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Gorji MT, Alaei-Shahmiri F, Darban Hosseini Amirkhiz G, Sezavar SH, Malek M, Khamseh ME. Appropriateness of Intensive Statin Treatment in People with Type Two Diabetes and Mild Hypercholesterolemia: A Randomized Clinical Trial. Arch Iran Med 2023; 26:290-299. [PMID: 38310429 PMCID: PMC10685836 DOI: 10.34172/aim.2023.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2024]
Abstract
BACKGROUND The aim of this study was to compare moderate- versus high-intensity statin therapy in patients with type 2 diabetes and low-density lipoprotein (LDL) cholesterol less than 130 mg/dL. METHODS This was a randomized, open-label, parallel design trial comprised of 79 patients randomly allocated into two groups receiving high-intensity [atorvastatin 40 mg (A40) or rosuvastatin 20 mg (R20) daily] or moderate-intensity [atorvastatin 20 mg (A20) or rosuvastatin 10 (R10) mg daily] statins for eight weeks. The variables investigated were lipid profile, high sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6). RESULTS The percentage of decrease in LDL levels (±SD) for the high-intensity group (-35.5±25.5) was significantly greater than the moderate-intensity group (-24.6±23.5) (P=0.04). While 38.1% (n:8) of patients receiving A20 and 55% (n:11) of those being on R10 achieved the targets of≥30% reduction in the LDL level, these figures were 63.2% (n=12) and 73.8% (n=14) for A40 and R20 subgroups, respectively. Subsequently, the likelihood of achieving LDL reduction≥30%, was significantly greater with high-intensity statin therapy (OR: 3.1, 95% CI: 1.09, 8.90, P=0.03). Logistic regression analysis also showed that for every 1 mg/ dL increase in the baseline LDL level, the odds of achieving the LDL reduction≥30% increased by 1.04 times [95% CI: (1.01, 1.07), P=0.003]. CONCLUSION Despite the general conception, moderate-intensity statins are not adequate for the majority of patients with T2DM and mild hyperlipidemia and greater numbers of patients could reach the LDL cholesterol target with high-intensity statin therapy.
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Affiliation(s)
- Mohammad Taghi Gorji
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fariba Alaei-Shahmiri
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Gisoo Darban Hosseini Amirkhiz
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Talasaz AH, Sadeghipour P, Bakhshandeh H, Sharif-Kashani B, Rashidi F, Beigmohammadi MT, Gohari Moghadam K, Rezaian S, Dabbagh A, Sezavar SH, Farrokhpour M, Abedini A, Aliannejad R, Riahi T, Yadollahzadeh M, Lookzadeh S, Rezaeifar P, Matin S, Tahamtan O, Mohammadi K, Zoghi E, Rahmani H, Hosseini SH, Mousavian SM, Abri H, Sadeghipour P, Baghizadeh E, Rafiee F, Jamalkhani S, Amin A, Mohebbi B, Parhizgar SE, Soleimanzadeh M, Aghakouchakzadeh M, Eslami V, Payandemehr P, Khalili H, Talakoob H, Tojari T, Shafaghi S, Tabrizi S, Kakavand H, Kashefizadeh A, Najafi A, Jiménez D, Gupta A, Madhavan MV, Sethi S, Parikh SA, Monreal M, Hadavand N, Hajighasemi A, Ansarin K, Maleki M, Sadeghian S, Barco S, Siegerink B, Spatz E, Piazza G, Kirtane AJ, Van Tassell BW, Lip GY, Klok E, Goldhaber SZ, Stone G, Krumholz H, Bikdeli B. Atorvastatin versus Placebo in ICU Patients with COVID-19: Ninety-day Results of the INSPIRATION-S Trial. Thromb Haemost 2023. [PMID: 36944357 DOI: 10.1055/a-2059-4844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUNDS In the INSPIRATION-S trial, atorvastatin versus placebo was associated with a non-significant 16% reduction in 30-day composite of venous/arterial thrombosis or death in ICU patients with COVID-19. Thrombo-inflammatory response in COVID-19 may last beyond the first 30 days. METHODS This article reports the effects of atorvastatin 20 mg daily versus placebo on 90-day clinical and functional outcomes from INSPIRATION-S, a double-blind multicenter randomized trial of adult ICU patients with COVID-19. The main outcome for this pre-specified study was a composite of adjudicated venous/arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause mortality. Functional status was assessed with Post-COVID-19 Functional Scale (PCFS). RESULTS In the primary analysis, 587 patients were included (age: 57 (Q1, Q3: 45, 68) years; 44% women). By 90-day follow-up, the main outcome occurred in 96 (33.1%) patients assigned to atorvastatin and 113 (38.0%) assigned to placebo (hazard ratio, HR: 0.80, 95% confidence interval, CI: 0.60-1.05, P=0.11). Atorvastatin in patients who presented within 7 days of symptom onset was associated with reduced 90-day hazard for the main outcome (HR: 0.60, 95% CI: 0.42-0.86, Pinteraction=0.02). Atorvastatin use was associated with improved 90-day functional status, although the upper bound CI crossed 1.0 (ORordinal, 0.64, 95% CI: 0.41 to 1.01, P=0.05). CONCLUSIONS Atorvastatin 20 mg compared with placebo did not significantly reduce the 90-day composite of death, treatment with ECMO, or venous/arterial thrombosis. However, the point estimates do not exclude a potential clinically meaningful treatment effect, especially among patients who presented within 7 days of symptom onset. (NCT04486508).
