Bio


I am a medical doctor and clinical epidemiologist, presently serving as a scientist at Stanford University. My work centers on precision medicine, employing digital health, computer science, and artificial intelligence (AI) techniques. I am dedicated to integrating and applying these methodologies within the medical field to generate novel insights and deepen understanding of health-related issues. My focus also extends to tackling health disparities, with the ultimate goal of enhancing patient care and reducing disease impact.

Honors & Awards


  • Roger R. Williams Award for Genetic Epidemiology and the Prevention and Treatment of Atherosclerosis, American Heart Association (2023)

Boards, Advisory Committees, Professional Organizations


  • Early Career Editorial Board, Journal of the American Heart Association (2023 - Present)

Stanford Advisors


Projects


  • Optimization Toolkit for Management of Heart Failure after Discharge: ENGAGE_HF, Stanford University

    I. Leading and development of Heart Failure management mobile application
    II. Partnering with stakeholders including patient panel, healthcare professionals, software engineers and other network collaborators for toolkit curation
    III. Creating patient-focused educational content through text and designing interactive animation videos to include in the application

    Location

    Palo Alto

    For More Information:

  • Role of social determinants of health in cardiac disease management, complications, and adherence using novel machine learning algorithms, Stanford University

    Location

    Palo Alto

    For More Information:

  • Cardiac Arrhythmia, Stanford University

    Defining computational phenotypes of positive and negative response to complex arrhythmia ablation. This involves data mining, assisting with natural language processing, data analysis, drafting abstracts and manuscripts

    Location

    Palo Alto

  • Epigenetics, Stanford University

    I. Identifying genetic and non-genetic determinants of cardiometabolic diseases.
    II. Leading large-scale genetic association studies.
    III. Conducting multi-trait analysis with correlated traits.
    IV. Developing and validating polygenic risk scores.
    V. Integrating multi-omics data for comprehensive analyses.
    VI. Employing Mendelian randomization to enhance our grasp of genetic and environmental contributors to cardiometabolic diseases.

    Location

    Palo Alto

All Publications


  • Patient Representativeness With Virtual Enrollment in the PRO-HF Trial. Journal of the American Heart Association Gupta, A., Skye, M., Calma, J., Din, N., Azizi, Z., Hernandez, M. F., Zheng, J., Kalwani, N. M., Malunjkar, S., Schirmer, J., Wang, P., Rodriguez, F., Heidenreich, P., Sandhu, A. T. 2024; 13 (2): e030903

    View details for DOI 10.1161/JAHA.123.030903

    View details for PubMedID 38226522

  • Challenge of Optimizing Medical Therapy in Heart Failure: Unlocking the Potential of Digital Health and Patient Engagement. Journal of the American Heart Association Azizi, Z., Golbus, J. R., Spaulding, E. M., Hwang, P. H., Ciminelli, A. L., Lacar, K., Hernandez, M. F., Gilotra, N. A., Din, N., Brant, L. C., Au, R., Beaton, A., Nallamothu, B. K., Longenecker, C. T., Martin, S. S., Dorsch, M. P., Sandhu, A. T. 2024; 13 (2): e030952

    View details for DOI 10.1161/JAHA.123.030952

    View details for PubMedID 38226520

  • Design and Implementation of an Electronic Health Record-Integrated Hypertension Management Application. Journal of the American Heart Association Funes Hernandez, M., Babakhanian, M., Chen, T. P., Sarraju, A., Seninger, C., Ravi, V., Azizi, Z., Tooley, J., Chang, T. I., Lu, Y., Downing, N. L., Rodriguez, F., Li, R. C., Sandhu, A. T., Turakhia, M., Bhalla, V., Wang, P. J. 2024; 13 (2): e030884

    Abstract

    High blood pressure affects approximately 116 million adults in the United States. It is the leading risk factor for death and disability across the world. Unfortunately, over the past decade, hypertension control rates have decreased across the United States. Prediction models and clinical studies have shown that reducing clinician inertia alone is sufficient to reach the target of ≥80% blood pressure control. Digital health tools containing evidence-based algorithms that are able to reduce clinician inertia are a good fit for turning the tide in blood pressure control, but careful consideration should be taken in the design process to integrate digital health interventions into the clinical workflow.We describe the development of a provider-facing hypertension management platform. We enumerate key steps of the development process, including needs finding, clinical workflow analysis, treatment algorithm creation, platform design and electronic health record integration. We interviewed and surveyed 5 Stanford clinicians from primary care, cardiology, and their clinical care team members (including nurses, advanced practice providers, medical assistants) to identify needs and break down the steps of clinician workflow analysis. The application design and development stage were aided by a team of approximately 15 specialists in the fields of primary care, hypertension, bioinformatics, and software development.Digital monitoring holds immense potential for revolutionizing chronic disease management. Our team developed a hypertension management platform at an academic medical center to address some of the top barriers to adoption and achieving clinical outcomes. The frameworks and processes described in this article may be used for the development of a diverse range of digital health tools in the cardiovascular space.

    View details for DOI 10.1161/JAHA.123.030884

    View details for PubMedID 38226516

  • Digital Health Interventions for Heart Failure Management in Underserved Rural Areas of the United States: A Systematic Review of Randomized Trials. Journal of the American Heart Association Azizi, Z., Broadwin, C., Islam, S., Schenk, J., Din, N., Hernandez, M. F., Wang, P., Longenecker, C. T., Rodriguez, F., Sandhu, A. T. 2024; 13 (2): e030956

    Abstract

    Heart failure disproportionately affects individuals residing in rural areas, leading to worse health outcomes. Digital health interventions have been proposed as a promising approach for improving heart failure management. This systematic review aims to identify randomized trials of digital health interventions for individuals living in underserved rural areas with heart failure.We conducted a systematic review by searching 6 databases (CINAHL, EMBASE, MEDLINE, Web of Science, Scopus, and PubMed; 2000-2023). A total of 30 426 articles were identified and screened. Inclusion criteria consisted of digital health randomized trials that were conducted in underserved rural areas of the United States based on the US Census Bureau's classification. Two independent reviewers screened the studies using the National Heart, Lung, and Blood Institute tool to evaluate the risk of bias. The review included 5 trials from 6 US states, involving 870 participants (42.9% female). Each of the 5 studies employed telemedicine, 2 studies used remote monitoring, and 1 study used mobile health technology. The studies reported improvement in self-care behaviors in 4 trials, increased knowledge in 2, and decreased cardiovascular mortality in 1 study. However, 3 trials revealed no change or an increase in health care resource use, 2 showed no change in cardiac biomarkers, and 2 demonstrated an increase in anxiety.The results suggest that digital health interventions have the potential to enhance self-care and knowledge of patients with heart failure living in underserved rural areas. However, further research is necessary to evaluate their impact on clinical outcomes, biomarkers, and health care resource use.URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022366923.

    View details for DOI 10.1161/JAHA.123.030956

    View details for PubMedID 38226517

  • Informative Artifacts in AI-Assisted Care. The New England journal of medicine Azizi, Z., Vedelli, J. K., Anand, K. J. 2023; 389 (22)

    View details for DOI 10.1056/NEJMc2311525

    View details for PubMedID 38048204

  • Role of sex and gender-related variables in development of metabolic syndrome: A prospective cohort study. European journal of internal medicine Alipour, P., Azizi, Z., Raparelli, V., Norris, C. M., Kautzky-Willer, A., Kublickiene, K., Herrero, M. T., Emam, K. E., Vollenweider, P., Preisig, M., Clair, C., Pilote, L. 2023

    Abstract

    The burden of metabolic syndrome (MetS) and its components has been increasing mainly amongst male individuals. Nevertheless, clinical outcomes related to MetS (i.e., cardiovascular diseases), are worse among female individuals. Whether these sex differences in the components and sequalae of MetS are influenced by gender (i.e., psycho-socio-cultural factors)) is a matter of debate.  Therefore, the purpose of this study was to determine the association between gender-related factors and the development of MetS, and to assess if the magnitude of the associations vary by sex.Data from the Colaus/PsyColaus study, a prospective population-based cohort of 6,734 middle-aged participants in Lausanne (Switzerland) (2003-2006) were used. The primary endpoint was the development of MetS as defined by the Adult Treatment Panel III of the National Cholesterol Education Program. Multivariable models were estimated using logistic regression to assess the association between gender-related factors and the development of MetS. Two-way interactions between sex,  age and gender-related factors were also tested.Among 5,195 participants without MetS (mean age=51.3 ± 10.6, 56.1 % females), 27.9 % developed MetS during a mean follow-up of 10.9 years. Female sex (OR:0.48, 95 %CI:0.41-0.55) was associated with decreased risk of developing MetS. Conversely, older age, educational attainment less than university, and low income were associated with an increased risk of developing MetS. Statistically significant interaction between sex and strata of age, education, income, smoking, and employment were identified showing that the reduced risk of MetS in female individuals was attenuated in the lowest education, income, and advanced age strata. However, females who smoke and reported being employed demonstrated increased risk of MetS. Conversely smoking and unemployment were significant risk factors for MetS development among male adults.Gender-related factors such as income level and educational attainment play a greater role in the development of MetS in female than individuals. These factors represent novel modifiable targets for implementation of sex- and gender-specific strategies to achieve health equity for all people.

    View details for DOI 10.1016/j.ejim.2023.10.006

    View details for PubMedID 37858442

  • Leveraging Digital Health to Improve the Cardiovascular Health of Women. Current cardiovascular risk reports Azizi, Z., Adedinsewo, D., Rodriguez, F., Lewey, J., Merchant, R. M., Brewer, L. C. 2023; 17 (11): 205-214

    Abstract

    In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women.Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care.Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.

    View details for DOI 10.1007/s12170-023-00728-z

    View details for PubMedID 37868625

    View details for PubMedCentralID PMC10587029

  • Evaluating Recommendations About Atrial Fibrillation for Patients and Clinicians Obtained From Chat-Based Artificial Intelligence Algorithms. Circulation. Arrhythmia and electrophysiology Azizi, Z., Alipour, P., Gomez, S., Broadwin, C., Islam, S., Sarraju, A., Rogers, A. J., Sandhu, A. T., Rodriguez, F. 2023: e012015

    View details for DOI 10.1161/CIRCEP.123.012015

    View details for PubMedID 37334705

  • Natural language processing to identify reasons for sex disparity in statin prescriptions. American journal of preventive cardiology Witting, C., Azizi, Z., Gomez, S. E., Zammit, A., Sarraju, A., Ngo, S., Hernandez-Boussard, T., Rodriguez, F. 2023; 14: 100496

    Abstract

    Background: Statins are the cornerstone of treatment of patients with atherosclerotic cardiovascular disease (ASCVD). Despite this, multiple studies have shown that women with ASCVD are less likely to be prescribed statins than men. The objective of this study was to use Natural Language Processing (NLP) to elucidate factors contributing to this disparity.Methods: Our cohort included adult patients with two or more encounters between 2014 and 2021 with an ASCVD diagnosis within a multisite electronic health record (EHR) in Northern California. After reviewing structured EHR prescription data, we used a benchmark deep learning NLP approach, Clinical Bidirectional Encoder Representations from Transformers (BERT), to identify and interpret discussions of statin prescriptions documented in clinical notes. Clinical BERT was evaluated against expert clinician review in 20% test sets.Results: There were 88,913 patients with ASCVD (mean age 67.8±13.1 years) and 35,901 (40.4%) were women. Women with ASCVD were less likely to be prescribed statins compared with men (56.6%vs 67.6%, p <0.001), and, when prescribed, less likely to be prescribed guideline-directed high-intensity dosing (41.4%vs 49.8%, p <0.001). These disparities were more pronounced among younger patients, patients with private insurance, and those for whom English is their preferred language. Among those not prescribed statins, women were less likely than men to have statins mentioned in their clinical notes (16.9%vs 19.1%, p <0.001). Women were less likely than men to have statin use reported in clinical notes despite absence of recorded prescription (32.8%vs 42.6%, p <0.001). Women were slightly more likely than men to have statin intolerance documented in structured data or clinical notes (6.0%vs 5.3%, p=0.003).Conclusions: Women with ASCVD were less likely to be prescribed guideline-directed statins compared with men. NLP identified additional sex-based statin disparities and reasons for statin non-prescription in clinical notes of patients with ASCVD.

