https://cbj.ssu.ac.ir/ Cardiovascular Biomedicine en daily 1 Tue, 30 Dec 2025 00:00:00 +0330 Tue, 30 Dec 2025 00:00:00 +0330 https://cbj.ssu.ac.ir/article_479.html It is my distinct pleasure to introduce the current issue of the Cardiovascular Biomedicine Journal, which features a comprehensive selection of original investigations, a case report, a narrative review, and a scholarly letter to the editor. Together, these contributions reflect the breadth of contemporary cardiovascular research, addressing clinically relevant questions, emerging disease entities, interventional outcomes, educational perspectives, and novel therapeutic targets. Letter to EditorThe cardiovascular consequences of the post-COVID era are addressed in [1071], a letter to the editor focusing on the hidden cardiovascular crisis of long COVID. This concise yet impactful contribution underscores the growing burden of persistent cardiovascular symptoms and complications following SARS-CoV-2 infection. The authors call for heightened clinical awareness, structured follow-up, and continued research to better understand and manage the long-term cardiovascular sequelae of COVID-19. Case ReportIn [1070], a compelling case report describes stress-induced cardiomyopathy in young military personnel during active combat. This report highlights the profound cardiovascular effects of extreme psychological and physical stress, even in young and otherwise healthy individuals. By drawing attention to this underrecognized condition in high-risk populations, the authors emphasize the importance of early recognition, appropriate diagnostic evaluation, and supportive management in austere and high-stress environments.         ReviewThe narrative review [1074] offers an in-depth discussion on targeting oxidized soluble guanylate cyclase in calcific aortic valve stenosis: a narrative review of ataciguat. By bridging molecular mechanisms with emerging pharmacological approaches, this review provides readers with a forward-looking perspective on novel disease-modifying strategies in structural heart disease—an area where effective medical therapies remain limited. Original Research Articles      Original article [1072] presents a case-control analysis investigating risk factors for in-stent restenosis in patients with acute coronary syndrome: a case-control analysis of risk factors following drug-eluting stent implantation. In-stent restenosis remains a clinically relevant challenge despite advances in stent technology. This study adds valuable insight into patient-and procedure-related predictors of restenosis, contributing to improved risk stratification and potentially guiding individualized therapeutic and follow-up strategies. Finally, [1075] examines the short-term success and recurrence of supraventricular arrhythmias after electrical cardioversion. This original study addresses a common clinical scenario in cardiology practice and offers practical insights into outcomes and recurrence patterns.The findings may assist clinicians in counseling patients, optimizing post-cardioversion management, and planning follow-up strategies. The issue opens with an important original investigation [1069], examining the impact of using morphine or meperidine on clinical outcomes of ST-elevation myocardial infarction patients undergoing primary percutaneous intervention. Given the widespread use of opioid analgesics in acute coronary syndromes and ongoing concerns regarding their interaction with antiplatelet therapy and myocardial outcomes, this study provides timely and clinically meaningful evidence. The authors’ findings offer valuable guidance for optimizing analgesic strategies while maintaining procedural efficacy and patient safety in acute cardiac care. In [1073], the authors explore the knowledge of senior dental students regarding dental management of cardiovascular patients: a cross-sectional study in Yazd, Iran. This cross-sectional study highlights the critical intersection between cardiovascular health and dental care, emphasizing the importance of interprofessional education. The findings reveal areas of strength and gaps in knowledge that have direct implications for patient safety and underscore the need for enhanced cardiovascular education within dental curricula. Collectively, the articles in this issue exemplify the mission of the Cardiovascular Biomedicine Journal to publish high-quality, clinically relevant, and forward-thinking research. I extend my sincere appreciation to the authors for their valuable contributions and to the reviewers and editorial team for their dedication to maintaining the scientific rigor and integrity of the journal. I trust that our readers will find this issue both informative and impactful. https://cbj.ssu.ac.ir/article_480.html The coronavirus disease 2019 (COVID-19) pandemic, initially characterized by acute respiratory distress syndrome (ARDS) and thrombotic complications, has progressively evolved into a persistent global health challenge owing to