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Affiliation(s)
| | - Parham Sadeghipour
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | - Babak Sharif-Kashani
- Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | | | - Mohammad Taghi Beigmohammadi
- Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Keivan Gohari Moghadam
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Somayeh Rezaian
- Alborz University of Medicine Science, Karaj, Iran., Tehran, Iran (the Islamic Republic of)
| | - Ali Dabbagh
- Cardiac Anesthesiology, Anesthesiology Research Center, Tehran, Iran (the Islamic Republic of)
| | - Seyed Hashem Sezavar
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mohsen Farrokhpour
- Firouzgar hospital, Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Atefeh Abedini
- Chronic Respiratory Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Rasoul Aliannejad
- Department of Pulmonary and Critical Care, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Taghi Riahi
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mahdi Yadollahzadeh
- Firouzgar hospital, Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Somayeh Lookzadeh
- Chronic Respiratory Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Parisa Rezaeifar
- Tuberculosis and lung diseases research center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran (the Islamic Republic of)
| | - Samira Matin
- Tuberclosis and Lung Diseases Research Center, Tabriz, Iran (the Islamic Republic of)
| | - Ooria Tahamtan
- Tuberculosis and lung diseases research center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran (the Islamic Republic of)
| | - Keyhan Mohammadi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Elnaz Zoghi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Hamid Rahmani
- Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Seyed Hossein Hosseini
- School of pharmacy, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Seyed Masoud Mousavian
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Homa Abri
- Firouzgar hospital, Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Pardis Sadeghipour
- Firouzgar hospital, Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Elahe Baghizadeh
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | - Farnaz Rafiee
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | - Sepehr Jamalkhani
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | - Seyed Ehsan Parhizgar
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | - Mahshid Soleimanzadeh
- Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | | | - Vahid Eslami
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Pooya Payandemehr
- Sina hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Hossein Khalili
- Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Hamed Talakoob
- Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran, Tehran, Iran (the Islamic Republic of)
| | - Taranom Tojari
- Department of Biotechnology, Faculty of Biological Sciences, Alzahra University, Tehran, Iran., Tehran, Iran (the Islamic Republic of)
| | - Shadi Shafaghi
- Lung Transplantion Research Center, Department of Cardiology, National Research Institute of Tuberculosls and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Sanaz Tabrizi
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Hessam Kakavand
- School of pharmacy, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Alireza Kashefizadeh
- Shahid Dr. Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Tehran, Iran (the Islamic Republic of)
| | - Atabak Najafi
- Sina Hospital, Tehran, Iran (the Islamic Republic of)
| | - David Jiménez
- Respiratory Division, Medicine Department, Ramón y Cajal Hospital, IRYCIS and Alcalá de Henares University, Madrid, Spain
| | - Aakriti Gupta
- Cardiovascular Research Foundation, New York, United States
| | | | - Sanjum Sethi
- Columbia University Irving Medical Center, New York, United States
| | - Sahil A Parikh
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, United States
| | - Manuel Monreal
- Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Naser Hadavand
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | | | - Khalil Ansarin
- Tuberculosis and lung diseases research center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran (the Islamic Republic of)
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of)
| | | | - Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Bob Siegerink
- Leiden University Medical Center Department of Clinical Epidemiology, Leiden, Netherlands
| | - Erica Spatz
- Yale University Center for Outcomes Research and Evaluation, New Haven, United States
| | | | - Ajay J Kirtane
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York City, United States
| | - Benjamin W Van Tassell
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, United States
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool Institute of Ageing and Chronic Disease, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Erik Klok
- Dept. of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Gregg Stone
- Cardiovascular Research Foundation, New York, United States
| | - Harlan Krumholz
- Yale University Center for Outcomes Research and Evaluation, New Haven, United States
| | - Behnood Bikdeli
- Yale University Center for Outcomes Research and Evaluation, New Haven, United States
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Ghorbani S, Sezavar SH, Bokharaei-Salim F, Ataei-Pirkooh A, Tavakoli A, Javanmard D, Sadri-Nahand J, Kiani SJ, Ghaffari H, Beikzadeh L, Hamidpoor L, Monavari SH. Expression levels of miR-22, miR-30c, miR-145, and miR-519d and their possible associations with inflammatory markers among patients with coronary artery disease. ARYA Atheroscler 2022; 18:1-10. [PMID: 36815956 PMCID: PMC9931943 DOI: 10.48305/arya.v18i0.2436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/17/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of death around the world. Micro-ribonucleic acid (miRNA) can be involved in forming of atherosclerotic plaques, inflammation, cholesterol metabolism, and other mechanisms involved in CAD development. This study aimed to evaluate the expression level of miR-22, miR-30c, miR-145, and miR-519d and their possible association with inflammatory markers among patients with CAD. METHODS The expression level of miR-22, miR-30c, miR-145, miR-519d, interleukin 6 (IL-6), and transforming growth factor beta (TGF-β) was determined in peripheral blood mononuclear cells (PBMCs) from 46 patients with CAD and 39 healthy controls using real-time quantitative polymerase chain reaction (qPCR) assay. RESULTS 53.8% (n = 21) and 52.2% (n = 24) of controls and cases were men, respectively; the mean age was 59.8 ± 7.4 and 57.0 ± 9.8 years, respectively. The miRNA expression pattern of each group showed significantly different expression profiles. In the CAD patients group, miR-22, miR-30c, and miR-145 were down-regulated compared to the control group. On the opposite, miR-519d was up-regulated in patients with CAD compared to the control group. Our results also showed that the expression levels of IL-6 and TGF-β were up-regulated among patients with CAD compared to the control group. In addition, the expression of miR-145 and miR-519d had a significantly negative and positive correlation with TGF-β and IL-6, respectively. CONCLUSION The change in expression levels of miR-22, miR-30c, miR-145, and miR-519d in PBMCs of patients with CAD could be considered as a potential biomarker for CAD.