    View details for DOI 10.1016/j.ajpc.2023.100496

    View details for PubMedID 37128554

  • Clinical Trial Technologies for Improving Equity and Inclusion in Cardiovascular Clinical Research. Cardiology and therapy Broadwin, C., Azizi, Z., Rodriguez, F. 2023

    Abstract

    Approximately one-third of clinical trials fail to meet their recruitment goals, which can cause costly delays to sponsors and compromise the scientific integrity and generalizability of a trial. Inadequate recruitment and retention of patient groups who have the disease under investigation may produce insufficient medical knowledge about the therapeutic effects of drugs or products for the population at large. It is essential to address these issues to ensure that certain groups are not unduly subjected to disproportionate risks or denied the benefits of research. This commentary will present opportunities for clinical trialists to use emerging technologies and decentralized approaches to improve clinical trial recruitment, mitigate disparities, and improve individual and population-level outcomes within cardiovascular medicine.

    View details for DOI 10.1007/s40119-023-00311-y

    View details for PubMedID 37043079

    View details for PubMedCentralID 9072305

  • Sociodemographic determinants of oral anticoagulant prescription in patients with atrial fibrillations: findings from the PINNACLE registry using machine learning. Heart rhythm O2 Azizi, Z., Ward, A. T., Lee, D. J., Gad, S. S., Bhasin, K., Beetel, R. J., Ferreira, T., Shankar, S., Rumsfeld, J. S., Harrington, R. A., Virani, S. S., Gluckman, T. J., Dash, R., Rodriguez, F. 2023; 4 (3): 158-168

    Abstract

    Current risk scores that are solely based on clinical factors have shown modest predictive ability for understanding of factors associated with gaps in real-world prescription of oral anticoagulation (OAC) in patients with atrial fibrillation (AF).In this study, we sought to identify the role of social and geographic determinants, beyond clinical factors associated with variation in OAC prescriptions using a large national registry of ambulatory patients with AF.Between January 2017 and June 2018, we identified patients with AF from the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) Registry. We examined associations between patient and site-of-care factors and prescription of OAC across U.S. counties. Several machine learning (ML) methods were used to identify factors associated with OAC prescription.Among 864,339 patients with AF, 586,560 (68%) were prescribed OAC. County OAC prescription rates ranged from 26.8% to 93%, with higher OAC use in the Western United States. Supervised ML analysis in predicting likelihood of OAC prescriptions and identified a rank order of patient features associated with OAC prescription. In the ML models, in addition to clinical factors, medication use (aspirin, antihypertensives, antiarrhythmic agents, lipid modifying agents), and age, household income, clinic size, and U.S. region were among the most important predictors of an OAC prescription.In a contemporary, national cohort of patients with AF underuse of OAC remains high, with notable geographic variation. Our results demonstrated the role of several important demographic and socioeconomic factors in underutilization of OAC in patients with AF.

    View details for DOI 10.1016/j.hroo.2022.11.004

    View details for PubMedID 36993910

    View details for PubMedCentralID PMC10041076

  • Sex and gender aspects in diabetes mellitus: Focus on access to health care and cardiovascular outcomes FRONTIERS IN PUBLIC HEALTH Gisinger, T., Azizi, Z., Alipour, P., Harreiter, J., Raparelli, V., Kublickiene, K., Herrero, M., Norris, C. M., El Emam, K., Pilote, L., Kautzky-Willer, A., GOING-FWD Consortium 2023; 11: 1090541

    Abstract

    The aim of this study was to elucidate whether sex and gender factors influence access to health care and/or are associated with cardiovascular (CV) outcomes of individuals with diabetes mellitus (DM) across different countries.Using data from the Canadian Community Health Survey (8.4% of respondent reporting DM) and the European Health Interview Survey (7.3% of respondents reporting DM), were analyzed. Self-reported sex and a composite measure of socio-cultural gender was constructed (range: 0-1; higher score represent participants who reported more characteristics traditionally ascribed to women). For the purposes of analyses the Gender Inequality Index (GII) was used as a country level measure of institutionalized gender.Canadian females with DM were more likely to undergo HbA1c monitoring compared to males (OR = 1.26, 95% CI: 1.01-1.58), while conversely in the European cohort females with DM were less likely to have their blood sugar measured compared to males (OR = 0.88, 95% CI: 0.79-0.99). A higher gender score in both cohorts was associated with less frequent diabetes monitoring. Additionally, independent of sex, higher gender scores were associated with higher prevalence of self-reported heart disease, stroke, and hospitalization in all countries albeit European countries with medium-high GII, conferred a higher risk of all outcomes and hospitalization rates than low GII countries.Regardless of sex, individuals with DM who reported characteristics typically ascribed to women and those living in countries with greater gender inequity for women exhibited poorer diabetes care and greater risk of CV outcomes and hospitalizations.

    View details for DOI 10.3389/fpubh.2023.1090541

    View details for Web of Science ID 000933476100001

    View details for PubMedID 36817907

    View details for PubMedCentralID PMC9932273

  • Missing Race and Ethnicity Data in Pediatric Studies JAMA Pediatr Vedelli, J. K., Azizi, Z., Anand, K. J. 2023
  • A comparison of synthetic data generation and federated analysis for enabling international evaluations of cardiovascular health. Scientific reports Azizi, Z., Lindner, S., Shiba, Y., Raparelli, V., Norris, C. M., Kublickiene, K., Herrero, M. T., Kautzky-Willer, A., Klimek, P., Gisinger, T., Pilote, L., El Emam, K. 2023; 13 (1): 11540

    Abstract

    Sharing health data for research purposes across international jurisdictions has been a challenge due to privacy concerns. Two privacy enhancing technologies that can enable such sharing are synthetic data generation (SDG) and federated analysis, but their relative strengths and weaknesses have not been evaluated thus far. In this study we compared SDG with federated analysis to enable such international comparative studies. The objective of the analysis was to assess country-level differences in the role of sex on cardiovascular health (CVH) using a pooled dataset of Canadian and Austrian individuals. The Canadian data was synthesized and sent to the Austrian team for analysis. The utility of the pooled (synthetic Canadian+real Austrian) dataset was evaluated by comparing the regression results from the two approaches. The privacy of the Canadian synthetic data was assessed using a membership disclosure test which showed an F1 score of 0.001, indicating low privacy risk. The outcome variable of interest was CVH, calculated through a modified CANHEART index. The main and interaction effect parameter estimates of the federated and pooled analyses were consistent and directionally the same. It took approximately one month to set up the synthetic data generation platform and generate the synthetic data, whereas it took over 1.5years to set up the federated analysis system. Synthetic data generation can be an efficient and effective tool for enabling multi-jurisdictional studies while addressing privacy concerns.

    View details for DOI 10.1038/s41598-023-38457-3

    View details for PubMedID 37460705

  • The role of sex and gender in hypertension JOURNAL OF HUMAN HYPERTENSION Azizi, Z., Alipour, P., Raparelli, V., Norris, C. M., Pilote, L. 2022

    Abstract

    Hypertension (HTN) is a critical primary modifiable risk factor for the development of cardiovascular diseases, with recognized sex-based differences. While sex refers to one's biological genetic makeup and attributes, gender encompasses the individual's psycho-socio-cultural characteristics, including their environment and living conditions. The impact of each gendered variable may differ amongst men and women with respect to HTN. Applying a sex and gender-based lenses to inform our understanding of HTN has the potential to unveil important contributors of HTN-related cardiovascular outcomes. For instance, increased life stressors, work related anxiety and depression, typically have more pronounced effect on women than men with HTN. The impact of social surrounding including marital status and social support on HTN also differs amongst men and women. While married men are less likely to have higher blood pressure, single women, and those who never married are less likely to have HTN. Additionally, the beneficial role of social support is more pronounced in more historically marginalized cultural groups compared to majority. Finally, socioeconomic status, including education level and income have a linear and inverse relationship in blood pressure control in more resource-rich countries. The aim of this review is to summarize how sex and gender interact in shaping the clinical course of HTN demonstrating the importance of both sex and gender in HTN risk and its treatment. Hence, when investigating the role of gendered factors in HTN it is imperative to consider cultural, and social settings. In this narrative we found that employment and education play a significant role in manifestation and control of HTN particularly in women.

    View details for DOI 10.1038/s41371-022-00789-4

    View details for Web of Science ID 000898466500001

    View details for PubMedID 36509989

  • Representation of Women in Atrial Fibrillation Clinical Practice Guidelines CANADIAN JOURNAL OF CARDIOLOGY Alipour, P., Azizi, Z., Norris, C. M., Raparelli, V., McMurtry, M., Macle, L., Andrade, J., Pilote, L. 2022; 38 (6): 729-735

    Abstract

    Atrial fibrillation (AF) is the most common arrhythmia in men and women worldwide, and its prevalence is increasing. Management of AF is guided by evidence-based clinical practice guidelines which provide recommendations based on available evidence. The extent of sex-specific data in the AF literature used to provide guideline recommendations has not been investigated. Therefore, using the 2020 Canadian Cardiovascular Society (CCS) AF management guidelines as an example, the purpose of this study was to review female representation and the reporting of sex-disaggregated data in the studies referenced in AF guidelines.Randomised controlled trials (RCTs) and prospective and retrospective cohorts were screened to calculate the proportion of study participants who were female and to establish whether studies provided sex-disaggregated analyses. The participant-prevalence ratio (PPR), a quotient of the female participant rate and the prevalence of women in the AF population, was calculated for each study.A total of 885 studies included in the CCS guidelines were considered. Of those, 467 met the inclusion criteria. Overall, women represented 39.1% of the population over all of the studies and RCTs had the lowest proportions of women (33.8%, PPR 0.70). Of studies with sex-disaggregated analyses (n = 140; 29.9%), single-centre RCTs and retrospective cohorts had the lowest and highest rates of sex-specific analyses, respectively (11.5% and 32.5%).The evidence used to derive guideline recommendations may be inadequate for sex-specific recommendations. Until enough data can support women-specific guidelines, increased inclusion of females in AF studies, may aid in the precision of recommendations.

    View details for DOI 10.1016/j.cjca.2021.12.017

    View details for Web of Science ID 000841434200010

    View details for PubMedID 35007706

  • Importance of sex and gender factors for COVID-19 infection and hospitalisation: a sex-stratified analysis using machine learning in UK Biobank data BMJ OPEN Azizi, Z., Shiba, Y., Alipour, P., Maleki, F., Raparelli, V., Norris, C., Forghani, R., Pilote, L., El Emam, K. 2022; 12 (5): e050450

    Abstract

    To examine sex and gender roles in COVID-19 test positivity and hospitalisation in sex-stratified predictive models using machine learning.Cross-sectional study.UK Biobank prospective cohort.Participants tested between 16 March 2020 and 18 May 2020 were analysed.The endpoints of the study were COVID-19 test positivity and hospitalisation. Forty-two individuals' demographics, psychosocial factors and comorbidities were used as likely determinants of outcomes. Gradient boosting machine was used for building prediction models.Of 4510 individuals tested (51.2% female, mean age=68.5±8.9 years), 29.4% tested positive. Males were more likely to be positive than females (31.6% vs 27.3%, p=0.001). In females, living in more deprived areas, lower income, increased low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio, working night shifts and living with a greater number of family members were associated with a higher likelihood of COVID-19 positive test. While in males, greater body mass index and LDL to HDL ratio were the factors associated with a positive test. Older age and adverse cardiometabolic characteristics were the most prominent variables associated with hospitalisation of test-positive patients in both overall and sex-stratified models.High-risk jobs, crowded living arrangements and living in deprived areas were associated with increased COVID-19 infection in females, while high-risk cardiometabolic characteristics were more influential in males. Gender-related factors have a greater impact on females; hence, they should be considered in identifying priority groups for COVID-19 infection vaccination campaigns.

