Cardiovascular research institute, Isfahan University of Medical Sciences ARYA Atherosclerosis Journal 1735-3955 22 Issue 1 2026 01 01 Mortality after emergency lower limb amputation due to ischemia: A case series 1 6 33124 10.48305/arya.2025.43395.3020 EN Henrique José Pereira De Godoy Vascular Surgery Discipline in Medicine School of São José do Rio Preto (FAMERP), Brazil 0000-0001-9463-7608 Laura Ignácio Cunha Vascular Surgery Discipline in Medicine School of São José do Rio Preto (FAMERP), Brazil 0009-0002-3388-1839 Bruna Aparecida Nunes Marra Medicine School in Sao Jose do Rio Preto-FAMERP, Brazil 0009-0005-9529-579X Thays Andrade De Souza Lopes Nurse of Vascular Surgery Discipline in Medicine School in Sao Jose do Rio Preto-FAMERP, Brazil Julia Vendemiatti Correia Medicine School in Sao Jose do Rio Preto-FAMERP, Brazil 0009-0002-6921-291X José Maria Pereira De Godoy Cardiology and Cardiovascular Surgery Department of the Medicine School in São José do Rio Preto (FAMERP), Head Vascular Surgery Discipline in FAMERP and CNPq (National Council for Research and Development), Brazil 0000-0001-5424-7787 Journal Article 2025 01 21 BACKGROUND: Morbidity and mortality rates in patients with peripheral arterial disease range from 30% to 70% during the 5- to 15-year period after diagnosis. The objective of the present study was to evaluate the mortality rate after emergency leg amputation and analyze the cause of death. METHODS: In this case series study, the incidence and cause of mortality, level of amputation, presence of chronic arterial disease, diabetes mellitus, smoking, and arterial hypertension were evaluated in 100 consecutive patient records. RESULTS: Sixty-one male and 39 female patients with a mean age of 66 years were studied. Amputation was indicated urgently in 86% of patients. Most (60%) suffered supra-genicular amputation, with 11 (18.33%) deaths, and 40% infra-genicular amputation, with seven (17.5%) deaths. The total death rate was 18%. CONCLUSION: Mortality in the perioperative period of emergency major lower limb amputation remains high, with infection being the leading cause.

https://arya.mui.ac.ir/article_33124_2e874776f1f92f702ba41b53941ccdc8.pdf

Cardiovascular research institute, Isfahan University of Medical Sciences ARYA Atherosclerosis Journal 1735-3955 22 Issue 1 2026 01 01 Health-promoting lifestyle in cardiac patients: The mediating role of cognitive flexibility in the relationship between intimate relationships and distress tolerance 7 17 33126 10.48305/arya.2025.45677.3105 EN Maedeh Mirzaei Malati Department of Psychology, Ra.C., Islamic Azad University, Rasht, Iran 0000-0002-2773-3402 Majid Baradaran Department of Psychology, Payame Noor University, Tehran, Iran 0000-0003-3309-398X Leila Moghtader Department of Psychology, Ra.C., Islamic Azad University, Rasht, Iran 0000-0002-5785-3464 Journal Article 2025 09 14 BACKGROUND: The present study aimed to determine the predictive model of health-promoting lifestyle in cardiovascular patients based on intimate relationships and distress tolerance, mediated by cognitive flexibility. METHODS: The research design was a cross-sectional correlational study using structural equation modeling. The statistical population included cardiovascular patients in 2025 who referred to three specialized cardiology clinics for outpatient examination. A total of 265 individuals were selected as the sample using convenience sampling. Standard questionnaires for health-promoting behaviors (Walker et al.), social intimacy (Miller and Lefcourt), distress tolerance (Simons and Gaher), and cognitive flexibility (Dennis and Vander Wal) were used. Statistical data analysis was performed using the Pearson correlation coefficient and path analysis with bootstrap testing, employing AMOS 24 and SPSS 26 software. RESULTS: The results of path analysis and bootstrap testing showed that the proposed model had a good statistical fit (χ²/df = 2.94, RMSEA = 0.071, CFI = 0.939, GFI = 0.990). The indirect effect of intimate relationships on health-promoting lifestyle through cognitive flexibility (β = 0.1148, p = 0.001) and the indirect effect of distress tolerance on health-promoting lifestyle through cognitive flexibility (β = 0.0924, p = 0.001) were confirmed. CONCLUSION: The structural model, with good fit, explained the mediating role of cognitive flexibility in the relationship between intimate relationships and distress tolerance with health-promoting lifestyle in cardiovascular patients. These findings provide an operational framework for psychotherapy interventions based on strengthening distress tolerance and interpersonal relationships to improve cardiovascular health.