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Affiliation(s)
- Saied Ghorbani
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hashem Sezavar
- Department of Cardiology, School of Medicine AND Research Center for Prevention of Cardiovascular Endocrinology and Metabolism, Research Institute Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farah Bokharaei-Salim
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Angila Ataei-Pirkooh
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Virology, School of Medicine AND Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Davod Javanmard
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Javid Sadri-Nahand
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jalal Kiani
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Ghaffari
- Department of Bacteriology and Virology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Leila Beikzadeh
- Department of Medical Laboratory Sciences, School of Paramedicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Seyed Hamidreza Monavari
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran,Address for correspondence: Seyed Hamidreza Monavari; Department of Medical Virology, School of Medicine, Iran University of
Medical Sciences, Tehran, Iran;
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Aminisani N, Azimi-Nezhad M, Shamshirgaran SM, Mirhafez SR, Borji A, Poustchi H, Sezavar SH, Ansarin K, Kolahi S, Javadpor A, Rezaei A, Hooshmand E, Maroufi N, Tabaei S, Eghtesad S, Hyde M, Kenny RA, Raina P, Stephens C, Malekzadeh R. Cohort Profile: The IRanian Longitudinal Study on Ageing (IRLSA): the first comprehensive study on ageing in Iran. Int J Epidemiol 2022; 51:e177-e188. [PMID: 35137100 DOI: 10.1093/ije/dyab272] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/26/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nayyereh Aminisani
- Department of Epidemiology and statistics, Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohsen Azimi-Nezhad
- Department of Basic Medical Sciences, Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Seyed Morteza Shamshirgaran
- Department of Epidemiology and statistics, Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Seyed Reza Mirhafez
- Department of Basic Medical Sciences, Non-Communicable Diseases Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Abasalt Borji
- Department of Basic Medical Sciences, Non-Communicable Diseases Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Hashem Sezavar
- Department of Cardiology, Research Center for Prevention of Cardiovascular Endocrinology & Metabolism, Research Institute Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ansarin
- Department of Internal Medicine, Tuberculosis and Lung Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Susan Kolahi
- Department of Internal Medicine, Connective Tissue Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Javadpor
- Department of Psychiatrics, Shiraz Geriatric Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Rezaei
- Department of Basic Medical Sciences, Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Elham Hooshmand
- Department of Epidemiology and statistics, Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Negin Maroufi
- Longitudinal Study on Ageing Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Samaneh Tabaei
- Department of Cardiology, Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Sareh Eghtesad
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Martin Hyde
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rose Anne Kenny
- Department of Medical Gerontology, Trinity College Dublin, Ireland
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | | | - Reza Malekzadeh
- Digestive Diseases Research Centre, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Sadeghipour P, Talasaz AH, Rashidi F, Sharif-Kashani B, Beigmohammadi MT, Farrokhpour M, Sezavar SH, Payandemehr P, Dabbagh A, Moghadam KG, Jamalkhani S, Khalili H, Yadollahzadeh M, Riahi T, Rezaeifar P, Tahamtan O, Matin S, Abedini A, Lookzadeh S, Rahmani H, Zoghi E, Mohammadi K, Sadeghipour P, Abri H, Tabrizi S, Mousavian SM, Shahmirzaei S, Bakhshandeh H, Amin A, Rafiee F, Baghizadeh E, Mohebbi B, Parhizgar SE, Aliannejad R, Eslami V, Kashefizadeh A, Kakavand H, Hosseini SH, Shafaghi S, Ghazi SF, Najafi A, Jimenez D, Gupta A, Madhavan MV, Sethi SS, Parikh SA, Monreal M, Hadavand N, Hajighasemi A, Maleki M, Sadeghian S, Piazza G, Kirtane AJ, Van Tassell BW, Dobesh PP, Stone GW, Lip GYH, Krumholz HM, Goldhaber SZ, Bikdeli B. Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality Among Patients With COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial. JAMA 2021; 325:1620-1630. [PMID: 33734299 PMCID: PMC7974835 DOI: 10.1001/jama.2021.4152] [Citation(s) in RCA: 427] [Impact Index Per Article: 142.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. OBJECTIVE To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized trial with a 2 × 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. INTERVENTIONS Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. MAIN OUTCOMES AND MEASURES The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 ×103/µL). All outcomes were blindly adjudicated. RESULTS Among 600 randomized patients, 562 (93.7%) were included in the primary analysis (median [interquartile range] age, 62 [50-71] years; 237 [42.2%] women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% [95% CI, -6.6% to 9.8%]; odds ratio, 1.06 [95% CI, 0.76-1.48]; P = .70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% [1-sided 97.5% CI, -∞ to 3.4%]; odds ratio, 1.83 [1-sided 97.5% CI, 0.00-5.93]), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% [95% CI, 0.4%-3.8%]; P = .01). CONCLUSIONS AND RELEVANCE Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04486508.