    View details for DOI 10.1136/bmjopen-2021-050450

    View details for Web of Science ID 000797890300003

    View details for PubMedID 35584867

    View details for PubMedCentralID PMC9118360

  • Sex, Gender, and Cardiovascular Health in Canadian and Austrian Populations CANADIAN JOURNAL OF CARDIOLOGY Azizi, Z., Gisinger, T., Bender, U., Deischinger, C., Raparelli, V., Norris, C. M., Kublickiene, K., Herrero, M., El Emam, K., Kautzky-Willer, A., Pilote, L., GOING FWD Investigators 2021; 37 (8): 1240-1247

    Abstract

    Evidence differentiating the effect of biological sex from psychosociocultural factors (gender) in different societies and its relation to cardiovascular diseases is scarce. We explored the association between sex, gender, and cardiovascular health (CVH) among Canadian (CAN) and Austrian (AT) populations.The Canadian Community Health Survey (CCHS) (n = 63,522; 55% female) and Austrian Health Interview Survey (AT-HIS) (n = 15,771; 56% female) were analyzed in a cross-sectional survey design. The CANHEART/ATHEART index, a measure of ideal CVH composed of 6 cardiometabolic risk factors (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes, and hypertension; range 0-6; higher scores reflecting better CVH) was calculated for both databases. A composite measure of psychosociocultural gender was computed for each country (range 0-1, higher score identifying characteristics traditionally ascribed to women).Median CANHEART 4 (interquartile range 3-5) and CAN gender scores 0.55 (0.49-0.60) were similar to median ATHEART 4 (3-5) and AT gender scores 0.55 (0.46-0.64). Although higher gender scores (CCHS: β = -1.33, 95% confidence interval [CI] -1.44 to -1.22; AT-HIS: β = -1.08, 95% CI -1.26 to -0.89)) were associated with worse CVH, female sex (CCHS: β = 0.35, 95% CI (0.33-0.37); AT-HIS: β = 0.60, 95% CI (0.55-0.64)) was associated with better CVH in both populations. In addition, higher gender scores were associated with increased prevalence of heart disease compared with female sex. The magnitude of this risk was higher in Austrians.These results demonstrate that individuals with characteristics typically ascribed to women reported poorer cardiovascular health and higher risk of heart disease, independently from biological sex and baseline CV risk factors, in both countries. Female sex exhibited better CV health and a lower prevalence of heart disease than male in both populations. However, gender factors and magnitude of gender impact varied by country.

    View details for DOI 10.1016/j.cjca.2021.03.019

    View details for Web of Science ID 000689316000020

    View details for PubMedID 33785367

  • Fluoroless Catheter Ablation of Atrial Fibrillation: Integration of Intracardiac Echocardiography and Cartosound Module. Journal of atrial fibrillation Elvin Gul, E., Azizi, Z., Alipour, P., Haseeb, S., Malcolm, R., Terricabras, M., Sanchez Somonte, P., Tsang, B., Khaykin, Y., Wulffhart, Z., Verma, A., Pantano, A. 2021; 14 (2): 20200477

    Abstract

    To evaluate the feasibility, safety, and clinical efficacy of non-fluoroscopic radiofrequency catheter ablation of atrial fibrillation (AF) in comparison to traditional fluoroscopy-guided ablation in a local Canadian community cohort.We retrospectively studied consecutive patients with paroxysmal and persistent AF undergoing pulmonary vein isolation (PVI) guided by intracardiac echocardiography (ICE) and Carto system (CartoSound module). ICE-guided PVI without fluoroscopy (Zero-fluoro group) was performed in 116 patients, and conventional fluoroscopy-guided PVI (Traditional group) was performed in 131 patients.Two hundred and forty-seven patients with AF (60.7% male; mean age: 62.2 ± 10.6 years; paroxysmal AF =63.1%) who underwent PVI were studied. Mean procedure times were similar between both groups (136.8±33.4 minutes in the zero-fluoro group vs. 144.3±44.9 minutes in the traditional group; p=0.2). Acute PVI was achieved in all patients. Survival from early AF recurrence was 85% and 81% in the zero-fluoro and traditional groups, respectively (p = 0.06). Survival from late AF recurrence (12-months) between the zero-fluoro and traditional groups was also similar (p=0.1). Moreover, there were no significant differences between complication rates, including hematoma (p = 0.2) and tamponade (p = 1),between both groups.Zero-fluoroscopy ICE and CartoSound-guided AF ablation may be safe and feasible in patients undergoing PVI compared to conventional fluoroscopy-guided ablation.

    View details for DOI 10.4022/jafib.20200477

    View details for PubMedID 34950370

    View details for PubMedCentralID PMC8691270

  • The Importance of Gender to Understand Sex Differences in Cardiovascular Disease CANADIAN JOURNAL OF CARDIOLOGY Connelly, P. J., Azizi, Z., Alipour, P., Delles, C., Pilote, L., Raparelli, V. 2021; 37 (5): 699-710

    Abstract

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. There is robust evidence of heterogeneity in underlying mechanism, manifestation, prognosis, and response to treatment of CVD between male and female patients. Gender, which refers to the socially constructed roles, behaviours, expressions, and identities of individuals, is an important determinant of CV health, and its consideration might help in attaining a broader understanding of the observed sex differences in CVD. Established risk factors such as hypertension, dyslipidemia, diabetes mellitus, obesity, and smoking are well known to contribute to CVD. However, despite the differences in CVD risk between male and female, most studies looking into the magnitude of effect of each risk factor have traditionally focused on male subjects. While biological sex influences disease pathophysiology, the psycho-socio-cultural construct of gender can further interact with this effect. Behavioural, psychosocial, personal, cultural, and societal factors can create, repress, or strengthen underlying biological CV health differences. Although mechanisms of action are largely unclear, it is suggested that gender-related factors can further exacerbate the detrimental effect of established risk factors of CVD. In this narrative review, we explore the current literature investigating the role of gender in CV risk and its impact on established risk factors as a fundamental step toward precision medicine.

    View details for DOI 10.1016/j.cjca.2021.02.005

    View details for Web of Science ID 000646228300005

    View details for PubMedID 33592281

  • Can synthetic data be a proxy for real clinical trial data? A validation study BMJ OPEN Azizi, Z., Zheng, C., Mosquera, L., Pilote, L., El Emam, K., GOING-FWD Collaborators 2021; 11 (4): e043497

    Abstract

    There are increasing requirements to make research data, especially clinical trial data, more broadly available for secondary analyses. However, data availability remains a challenge due to complex privacy requirements. This challenge can potentially be addressed using synthetic data.Replication of a published stage III colon cancer trial secondary analysis using synthetic data generated by a machine learning method.There were 1543 patients in the control arm that were included in our analysis.Analyses from a study published on the real dataset were replicated on synthetic data to investigate the relationship between bowel obstruction and event-free survival. Information theoretic metrics were used to compare the univariate distributions between real and synthetic data. Percentage CI overlap was used to assess the similarity in the size of the bivariate relationships, and similarly for the multivariate Cox models derived from the two datasets.Analysis results were similar between the real and synthetic datasets. The univariate distributions were within 1% of difference on an information theoretic metric. All of the bivariate relationships had CI overlap on the tau statistic above 50%. The main conclusion from the published study, that lack of bowel obstruction has a strong impact on survival, was replicated directionally and the HR CI overlap between the real and synthetic data was 61% for overall survival (real data: HR 1.56, 95% CI 1.11 to 2.2; synthetic data: HR 2.03, 95% CI 1.44 to 2.87) and 86% for disease-free survival (real data: HR 1.51, 95% CI 1.18 to 1.95; synthetic data: HR 1.63, 95% CI 1.26 to 2.1).The high concordance between the analytical results and conclusions from synthetic and real data suggests that synthetic data can be used as a reasonable proxy for real clinical trial datasets.NCT00079274.

    View details for DOI 10.1136/bmjopen-2020-043497

    View details for Web of Science ID 000641716000008

    View details for PubMedID 33863713

    View details for PubMedCentralID PMC8055130

  • Initial Experience, Safety, and Feasibility of Left Bundle Branch Area Pacing A Multicenter Prospective Study JACC-CLINICAL ELECTROPHYSIOLOGY Padala, S. K., Master, V. M., Terricabras, M., Chiocchini, A., Garg, A., Kron, J., Shepard, R., Kalahasty, G., Azizi, Z., Tsang, B., Khaykin, Y., Pantano, A., Koneru, J. N., Ellenbogen, K. A., Verma, A. 2020; 6 (14): 1773-1782

    Abstract

    This study sought to evaluate the safety and feasibility of conduction system pacing by performing left bundle branch area pacing (LBBAP).There are limited data from single centers showing that LBBAP may circumvent the technical and electrophysiological challenges encountered with His bundle pacing.Patients referred for pacemaker implantation at 2 centers between February 1, 2019, and March 31, 2020, were considered for LBBAP. LBBAP was performed by implanting a lumen-less, exposed helix lead approximately 2 cm distal to the His bundle and deep into the septum using a specialized delivery sheath. Implant success rates, complications, and electrophysiological parameters were assessed.LBBAP was successful in 305 of 341 patients (89%). Mean age was 72 ± 12 years; 45% were women; and 39% had QRS duration (QRSd) >130 ms, 22% right bundle branch block, 11% left bundle branch block, and 6% intraventricular conduction defect. Pacing indications were sinus node dysfunction in 28.7%, atrioventricular block in 52.5%, cardiac resynchronization therapy in 8.8%, and refractory atrial fibrillation in 10% of patients. Procedural duration was 74.7 ± 34 min and fluoroscopic time was 10.4 ± 8.1 min. The mean baseline QRSd and paced QRSd in the overall cohort was 114 ± 29.8 ms versus 112 ± 11.7 ms (p < 0.001) and in patients with infra-Hisian disease was 144.5 ± 19 ms versus 115 ± 12 ms (p < 0.001), respectively. Mean left ventricular activation time was 71.7 ± 11 ms at high output and 74.7 ± 11 ms at low output. LBB potentials were noted in 41% patients. Pacing threshold and R waves were 0.74 ± 0.3 V at 0.4 ms and 10.7 ± 4.9 mV at time of implantation and were stable at 1-, 3-, 6-, and 12-month follow-ups. The only major complications were 3 LBBAP lead dislodgements, 2 within 24 h and 1 at 2 weeks.LBBA pacing is safe, feasible, and a reliable alternative to His bundle pacing for providing physiological pacing. Randomized controlled studies are needed to confirm the safety, feasibility, and clinical outcomes of LBBAP.

    View details for DOI 10.1016/j.jacep.2020.07.004

    View details for Web of Science ID 000602753200005

    View details for PubMedID 33357573

  • Relationship between quality of life and burden of recurrent atrial fibrillation following ablation: CAPCOST multicentre cohort study EUROPACE Essebag, V., Azizi, Z., Alipour, P., Khaykin, Y., Leong-Sit, P., Sarrazin, J., Sturmer, M., Morillo, C., Terricabras, M., Amit, G., Roux, J., Patterson, S., Verma, A. 2020; 22 (7): 1017-1025

    Abstract

    Atrial fibrillation (AF) significantly impairs patients' quality of life (QOL). We performed this study to investigate the effect of AF-ablation success and atrial fibrillation burden (AFB) on QOL measures.Overall, 230 patients with paroxysmal AF refractory to antiarrhythmic drugs were enrolled and underwent ablation in a multicentre, prospective cohort. Electrocardiogram, 48-h Holter, Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF), short form-12 (SF-12), and Atrial Fibrillation Effect on Quality of life (AFEQT) scales were used to assess patients. Atrial fibrillation burden was defined as total duration of AF during the month prior to each visit (h/month). The change in AFB was calculated as the difference between the month prior to the 12-month post-ablation and the baseline pre-ablation. The Minimal Clinically Important Difference (MCID) was considered as a 19-point change for AFEQT and 3-5-point change for SF-12 scores. There was significant rise in the AFEQT and SF12 and decrease in CCS-SAF score post-AF ablation; however, the magnitude of these changes was greater in patients without AF recurrence (P < 0.05). The QOL score that best differentiated patients with and without recurrence was AFEQT, while, CCS-SAF was the most specific score. Patients with AFB decrease >19 h/month had significantly greater change in QOL scores. Atrial fibrillation burden < 24 h/month at 12-months post-ablation was associated with significant changes in QOL and CCS-SAF when adjusting for baseline scores and other covariates. These changes were consistent with the MCID of these measures.Patients experience significant improvements in QOL post-ablation, which correlate with a decrease in AFB despite ongoing brief recurrences of AF.NCT01562912. https://www.clinicaltrials.gov/ct2/show/NCT01562912? term=capcost&rank=1.

