مقالات رزومه دکتر مرضیه نیک پرور

 Pulmonary hypertension (PH) is associated with an increased risk of cardiac failure among asymptomatic patients with beta-thalassemia. This study aimed to determine the prevalence of PH and associated risk factors in patients with beta-thalassemia major (TM) and beta-thalassemia intermedia (TI) in Hormozgan province, Iran.

 Eighty-nine patients, including 65 TM and 24 TI, were enrolled in this cross-sectional study. The data regarding the gender, age, history of splenectomy, and type of chelating therapy were collected, and then hematocrit, hemoglobin (Hb), and serum ferritin levels were determined. Doppler echocardiography was performed for patients, and tricuspid regurgitation jet velocity (TRV)≥2.5 m/s was used to screen PH. Eventually, the data were analyzed using SPSS.

 The prevalence of TRV≥2.5 m/s was 21.3% in all patients, indicating that it was not significantly different between patients with TM (21.8%) and TI (20.8%). There was a significant association between the prevalence of PH and the male gender. Based on the results, TRV≥2.5 m/s was observed in both children and adults. No significant association was detected between Hb, serum ferritin levels, and splenectomy with PH prevalence.

 The findings revealed that PH is common in both children and adult patients with TM and TI in our population and should be considered to choose the optimal treatment of patients with TM and TI.

Iron-induced cardiomyopathy is the main cause of heart failure in patients with beta-thalassemia major (β-TM). Early diagnosis and timely cardiac iron overload (IO) therapy can improve patients’ prognosis.

This study evaluated the value of exercise test parameters and high-sensitivity C-reactive protein (hs-CRP) in detecting cardiac IO in patients with β-TM.

Forty β-TM patients (age range:18 – 48) were enrolled in this cross-sectional study. Serum hs-CRP was measured using ELISA. Echocardiography and exercise treadmill tests were performed. Cardiac IO was determined using cardiac T2* (CT2*) magnetic resonance imaging, and patients were divided into abnormal (CT2* < 20 ms; n = 22) and normal (CT2* > 20 ms; n = 18) groups. Statistical analyses were conducted using SPSS software. The Mann-Whitney U-test was used to assess differences between the groups. The correlations of variables were evaluated using Pearson’s or Spearman’s correlation analysis. Receiver operator characteristic (ROC) curves were drawn to calculate the optimum cutoff for each test.

We found a significantly higher level of hs-CRP (P = 0.011) and lower levels of the chronotropic index (CI) (P = 0.009) and heart rate recovery (HRR) at minutes 2 – 5 (P < 0.01) in the patients with abnormal CT2*. CT2* was inversely correlated with hs-CRP (r = -0.381, P = 0.022) and positively correlated with the CI (r = 0.346, P = 0.031) and HRR at minute 4 (HRR4) (r = 0.456, P = 0.005). ROC curve data showed diagnostic values of CI (AUC = 0.80, P = 0.005), HRR4 (AUC = 0.786, P = 0.008), and hs-CRP (0.711, P = 0.033) in predicting the severity of IO. These tests showed high sensitivity (CI = 84.6%, HRR4 = 84.6%, and hs-CRP = 85.7%) but low specificity (CI = 70.6%, HRR4 = 41.2%, and hs-CRP = 53.3%) in detecting the severity of cardiac IO.

We found that hs-CRP, CI, and HRRs were significantly associated with the severity of cardiac IO. Despite high sensitivity, these markers showed poor specificity in predicting cardiac iron deposition in β-TM patients.

Controlling hypertension is a key component in the management of cardiovascular risk factors and is an essential part of the prevention strategy.

This descriptive cross-sectional study was conducted in seven integrated health centers covering most families in Bandar Abbas from July 2019 to February 2020. The sample size was estimated to include 968 individuals. Independent samples t-test and Chi-square test were used to compare groups. In addition, some factors affecting uncontrolled blood pressure were identified using logistic regression.

In this study, 68.4% and 31.6% were women and men, respectively, of whom 136 cases were single, while 756 cases were married. With an increase in age, the prevalence of uncontrolled hypertension in both genders showed a significant increase (P < 0.001). Univariate logistic regression (crude odds ratios, ORs) demonstrated that age over 60 years, smoking, diabetes mellitus, physical inactivity, and the use of salt were the most important factors influencing the presence of uncontrolled hypertension. According to the results of the multivariable logistic regression model, smoking was the most important factor affecting the inability to control hypertension since controlling the effect of other variables triggered the chance of not controlling hypertension in smokers as 2.76 times higher than in non-smokers (adjusted OR: 2.76, 95% confidence interval: 1.05-7.26).