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Affiliation(s)
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azita H Talasaz
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Rashidi
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sharif-Kashani
- Tobacoo Prevention and control Research center, National Research institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Beigmohammadi
- Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Farrokhpour
- Firouzgar hospital, Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Dabbagh
- Department of Anesthesiology, School of Medicine Anesthesiology Research Center Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sepehr Jamalkhani
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Yadollahzadeh
- Firouzgar hospital, Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Taghi Riahi
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Rezaeifar
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ouria Tahamtan
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samira Matin
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Abedini
- Chronic Respiratory Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Lookzadeh
- Chronic Respiratory Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Rahmani
- Department of Pharmacotherapy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elnaz Zoghi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyhan Mohammadi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Sadeghipour
- Firouzgar hospital, Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Homa Abri
- Firouzgar hospital, Department of internal medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Tabrizi
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Hooman Bakhshandeh
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran
| | - Farnaz Rafiee
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran
| | - Elahe Baghizadeh
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ehsan Parhizgar
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran
| | - Rasoul Aliannejad
- School of Medicine, Department of Pulmonary and Critical Care, Shariati Hospital, Tehran, Iran
- Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Eslami
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Kashefizadeh
- Shahid Dr Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hessam Kakavand
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shadi Shafaghi
- Lung Transplantation Research Center, Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samrand Fattah Ghazi
- Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Aakriti Gupta
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
- Yale/YNHH Center for Outcomes Research & Evaluation, New Haven, Connecticut
| | - Mahesh V Madhavan
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Sanjum S Sethi
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Sahil A Parikh
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Universidad Católica de Murcia, Murcia, Spain
| | - Naser Hadavand
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran
| | | | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ajay J Kirtane
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Benjamin W Van Tassell
- School of Pharmacy, Department of Pharmacotherapy and Outcome Science, Virginia Commonwealth University, Richmond, Virginia
- School of Pharmacy, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Paul P Dobesh
- College of Pharmacy, University of Nebraska Medical Center, Omaha
| | - Gregg W Stone
- Cardiovascular Research Foundation (CRF), New York, New York
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Aalborg University, Aalborg, Denmark
| | - Harlan M Krumholz
- Yale/YNHH Center for Outcomes Research & Evaluation, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Behnood Bikdeli
- Cardiovascular Research Foundation (CRF), New York, New York
- Yale/YNHH Center for Outcomes Research & Evaluation, New Haven, Connecticut
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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6
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Bikdeli B, Talasaz AH, Rashidi F, Bakhshandeh H, Rafiee F, Rezaeifar P, Baghizadeh E, Matin S, Jamalkhani S, Tahamtan O, Sharif-Kashani B, Beigmohammadi MT, Farrokhpour M, Sezavar SH, Payandemehr P, Dabbagh A, Moghadam KG, Khalili H, Yadollahzadeh M, Riahi T, Abedini A, Lookzadeh S, Rahmani H, Zoghi E, Mohammadi K, Sadeghipour P, Abri H, Tabrizi S, Mousavian SM, Shahmirzaei S, Amin A, Mohebbi B, Parhizgar SE, Aliannejad R, Eslami V, Kashefizadeh A, Dobesh PP, Kakavand H, Hosseini SH, Shafaghi S, Ghazi SF, Najafi A, Jimenez D, Gupta A, Madhavan MV, Sethi SS, Parikh SA, Monreal M, Hadavand N, Hajighasemi A, Maleki M, Sadeghian S, Piazza G, Kirtane AJ, Van Tassell BW, Stone GW, Lip GYH, Krumholz HM, Goldhaber SZ, Sadeghipour P. Intermediate-Dose versus Standard-Dose Prophylactic Anticoagulation in Patients with COVID-19 Admitted to the Intensive Care Unit: 90-Day Results from the INSPIRATION Randomized Trial. Thromb Haemost 2021; 122:131-141. [PMID: 33865239 DOI: 10.1055/a-1485-2372] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Thrombotic complications are considered among the main extrapulmonary manifestations of coronavirus disease 2019 (COVID-19). The optimal type and duration of prophylactic antithrombotic therapy in these patients remain unknown. METHODS This article reports the final (90-day) results of the Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) study. Patients with COVID-19 admitted to intensive care were randomized to intermediate-dose versus standard-dose prophylactic anticoagulation for 30 days, irrespective of hospital discharge status. The primary efficacy outcome was a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause death. The main safety outcome was major bleeding. RESULTS Of 600 randomized patients, 562 entered the modified intention-to-treat analysis (median age [Q1, Q3]: 62 [50, 71] years; 237 [42.2%] women), of whom 336 (59.8%) survived to hospital discharge. The primary outcome occurred in 132 (47.8%) of patients assigned to intermediate dose and 130 (45.4%) patients assigned to standard-dose prophylactic anticoagulation (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.95-1.55, p = 0.11). Findings were similar for other efficacy outcomes, and in the landmark analysis from days 31 to 90 (HR: 1.59, 95% CI: 0.45-5.06). There were 7 (2.5%) major bleeding events in the intermediate-dose group (including 3 fatal events) and 4 (1.4%) major bleeding events in the standard-dose group (none fatal) (HR: 1.82, 95% CI: 0.53-6.24). CONCLUSION Intermediate-dose compared with standard-dose prophylactic anticoagulation did not reduce a composite of death, treatment with ECMO, or venous or arterial thrombosis at 90-day follow-up.