    View details for DOI 10.1093/europace/euaa066

    View details for Web of Science ID 000569106700004

    View details for PubMedID 32531030

  • Comparison of efficacy of phased multipolar versus traditional radiofrequency ablation: A prospective, multicenter study (CAPCOST) PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY Essebag, V., Azizi, Z., Alipour, P., Khaykin, Y., Leong-Sit, P., Sarrazin, J., Sturmer, M., Morillo, C., Terricabras, M., Amit, G., Roux, J., Patterson, S., Verma, A. 2019; 42 (7): 942-950

    Abstract

    Multipolar phased pulmonary vein ablation catheter (PVAC), specifically its second-generation (PVAC-Gold), has been associated with reduced procedural time for atrial fibrillation (AF) ablation compared to traditional catheters. We performed this study to compare the efficacy of PVAC with point-by-point radiofrequency (RF) ablation.This is a multicenter-cohort study (2012-2017), involving patients with symptomatic, paroxysmal AF refractory to at least one antiarrhythmic medication. Overall, 230 patients were enrolled to (A) PVAC and (B) control groups. Subanalyses were done for ablations performed with PVAC-Gold, and for ablations performed without left atrial (LA) ablation in addition to pulmonary vein isolation. Electrocardiogram and 48-h Holter monitoring were used to assess patients at 3, 6, 9, and 12 months postablation. Recurrence was defined as any atrial arrhythmia >30 s excluding an initial 3-month blanking period.Freedom from any atrial arrhythmia at 12 months postablation was 35.70% and 52.80% in groups A and B, respectively (P = .01). Freedom from atrial arrhythmia was not significantly different when limiting the PVAC cohort to PVAC-Gold and excluding patients with additional LA ablation (A: 44.30%; B: 44.30%, P = .80). Procedural and ablation time was significantly lower in group A than B. Multivariate regression model showed female gender (odds ratio [OR] = 2.90) and recurrence during blanking period (OR = 6.60) as significant predictors of recurrence.This study suggests that PVAC may achieve less freedom from AF than point-by-point RF; however, efficacy is similar when comparing PVAC-Gold and point-by-point stand-alone PV isolation. PVAC is associated with significantly reduced procedural times for AF ablation.

    View details for DOI 10.1111/pace.13737

    View details for Web of Science ID 000474649700023

    View details for PubMedID 31157407

  • Defining Blanking Period Post-Pulmonary Vein Antrum Isolation. JACC. Clinical electrophysiology Alipour, P., Azizi, Z., Pirbaglou, M., Ritvo, P., Pantano, A., Verma, A., Khaykin, Y. 2017; 3 (6): 568-576

    Abstract

    This study sought to determine the exact period after pulmonary vein antrum isolation (PVI) during which early recurrence of atrial tachyarrhythmia (ERAT) does not predict late arrhythmia recurrence (LR), in order to better define the blanking period.Recurrence of atrial fibrillation after PVI is not uncommon. The first 3 months after PVI have been commonly treated as a blanking period, during which ERAT is not thought to predict LR after PVI; however, recent studies have shown that ERAT does predict LR.Baseline and follow-up data for 636 patients (mean age: 61.4 ± 10.6 years; 67.1% male; 59% paroxysmal atrial fibrillation; 31.4% ERAT) who underwent PVI between 2010 and 2014 were included. Recurrences were monitored by electrocardiography and Holter monitoring at 1-, 3-, 6-, 9-, and 12-month intervals post-procedure. Receiver-operating characteristic curve analysis was used to define the blanking period after PVI.Overall, 51%, 76%, and 92% of patients who had ERAT in the first, second, and third month post-PVI, respectively, also experienced LR (p = 0.001). Using a logistic regression model, those manifesting ERAT during the first, second, and third month post-PVI were 4.22, 9.03, and 19.43 (p = 0.001) times more likely to experience LR, respectively, compared to those without ERAT. Furthermore, receiver-operating characteristic analysis revealed that 23 days post-PVI is the optimal cutoff date for the blanking period, with area under the curve of 0.7, sensitivity of 69.2%, and specificity of 61.2%.The likelihood of experiencing LR progressively rises with ERAT after the first month post-PVI. Blanking period after PVI should be limited to the first 23 days clinically and in future studies.

    View details for DOI 10.1016/j.jacep.2017.01.006

    View details for PubMedID 29759429

  • A Triple Blinded, Randomized, Placebo-Controlled Clinical Trial to Evaluate the Efficacy and Safety of Oral Vancomycin in Primary Sclerosing Cholangitis: a Pilot Study. Journal of gastrointestinal and liver diseases : JGLD Rahimpour, S., Nasiri-Toosi, M., Khalili, H., Ebrahimi-Daryani, N., Nouri-Taromlou, M. K., Azizi, Z. 2016; 25 (4): 457-464

    Abstract

    Recent studies have suggested the therapeutic effect of antimicrobial agents on primary sclerosing cholangitis (PSC). Therefore, we aimed to evaluate the efficacy of oral vancomycin in patients with PSC.A triple blinded, randomized, placebo-controlled trial was performed on 29 patients (2015-2016) in the Imam Khomeini Hospital, Tehran, Iran (NCT02605213). Patients were divided into two groups by simple randomization method: placebo 11 (37.9%)/vancomycin 18 (62.1%) and were treated with oral vancomycin (125 mg, four times a day) for 12 weeks. All patients in both groups simultaneously underwent treatment with ursodeoxycholic acid (UDCA, 300 mg, three times a day) before and during the study. Patients' laboratory data and clinical symptoms were recorded at the beginning, first and third month after starting treatment, and the response to treatment was analyzed.29 patients with a mean age of 36.27+/-10.60 years were included in the study. Primary endpoints were accomplished in the vancomycin group showing a significant decline in the mean level of PSC Mayo risk score (decrease rate 3rd month - baseline = -322.03%, p=0.026) during follow up time. Moreover, the analysis of the level of alkaline phosphatase (ALP) in the vancomycin group showed a significant decrease in the third month of treatment as compared to its level in the first month (mean difference 3rd month -1st month = -142.92, Decrease rate= -18.24%, p=0.02). Among secondary endpoints, erythrocyte sedimentation rate (p=0.005), gamma-glutamyl transpeptidase (p=0.02) and patients' symptoms including fatigue, pruritus, diarrhea and anorexia showed a significant decrease in the vancomycin group.This study demonstrated an acceptable efficacy of vancomycin in the treatment of PSC.

    View details for DOI 10.15403/jgld.2014.1121.254.rah

    View details for PubMedID 27981301

  • The correlation between prolonged corrected QT interval with the frequency of respiratory arrest, endotracheal intubation, and mortality in acute methadone overdose. Cardiovascular toxicology Farsi, D., Mirafzal, A., Hassanian-Moghaddam, H., Azizi, Z., Jamshidnejad, N., Zehtabchi, S. 2014; 14 (4): 358-67

    Abstract

    Corrected QT interval (QTc) prolongation is long considered as a predisposing factor for the occurrence of torsade de pointes (TdP) and sudden cardiac arrest in methadone maintenance treatment. We aimed to elucidate the correlation between QTc prolongation and in-hospital death, respiratory arrest, and endotracheal intubation in acute methadone-intoxicated patients presenting to the emergency department and to assess the value of QTc in predicting these outcomes. A prospective cross-sectional study with a convenience sample of patients with acute methadone overdose was done. Participants were 152 patients aged 15-65 with negative urinary dipstick test for cyclic antidepressants, no history of other QTc-prolonging conditions and co-ingestions, no severe comorbidities affecting the outcomes, and positive urinary dipstick results for methadone. QTc intervals were measured and calculated in triage-time electrocardiogram (ECG). Death was correlated with QTc (P = 0.014) and length of ICU admission (P < 0.001). In multivariable analysis, death was independently associated only with length of ICU admission [odds ratio (OR) 95 % confidence intervals (95 % CI) 1.36 (1.14-1.61)]. Intubation and respiratory arrest were independently associated with QTc interval [OR (95 % CI) 1.03 (1.02-1.04) and 1.02 (1.01-1.03), respectively]. The receiver operating characteristics curves drawn to show the ability of QTc to predict death, intubation, and respiratory arrest showed thresholds of 470, 447.5, and 450 ms with sensitivity (95 % CI) and specificity (95 % CI) of 87.5 (47.3-99.7), 86.8 (74.7-94.5), and 77.3 (62.2-88.5), respectively. Our study showed that QTc is a potential predictor for adverse outcomes related to acute methadone intoxication. The correlations shown in this study between triage-time QTc and in-hospital respiratory arrest or intubation in methadone overdose may be of clinical value, whether these outcomes are hypothesized to be a reflection of background TdP or intoxication severity.

    View details for DOI 10.1007/s12012-014-9259-x

    View details for PubMedID 24811951

  • Novel scoring system for predicting mortality in patients with ventricular arrhythmias: Analysis from a 24,000 patient cohort Deb, B., Rogers, A. J., Tjong, F. Y., Somani, S., Desai, Y., Azizi, Z., Chang, H. J., Bhatia, N. K., Clopton, P., Narayan, S. M. OXFORD UNIV PRESS. 2023
  • Changes in medical therapy after cardiac resynchronization in patients with heart failure: insights from the US Veterans Affairs healthcare system Varshney, A., Skye, M., Azizi, Z., Heidenreich, P. A., Sandhu, A. T. OXFORD UNIV PRESS. 2023
  • Validating the association between a composite metric of guideline-directed medical therapy (GDMT) and clinical outcomes for patients with heart failure with reduced ejection fraction (HFrEF) Calma, J., Hsiao, S., Varshney, A. S., Azizi, Z., Golbus, J. R., Heidenreich, P. A., Sandhu, A. T. OXFORD UNIV PRESS. 2023
  • Risk of complications in patients undergoing pulmonary vein antrum isolation: a single centre experience Khaykin, Y., Azizi, Z., Alipour, P., Gao-Kang, J., Pirbaglou, M., Falvey, G., Khaykin, M., Mooring, A., Jasrai, A., Kamyab, S., Narbonne, M., Malcolm, R., Timajchi, E., Pantano, A., Sadek, M. M. OXFORD UNIV PRESS. 2023
  • Use of Human-Centered Design Methodology to Develop a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy. The Journal of cardiovascular nursing Spaulding, E. M., Isakadze, N., Molello, N., Khoury, S. R., Gao, Y., Young, L., Antonsdottir, I. M., Azizi, Z., Dorsch, M. P., Golbus, J. R., Ciminelli, A., Brant, L. C., Himmelfarb, C. R., Coresh, J., Marvel, F. A., Longenecker, C. T., Commodore-Mensah, Y., Gilotra, N. A., Sandhu, A., Nallamothu, B., Martin, S. S. 2023

    Abstract

    Guideline-directed medical therapies (GDMTs) improve quality of life and health outcomes for patients with heart failure (HF). However, GDMT utilization is suboptimal among patients with HF.The aims of this study were to engage key stakeholders in semistructured, virtual human-centered design sessions to identify challenges in GDMT optimization posthospitalization and inform the development of a digital toolkit aimed at optimizing HF GDMTs.For the human-centered design sessions, we recruited (a) clinicians who care for patients with HF across 3 hospital systems, (b) patients with HF with reduced ejection fraction (ejection fraction ≤ 40%) discharged from the hospital within 30 days of enrollment, and (c) caregivers. All participants were 18 years or older, English speaking, with Internet access.A total of 10 clinicians (median age, 37 years [interquartile range, 35-41], 12 years [interquartile range, 10-14] of experience caring for patients with HF, 80% women, 50% White, 50% nurse practitioners) and three patients and one caregiver (median age 57 years [IQR: 53-60], 75% men, 50% Black, 75% married) were included. Five themes emerged from the clinician sessions on challenges to GDMT optimization (eg, barriers to patient buy-in). Six themes on challenges (eg, managing medications), 4 themes on motivators (eg, regaining independence), and 3 themes on facilitators (eg, social support) to HF management arose from the patient and caregiver sessions.The clinician, patient, and caregiver insights identified through human-centered design will inform a digital toolkit aimed at optimizing HF GDMTs, including a patient-facing smartphone application and clinician dashboard. This digital toolkit will be evaluated in a multicenter, clinical trial.