https://arya.mui.ac.ir/article_33126_1df46b08d20c24e4a93cfa88131b4185.pdf

Cardiovascular research institute, Isfahan University of Medical Sciences ARYA Atherosclerosis Journal 1735-3955 22 Issue 1 2026 01 01 The use and the cost of inpatient diagnostic and therapeutic procedures for cardiovascular diseases in public hospitals of Isfahan, Iran 18 26 33128 10.48305/arya.2025.45299.3061 EN Reza Rezayatmand Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-9907-3597 Davood Nasiri Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran Alireza Khosravi Farsani Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0003-0736-2090 Farzaneh Mohammadi-Sefiddashti Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-8872-6724 Journal Article 2025 06 02 BACKGROUND: Cardiovascular diseases (CVDs) are the most important cause of mortality and disability worldwide, causing substantial personal, social, and economic problems. This study determined the use and Cost of inpatient diagnostic and therapeutic CVD procedures in Isfahan from 2019 to 2021. METHODS: This descriptive study covered a three-year period (2019–2021). Data were gathered from the Health Information System of two public hospitals that carried out these procedures (Chamran and Khorshid hospitals) in Isfahan, Iran. A list of procedures was carefully chosen according to experts’ opinions, for which the use and cost of these procedures were extracted. RESULTS: Coronary angiography demonstrated the highest annual average use (47.65%), while mitral valve repair showed the lowest (0.06%). The highest annual average total cost was seen in angioplasty (617,425,750,917 IRR), while the lowest was seen in mitral valve repair (2,375,305,232 IRR). Regarding cost per procedure, VSD surgery (409,107,479 IRR) had the highest annual average cost, while the lowest was seen in coronary angiography (56,340,938 IRR). A consistent upward trend in cost per procedure (in IRR) was observed across all procedures during the study period. CONCLUSION: The majority of cardiovascular procedure costs are attributable to diagnosing and treating ischemic heart disease (IHD). Consequently, the increasing prevalence of CVDs particularly IHD coupled with the use of advanced technologies, imposes a significant financial burden on the healthcare system. This underscores the critical need for policy actions focused on lifestyle modification and primary prevention. Such measures are essential to curb rising costs and ensure healthcare system sustainability.