Since using table salt, a sedentary lifestyle, and smoking count as risk factors for cardiovascular diseases, necessary prevention and treatment planning are strongly recommended to control modifiable risk factors in this city through public education.

 Although cigarette smoking is a risk factor for cardiovascular disease (CVD), smoking cessation has considerable effects on the reduction of mortality and incidence of acute myocardial infarction (AMI). This study was done to examine the effect of tobacco smoking status and its short-term outcomes after AMI.

 In this longitudinal study, 96 patients smoking tobacco products (cigarette and waterpipe) within the age range of 30-70 years who had undergone angiography following the first AMI were evaluated. The patients were evaluated at three time points in terms of tobacco smoking status, additional myocardial infarction (MI), hospitalization due to cardiac events, and some other variables. Data collection was done using a checklist and phone calls.

 The mean age of the patients was 52.99±9.2 years. Six months following the first MI, more than 60% of the patients had ceased their tobacco smoking, but over time and at the end of the study, this value diminished, especially in waterpipe smokers. The chance of hospitalization among the men younger than 54 years who were not smokers at the baseline was 0.801. On the other hand, this chance for men below 54 years who smoked 1-10 cigarettes per day was 4.75 times higher (OR=4.747, P=0.002). In addition, men younger than 54 years who smoked waterpipe twice or more per day were hospitalized 31 times more frequently compared to the men who did not smoke waterpipe (P=0.001, OR=31.112).

 Not smoking cigarettes or waterpipe over time would considerably reduce the chance of hospitalization due to CVD.

Stroke is a significant cause of morbidity and mortality worldwide. The association between non-hemorrhagic stroke and some electrocardiographic and echocardiographic findings shows its potential cardiac source. This study aimed to evaluate electrocardiographic and echocardiographic findings of patients with non-hemorrhagic stroke.

This cross-sectional study included 134 patients with non-hemorrhagic stroke admitted to the neurology ward of Shahid Mohammadi hospital, Bandar Abbas, Iran, from 2018 to 2019. Patients’ characteristics including age, gender, family history of stroke, diabetes, hypertension, dyslipidemia, inadequate physical activity, and smoking were recorded. All patients underwent electrocardiography (ECG) and echocardiography.

The patients’ mean age was 68.57±12.08 years. Additionally, 84 patients (62.7%) were male. The most common risk factor was dyslipidemia (72.4%) followed by hypertension (64.9%), diabetes (45.5%), smoking (44.8%), and family history of stroke (17.2%). Inadequate physical activity was found in 69.4% of the patients. The most common ECG finding was old myocardial infarction (MI) accounting for 24.6% of the patients, followed by atrial fibrillation (AF) (14.9%) and new MI (3.7%). The most common echocardiographic finding was significant mitral regurgitation (MR) (23.1%), followed by left ventricular systolic dysfunction (21.6%), significant tricuspid regurgitation (TR) (11.2%), mitral stenosis (MS) (4.5%), aortic stenosis (AS) (4.5%), and mitral annulus calcification (MAC) (2.2%).

The most common echocardiographic and ECG findings of patients with non-hemorrhagic stroke in this study were MR and old MI and the most common risk factor was dyslipidemia.

Heart failure is one of the most important public health problems with an increasing prevalence and identifying its contributing factors is imperative. This study was conducted to evaluate the iron status in patients with chronic systolic heart failure in Shahid Mohammadi Hospital of Bandar Abbas.

A total of 80 patients with chronic left ventricular failure participated in this cross-sectional study. Data were collected using a researcher developed checklist containing demographic details and echocardiographic data (left ventricular ejection fraction, LVEF%). Additionally, the frequency and distribution of iron status were measured in the research population.

The results showed that the prevalence of anemia was significantly high in patients with chronic heart failure (77.3%). The prevalence of iron deficiency (ID) was 77.33% based on iron level (<60 μg/dL), and it was 82.66% based on the mean ferritin level (ferritin<100, or ferritin of 100 to 299 ng/mL, and transferrin saturation<20%). The prevalence of total iron binding capacity (TIBC)>360 μg/dL was 26.66%, and the prevalence of mean corpuscular volume (MCV)<80 fL was 60%. Age less than 60 years, glomerular filtration rate (GFR) less than 60, and body mass index (BMI) less than 18.5 were also found to increase the risk of anemia in these patients.

Our study showed that the prevalence of anemia was significantly high in patients with chronic heart failure. Due to the high prevalence of anemia in patients with chronic systolic heart failure and the impact of anemia on the prognosis of the disease in these patients, effective treatment is necessary in high-risk patients to reduce the severity of their disease, compensate for their heart failure, and reduce their mortality.