    View details for DOI 10.1097/JCN.0000000000001051

    View details for PubMedID 37855732

  • VENTRICULAR TACHYCARDIA PREDICTS ATRIAL FIBRILLATION RECURRENCE POST ABLATION: A PROPENSITY SCORE-MATCHED ANALYSIS OF A LARGE PROSPECTIVE STUDY Azizi, Z., Deb, B., Feng, R., Ganesan, P., Rogers, A. J., Chang, H., Clopton, P., Narayan, S. M. ELSEVIER SCIENCE INC. 2023: 186
  • OBSTRUCTIVE SLEEP APNEA PORTENDS STROKE IN YOUNG INDIVIDUALS WITHOUT ATRIAL FIBRILLATION: A LARGE REGISTRY STUDY Deb, B., Vasireddi, S., Bhatia, N. K., Rogers, A. J., Clopton, P., Baykaner, T., Ganesan, P., Feng, R., Azizi, Z., Narayan, S. M. ELSEVIER SCIENCE INC. 2023: 130
  • Long-term full-scale intelligent quotient outcomes following pediatric and childhood epilepsy surgery: A systematic review and meta-analysis. Seizure Arfaie, S., Amin, P., Kwan, A. T., Solgi, A., Sarabi, A., Hakak-Zargar, B., Brunette-Clément, T., Pushenko, D., Mir-Moghtadaei, K., Mashayekhi, M. S., Mofatteh, M., Honarvar, F., Ren, L. Y., Noiseux-Lush, C., Azizi, Z., Pearl, P. L., Baldeweg, T., Weil, A. G., Fallah, A. 2023; 106: 58-67

    Abstract

    Cognitive measures are an important primary outcome of pediatric, adolescents, and childhood epilepsy surgery. The purpose of this systematic review and meta-analysis is to assess whether there are long-term alterations (≥ 5 years) in the Full-Scale Intelligence Quotient (FSIQ) of pediatric patients undergoing epilepsy surgery.Electronic databases (EMBASE, MEDLINE, and Scopus) were searched for English articles from inception to October 2022 that examined intelligence outcomes in pediatric epilepsy surgery patients. Inclusion criteria were defined as the patient sample size of ≥ 5, average follow- up of ≥5 years, and surgeries performed on individuals ≤ 18 years old at the time of surgery. Exclusion criteria consisted of palliative surgery, animal studies, and studies not reporting surgical or FSIQ outcomes. Publication bias was assessed using a funnel plot and the Quality in Prognosis Studies (QUIPS) toolset was used for quality appraisal of the selected articles. A random-effects network meta-analysis was performed to compare FSIQ between surgical patients at baseline and follow-up and Mean Difference (MD) was used to calculate the effect size of each study. Point estimates for effects and 95% confidence intervals for moderation analysis were performed on variables putatively associated with the effect size.21,408 studies were screened for abstract and title. Of these, 797 fit our inclusion and exclusion criteria and proceeded to full-text screening. Overall, seven studies met our requirements and were selected. Quantitative analysis was performed on these studies (N = 330). The mean long-term difference between pre- and post- operative FSIQ scores across all studies was noted at 3.36 [95% CI: (0.14, 6.57), p = 0.04, I2 = 0%] and heterogeneity was low.To our knowledge, this is the first meta-analysis to measure the long-term impacts of FSIQ in pediatric and adolescent epilepsy patients. Our overall results in this meta-analysis indicate that while most studies do not show long-term FSIQ deterioration in pediatric patients who underwent epilepsy surgery, there was an increase of 3.36 FSIQ points, however, the observed changes were not clinically significant. Moreover, at the individual patient level analysis, while most children did not show long-term FSIQ deterioration, few had significant decline. These findings indicate the importance of surgery as a viable option for pediatric patients with medically refractory epilepsy.

    View details for DOI 10.1016/j.seizure.2023.01.020

    View details for PubMedID 36774775

  • County-Level Factors Explaining the Reversal of the Hispanic Mortality Paradox Zuma, B. Z., Azizi, Z., Sarraju, A., Ngo, S., Scheinker, D., Rodriguez, F. 2023
  • EVALUATION OF CHAT-BASED ARTIFICIAL INTELLIGENCE ALGORITHMS FOR PROVIDING ATRIAL FIBRILLATION RECOMMENDATIONS TO PATIENTS AND CLINICIANS Azizi, Z., Alipour, P., Gomez, S., et al 2023
  • Variance In Endocardial Voltage Between The Sinus Node And Other Bi-atrial Regions In Patients With Atrial Fibrillation Srivastava, V., Ganesan, P., Goyal, J., Deb, B., Azizi, Z., Narayan, S. M. 2023
  • Optimizing ChatGPT to Detect VT Recurrence From Complex Medical Notes Feng, R., Brennan, K. A., Azizi, Z., Goyal, J., Pedron, M., Chang, H., Ganesan, P., Ruiperez-Campillo, S., Deb, B., Clopton, P. L., Baykaner, T., Rogers, A. J., Narayan, S. M. 2023
  • Global burden of cardiovascular diseases and risks, 1990-2022 Journal of the American College of Cardiology Mensah, G. A., et al 2023; 82 (25)
  • EVALUATION OF CHAT-BASED ARTIFICIAL INTELLIGENCE ALGORITHMS FOR PROVIDING ATRIAL FIBRILLATION RECOMMENDATIONS TO PATIENTS AND CLINICIANS Azizi, Z., Alipour, P., Gomez, S., et al 2023
  • QRS DURATION CHANGE FOLLOWING AORTIC VALVE REPLACEMENT: ASSOCIATION WITH PERMANENT PACEMAKER RISK AND DIAGNOSTIC UTILITY IN INDIVIDUALS WITHOUT PRE-PROCEDURE CONDUCTION AND RHYTHM DISTURBANCES Tsang, B., Pirbaglou, M., Azizi, Z., et al 2023
  • PULMONARY VEIN ANTRUM ISOLATION AS A STANDALONE OUTPATIENT PROCEDURE IN LOW RISK PATIENTS: A FEASABILITY EVALUATION Khaykin, Y., Alipour, P., Azizi, Z., et al 2023
  • Using Human-Centered Design Methodology to Identify Challenges and Inform the Development of a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy From Diverse Clinician, Patient, and Patient Health Partner Perspectives Spaulding, E., Isakadze, N., Molello, N., Khoury, S., Gao, Y., Young, L., Zghyer, F., Azizi, Z., et al 2023
  • Medial Temporal Tau Predicts Memory Decline in Cognitively Unimpaired Elderly (P5-6.011) Kwan, A., Arfaie, S., Therriault, J., Azizi, Z., et al 2023
  • PERI-OPERATIVE AMIODARONE PROPHYLAXIS IN CARDIOVASCULAR SURGERY: IMPACTS ON POST-OPERATIVE LENGTH OF STAY ACCORDING TO PROCEDURE TYPES Shamiss, Y., Pirbaglou, M., Gao-Kang, J., Alipour, P., Azizi, Z., et al 2023
  • PRE-OPERATIVE DISCONTINUATION OF NOVEL ORAL ANTICOAGULANTS IN CARDIOVASCULAR SURGERY: IS TWO DAYS ENOUGH? Shamiss, Y., Pirbaglou, M., Gao-Kang, J., Alipour, P., Azizi, Z., et al 2023
  • PRE-OPERATIVE DISCONTINUATION OF NOVEL ORAL ANTICOAGULANTS IN CARDIOVASCULAR SURGERY: HOLD TIME IS ASSOCIATED WITH LENGTH OF STAY Shamiss, Y., Pirbaglou, M., Gao-Kang, J., Alipour, P., Azizi, Z., et al 2023
  • MULTIVARIATE PREDICTORS OF MORTALITY IN PATIENTS WITH VENTRICULAR TACHYARRHYTHMIA: INSIGHTS FROM A COMMUNITY COHORT OF 24000 INDIVIDUALS Deb, B., Goyal, J., Tjong, F., Somani, S., Rogers, A., Desai, Y., Azizi, Z., et al 2023
  • IMPACT OF ELECTRONIC HEALTH RECORD BASED CLINICAL DECISION SUPPORT ON OFF-LABEL DOSING OF DIRECT ORAL ANTICOAGULANTS: RESULTS OF A SINGLE-CENTRE QUASI-EXPERIMENTAL STUDY Azizi, Z., Din, N., Fan, J., et al 2023
  • QRS DURATION CHANGE FOLLOWING AORTIC VALVE REPLACEMENT: ASSOCIATION WITH PERMANENT PACEMAKER RISK AND DIAGNOSTIC UTILITY IN INDIVIDUALS WITHOUT PRE-PROCEDURE CONDUCTION AND RHYTHM DISTURBANCES Tsang, B., Pirbaglou, M., Azizi, Z., et al 2023
  • PULMONARY VEIN ANTRUM ISOLATION AS A STANDALONE OUTPATIENT PROCEDURE IN LOW RISK PATIENTS: A FEASABILITY EVALUATION Khaykin, Y., Alipour, P., Azizi, Z., et al 2023
  • Risk of complications in patients undergoing pulmonary vein antrum isolation: a single centre experience Khaykin, Y., Azizi, Z., Alipour, P., et al 2023
  • Novel scoring system for predicting mortality in patients with ventricular arrhythmias: Analysis from a 24,000 patient cohort Deb, B., Rogers, A., Tjong, F., Somani, S., Desai, Y., Azizi, Z., Chang, H., Bhatia, N., Clopton, P., Narayan, S. 2023
  • Validating the association between a composite metric of guideline-directed medical therapy (GDMT) and clinical outcomes for patients with heart failure with reduced ejection fraction (HFrEF) Calma, J., Hsiao, S., Varshney, A., Azizi, Z., Golbus, J., Heidenreich, P., Sandhu , A. 2023
  • Changes in medical therapy after cardiac resynchronization in patients with heart failure: insights from the US Veterans Affairs healthcare system Varshney, A., Skye, M., Azizi, Z., Heidenreich, P., Sandhu, A. 2023
  • Pre-Operative Predictors of Permanent Pacemaker Implantation Post Aortic Valve Replacement: A Retrospective Cohort Evaluation Tsang, B., Pirbaglou, M., Azizi, Z., Alipour, P., Gao-Kang, J., Yang, J., Pantano, A., Sadek, M., Khaykin, Y. 2023
  • Medial temporal tau predicts memory decline in cognitively unimpaired elderly BRAIN COMMUNICATIONS Kwan, A. H., Arfaie, S., Therriault, J., Azizi, Z., Lussier, F. Z., Tissot, C., Chamoun, M., Bezgin, G., Servaes, S., Stevenon, J., Rahmouni, N., Pallen, V., Gauthier, S., Rosa-Neto, P. 2022; 5 (1): fcac325