https://arya.mui.ac.ir/article_33128_bc6413b0348aeeed0bbc0836604acc75.pdf

Cardiovascular research institute, Isfahan University of Medical Sciences ARYA Atherosclerosis Journal 1735-3955 22 Issue 1 2026 01 01 Predicting treatment outcomes by door-to-device time and baseline characteristics in STEMI patients undergoing PPCI: a cross-sectional study in southern Iran 27 40 33127 10.48305/arya.2025.45242.3055 EN Sajad Vosoughi Student Research Committee, Department of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mohammad Adineh Nursing Care Research Center in Chronic Diseases, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 0000-0002-8696-8447 Ali Kardooni Department of Cardiology, School of Medicine, Atherosclerosis Research Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mehrnaz Ahmadi Nursing Care Research Center in Chronic Diseases, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Saeed Ghanbari Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 0000-0002-8696-8447 Journal Article 2025 05 20 BACKGROUND: Primary percutaneous coronary intervention (PPCI) is considered the gold standard for ST-elevation myocardial infarction (STEMI) treatment. While door-to-device (DTD) time critically influences outcomes, its combined impact with baseline characteristics requires further investigation. METHODS: In this descriptive cross-sectional analytical study, 163 patients with STEMI undergoing PPCI were recruited through convenience sampling at two hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences between November 2024 and May 2025. Data were collected via hospital records and a researcher-designed checklist covering demographic and clinical variables. Statistical analyses were performed using SPSS version 26. RESULTS: The mean age of participants was 57.55 ± 13.19 years, and 85.9% were male. The mean DTD time was 108.08 minutes. Longer DTD time was significantly associated with prolonged CCU stay (r = 0.335, p < 0.001) and lower left ventricular ejection fraction (LVEF) (r = –0.232, p = 0.003). Although DTD time did not differ significantly between survivors and non-survivors (p = 0.573), it varied significantly across different degrees of myocardial injury (p = 0.027). Multivariate regression analysis showed that male gender (β = –8.007, p = 0.002), increased DTD time (β = –0.043, p = 0.005), and myocardial injury (β = –14.904, p = 0.016) were significantly associated with reduced LVEF. Increased DTD time (β = 0.014, p < 0.001) and decreased LVEF (β = –0.061, p = 0.003) were significantly associated with longer CCU stays. CONCLUSION: While baseline characteristics showed minimal impact, DTD time significantly predicted worse outcomes, including prolonged CCU stays, reduced LVEF, and myocardial injury. These findings emphasize the critical importance of reducing DTD time (<60 minutes) through optimized emergency protocols to improve STEMI management outcomes.

https://arya.mui.ac.ir/article_33127_d31659eda7c840776f9caf88e48fd6dd.pdf

Cardiovascular research institute, Isfahan University of Medical Sciences ARYA Atherosclerosis Journal 1735-3955 22 Issue 1 2026 01 01 Association between the bifurcation angle and the angle of the origin of the left anterior descending with the severity of coronary artery disease 41 47 33125 10.48305/arya.2025.45215.3052 EN Maryam Moradi Department of Radiology, Isfahan University of Medical Sciences, Medical School, Isfahan, Iran 0000-0002-7601-2468 Saeid Zeidy Department of Radiology Technology, Isfahan University of Medical Sciences, Isfahan, Iran 0009-0001-7322-9258 Asieh Maghami-Mehr Department of Statistics, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-4104-9324 Fatemeh Poursabagh Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran 0009-0004-3927-1753 Journal Article 2025 05 31 BACKGROUND: This study aimed to evaluate the association between the bifurcation angle and the angle of the origin of the left anterior descending (LAD) coronary artery with the degree of proximal LAD (pLAD) stenosis. METHODS: This study was cross-sectional and addressed 578 patients suspected of coronary artery disease (CAD) who underwent coronary computed tomography angiography (CCTA) because of angina pectoris symptoms at Shahid Chamran Hospital, Isfahan. PLAD stenosis as well as the left main (LM)-LAD and the LAD-left circumflex artery (LCX) (bifurcation) angles were assessed and recorded on CCTA images. Then, one-way analysis of variance (ANOVA) or chi-squared tests were used. ROC analysis was used to evaluate the diagnostic value of each of the two angles in identifying pLAD stenosis. RESULTS: Using a cut-off value of 23º for the LM-LAD angle, the sensitivity and specificity for predicting pLAD stenosis <50% were 63.70% and 47.67%, respectively. In addition, using a cut-off value of 30º for the LM-LAD angle, the sensitivity and specificity for predicting pLAD stenosis ≥50% were 52.24% and 68.77%, respectively (P value<0.05). Moreover, for predicting pLAD stenosis <50%, a 49º cut-off for the LAD-LCX angle demonstrated a sensitivity and specificity of 61.64% and 56.99%, respectively. Furthermore, for predicting pLAD stenosis ≥50%, a 50º cut-off for the LAD-LCX angle yielded a sensitivity and specificity of 70.15% and 58.63%, respectively (P value<0.05). CONCLUSION: The findings of this study showed that the LAD-LCX and LM-LAD angles had a direct and significant association with the severity of pLAD stenosis, such that wider angles were associated with greater pLAD stenosis.