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Affiliation(s)
- Behnood Bikdeli
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States.,Cardiovascular Research Foundation, New York, New York, United States
| | - Azita H Talasaz
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Rashidi
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hooman Bakhshandeh
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Rajaie Cardiovascular Medical and Research Center, Iran university of Medical Sciences, Tehran, Iran
| | - Farnaz Rafiee
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical Sciences, Tehran, Iran
| | - Parisa Rezaeifar
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elahe Baghizadeh
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical Sciences, Tehran, Iran
| | - Samira Matin
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sepehr Jamalkhani
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Ouria Tahamtan
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sharif-Kashani
- Tobacoo Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Cardiology, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Beigmohammadi
- Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Farrokhpour
- Department of Internal Medicine, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Dabbagh
- Department of Anesthesiology, School of Medicine Anesthesiology Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hossein Khalili
- Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Yadollahzadeh
- Department of Internal Medicine, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Taghi Riahi
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Lookzadeh
- Chronic Respiratory Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Rahmani
- Department of Pharmacotherapy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elnaz Zoghi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyhan Mohammadi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Sadeghipour
- Department of Internal Medicine, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Homa Abri
- Department of Internal Medicine, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Tabrizi
- Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ehsan Parhizgar
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical Sciences, Tehran, Iran
| | - Rasoul Aliannejad
- Department of Pulmonary and Critical Care, School of Medicine, Shariati Hospital, Tehran, Iran.,Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Eslami
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Kashefizadeh
- Shahid Dr. Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Paul P Dobesh
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Hessam Kakavand
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shadi Shafaghi
- Department of Cardiology, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samrand Fattah Ghazi
- Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal, Madrid, Spain.,Medicine Department, Universidad de Alcalá, Madrid, Spain.,CIBER Enfermedades Respiratorias, Madrid, Spain
| | - Aakriti Gupta
- Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States.,Cardiovascular Research Foundation, New York, New York, United States.,Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
| | - Mahesh V Madhavan
- Cardiovascular Research Foundation, New York, New York, United States.,Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
| | - Sanjum S Sethi
- Cardiovascular Research Foundation, New York, New York, United States.,Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
| | - Sahil A Parikh
- Cardiovascular Research Foundation, New York, New York, United States.,Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,Universidad Católica de Murcia, Murcia, Spain
| | - Naser Hadavand
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical Sciences, Tehran, Iran
| | | | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran university of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, New York, United States.,Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
| | - Benjamin W Van Tassell
- Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, United States.,Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York, United States.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Aalborg University, Aalborg, Denmark
| | - Harlan M Krumholz
- Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States.,Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, United States
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Parham Sadeghipour
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Rajaie Cardiovascular Medical and Research Center, Iran university of Medical Sciences, Tehran, Iran.,School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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7
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Kooranifar S, Naghshin R, Sezavar SH, Hajsadeghi S, Talebzadeh SM. Diagnostic value of chest spiral CT scan and Doppler echocardiography compared to right heart catheterization to predict pulmonary arterial hypertension in patients with scleroderma. Acta Biomed 2021; 92:e2021074. [PMID: 33682822 PMCID: PMC7975950 DOI: 10.23750/abm.v92i1.9216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Because of invasive nature of catheterization, using other noninvasive tools is more preferred to assess pulmonary arterial hypertension (PAH). The present study assessed the value of chest spiral CT scan and Doppler echocardiography compared to right heart catheterization (RHC) to predict PAH in patients with scleroderma. METHODS This cross-sectional study was performed on 15 patients with limited scleroderma. All subjects underwent Doppler echocardiography (to assess PAP) and chest spiral CT scan without injection (to assess pulmonary trunk length or PUL), followed by RHC to assess PAH. RESULTS Comparing PUL in spiral CT scan with PAP in RHC yielded a sensitivity of 75.0% and a specificity of 100% for predicting PAH. Similarly, comparing PAP value in echocardiography with PAP in RHC achieved a sensitivity of 100% and a specificity of 63.6% to discriminate PAH from normal PAP condition. Analysis of the area under the ROC curve showed high power of CT scan to predict PAH (AUC = 1.000). The best cutoff point for PUL to predict PAH was 29.95 yielding a sensitivity of 100% and a specificity of 100%. Also, ROC curve analysis showed high value of echocardiography to discriminate PAH from normal PAP status (AUC = 0.841) that considering a cutoff value of 22.88 for PAP assessed by echocardiography reached to a sensitivity of 72.7% and a specificity of 100%. Conclusion: Both chest spiral CT scan and Doppler echocardiography are very useful to diagnose PAH and its severity in patients with scleroderma.