    Abstract

    Alzheimer's disease can be detected in living people using in vivo biomarkers of amyloid-β and tau, even in the absence of cognitive impairment during the preclinical phase. [18F]-MK-6420 is a high-affinity PET tracer that quantifies tau neurofibrillary tangles, but its ability to predict cognitive changes associated with early Alzheimer's disease symptoms, such as memory decline, is unclear. Here, we assess the prognostic accuracy of baseline [18F]-MK-6420 tau-PET for predicting longitudinal memory decline in asymptomatic elderly individuals. In a longitudinal observational study, we evaluated a cohort of cognitively normal elderly participants (n = 111) from the translational biomarkers in ageing and dementia study (data collected between October 2017 and July 2020, with a follow-up period of 12 months). All participants underwent tau-PET with [18F]-MK-6420 and amyloid-β PET with [18F]-AZD-4694. The exclusion criteria included the presence of head trauma, stroke or other neurological disorders. There were 111 eligible participants selected based on the availability of amyloid-β PET, tau-PET, MRI and APOEɛ4 genotyping. Among these participants, the mean standard deviation age was 70.1 (8.6) years; 20 (18%) were tau-PET-positive and 71 of 111 (63.9%) were women. A significant association between the baseline Braak Stages I-II [18F]-MK-6240 standardized uptake value ratio positivity and change in composite memory score were observed at the 12-month follow-up, after correcting for age, sex and years of education [logical memory and Rey Auditory Verbal Learning Test, standardized beta = -0.52 (-0.82-0.21), P < 0.001, for dichotomized tau-PET and -1.22 (-1.84-(-0.61)], P < 0.0001, for continuous tau-PET]. Moderate cognitive decline was observed for A + T + over the follow-up period, whereas no significant change was observed for A-T+, A + T- and A-T-, although it should be noted that the A-T + group was small. Our results indicate that baseline tau neurofibrillary tangle pathology is associated with longitudinal changes in memory function, supporting the use of [18F]-MK-6420 PET to predict the likelihood of asymptomatic elderly individuals experiencing future memory decline. Overall, [18F]-MK-6420 PET is a promising tool for predicting memory decline in older adults without cognitive impairment at baseline. This is of critical relevance as the field is shifting towards a biological model of Alzheimer's disease defined by the aggregation of pathologic tau. Therefore, early detection of tau pathology using [18F]-MK-6420 PET provides us with hope that living patients with Alzheimer's disease may be diagnosed during the preclinical phase before it is too late.

    View details for DOI 10.1093/braincomms/fcac325

    View details for Web of Science ID 000907993700001

    View details for PubMedID 36627889

    View details for PubMedCentralID PMC9814120

  • Diversity, equity and inclusion in autophagy research AUTOPHAGY Klionsky, D. J. 2022; 18 (12): 2765-2768

    Abstract

    Over the past several years, I have been interacting with an increasing number of Iranian scientists, including those currently living in Iran as well as others who are being educated elsewhere or have independent positions outside of that country. In all circumstances, the resulting collaborations have extended my own knowledge and allowed me to contribute to papers on a variety of topics that are outside my specific area of expertise, including xenophagy, nanoparticles, cardiac disease and cancer. As the editor-in-chief of this journal, one of my goals is to be as inclusive as possible, encouraging scientists from around the world to engage in autophagy-related research, and to heighten awareness of this work with an aim toward a more complete understanding of the basic process, and to aid in progress toward the modulation of autophagy for medical applications. For this reason, I have been extremely dismayed by the actions of the current government in Iran, which have led to attacks on scientists and students, and in particular to policies that encourage the repression of women. Although we still have not achieved full equality for women in the United States of America, I think we are slowly moving in a positive direction. It is my sincere hope that the lives and aspirations of women around the world can continue to improve so that this half of our population can fully contribute to the scientific enterprise.

    View details for DOI 10.1080/15548627.2022.2140551

    View details for Web of Science ID 000882918600001

    View details for PubMedID 36369701

    View details for PubMedCentralID PMC9673949

  • Multivariate Predictors of Long-Term Outcome From Ventricular Tachycardia Ablation in a Large Registry Goyal, J., Deb, B., Le Menestrel, T., Chang, H., Tjong, F. V., Rogers, A. J., Azizi, Z., Ruiperez-Campillo, S., Feng, R., Ganesan, P., Baykaner, T., John, R., Perez, M. V., Perino, A. C., Wang, P. J., Viswanathan, M. N., Badhwar, N., Narayan, S. M. LIPPINCOTT WILLIAMS & WILKINS. 2022
  • Gendered Social Determinants of Health and Risk of Major Adverse Outcomes in Atrial Fibrillation: An Analysis From the ESC-EHRA Eurobservational Research Programme in Atrial Fibrillation General Long-Term Registry Houle, J., Proietti, M., Raparelli, V., Azizi, Z., Atzema, C., Norris, C. M., Abrahamowicz, M., Lip, G., Boriani, G., Pilote, L. LIPPINCOTT WILLIAMS & WILKINS. 2022
  • Sex and Gender Impact Mental and Emotional Well-Being During COVID-19 Pandemic: A European Countries Experience JOURNAL OF WOMENS HEALTH Gisinger, T., Dev, R., Kautzky, A., Harreiter, J., Raparelli, V., Kublickiene, K., Herrero, M., Norris, C. M., Lavoie, K. L., Pilote, L., Kautzky-Willer, A., GOING-FWD Consortium, iCARE Study Team 2022; 31 (11): 1529-1539

    Abstract

    Objective: The COVID-19 pandemic influences mental health drastically. Therefore, our aim was to investigate whether biological sex and gender-related factors are associated with mental health during the COVID-19 pandemic. Materials and Methods: The International COVID-19 Awareness and Responses Evaluation Study is an international multiwave cross-sectional observational cohort study of public awareness, attitudes, and responses to public health policies (www.mbmc- cmcm.ca/covid19). The study is led by the Montreal Behavioural Medicine Centre in collaboration with 200 international collaborators from 42 countries. It has received research ethics board approval from the Comité d'éthique de recherche du CIUSSS-NIM (Centre intégré universitaire de santé et de services sociaux du Nord- de-l'île-de-Montréal), approval no.: 2020-2099/25-03-2020. Recruitment began on March 27, 2020, and the survey is available in 34 languages. The associations between biological sex, sociocultural gender, and mental health were assessed in multivariate logistic regression models only for the European population (n = 12,300). Results: Positive correlations were found between female sex and "feeling nervous, anxious or worried" (OR = 3.2, p < 0.001, 95% CI 1.87-5.63) and "feeling sad, depressed or hopeless" (OR 1.8, p = 0.031, CI 1.05-3.05). Male sex was related to more frequently "feeling irritable, frustrated, and angry" (OR = 1.8, p = 0.04, 95% CI 1.03-2.99). Concerning gender, a negative correlation between being employed and "feeling lonely or isolated" (OR = 0.26, p < 0.001, 95% CI 0.11-0.59) was observed in the female cohort. Conclusion: Sex and gender differences exist in the emotional responses during the COVID-19 pandemic. Especially, within the female cohort, unemployment is negatively associated with mental health. Therefore, this study suggests more targeted psychological and social support for females during the pandemic.

    View details for DOI 10.1089/jwh.2022.0115

    View details for Web of Science ID 000924621500003

    View details for PubMedID 36356181

  • Sex and gender influence on cardiovascular health in sub-saharan Africa: findings from Ghana, Gambia, Mali, Guinea, and Botswana Devi, R., Favour-Ofili, D., Raparelli, V., Behlouli, H., Azizi, Z., Kublickiene, K., Kautzky-Willer, A., Trinidad Herrero, M., Pilote, L., Norris, C. M., GOING-FWD OXFORD UNIV PRESS. 2022: 2252
  • SEX AND GENDER ASPECTS IN HYPERTENSION PREVALENCE OF CANADIAN AND EUROPEAN POPULATIONS Azizi, Z., Lindner, S., Ruiz, M., Alipour, P., Raparelli, V., Norris, C. M., Kublickiene, K., Willer, A., Klimek, P., El Emam, K., Villalba, E., Herrero, M., Pilote, L., GOING-FWD Investigators LIPPINCOTT WILLIAMS & WILKINS. 2022
  • ROLE OF SEX AND GENDER IN DEVELOPMENT OF METABOLIC SYNDROME: A PROSPECTIVE COHORT STUDY Alipour, P., Azizi, Z., Raparelli, V., et al 2022
  • Cardiovascular health through a sex and gender lens in six South Asian countries: Findings from the WHO STEPS surveillance JOURNAL OF GLOBAL HEALTH Dev, R., Raparelli, V., Pilote, L., Azizi, Z., Kublickiene, K., Kautzky-Willer, A., Herrero, M., Norris, C. M., GOING-FWD Consortium 2022; 12: 04020

    Abstract

    Sex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries. However, these relationships have not been examined in low- and middle-income countries. The main aim of this study was to examine how sex and gender-related factors are associated with cardiovascular risk factors of people in South Asian countries.We conducted a retrospective analysis of the World Health Organization's "STEPwise approach to surveillance of risk factors for non-communicable disease" or "STEPS" from six South Asian countries, surveys conducted between 2014-2019. The main outcomes were CVH as measured by a composite measure of STEPS-HEART health index (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension), values ranging from 0 (worst) to 6 (best or ideal) and self-reported occurrence of cardiovascular disease (ie, heart attack and stroke). Multivariate linear and logistic regression models were performed. Multiple imputation with chained equations was performed.The final analytic sample consisted of 33 106 participants (57.5% females). The mean STEPS-HEART index score in the South Asian population was 3.43 [SD: 0.92]. Female sex (β: 0.05, 95% confidence interval (CI) = 0.01-0.08, P < 0.05) was significantly associated with better CVH compared to males. Being married (βmale = -0.30, 95% CI = -0.37, -0.23 vs βfemale = -0.23, 95% CI = -0.29, -0.17; P < 0.001) and having a household size ≥5 (βmale = -0.15, 95% CI = -0.24, -0.06 vs βfemale = -0.11, 95% CI = -0.16, -0.04; P < 0.01) were associated with poorer CVH, more so in males. Being married was also associated with high risk of CVD (ORmale = 2.54, 95% CI = 1.68-3.86, P < 0.001 vs ORfemale = 1.19, 95% CI = 0.84-1.68, P = 0.31), significant in males.Among the South Asian population, being female may be advantageous in having an ideal CVH. However, gender-related factors such as marital status and large household size were associated with poorer CVH and greater risk of CVD, regardless of sex.

    View details for DOI 10.7189/jogh.12.04020

    View details for Web of Science ID 000767317600001

    View details for PubMedID 35265330

    View details for PubMedCentralID PMC8876159

  • Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana GLOBAL HEART Dev, R., Favour-Ofili, D., Raparelli, V., Behlouli, H., Azizi, Z., Kublickiene, K., Kautzky-willer, A., Herrero, M., Pilote, L., Norris, C. M. 2022; 17 (1): 63

    Abstract

    There is an upsurge of cardiovascular diseases (CVDs) in sub-Saharan Africa (SSA). Irrespective of biological sex, gender-related factors could be the precursor of these conditions.To examine the associations between biological sex, gender-related variables, and cardiovascular health (CVH) risk factors in SSA countries.We used data from the STEPwise approach to surveillance of risk factors for non-communicable disease survey, conducted in adults from Ghana, Gambia, Mali, Guinea, and Botswana. The main outcome was CVH, measured through the health index with values ranging from 0 (worst) to 5 (best or ideal) CVH. Multivariable logistic regression was applied to determine the gender-related factors related to poorer CVH (index less than 4).Data included 15,356 adults (61.4% females, mean age 36.9 years). The prevalence of hypertension (21.6% vs. 13.8%) and overweight/obesity (48.3% vs. 27.5%) was higher among females as compared to males. Females were more likely to be unemployed (17.3% vs. 9.7%) or reported unpaid work (36.8% vs. 15.2%). Overall, females showed worse CVH than males (ORfemale = 0.95, 95% CI:0.91-0.99). Being married was associated with better CVH compared with being single, more so for males (ORmale = 1.09, 95% CI:0.96-1.24, pinteraction < 0.01). Males with unpaid work (ORmale = 1.28, 95% CI:1.12-1.47) had better CVH than their unpaid female counterparts (ORfemale = 1.08, 95% CI:1.01-1.17).In SSA populations, being female was associated with poorer CVH given the disproportionate burden of hypertension and overweight/obesity. Gender-related factors such as marital status and unpaid work were associated with better CVH in males compared to females.