https://arya.mui.ac.ir/article_33125_1e3efda407ac3298fc58bf92e22919a9.pdf

Cardiovascular research institute, Isfahan University of Medical Sciences ARYA Atherosclerosis Journal 1735-3955 22 Issue 1 2026 01 01 Isfahan familial hypercholesterolemia cohort (IFHC) study: Methods, insights and early results 48 59 33138 10.48305/arya.2025.45154.3050 EN Sonia Zarfeshani Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0003-0497-5588 Golnaz Vaseghi Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0003-3040-6135 Noushin Mohammadifard Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0003-1776-1060 Minoo Dianatkhah Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0001-8092-2045 Jamshid Najafian Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-1472-1218 Masood Shekarchizadeh Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0001-6432-5486 Shabnam Hajian Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Ali Pourmoghaddas Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Anita Vaseghi School of Population & Public Health, University of British Columbia, Vancouver, Canada Elham Khosravi Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Kiyan Heshmat-Ghahdarijani Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Nizal Sarrafzadegan Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran School of Population & Public Health, University of British Columbia, Vancouver, Canada 0000-0002-8352-0540 Journal Article 2025 05 06 BACKGROUND: Familial hypercholesterolemia (FH) is the most common monogenic disorder in humans. There is a lack of data on the clinical characteristics and natural history of FH patients in Iran, which necessitates performing a longitudinal study. METHODS: In this five-year prospective longitudinal cohort study, we enrolled patients with high LDL cholesterol who were registered in the Iranian Registry of Hypercholesterolemia (IFHR), diagnosed as definite and probable FH cases based on the Dutch Lipid Clinic Network Score (DLCN ≥6). General characteristics, lipid profiles, and cardiovascular disease assessments were evaluated in the baseline phase, and whole blood samples were stored for future genetic and epigenetic studies. This study will evaluate the incidence and recurrence rates of cardiovascular disease (CVD) and mortality as the main outcomes during five years of follow-up. RESULTS: During the initial year, we successfully identified and enrolled patients with FH. We are reporting the whole methodology and the results of the first 50 who were followed up. At the study’s outset, the patients exhibited a mean age of 50.27±12.06 years, with 64% being men and 36% women. The mean LDL level recorded was 312.8 ±106.3 mg/dL, with the highest LDL concentration observed at 623.5 mg/dL. A total of 62.0% of patients were on lipid-lowering treatment mostly of the PCAD group. CONCLUSION: In this paper, we present the design and methodology of the Isfahan Familial Hypercholesterolemia Cohort (IFHC) study in detail with the aim of helping future research generate evidence from comprehensive IFHC data sources.

https://arya.mui.ac.ir/article_33138_c4829296d8ff463d96c343cc0682c6fb.pdf

Cardiovascular research institute, Isfahan University of Medical Sciences ARYA Atherosclerosis Journal 1735-3955 22 Issue 1 2026 01 01 Hypertriglyceridemic waist phenotype and 10-year incidence of hypertension: Yazd healthy heart cohort study 60 68 33163 10.48305/arya.2025.45945.3126 EN Mohammadtaghi Sarebanhassanabadi Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 0000-0002-8867-4717 Mahnaz Eider Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Hamideh Mihanpour Department of Occupational Health Engineering, Genetic and Environmental Adventures Research Center, School of Abarkouh Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 0000-0002-3886-6323 Pedro Marques-Vidal Department of Internal Medicine, BH10-642, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland Seyed Jalil Mirhosseini Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Lida Hosseini Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Seyedeh Mahdieh Namayandeh Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 0000-0003-3616-2864 Sima Mozafari Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 0000-0003-4960-2718 Journal Article 2025 12 08 BACKGROUND: The hypertriglyceridemic waist phenotype (HTGW), a surrogate indicator of visceral adiposity, has been proposed as a simple screening tool for cardiometabolic risk. Limited information is available on the influence of HTGW and its temporal variations on the development of hypertension. This study examined the association between HTGW and decade-long hypertension incidence in an urban population of Iranian adults. METHODS: Data were obtained from the Yazd Healthy Heart Project (YHHP). In its initial phase (2005–2006), 2,000 participants aged 20–74 years were enrolled. At baseline, demographic characteristics, blood pressure, anthropometric data, and biochemical tests were evaluated and reassessed in 2015–2016. After excluding individuals with hypertension at baseline, 1,269 normotensive participants were followed for approximately 10 years to assess incident hypertension, using multivariable logistic regression analyses in SPSS. RESULTS: In this study, after excluding participants lost to follow-up, 786 participants were selected for the final analysis. The cumulative incidence of hypertension was 40.3% (317 out of 786). After adjustment for potential confounders, the risk of HTN was significantly higher among participants with hypertriglyceridemia (OR=2.38, 95% CI: 1.21–4.67) and those with HTGW (OR=1.88, 95% CI: 1.12–3.13) compared to those with normal waist and normal triglycerides (NWNT) in the total population. In men, there was a significant positive association between hypertriglyceridemia (OR=2.71, 95% CI: 1.22–6.02) and HTGW (OR=2.35, 95% CI: 1.23–4.47) and the 10-year incidence of HTN after multivariate adjustment. CONCLUSION: Our findings showed that hypertriglyceridemia and HTGW are independent predictors of 10-year hypertension incidence, particularly among men, in an Iranian urban adult population.