its long-term sequelae, particularly cardiovascular complications. These chronic manifestations, commonly referred to as post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) or Long COVID, place a considerable burden on healthcare systems worldwide, including in individuals who experienced only mild or asymptomatic acute infection. This letter explores the diverse cardiovascular manifestations of Long COVID, elucidates their complex pathophysiological mechanisms, and underscores the urgent need for integrated clinical and research strategies to address this growing concern. Long COVID is associated with a broad spectrum of cardiovascular manifestations, including persistent palpitations, exertional dyspnea, chest pain (CP), and severe fatigue (2).  Objective evidence supports these symptoms; for instance, cardiac magnetic resonance imaging (CMR) has demonstrated persistent myocardial inflammation and fibrosis several months after viral clearance (3). Electrocardiographic (ECG) studies have further identified new-onset arrhythmias, such as atrial fibrillation (AF) and ventricular tachycardia (VT), indicating an elevated risk for such events (4). Subclinical myocarditis, initially observed as an acute complication, may persist beyond the acute phase and contribute to ongoing symptoms (2). Moreover, postural orthostatic tachycardia syndrome (POTS), defined by an exaggerated heart rate (HR) response upon standing, has been reported, compounding morbidity with manifestations such as dizziness and cognitive impairment (4). These data underscore the cardiovascular system as a sustained target of both SARS-CoV-2 infection and the host inflammatory response (1). The cardiovascular effects of Long COVID arise from a complex interplay of various mechanisms. Direct viral invasion of cardiomyocytes via the angiotensin-converting enzyme 2 (ACE2) receptor may precipitate acute injury, especially in myocarditis (5). However, chronic symptoms likely arise from broader processes, including persistent low-grade systemic inflammation and immune dysregulation, which impair microvascular function and cause endothelial dysfunction, contributing to CP and fatigue (2). Furthermore, dysregulation of the autonomic nervous system (ANS), notably in POTS, leads to exercise intolerance and orthostatic symptoms, potentially due to immune-mediated neural injury or brainstem inflammation (4). Additionally, a prolonged prothrombotic state elevates the risk of microvascular thrombosis, exacerbating cardiovascular strain (5). To fully understand the mechanisms, this complex cascade of direct viral effects, chronic inflammation, autonomic dysfunction, and thrombogenicity necessitates further research. The cardiovascular burden of Long COVID represents a substantial public health challenge. With millions of individuals affected worldwide, even a modest proportion of patients developing chronic sequelae places considerable strain on healthcare systems (1). The heterogeneity of clinical presentations further complicates management, as standardized diagnostic and therapeutic protocols remain lacking (2). Managing these complex manifestations requires a multidisciplinary approach that integrates expertise from cardiology, neurology, pulmonology, and rehabilitation medicine. For instance, POTS may be managed with beta-blockers and structured rehabilitation programs, whereas persistent myocardial inflammation could necessitate anti-inflammatory interventions (4). To guide clinical practice, large-scale prospective studies are urgently needed to establish standardized diagnostic criteria, identify reliable biomarkers, and develop targeted therapies, including anti-inflammatory agents and autonomic modulators, aimed at reducing the long-term cardiovascular consequences of SARS-CoV-2 infection (1). The cardiovascular sequelae of Long COVID persist well beyond the acute phase of COVID-19, posing an escalating public health challenge. Mitigating this crisis requires a coordinated effort from scientific and clinical communities to enhance understanding, develop standardized care pathways, and provide patient-centered care. Sustained dedication to research and clinical innovation is essential to alleviating the long-term burden of this silent pandemic. https://cbj.ssu.ac.ir/article_481.html Objectives: Takotsubo cardiomyopathy (TTC), referred to as stress-induced cardiomyopathy, is characterized as a transient syndrome of myocardial dysfunction mimicking acute coronary syndrome that occurs without significant coronary artery disease (1). While predominantly occurring in postmenopausal women, there is a growing number of young men experiencing extreme stress who are also being diagnosed with TTC. Case Summary: We present a 21-year-old male soldier who presented with acute cardiac arrest with electrocardiographic signs of extensive anterior ST-elevation myocardial infarction while in active military service in a war zone. Despite an initial presentation suggestive of massive myocardial infarction