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Affiliation(s)
- Siavash Kooranifar
- Department of Pulmonary Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran..
| | - Roozbeh Naghshin
- Department of Pulmonary Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran..
| | - Seyed Hashem Sezavar
- Department of Cardiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Shokoufeh Hajsadeghi
- Department of Cardiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mehdi Talebzadeh
- Department of Pulmonary Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran..
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8
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Sezavar SH, Hassanzadeh M, Akhlagh Moayed D, Tabandeh M, Ghasemi M, Abdi S, Firoozi I, Golbidi P, Pourjafari M, Taslimi N, Akhlaghi AA, Hashemian M. Current practice of percutaneous coronary intervention on patients with acute coronary syndrome in Iran: A prospective observational study. Med J Islam Repub Iran 2020; 34:13. [PMID: 32551302 PMCID: PMC7293802 DOI: 10.34171/mjiri.34.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Frequent Percutaneous Coronary Intervention (PCI) procedures are being performed on a daily basis in Iran. However, no study has been reported on the current PCI practice in patients with acute coronary syndrome (ACS) in Iran. We aimed to describe the clinical characteristics and treatment patterns in Iranian ACS patients treated with PCI.
Methods: Between February 2017 and July 2017, ACS patients presented to 5 referral hospitals in two major cities of Iran (Tehran and Shiraz) were included in this observational study if aged > 18 years and underwent PCI for ACS during hospitalization; and their clinical and procedural characteristics were collected. All data were entered into SPSS v.21 and descriptive statistics were performed.
Results: Of a total of 314 patients, 228 (73%) were males, 162 (52%) were diagnosed with ST-elevation myocardial infarction and 152 (48%) with Unstable angina/ Non-ST elevation myocardial infarction. Trans-femoral approach was more often (64%) used for PCI procedures. Stent placement was the most frequent (98%) treatment strategy on PCI, with drug-eluting stent selected in the majority of subjects (98%). The overall rate of PCI success was 95%, with 4.1% PCI-related complications, and 1.6% post-PCI bleeding events. The vast majority of the study patients (99%) were discharged with dual anti-platelet therapy.
Conclusion: In this study, we observed a high level of adherence to the currently accepted guidelines in the current PCI practice on ACS patients in Iran. Also we found our practice is highly in line with the global reduction trend in the PCI-related complications.
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Affiliation(s)
- Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hassanzadeh
- Department of Internal Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Massoud Ghasemi
- Department of Cardiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | - Ali Asghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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9
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Saberian P, Tavakoli N, Hasani-Sharamin P, Sezavar SH, Dadashi F, Vahidi E. The effect of prehospital telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction patients undergoing primary percutaneous coronary intervention: A cross-sectional study. Turk J Emerg Med 2020; 20:28-34. [PMID: 32355899 PMCID: PMC7189824 DOI: 10.4103/2452-2473.276380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/03/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The sooner the primary percutaneous coronary intervention (PPCI) is performed, the better prognosis is expected in patients with acute myocardial infarction. The objective is to evaluate the effect of prehospital triage based on electrocardiogram (ECG) and telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction (STEMI) patients undergoing PPCI. METHODS This cross-sectional study was conducted based on the data extracted from the hospital information system (HIS) of one general hospital, which had the capability of performing PPCI 24 h a day, 7 days a week. All patients with STEMI who undergone PPCI during 1 year, transferred by emergency medical service (EMS) and their data were registered in the HIS were eligible. Besides the baseline characteristics, first medical contact (FMC)-to-balloon time was recorded. Morbidity based on predischarge left ventricular ejection fraction (LVEF) and mortality based on Global Registry of Acute Cardiac Events (GRACE) score were also recorded. Patients who were referred to the hospital by EMS with prehospital ECG and telecardiology were compared with those without prehospital ECG. RESULTS Totally, 298 patients with STEMI were enrolled, of whom 183 patients (61.4%) had prehospital ECG (telecardiology), and 115 patients (38.6%) had not. The means of predischarge LVEF of the patients in the first and the second groups were 40.7 ± 10.4 and 40.6 ± 11.2, respectively (P = 0.946). The mean of the probability of 6-month mortality based on GRACE score in the first group was significantly less than that of the second group (P = 0.004). Analyses of multivariable ordinal logistic regression showed that 6-month mortality severity risk in the second group was 1.5 times more than the first group (95% confidence interval 0.8-2.6), although this difference was not statistically significant (P = 0.199). CONCLUSIONS It is likely that prehospital telecardiology, with shortening FMC to balloon time result in reducing probability 6-month mortality in STEMI patients who undergone PPCI. However, the process of telecardiology had no effect on predischarge LVEF in the current study.