https://arya.mui.ac.ir/article_33163_d6290b8d794ef655534893019447d118.pdf

Cardiovascular research institute, Isfahan University of Medical Sciences ARYA Atherosclerosis Journal 1735-3955 22 Issue 1 2026 01 01 Escaping voluntary confinement: A framework to address Stockholm syndrome in cardiac nursing 69 81 33248 10.48305/arya.2026.45990.3134 EN Mohammadreza Shafeie Department of Public Administration, Isf.C., Islamic Azad University, Isfahan, Iran Akbar Etebarian Department of Public Administration, Isf.C., Islamic Azad University, Isfahan, Iran Saeid Sharifi Department of Cultural Management and Planning, Isf.C., Islamic Azad University, Isfahan, Iran 0000-0001-5643-8157 Mashallah Valikhani Dehaqani Department of Public Administration, ST.C., Islamic Azad University, Tehran, Iran Journal Article 2025 12 10 BACKGROUND: Due to high burnout and intense emotional investment in patient outcomes, nurses may inadvertently become trapped in dysfunctional interpersonal dynamics at work, resembling Stockholm syndrome. Understanding and managing this phenomenon requires field research. This study explores intervention strategies to address organizational Stockholm syndrome among nursing staff in cardiac care hospitals in Isfahan. METHODS: This sequential exploratory mixed-methods study comprised qualitative and quantitative phases. In Phase I, 21 cardiac nursing specialists were purposively recruited and interviewed using semi-structured, in-depth interviews. Data were analyzed using Braun and Clarke’s thematic analysis, and trustworthiness was ensured according to Lincoln and Guba’s criteria. In Phase II, the qualitative findings informed the development of a structured survey administered to 276 staff working in cardiovascular wards in Isfahan. Participants rated eight qualitatively derived strategic domains using a 5-point Likert scale. A hierarchical model was tested in AMOS 22 to examine the higher-order organization and conceptual coherence of the proposed framework. RESULTS: The findings support a hierarchical framework for addressing organizational Stockholm syndrome among cardiac nurses, highlighting coordinated strategies across individual, interpersonal, and organizational domains. The three higher-order dimensions were Individual Empowerment (positive affect, psychological development, and self-belief), Interpersonal Development (social capital and communication climate), and Improving Organizational Climate (social hope and morale). The quantitative findings indicated acceptable hierarchical coherence among the domains, providing preliminary structural support for the proposed framework. CONCLUSION: The proposed tri-level framework offers a practical approach for hospital management to address organizational Stockholm syndrome by supporting empowerment initiatives, strengthening organizational voice, and enhancing transparency. Integrating these strategies may improve psychological safety, promote staff well-being, and ultimately contribute to better quality of patient care.

https://arya.mui.ac.ir/article_33248_33363f7b038639dc7ecf8c4a2d17de66.pdf