with severely elevated cardiac biomarkers and cardiogenic shock necessitating prolonged cardiopulmonary resuscitation, coronary angiography revealed normal coronary arteries. Remarkably, full cardiac and neurological recovery occurred within days, confirming the diagnosis of stress- induced cardiomyopathy. Conclusions: This case underscores the clinical importance of considering TTC for young patients who exhibit signs of acute coronary syndrome, particularly in high-stress settings such as military combat zones. https://cbj.ssu.ac.ir/article_482.html Objectives: No pharmacologic treatment has been shown to slow the course of calcific aortic valve stenosis (CAVS), an active fibrocalcific disease. A downstream signaling bottleneck in the NO–sGC–cyclic guanosine monophosphate (cGMP) pathway is created when oxidative stress transforms soluble guanylate cyclase (sGC) into nitric oxide (NO)–insensitive, oxidized/heme-free states. With an emphasis on the NO-independent sGC activator ataciguat (HMR-1766), this narrative review aims to highlight the molecular, translational, and clinical evidence supporting oxidized/heme-free sGC as a therapeutic target in CAVS. Methods: We conducted a structured narrative literature search across PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Central, and trial registries (ClinicalTrials.gov/WHO ICTRP) through October 19, 2025. We prioritized original mechanistic/structural studies, preclinical pharmacology, valve-biology investigations, and human translational/clinical studies evaluating ataciguat, sGC redox biology, and disease-modification endpoints (e.g., CT-derived aortic valve calcium [CT-AVC] and ^18F-NaF PET). Results: Across structural and biochemical studies, heme-mimetic sGC activators selectively bind oxidized/heme-free sGC and restore cGMP signaling by occupying the heme pocket, thereby bypassing NO insensitivity. Valve-biology studies indicate that NO–sGC–cGMP signaling and NO-dependent S-nitrosylation/NOTCH pathways function as complementary anti-calcific mechanisms linked to shear stress and endothelial integrity. Imaging biomarkers such as CT-AVC and ^18F-NaF PET provide sensitive readouts of calcification burden and activity. Early randomized clinical evidence in moderate CAVS suggests oral ataciguat is generally well tolerated and is associated with a directional slowing of CT-AVC progression over six months. Conclusions: All currently available information suggests that oxidized/heme-free sGC is a biologically reasonable and treatable target in CAVS. Ataciguat exhibits early human signs of delayed calcific development and redox-selective restoration of NO–cGMP signaling. To verify long-term structural advantages and clinical impact, however, longer-term, well-powered clinical investigations are needed. https://cbj.ssu.ac.ir/article_483.html Objectives: In-stent restenosis (ISR) remains a significant complication following percutaneous coronary intervention (PCI) with drug-eluting stents (DES), contributing to recurrent cardiovascular events and increased healthcare burden. To assess the occurrence of ISR and identify related risk factors in patients receiving PCI at a tertiary cardiac facility in northwestern Iran.Methods: The present study is a case-control study involving 593 patients who underwent repeat coronary angiography after prior DES placement between 2020 and 2024 at Seyed ol-Shohadai Hospital in Urmia. The samples consisted of patients in two categories: ISR-positive (n = 209, 35.2%) and ISR-negative (n = 384, 64.8%). The researchers analyzed demographic information, cardiovascular risk factors, laboratory results, and procedural variables between the groups using independent t-tests and chi-square tests.Results: ISR-positive patients were significantly older (67.61±8.71 vs. 60.13±8.01 years, P=0.03) with a higher prevalence of hypertension (55% vs. 41.4%, P=0.002). Positive C-reactive protein (CRP) was more frequent in ISR patients (63.2% vs. 14.1%, P<0.001). Mean triglyceride (118.48±81.86 vs. 100.95±60.73 mg/dL, P=0.003), LDL-cholesterol (LDL-C) (66.77±30.17 vs. 57.01±19.25 mg/dL, P<0.001), and reduced left ventricular ejection fraction (LVEF) <30% (7.7% vs. 1%, P=0.005) were significantly associated with ISR. Longer intervals between initial and repeat angiography (59.93±38.01 vs. 50.51±32.62 months, P=0.002) and stent length ≥20mm (32.5% vs. 14.3%, P<0.001) increased ISR risk. Everolimus stents showed higher ISR rates compared to sirolimus stents.Conclusions: Advanced age, hypertension, systemic inflammation, dyslipidemia, impaired ventricular function, longer follow-up intervals, and specific stent characteristics were significantly associated with ISR development in univariate analysis. These findings suggest potential risk factors warranting further investigation through multivariate analysis. Enhanced surveillance and aggressive modification of risk factors in high-risk patients may decrease the incidence of ISR. https://cbj.ssu.ac.ir/article_484.html Objectives: Electrical cardioversion is a common treatment for terminating supraventricular arrhythmias, particularly atrial fibrillation. However, factors related to immediate success and subsequent arrhythmia recurrence remain unclear in some populations. This study assessed the immediate success rate of electrical cardioversion and the recurrence rate among patients who initially responded. Methods: This analytical cross-sectional study was conducted at Afshar Hospital in Yazd, Iran, from 2014 to 2019. A consecutive sample of 75 adults with supraventricular arrhythmias (atrial fibrillation, atrial flutter, or atrial tachycardia) who underwent electrical cardioversion was included. Patients with prior CABG, pregnancy, or incomplete records were excluded. Data were collected using a structured checklist covering demographics, clinical history (cardiac disease, valvular disease, diabetes, hypertension, smoking), and procedural outcomes (immediate success, number of attempts, recurrence). Analyses were performed in SPSS v 26. Results: Among 75 patients (60% male; mean age 52 ± 15 years), atrial fibrillation was the most common arrhythmia (44%). Electrical cardioversion restored sinus rhythm immediately in 68 patients (90%). Immediate success was not significantly associated with baseline comorbidities (cardiac disease, valvular disease, diabetes, hypertension, or smoking), left ventricular ejection fraction, or arrhythmia subtype (all p > 0.05). During follow-up, recurrence occurred in 23 of 68 patients with immediate success (33.8%) and was not significantly related to comorbidities, LVEF, or arrhythmia type (all p > 0.05). However, recurrence differed significantly by immediate procedural outcome (p = 0.001). Conclusions: Electrical cardioversion achieved a high immediate success rate in supraventricular arrhythmias, and successful cardioversion was associated with a substantially lower recurrence rate. Comorbid conditions did not significantly influence immediate procedural success in this cohort. https://cbj.ssu.ac.ir/article_485.html Objectives: Opioids are commonly used for treating chest pain in patients with acute coronary syndrome. Despite the beneficial effects of opioids, they could have adverse effects on patients, too. This study aims to compare the effects of morphine and meperidine on major adverse cardiac events (MACE) and mortality in patients undergoing percutaneous intervention. Methods: The researchers retrospectively reviewed data from 161 patients with the confirmed diagnosis of ST-elevation myocardial infarction undergoing primary percutaneous intervention. We compared the medical records of patients with MACE. In-hospital and one-year MACE were our primary measured outcomes. Results: Patients treated with morphine were more likely to experience in-hospital MACE (P-value: 0.006). Heart failure in the hospital was more in the morphine group (p-value: 0.002). However, none of the one-year clinical outcomes were statistically different between the two groups treated with morphine or meperidine. Left ventricular ejection fraction, ischemic heart disease, and hospital length of stay remained independent variables for predicting both in-hospital and one-year MACE, but morphine or meperidine didn’t remain independent in multivariable analysis. Conclusions: Although heart failure occurred more frequently in patients who received morphine, neither morphine nor meperidine independently predicted in-hospital or one-year MACE. https://cbj.ssu.ac.ir/article_486.html Objectives: Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide. Patients with these conditions require special considerations during dental treatment to prevent adverse events. Therefore, the knowledge of dental practitioners is essential for the safe and effective management of such patients. Methods: A descriptive cross-sectional study was conducted in 2023 at Shahid Sadoughi University of Medical Sciences in Yazd, Iran. A total of 65 final-year dental students were surveyed using a validated questionnaire consisting of demographic questions and 18 items assessing their level of awareness. Data were analyzed using SPSS version 23, employing both descriptive statistics and inferential tests, including the t-test and Pearson correlation. Results: A total of 65 students participated (response rate: 100%). The mean awareness score was 13.04 ± 3.42 out of 20, with 78.5% of students demonstrating acceptable knowledge levels. Female students scored higher than males, but the difference was not statistically significant (p = 0.057). Term 12 students scored significantly higher than Term 11 students (p < 0.001). A significant inverse correlation was found between age and awareness (r = –0.327, p = 0.008). Conclusions: Although the overall level of awareness was acceptable, certain demographic variables, such as age and academic term, were found to influence knowledge levels. These findings highlight the need for targeted training in cardiology-related dental care within the dental curriculum.