Patients who undergo percutaneous coronary intervention (PCI) receive anticoagulants, most commonly heparin to prevent thrombotic events during the procedure. Opioid addicts may require higher doses of heparin for PCI. We aimed to compare the effect of heparin on activated clotting time (ACT) between opioid addicts and non-addicts prior to and during PCI.

This comparative study included 107 patients scheduled for elective PCI, of whom 50 were opioid addicts and 57 non-addicts. Patients’ baseline characteristics including age, gender, weight, comorbidities, drug history, and smoking were recorded. Prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), and platelet count were measured in venous blood samples collected from all participants. All patients underwent PCI through femoral access. They received 100 IU/kg heparin right at the beginning of the procedure. ACT was measured at 2 and 30 minutes.

Age, gender, weight, and the amount of heparin used were comparable between groups. As for general characteristics, the number of patients with hyperlipidemia was significantly higher in non-addicts (P = 0.031), and cigarette smoking was higher in opioid addicts (P < 0.001). No significant difference was found between the groups regarding PT, PTT, INR, and platelet count (P > 0.050). ACT at 2 and 30 min were significantly lower in opioid addicts (P < 0.001). Taking other variables into account, ACT at 2 min was directly correlated with drug history of aspirin in opioid addicts (P = 0.031) and inversely correlated with cigarette smoking in non-addicts (P = 0.023).

Opioid addicts may require higher doses of heparin in PCI for the prevention of thrombotic complications compared to non-addicts.

Heart failure is one of the most common cardiovascular disorders and also it is one of the main problems of general health in the current society. Considering the role of health literacy in improving the quality of life of patients, the present study was conducted to determine the health literacy status of patients with heart failure hospitalized in Shahid Mohammadi Hospital in Bandar Abbas and its relationship with quality of life in these patients. This cross-sectional study was performed on 200 patients with heart failure hospitalized in Shahid Mohammadi Hospital in Bandar Abbas in 2019. Sampling was random sampling in even days of week. Data was collected by two questionnaires including standard questionnaire of health literacy and the Minnesota Quality of Life Questionnaire (MLHF). The reliability of each scale was tested by Cronbach alpha. Data were analyzed by descriptive statistics and Pearson correlation test using SPSS 21 software. The average level of health literacy and the quality of life were 34.60 and 79.10, respectively. Health literacy cannot be ranked as a predictor of quality of life in heart failure patients. However, a significant relationship was observed between functional, communicational and critical dimension of health literacy and mental dimension of quality of life. Participants in our study had poor quality of life. Their health literacy also was inadequate. Although this study did not find any meaningful relationship between health literacy and quality of life, attention to improving the level of health literacy and quality of life in all dimensions in this group of patients seems necessary.

High blood pressure is known as a major risk factor for myocardial infarction and renal impairment. Various factors, including the pattern of food intake and physical activity, are effective in the incidence of hypertension.

This study aimed at evaluating the relationship between dietary factors and hypertension in Hormozgan Province, South of Iran.

This descriptive study was conducted on 5075 adults aged more than 18 years from Hormozgan in 2016. Samples were selected through cluster sampling and randomly. The subjects’ information, including demographic information, dietary intake, anthropometric status, and blood pressure, were collected.

The high blood pressure in men was higher than in women. There was a significant relationship between systolic and diastolic blood pressure and age, body mass index, wrist and waist circumference, and waist-to-hip ratio. There was a statistically significant reverse relationship between hypertension and fruits intake, dairy products, fish, and decrease meat and nonalcoholic drink consumption.

Regarding the high prevalence of hypertension among people and its strong association with food intake, improving dietary patterns should be considered as an essential preventive action.

Cardiac myxomas are the most common primary tumors of the heart with high embolic potential.

We present a young man with progressing stroke and atrial myxoma in an unusual site from the left upper pulmonary vein.

Intravenous (IV) thrombolysis can be safe in patients with intracardiac myxoma and CNS embolization after good case selection. However, further studies are needed for better decision-making.

Heart failure (HF) is one of the most prevalent cardiovascular disorders. Patients with HF need self-care behaviors and, thus, need to be equipped with health literacy to make informed decisions. This study aimed to evaluate health literacy among patients with HF hospitalized in Shahid Mohammadi Hospital, Bandar Abbas, Iran, and its effect on self-care behaviors.

The present cross-sectional correlational investigation was conducted on 192 patients with HF ed via convenience sampling. The data collection instruments were HF health literacy in 3 domains and the European Heart Failure Self-care Behavior scale. The data were analyzed using SPSS, version 23, and descriptive statistics were used along with the Pearson correlation coefficient.