    View details for DOI 10.5334/gh.1146

    View details for Web of Science ID 000859394900001

    View details for PubMedID 36199562

    View details for PubMedCentralID PMC9438458

  • A COMPARISON OF SYNTHETIC DATA GENERATION AND FEDERATED ANALYSIS FOR PERFORMING AN INTERNATIONAL ASSESSMENT OF GENDER EFFECTS ON CARDIOVASCULAR HEALTH Azizi, Z., Linder, S., Shiba, Y., et al 2022
  • A systematic review and meta-analysis of the effect of treadmill desks on energy expenditure, sitting time and cardiometabolic health in adults BMC PUBLIC HEALTH Oye-Somefun, A., Azizi, Z., Ardern, C., Rotondi, M. A. 2021; 21 (1): 2082

    Abstract

    As the health risks of sedentary working environments become more clear, greater emphasis on the implementation of walking interventions to reduce sitting time is needed. In this systematic review and meta-analysis, we investigate the role of treadmill-desk interventions on energy expenditure, sitting time, and cardiometabolic health in adults with sedentary occupations.Relevant studies published in English were identified using CINAHL, EMBASE, MEDLINE, Web of Science, Scopus, and PubMed databases up to December 2020. Random effects meta-analysis models were used to pool study results.Thirteen relevant studies (six workplaces and seven laboratories) were found with a total of 351 participants. Pooled analysis of laboratory studies showed a significant increase in energy expenditure (105.23 kcal per hour, 95% confidence interval [CI]: 90.41 to 120.4), as well as metabolic rate (5.0 mL/kg/min, 95% CI: 3.35 to 6.64), among treadmill desk users compared to sitting conditions. No evidence of significant differences in blood pressure were found. In workplace studies, we observed a significant reduction in sitting time over a 24-h period (- 1.73 min per hour, 95% CI: - 3.3 to - 0.17) among users of treadmill desks, compared to a conventional desk. However, there were no evidence of statistically significant changes in other metabolic outcomes.Treadmill desks offer a feasible and effective intervention to increase energy expenditure and metabolic rate and reduce sitting time while performing work-related tasks. Future studies are needed to increase generalizability to different workplace settings and further evaluate their impact on cardiometabolic health.

    View details for DOI 10.1186/s12889-021-12094-9

    View details for Web of Science ID 000718093900001

    View details for PubMedID 34774020

    View details for PubMedCentralID PMC8590128

  • COMPARING THE CLINICAL OUTCOME OF PATIENTS UNDERGOING CONTACT FORCE GUIDED RADIOFREQUENCY AND SECOND GENERATION CRYOBALLOON ABLATION Azizi, Z., Alipour, P., Malcolm, R., Donegan, S., Nath, S., Sharifzad, F., Falvey, G., Forman, J., Stitz, K., Alireza, S., Gao-Kang, J., Nath, N., Sayrafizadeh, N., Sayrafizadeh, F., Dadak, R., Sharifzad, A., Mogadasian, N., Rasti-Lari, Z., Tamjidi, S., Taheri, S., Kohli, R., Jacobson, G., Pantano, A., Verma, A., Khaykin, Y. ELSEVIER SCIENCE INC. 2021: 418
  • SEX, GENDER AND CARDIOVASCULAR HEALTH, AN ANALYSIS OF SYNTHETIC DATA FROM A POPULATION BASED STUDY Azizi, Z., Pilote, L., Raparelli, V., Norris, C., Kublickiene, K., Herrero, M., Kautzky-Willer, A., El Emam, K., GOING-FWD Investigators ELSEVIER SCIENCE INC. 2021: 3258
  • PERIOPERATIVE MANAGEMENT OF ORAL ANTICOAGULANTS IN CARDIAC SURGERY, WHEN IS THE OPTIMAL STOP TIME Shamiss, Y., Azizi, Z., Malcolm, R., Donegan, S., Gao-Kang, J., Batrak, M., Samani, A., Owen, C., Falvey, G., Sharifzad, F., Nath, S., Nath, N., Forman, J., Stitz, K., Dadak, R., Peniston, J., Tamjidi, S., Kohli, R., Kalliecharan, N., Chan-Smith, L., Teng, C., Teoh, K., O'Blenes, S., Khaykin, Y., Peniston, C. ELSEVIER SCIENCE INC. 2021: 1190
  • The Association Between Sex, Gender and Health Status of Stroke Survivors in the Canadian Population Azizi, Z., Raparelli, V., Norris, C. M., El Emam, K., Pilote, L., GOING FWD Investigators LIPPINCOTT WILLIAMS & WILKINS. 2021
  • Association Between Rehabilitation and Functional Outcomes of Stroke Survivors: A Population-Based Study Azizi, Z., Alipour, P., Rotondi, M., Ardern, C. LIPPINCOTT WILLIAMS & WILKINS. 2021
  • EFFECT OF SINUS NODE DYSFUNCTION ON RECURRENCE OF ATRIAL FIBRILLATION IN PATIENTS UNDERGOING PULMONARY VEIN ANTRUM ISOLATION Alipour, P., Azizi, Z., Malcolm, R., et al 2021
  • Identification and inclusion of gender factors in retrospective cohort studies: the GOING-FWD framework BMJ GLOBAL HEALTH Raparelli, V., Norris, C. M., Bender, U., Herrero, M., Kautzky-Willer, A., Kublickiene, K., El Emam, K., Pilote, L., GOING FWD Collaborators 2021; 6 (4)

    Abstract

    Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men and gender diverse people. Gender-related factors are seldom assessed as determinants of health outcomes, despite their powerful contribution. The Gender Outcomes INternational Group: to Further Well-being Development (GOING-FWD) project developed a standard five-step methodology applicable to retrospectively identify gender-related factors and assess their relationship to outcomes across selected cohorts of non-communicable chronic diseases from Austria, Canada, Spain, Sweden. Step 1 (identification of gender-related variables): Based on the gender framework of the Women Health Research Network (ie, identity, role, relations and institutionalised gender), and available literature for a certain disease, an optimal 'wish-list' of gender-related variables was created and discussed by experts. Step 2 (definition of outcomes): Data dictionaries were screened for clinical and patient-relevant outcomes, using the International Consortium for Health Outcome Measurement framework. Step 3 (building of feasible final list): a cross-validation between variables per database and the 'wish-list' was performed. Step 4 (retrospective data harmonisation): The harmonisation potential of variables was evaluated. Step 5 (definition of data structure and analysis): The following analytic strategies were identified: (1) local analysis of data not transferable followed by a meta-analysis combining study-level estimates; (2) centrally performed federated analysis of data, with the individual-level participant data remaining on local servers; (3) synthesising the data locally and performing a pooled analysis on the synthetic data and (4) central analysis of pooled transferable data. The application of the GOING-FWD multistep approach can help guide investigators to analyse gender and its impact on outcomes in previously collected data.

    View details for DOI 10.1136/bmjgh-2021-005413

    View details for Web of Science ID 000639750200001

    View details for PubMedID 33836996

    View details for PubMedCentralID PMC8043043

  • ROLE OF SEX AND GENDER IN ACCESS TO CARE AND CARDIOVASCULAR COMPLICATIONS OF INDIVIDUALS WITH DIABETES MELLITUS Azizi, Z., Gisinger, T., Alipour, P., et al 2021
  • Sex, Gender Factors and Cardiovascular Health in Canadian and Austrian Populations Azizi, Z., Gisinger, T., Bender, U., Raparelli, V., Norris, C. M., Kublickiene, K., Herrero, M. T., El Emam, K., Kautzky-Willer, A., Pilote, L., GOING-FWD Investigators LIPPINCOTT WILLIAMS & WILKINS. 2020
  • HSP70/IL-2 Treated NK Cells Effectively Cross the Blood Brain Barrier and Target Tumor Cells in a Rat Model of Induced Glioblastoma Multiforme (GBM) INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES Sharifzad, F., Mardpour, S., Mardpour, S., Fakharian, E., Taghikhani, A., Sharifzad, A., Kiani, S., Heydarian, Y., Los, M. J., Azizi, Z., Ghavami, S., Hamidieh, A., Ebrahimi, M. 2020; 21 (7)

    Abstract

    Natural killer (NK) cell therapy is one of the most promising treatments for Glioblastoma Multiforme (GBM). However, this emerging technology is limited by the availability of sufficient numbers of fully functional cells. Here, we investigated the efficacy of NK cells that were expanded and treated by interleukin-2 (IL-2) and heat shock protein 70 (HSP70), both in vitro and in vivo. Proliferation and cytotoxicity assays were used to assess the functionality of NK cells in vitro, after which treated and naïve NK cells were administrated intracranially and systemically to compare the potential antitumor activities in our in vivo rat GBM models. In vitro assays provided strong evidence of NK cell efficacy against C6 tumor cells. In vivo tracking of NK cells showed efficient homing around and within the tumor site. Furthermore, significant amelioration of the tumor in rats treated with HSP70/Il-2-treated NK cells as compared to those subjected to nontreated NK cells, as confirmed by MRI, proved the efficacy of adoptive NK cell therapy. Moreover, results obtained with systemic injection confirmed migration of activated NK cells over the blood brain barrier and subsequent targeting of GBM tumor cells. Our data suggest that administration of HSP70/Il-2-treated NK cells may be a promising therapeutic approach to be considered in the treatment of GBM.

    View details for DOI 10.3390/ijms21072263

    View details for Web of Science ID 000535574200005

    View details for PubMedID 32218162

    View details for PubMedCentralID PMC7178276

  • Sex and gender factors and the cardiovascular health of canadians Azizi, Z., Bender, U., Tadiri, C., et al 2020
  • Effectiveness of atrial fibrillation ablation using a contact force stability module with contact force or non-contact force catheter Khaykin, Y., Alipour, P., Azizi, Z., et al 2020
  • Relationship Between CHA2DS2-VASc Score and Long-Term Outcome of Catheter Ablation in Patients With Atrial Fibrillation Azizi, Z., Alipour, P., Khaykin, Y., Jansen, C., Avoulov, A., Donegan, S., Lightstone, H., Morris, S., Tamjidi, S., Nath, S., Chiocchini, A., Terricabras, M., Verma, A. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Evaluating The Rate Of Coumadin Prescription In The Era Of Direct Oral Anticoagulants Shamiss, Y., Alipour, P., Azizi, Z., Tohidi, H., Jansen, C., Shusterman, A., Varah, N., Donegan, S., Nath, S., Avoulov, A., Tamjidi, S., Lightstone, H., Morris, S., Khaykin, Y. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • EVALUATION OF NOVEL ORAL ANTICOAGULANT PRESCRIPTION PATTERNS IN A TERTIARY CARE CLINIC Shamiss, Y., Alipour, P., Azizi, Z., Tohidi, H., Shusterman, A., Lightstone, H., Morris, S., Nath, S., Varah, N., Donegan, S., Avoulov, A., Jansen, C., Tamjidi, S., Khaykin, Y. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Predictors of Minimal Clinically Important Difference of Quality of Life and Severity Score Post Atrial Fibrillation Ablation Azizi, Z., Essebag, V., Alipour, P., Khaykin, Y., Leong-Sit, P., Sarrazin, J., Sturmer, M., Morillo, C. A., Terricabras, M., Amit, G., Roux, J., Verma, A. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • IMPACT OF EVIDENCE-BASED EMR POINT-OF-CARE ALERTS IN GUIDING MEDICAL THERAPY IN PATIENTS WITH CONGESTIVE HEART FAILURE Azizi, Z., Tohidi, H., Alipour, P., Sharifzad, A., Khaykin, Y. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Effects of Cognitive Behavioral and Psycho-Educational Therapy in Patients With Implantable Cardioverter Defibrillators: Systematic Review and Meta-Analysis of Randomized and Quasi-Experimental Trials Azizi, Z., Tohidi, H., Alipour, P., Pirbaglou, M., Ardern, C., Rotondi, M., Ritvo, P., Verma, A., Khaykin, Y. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Clinical Predictors of Ventricular Tachycardia Induced Cardiomyopathy Azizi, Z., Alipour, P., Tohidi, H., Khaykin, Y., Chiocchini, A., Terricabras, M., Verma, A. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Pseudoaneurysm of thoracic aorta presenting as inappropriate sinus tachycardia: a case report JOURNAL OF MEDICAL CASE REPORTS Azizi, Z., Alipour, P., Terricabras, M., Khaykin, Y. 2019; 13 (1): 239