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Affiliation(s)
- Peyman Saberian
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Hasani-Sharamin
- Tehran Emergency Medical Service Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dadashi
- Tehran Emergency Medical Service Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Vahidi
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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10
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Goudarzi M, Fatemi I, Siahpoosh A, Sezavar SH, Mansouri E, Mehrzadi S. Protective Effect of Ellagic Acid Against Sodium Arsenite-Induced Cardio- and Hematotoxicity in Rats. Cardiovasc Toxicol 2019; 18:337-345. [PMID: 29383632 DOI: 10.1007/s12012-018-9446-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ellagic acid (EA) is a phenolic constituent in certain fruits and nuts with wide range of biological activities, including potent antioxidant, antidiabetic, anti-inflammatory, anticancer and antimutagen properties. The aim of this study was to evaluate the effect of EA on sodium arsenic (SA)-induced cardio- and hematotoxicity in rats. Animals were divided into five groups. The first group was used as control. Group 2 was orally treated with sodium arsenite (SA, 10 mg/kg) for 21 days. Group 3 was orally treated with EA (30 mg/kg) for 14 days. Groups 4 and 5 were orally treated with SA for 7 days prior to EA (10 and 30 mg/kg, respectively) treatment and continued up to 21 days simultaneous with SA administration. Various biochemical, histological and molecular biomarkers were assessed in blood and heart. The results indicate that SA-intoxicated rats display significantly higher levels of plasma cardiac markers (AST, CK-MB, LDH and cTnI) than normal control animals. Moreover, an increase in MDA and NO with depletion of GSH and activities of CAT, SOD and GPx occurred in the heart of rats treated with SA. Furthermore, SA-treated rats showed significantly lower WBC, RBC, HGB, HCT and PLT and significantly higher MCV and MCH. Administration of EA (30 mg/kg) resulted in a significant reversal of hematological and cardiac markers in arsenic-intoxicated rats. These biochemical disturbances were supported by histopathological observations of the heart. In conclusion, the results of this study suggest that EA treatment exerts a significant protective effect on SA-induced cardio- and hematotoxicity.
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Affiliation(s)
- Mehdi Goudarzi
- Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Iman Fatemi
- Department of Physiology and Pharmacology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Physiology-Pharmacology Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Amir Siahpoosh
- Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Pharmacognosy, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Esrafil Mansouri
- Cellular and Molecular Research Center, Department of Anatomical Sciences, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Mehrzadi
- Razi Drug Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Hosseinzadeh A, Houshmand G, Goudarzi M, Sezavar SH, Mehrzadi S, Mansouri E, Kalantar M. Ameliorative effect of gallic acid on sodium arsenite-induced spleno-, cardio- and hemato-toxicity in rats. Life Sci 2018; 217:91-100. [PMID: 30472295 DOI: 10.1016/j.lfs.2018.11.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/17/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022]
Abstract
AIM Arsenic is an important toxic chemical affecting millions of people around the world. Exposure to inorganic arsenic results in various health problems including skin lesions, hypertension, hematological disturbance, cardiovascular disease, spleen enlargement and cancer. Gallic acid (GA) is an important phenolic compound possessing various pharmacological properties including anti-inflammatory, antioxidant and free radical scavenging activities. The present study investigated effects of GA against sodium arsenite (SA)-induced spleno-, cardio- and hemato-toxicity. MAIN METHODS Thirty-five adult male Wistar rats were randomly divided into five groups; group I received normal saline (2 ml/kg/day, p.o.) for 21 days, group II received SA (10 mg/kg/day, p.o.) for 14 days, group III and IV were treated with GA (10 and 30 mg/kg/day, respectively) for 7 days prior to receive SA and treatment was continued up to 21 days in parallel with SA administration, group V received GA (30 mg/kg/day, p.o.) for 21 days. The level of MDA, NO and glutathione (GSH) and the activity of glutathione peroxidase (GPx), superoxide dismutase (SOD) and catalase were measured in heart and spleen tissues. Creatine kinase-MB (CK-MB) activity and hematological and histopathological parameters were also assessed. KEY FINDINGS GA significantly decreased SA-induced elevation of MDA and NO levels and reduction of GSH level and GPx and SOD activity in heart and spleen tissues. Furthermore, GA improved SA-induced alteration in hematological and histopathological parameters and reduced SA-induced elevation of serum CK-MB activity. SIGNIFICANCE Our results suggest that GA inhibits SA-induced spleno-, cardio- and hemato-toxicity through reducing oxidative stress.
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Affiliation(s)
- Azam Hosseinzadeh
- Razi Drug Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Houshmand
- Department of Pharmacology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Goudarzi
- Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Mehrzadi
- Razi Drug Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Esrafil Mansouri
- Cellular and Molecular Research Center, Department of Anatomical Sciences, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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12
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Fallah S, Ahmadi R, Moradi N, Fadaei R, Sezavar SH, Seifi M. Helicobacter pylori infection and iron deficiency in patients with coronary artery disease. Cell Mol Biol (Noisy-le-grand) 2016; 62:8-14. [PMID: 27545208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to investigate whether impact of the seropositivity to Helicobacter pylori (H pylori) infection on ferritin and iron levels is an independent risk factor for atherosclerosis in patients with cardiovascular disease. The anti H pylori IgG, IgA levels, serum ferritin and iron concentration of 86 patients with cardiovascular disease and 64 participants free of cardiovascular disease as control subjects were determined by ELISA assay. The results of present study showed that seropositivity to H pylori IgG and IgA levels of coronary artery disease (CAD) patients was higher than controls and CAD patients with negative anti H pylori IgG and IgA significantly. A significant negative correlation was found between seropositivity to H pylori IgG and IgA, ferritin and iron levels of CAD patients with seronegativity and seronegativity to H pylori IgG and IgA in comparison with controls. The achieved results from present study suggest that the involvement of H pylori infection in atherosclerosis process is based on the chronic inflammation which might facilitate the CAD-related pathologies. Moreover, impact of the presence of H pylori infection on reduction of the ferritin and iron levels of CAD patients as a risk factor independent of other classic factors including lipid profiles and inflammatory factors was remarkable.
