL and triglyceride in AGA patients, it seems that, AGA increases risk of coronary heart disease. To determine a definite association between AGA and hyperlipidemia more studies are recommended.

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Background: Calcium channel blockers have an important role in treatment of various cardiovascular diseases including hypertension, angina pectoris and cardiac arrhythmias, so study of cardiovascular effects of derivatives of these drugs are useful. Nifedipine is one of these drugs that used widely to treat hypertension and other cardiovascular diseases. The aim of the present study was to evaluate the central effects of synthesized dihydropyridine derivatives on systolic blood pressure and heart rate of rats and comparison to nifedipine. Methods: Sixty four male rats, after induction of anesthesia and intracerebral ventricu-lar cannulation using stereotaxis method, were divided into eight equal groups. One week after the stereotaxis surgery, the systolic blood pressure and heart rate were eval-uated in times 15 to 60 minutes after intracerebral ventricular injection of DMSO (di-methylsulfoxide) and nifedipine in doses of 80 to 320 microgram/rat and also three synthesized dihydropyridine derivatives (A, B and C) in dose of 240 microgram/rat. Effects of these drugs on systolic blood pressure and heart rate were analyzed using two way repeated measure ANOVA statistical test, followed by Bonferroni posthoc test. All data were considered significant at P<0.05. Results: The inhibitory effects of derivative B on systolic blood pressure and heart rate in dose of 240 microgram/rat in times of 15 and 30 minutes after injection were more potent than nifedipine (P<0.001), while A and C derivatives showed weaker inhibitory properties, compared with nifedipine. Also the inhibitory effects of derivative B on heart rate in dose of 240 microgram/rat were stronger than nifedipine in times of 15 to 60 minutes after injection (P<0.05). Conclusion: Novel dihydropyridine derivatives can possess more potent and stable in-hibitory effects on systolic blood pressure and heart rate, and some part of these properties at least, can be attributed to their direct inhibitory effects on brain neurons.

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Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until dis-charge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago. Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study. Results: Eighteen patients included in the study, 11 female and seven male. Patients’ ages were in the range of 13 to 76 years (mean 53 years). Mean time from diagnosis to operation was 5.8 days and mean time from surgery to discharge was 8.6±6.1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to trans thoracic echocardiography (TTE), in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94.4% of all tumors (17 cases) were primary cardiac tumors and only one tumor (5.6%) was recurrent. In 16 patients (88.9%) tumor were found in the Left Atrium (L.A) and in one case, tumor was found in both atria and in another case, tumor was in the ventricle. After tumor excision, atrial septum was repaired primarily in seven cases (38.9%) and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft (CABG) and another patient underwent concomitant pulmonary valve repair. 14 patients (77.8%) discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cerebrovascular accident (CVA) developed in two patients. One patient died (5.6%). Conclusion: Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but ad-vances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size.

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Background: In patients who undergoing PCI, association between right ventricular function and outcome of the procedure remained unclear. The present study aimed to determine association between echocardiography findings of systolic right ventricular function and functional status of patients following PCI. Methods: In a cross-sectional study conducted at Imam Ali hospital and heart center in Kermanshah, Iran in 2013, 40 patients with history of inferior wall myocardial infarction (Inf MI) according to previous electrocardiography (ECG) in past hospitalization for MI who were candidate for percutaneous coronary intervention (PCI) on right coronary artery (RCA) and had left ventricle ejection fraction (LVEF) less than 40% were included. The subjects underwent echocardiography on admission to assess echocardiography indices of systolic right ventricular function including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TASV), Tei-index (Myocardial performance index), and RV fractional area (RVFA) change that was repeated one month later. Baseline functional status was assessed based on the New York Heart Association functional classification score (NYHA score) that divided to 4 grades. Results: NYHA score improved following PCI procedure (from 2.20±0.46 to 1.10±0.30, P<0.001). The mean score of TAPSE significantly increased from 18.68±2.12 to 20.40±2.11 (P<0.001). The mean of TASV also increased from 13.28±1.52 to 14.85±1.90 (P<0.001). Also, Tei-index was improved from 0.52±0.05 to 0.47±0.03 (P<0.001). Moreover, RVFA was significantly increased after PCI (from 35.02±2.40 to 38.25±2.57, P<0.001). There was no significant relationship between the changes in NYHA score and each of right ventricular systolic function indices. Conclusion: Although right ventricular systolic function considerably improved fol-lowing PCI procedure, but the changes in this improvement is not associated with the improvement of function class after the procedure.

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Background: Cardiovascular complications have very high incidence and are the main cause of mortality in human. Although the cardiovascular risk factors among apparently healthy subjects have been studied, these factors among patients who have undergone coronary artery bypass graft surgery have not evaluated clearly. Methods: The present study is a descriptive, cross-sectional survey on 1592 patients which suffered coronary artery bypass surgery (CABG) from May 2009 to May 2013 in Baqiyatallah Hospital, Tehran. Before surgery, all patients were carefully assessed and typical and atypical cardiovascular risk factors were determined and the desired data were collected. Results: More than 70.8% of subjects were men and 29.2% were women. Average age of all patients was 60.39±7.5 years and the mean weight was 73.91±6.3 kg. Typical risk factors including: smoking, plasma cholesterol level, hypertension, diabetes mellitus and family history of cardiac problems, were common in these patients. Forty seven percent of patients had diabetes mellitus, 79.4% had hypercholesterolemia, 34.3% had a smoking history, 64.5% had hypertension and 44.2% of patients had a family history of cardiovascular disease. Among atypical risk factors, various types of angina (chest pain) had high prevalence (88.8% of all). Also, mean body mass index (BMI) were higher than normal (27.46±2.1) which showed the incidence of obesity among these patients. But, other atypical risk factors did not have high incidence. Conclusion: We demonstrated that typical and well known risk factors have also high prevalence in CABG patients. Our results indicates that we can recognize high risk persons with continuous and accurate screening as a safe and inexpensive preventive tool. This can be done in both apparently healthy subjects and in cardiovascular patients. We can prevent the occurrence of severe degrees of atherosclerosis and also CABG. So the cost and performing surgeries will be decreased.