The mean score of health literacy and self-care was 34.6 and 30, respectively. A statistically significant correlation was found between the functional dimension of health literacy and self-care. Thus, a higher health literacy rate was associated with more self-care efforts. The mean score of health literacy varied among the subjects with different education levels.

Considering the statistically significant relationship between health literacy and self-care, it is essential to pay attention to the promotion of the whole dimension of health literacy among patients with HF, especially those of lower education levels, in order to improve their level of self-care. Effective interventions are required to improve patients’ skills in the critical analysis of information and to promote their power of making therapeutic decisions. (Iranian Heart Journal 2020; 21(2): 57-63)

Today, obesity is a key healthcare problem on a global scale including Iran. The present study aimed at determining the prevalence of overweight and obesity in Hormozgan province, Iran to propose effective healthcare programs and strategies to reduce this dilemma in future.

The current study conducted in the South of Iran aimed at exploring the prevalence of overweigh and obesity in males and females in terms of social variables affected by demographic variables such as age, gender, marital status, education level, smoking, and physical activity.

In the current cross sectional, observational study, a sample of 5000 eligible males and females above 18 years old were selected based on a multi-stratified clustering sampling method. The data were collected by a researcher-made questionnaire consisting of variables such as weight, height, drug consumption, and physical activity. Statistical analysis was performed.

The present study findings revealed that 31.8% of the population in Hormozgan province was overweight, while only 15.2% were obese. The highest percentage of obesity (18.3%) was observed among the subjects aged 35 - 44 years. The prevalence of obesity among females was higher in urban population.

The current study results showed that the urban married middle-aged females had the highest rate of obesity, which requires appropriate educational planning and utilization of efficient models in the realm of females’ health

Hypertension is an important cause of stroke and heart and kidney diseases, which account for nearly two-thirds of all mortalities worldwide. Studies conducted in different provinces of Iran have shown that hypertension is common in the country. However, awareness, treatment, and control rates of the disease have been reported to be low in developing countries.

This study aimed to assess the prevalence, awareness, treatment, and control of hypertension in Hormozgan province.

This descriptive study was conducted on 5065 participants older than 18 years. A questionnaire was completed and blood pressure was measured according to the ESC/ESH 2018 guidelines. Systolic Blood Pressure (SBP) ≥ 140 mmHg, diastolic Blood Pressure (DBP) ≥ 90 mmHg, or receiving any antihypertensive treatment was considered to be hypertension. The data were analyzed using logistic regression, odds ratio, chi-square, and descriptive statistics.

The prevalence of hypertension in Hormozgan province was 23.2%. Only 28.3% of the participants were aware of their hypertension; 17.6% were treated and only 7.2% had controlled hypertension. Hypertension was more prevalent in urban areas (28.8% versus 18.1%), but more controlled among the rural population (13.2% vs. 2.4%). The frequency of hypertension increased from 6.2% to 58.9% in 20 - 29 age group compared to the cases older than 70 years, which indicated a linear trend between the increased risk of hypertension and advanced age.

The results showed that hypertension was more prevalent in urban areas in south of Iran. Indeed, nearly less than 30% of the participants were aware of their disease and less than 4% of urban population were controlled. On the contrary, almost 13% of the rural population, particularly females, had controlled hypertension.

Primary percutaneous coronary intervention (PPCI) is the gold standard for the treatment of ST-segment-elevation myocardial infarction (STEMI). Guidelines emphasize the importance of STEMI networks in order to facilitate rapid acute reperfusion therapy and improve prognosis. The outcomes of PPCI in a single tertiary university hospital in Hormozgan Province in Iran are reported herein.

We performed an observational study including all the consecutive STEMI cases admitted to our interventional cardiology department. Symptom to door, door to ECG, door to diagnosis, door to cath lab, door to balloon, and mortality were reported. Descriptive statistics (median, quartile 1-3) and nonparametric tests (Kruskal–Wallis and Mann–Whitney) were used.

Totally, 195 patients were considered eligible for PPCI. The mean age of the patients was 54.90 years old (range =21–91 y). Women accounted for 28.2% of the study population. All the patients successfully underwent PPCI with a 100% rate of stenting. The in-hospital mortality rate was 1.45%. The median time for symptom-to-door, door-to-diagnosis, code-activation, symptom-to-device, and door-to-device times was 167.50, 23, 35, 266, and 60 minutes, respectively.

Our results, in line with previous studies, confirm the role of PPCI as the frontline approach to STEMI. Our results display the continuous efforts provided to reduce the in- hospital procedural times; nevertheless, ongoing efforts are needed to decrease symptom-to- door times.