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Affiliation(s)
- S Fallah
- Iran University of Medical Sciences Research center of Pediatric Infectious Disease, Rasool Akram Hospital Tehran Iran
| | - R Ahmadi
- Iran University of Medical Sciences Department of Biochemistry, Faculty of Medicine Tehran Iran
| | - N Moradi
- Iran University of Medical Sciences Department of Biochemistry, Faculty of Medicine Tehran Iran
| | - R Fadaei
- Tehran University of Medical Sciences Department of Clinical Biochemistry, Faculty of Medicine Tehran Iran
| | - S H Sezavar
- Rasool Akram Hospital of Iran University of Medical Sciences Tehran Iran
| | - M Seifi
- University of Alberta Department of Medical Genetics, Faculty of Medicine and Dentistry Edmonton Canada
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Sezavar SH, Hajsadeghi S, Hejrati M, Ghaleh Bandi MF. Left Ventricular Mass Index and Pulmonary Artery Pressure in Patients with the Obstructive Sleep Apnea Syndrome. J Tehran Heart Cent 2016; 11:11-4. [PMID: 27403184 PMCID: PMC4939250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Sleep apnea is accompanied by some cardiovascular complications. It has even been hypothesized that sleep apnea, itself, can induce some of these complications. Given such controversies, we assessed the left ventricular mass index (LVMI) and systolic pulmonary artery pressure in patients with sleep apnea. METHODS Through convenience sampling, 56 patients with the obstructive sleep apnea syndrome (OSAS) were included in the present descriptive cross-sectional study. Patients with any past history of hypertension and diabetes mellitus were excluded. The apnea severity was assessed via the polysomnography-derived apnea-hypopnea index (AHI). All the patients underwent transthoracic echocardiography. In this cross-sectional study - data regarding age, gender, smoking, systolic and diastolic blood pressures, polysomnographic parameters (AHI, severity of disease, mean heart rate, mean oxygen saturation [SaO2], lowest SaO2, and duration of SaO2 below 90% [d.SaO2 < 90%]), and echocardiographic parameters (systolic pulmonary artery pressure and LVMI) were accumulated and processed. RESULTS Fifty-two men and 14 women at a mean age of 49.29 ± 11.79 years participated in this study. Systolic and was significantly high in the severe group compared with the mild group (128.21 ± 9.73 mmHg vs. 119.23 ± 12.5 mmHg; p value = 0.007). The LVMI was increased parallel to an increase in the severity of the OSAS, but that increase was not statistically significant (p value = 0.161). The d.SaO2 < 90% was positively correlated with the LVMI, and this relationship remained true after adjustment for the body mass index (r = 0.27; p value = 0.042). CONCLUSION Severe OSAS was accompanied by a higher blood pressure. The LVMI did not differ significantly between the patients with the OSAS and those who did not suffer from other risk factors of cardiac diseases.
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Affiliation(s)
| | - Shokoufeh Hajsadeghi
- Corresponding Author: Shokoufeh Hajsadeghi, Associate Professor of Cardiology, Iran University of Medical Sciences, Rasoul-e-Akram Hospital, Sattarkhan Street, Niyayesh Street, Tehran, Iran. 14456113131. Tel: +98 912 3409967. Fax: +98 21 66517118. .
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Savaj S, Savoj J, Jebraili I, Sezavar SH. Remote ischemic preconditioning for prevention of contrast-induced acute kidney injury in diabetic patients. Iran J Kidney Dis 2014; 8:457-460. [PMID: 25362220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/25/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION There are some clinical trials showing that short-term ischemia in one organ can protect different organs against higher intensity and longer ischemic insult. We designed a study to assess whether remote ischemic preconditioning (RIPC) on one organ can decrease the rate of contrast-induced acute kidney injury (AKI) in diabetic patients who undergo coronary artery angiography (CAA). MATERIALS AND METHODS This randomized control trial included 96 diabetic patients who were candidates for CAA. Exclusion criteria were congestive heart failure and complications during CAA. All of the patients received 1000 mL of normal saline before CAA. The RIPC group underwent 3 cycles of 5-minute ischemia in their right arm. Serum creatinine was measured before and 24 hours after CAA. RESULTS Contrast-induced AKI was reported in 5 cases in the control group and 1 case in the RIPC group (P = .13, odds ratio, 5.4). The differences in serum creatinine level before and after the procedure was significantly lower in RIPC group than that in the control group (P = .04, odds ratio, 0.08). Serum creatinine rise significantly correlated with contrast dose (P = .02) and a history of hypertension (P = .02) in both groups. CONCLUSIONS Ischemic preconditioning had a protective effect on contrast-induced AKI in our study. Since this method is harmless and cost effective, further studies on patients with chronic kidney disease is required to evaluate addition of ischemic preconditioning to our clinical practice for prevention of contrast-induced AKI.
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Affiliation(s)
- Shokoufeh Savaj
- Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
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