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Background: In Nov 2013, the instruction for controlling high cholesterol has been released by the American College of Cardiology (ACC) and the American Heart Association (AHA) which need to be assessed in the different communities. Methods: Of total 6275 individual aged 40-75 years who entered at the Tehran Lipids and Glucose Study from March 1999 to 20 March 2010 in first examination cycle, 5153 with the median follow-up of more than ten years were eligible to enter in this study. The 10-year risk of hard cardiovascular disease (Hard CVD) for Statin therapy based on ACC/AHA clinical guideline was calculated and this risk was calculated for each subgroup of the guideline who recommended for statin therapy comparing to the risk in individuals with prevalent CVD. Results: Of nearly 6.5 million urban population of Iran (according to the 1996 census) about 4 million individuals (2.55 million men and 1.4 million women) were eligible for statin therapy. With respect to the urban population growth from the 1996 to the 2011 census (about 2.5 percent increases) the number of individuals for receiving statin increased by 50% (5 million men and 3 million women). Also, the risk in non-diabetic men with calculated risk of 5-7.5% and diabetic women with calculated risk of <5% for hard CVD was lower than 0.2. By removing these people from total eligible population, the burden of statin therapy will reduced about 8% which is about 540.752 persons, according to the Census 1996 and 1.155.079 individuals based on the census 2011. Conclusion: The new guideline of ACC/AHA for statin therapy is relatively reasonable except for some subgroups. To reduce the burden of medical expenses, statin prescription can be ignored by physicians in these subgroups. Of course further research is required to calculate the net benefit for estimating the clinical usefulness of statin therapy in recommended guideline subgroups.

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It was assumed that the loss of cardiomyocytes is irreversible. The main goal is to develop widely available and clinically applicable treatments for heart diseases. The several studies have showed that the use of stem cells can improve complicacies such as cardiovascular diseases. Stem cells have a potential benefit of the self-renewal and cell differentiation into the cell types that can play an important role in the organogenesis and the embryonic development. In a lifetime, the heart muscle has a population of cardiac stem cells (CSCs) in which a dramatically increase after cardiovascular damages. So far, seven types of CSCs have been discovered with the different molecular phenotype and the cell differentiation potential. In this regard, the proliferation and the differentiation increase of CSCs in the cardiac ischemic areas can be a key factor to improve heart complicacies. Paracrine and/or autocrine factors, the extracellular matrix and the genetic mediators including microRNA can control the function of CSCs. It has clearly been understood that the factors mentioned previously have the ability to improve these complicacies. The differentiation, the survival and the self-renewal of CSCs are largely under the control of factors in the heart microenvironment. Several studies showed that the cytokines and the growth factors play the important role in the proliferation and the migration of CSCs. Taking advantage of these factors together CSCs to repair damaged heart can enhance this method efficiency. This review will discuss the different kinds of CSCs, their molecular phenotype and cardiac regeneration potential in order to improve cardiovascular diseases. It seems that CSCs-based therapy is emerging as a novel approach for myocardial repair over conventional cardiovascular therapies. Therefore, understanding the new aspects on the molecular mechanisms and the signaling pathways involving CSCs is critical for the development of the therapeutic strategies in cardiac patients that would be valuable for researchers in both fields of molecular and clinical cardiology.

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Background: Cerebral arteriovenous malformations are rare congenital anomalies presenting as different symptoms depending on their size and the age of patient. Congestive heart failure is a rare condition in neonatal period and is most common due to structural heart defects, but rarely may be a result of peripheral shunts such as cerebral arteriovenous malformation.

Case presentation: A term male newborn infant who was delivered by Caesarean Section in Chamran Hospital, Ferdows, South Khorasan Province, June 2016. The infant was admitted to neonatal care unit due to nonreactive nonstress (NST) with normal Apgar score. In first postpartum visit, a systolic heart murmur was detected. Echocardiography showed small atrial septal defect secundum type and patent foramen ovale (PFO). He presented clinical manifestations of heart failure after 72 hours of birth. Antibiotic and treatment of heart failure was started. Following excluding most common etiologies of heart failure such as sepsis, anemia and arrhythmias, for detecting less common conditions such as cerebral vascular aneurism a transfontanelle ultrasonography was performed which showed dilated cerebral venous system. Magnetic resonance imaging (MRI) and Magnetic resonance venography (MRV) revealed a large congenital cerebral arterio-venous malformation (CAVM), in right cerebral hemisphere. Finally, he was expired 9 days after birth due to severe heart failure before any definitive treatment for closing CAVM could be done. 

Conclusion: CAVM are extremely rare vascular anomalies in newborns which may present occasionally as congestive heart failure in neonatal period. So after excluding other most common etiologies of heart failure such as structural heart defects, screening CAVMs should be done. Inspite of early diagnosis, usually they have extremely poor prognosis.