    Abstract

    Pseudoaneurysm of thoracic aorta as a complication of blunt trauma to the chest, can present with a variety of symptoms due to mass compression effect. Here we report the first pseudoaneurysm of thoracic aorta presenting with chronic cough and inappropriate sinus tachycardia. The purpose of this case report is to highlight pseudoaneurysm of thoracic aorta as a rare differential diagnosis for inappropriate sinus tachycardia.Here we report a case of 29-year-old white woman, a nurse, with history of a motor vehicle accident. She initially presented to medical attention with inappropriate sinus tachycardia 2 years following the motor vehicle accident during her pregnancy. Six years later she underwent sinoatrial node modification after failing a number of medications. Days prior to the ablation she developed a mild cough which became constant within a week following ablation. A computed tomography scan of her chest performed as part of a workup revealed an outpouching of the inferomedial aspect of the aortic arch, which was compressing her left main bronchus. She underwent arch repair surgery and recovered without complications. Four years later she presented with significant symptomatic sinus bradycardia requiring pacemaker placement.This is the first reported case of thoracic pseudoaneurysm of aorta presenting with inappropriate sinus tachycardia due to compression of the vagal nerve and cough as a result of the left main bronchus compressive effect; it highlights the importance of considering structural abnormalities in a differential diagnosis of inappropriate sinus tachycardia before any interventions.

    View details for DOI 10.1186/s13256-019-2167-8

    View details for Web of Science ID 000704849200001

    View details for PubMedID 31375131

    View details for PubMedCentralID PMC6679445

  • Glioblastoma cancer stem cell biology: Potential theranostic targets DRUG RESISTANCE UPDATES Sharifzad, F., Ghavami, S., Verdi, J., Mardpour, S., Sisakht, M., Azizi, Z., Taghikhani, A., Los, M. J., Fakharian, E., Ebrahimi, M., Hamidieh, A. 2019; 42: 35-45

    Abstract

    Glioblastoma multiforme (GBM) is among the most incurable cancers. GBMs survival rate has not markedly improved, despite new radical surgery protocols, the introduction of new anticancer drugs, new treatment protocols, and advances in radiation techniques. The low efficacy of therapy, and short interval between remission and recurrence, could be attributed to the resistance of a small fraction of tumorigenic cells to treatment. The existence and importance of cancer stem cells (CSCs) is perceived by some as controversial. Experimental evidences suggest that the presence of therapy-resistant glioblastoma stem cells (GSCs) could explain tumor recurrence and metastasis. Some scientists, including most of the authors of this review, believe that GSCs are the driving force behind GBM relapses, whereas others however, question the existence of GSCs. Evidence has accumulated indicating that non-tumorigenic cancer cells with high heterogeneity, could undergo reprogramming and become GSCs. Hence, targeting GSCs as the "root cells" initiating malignancy has been proposed to eradicate this devastating disease. Most standard treatments fail to completely eradicate GSCs, which can then cause the recurrence of the disease. To effectively target GSCs, a comprehensive understanding of the biology of GSCs as well as the mechanisms by which these cells survive during treatment and develop into new tumor, is urgently needed. Herein, we provide an overview of the molecular features of GSCs, and elaborate how to facilitate their detection and efficient targeting for therapeutic interventions. We also discuss GBM classifications based on the molecular stem cell subtypes with a focus on potential therapeutic approaches.

    View details for DOI 10.1016/j.drup.2018.03.003

    View details for Web of Science ID 000466454400004

    View details for PubMedID 30877905

  • EVALUATING THE EFFECT OF VALSARTAN/SACUBITRIL VS DEVICE THERAPY IN HEALTHCARE RESOURCE UTILIZATION FOR PATIENTS WITH HEART FAILURE Azizi, Z., Tohidi, H., Alipour, P., et al 2019
  • Sleep and Cardiac Tachyarrhythmia: Results from the Cross-Sectional Sleep Heart Health Study Alipour, P., Azizi, Z., Khaykin, Y., et al 2019
  • Clinical predictors of ventricular tachycardia induced cardiomyopathy Azizi, Z., Khaykin, Y., Tohidi, H., et al 2019
  • BURDEN OF PATIENT-REPORTED ARRHYTHMIA FOLLOWING CATHETER ABLATION IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION Khaykin, Y., Azizi, Z., Alipour, P., et al 2019
  • Clinical Characteristics and Surgical Outcomes of Coronary Artery Aneurysm: A Case Series Multidisciplinary Cardiovascular Annals Azizi, Z., Baharestani, B., Gholampour Dehaki, M., Yaghoubi, A., Ghafarinejad, M., Sadeghpour Tabaei, A., Alizadeh Ghavidel, A. 2019; 10 (1)

    View details for DOI 10.5812/mca.89833

  • Predictors of Implantable Defibrillator Shock Delivery in Patients With Ischemic Cardiomyopathy Undergoing Ablation for Ventricular Tachycardia Alipour, P., Khaykin, Y., Azizi, Z., Terricabras, M., Pantano, A., Verma, A. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • An Analysis of the Hypothalamic-Pituitary-Adrenal Axis Functions in Cirrhotic Rats in Response to Surgical Stress. Surgery research and practice Yarigholi, F., Zare Mehrjardi, A., Azizi, Z., Baghai Wadji, M. 2018; 2018: 7606304

    Abstract

    The activation of hypothalamic-pituitary-adrenal (HPA) axis through severe diseases and stress courses leads to a rise in circulatory cortisol for an adequate response to stress. This axis is one of the important systems that involve in neuroendocrine response to the surgical stress. Hepatoadrenal syndrome that is a manifestation of adrenal insufficiency (AI) in the course of liver disease is described as insufficient production of steroid hormones mainly cortisol due to primary dysfunction of the adrenal gland or secondary malfunction of the HPA axis to provoke the adrenal gland leading to severe illness and increased mortality. Through this evidence, we presented this question as to whether cirrhotic patients have a greater mortality rate than other patients after surgery and if the HPA axis is partly responsible for this phenomenon. Also how the adrenal gland functions during surgery in cirrhotic rats. We conducted this study to assess the effect of cirrhosis on the HPA axis through surgery in cirrhotic rats by evaluating the changes in serum corticosterone level and blood sugar before, immediately, and 30 minutes after surgery.This study was performed in the animal lab approved by the Ethics Committee of Tehran University of Medical Sciences in 2014, on 25 male Wistar rats. Thioacetamide was used for induction of cirrhosis in rats with new method of monitoring weekly changes of rats' weight which had 100% success in procedure and reduction in mortality rate. Laparotomy was performed on all of the rats during 9-12 in the morning within 10-15 minutes. Laparotomy was chosen as surgical stress because of its simplicity and feasibility. Three blood samples were obtained from each rat immediately after inducing anesthesia, immediately after the conclusion of surgery, and 30 minutes after surgery. The plasma concentration of corticosterone was measured with enzyme-linked immunosorbent assay test. P value of 0.05 or less was considered as statistical significance.Cirrhotic rat group consisted of 15 rats and control group consisted of 10 rats. There was a significant difference in the mean level of corticosterone and blood sugar between the cirrhotic rat group and control group in the 3 time levels (P=0.044/P < 0.001). Pairwise comparison of mean corticosterone and blood sugar levels between case (mean: 249.359 ± 3.90) and control (mean: 262.40 ± 4.69) showed a significant difference (P=0.04, 95% CI = 0.30-25.79/P < 0.001, 95% CI = 129.62-233.96). Unlike the control group, the level of serum corticosterone was compared in the cirrhotic rat group (group 1) before, immediately, and 30 minutes after surgery, which showed a significant difference in our study (P value  = 0.005). However, this result was also significant in comparing the blood sugar in 3 time levels of surgery in the control group (P value < 0.001) but not in the cirrhotic rat group (P value = 0.233).There was a significant rise in corticosterone levels during 3 time levels of surgery in cirrhotic rats; nevertheless, this elevation was significantly lower than the control group. Also the mean level of blood sugar was higher in the control group than in cirrhotic rats. However, this difference was significant in comparison with the same times of surgery between the two groups. These results approximately can substantiate our hypothesis that AI in the field of cirrhosis would also affect the response of HPA axis to stress during and after surgery that can be concomitant with higher rate of cardiovascular unsteadiness incidences, deteriorating the severity of illness and rise in mortality rate.

    View details for DOI 10.1155/2018/7606304

    View details for PubMedID 30050969

    View details for PubMedCentralID PMC6046119

  • VALIDATION OF OBJECTIVE SOFTWARE-BASED LESION DEMARCATION SYSTEM DURING PULMONARY VEIN ANTRUM ISOLATION Alipour, P., Khaykin, Y., Azizi, Z., Pirbaglou, M., Morris, S., Avoulov, A., Nath, S., Nath, N., Motamed, M., Forman, J., Mallany, P., Ritvo, P., Pantano, A., Verma, A. ELSEVIER SCIENCE INC. 2018: 381
  • QUALITY OF LIFE POST AF ABLATION AND RELATIONSHIP TO OUTCOME AND AF BURDEN Azizi, Z., Verma, A., Alipour, P., Khaykin, Y., Leong-Sit, P., Sarrazin, J., Sturmer, M., Patterson, S., Morillo, C., Amit, G., Roux, J., Essebag, V. ELSEVIER SCIENCE INC. 2018: 379
  • Differentiation of Crohn's disease and ulcerative colitis in comparison with healthy controls using intestinal wall thickness of the colon: A diagnostic accuracy study of endoscopic ultrasonography Roushan, N., Niksirat, A., Daryani, N., Azizi, Z., Pournaghshband, H. OXFORD UNIV PRESS. 2018: S245-S246
  • HEALTHCARE RELATED COSTS ASSOCIATED WITH RADIOFREQUENCY VERSUS CRYOBALLOON CATHETER ABLATION: FIRE AND ICE TRIAL CANADIAN HEALTH ECONOMIC STUDY Alipour, P., Azizi, Z., Anderson, C., , et al 2018
  • REDUCTION OF HEMATOMA INCIDENTS BY APPLICATION OF FIGURE-OF-8 SUTURE AT THE ACCESS SITE POST CATHETER ABLATION Alipour, P., Azizi, Z., Khyakin, Y. 2018
  • RISKS OF CONCOMITANT ATRIAL FIBRILLATION WITH IDIOPATHIC VENTRICULAR TACHYCARDIA Azizi, Z., Terricabras, M., Alipour, P., et al 2018
  • RELATIONSHIP BETWEEN QUALITY OF LIFE MEASURES WITH ATRIAL FIBRILLATION BURDEN AND ABLATION OUTCOME: CAPCOST MULTICENTER COHORT SUB-STUDY Azizi, Z., Verma, A., Terricabras, M., et al 2018
  • HEALTHCARE RESOURCE UTILIZATION IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH CATHETER ABLATION: THE EFFECT OF RECURRENCE AND AF BURDEN Azizi, Z., Verma, A., Terricabras, M., Khaykin, Y., Alipour, P., et al 2018
  • Multicenter Prospective Study Comparing Phased Multipolar versus Traditional Radiofrequency Ablation Azizi, Z., Verma, A., Alipour, P., Khaykin, Y., Leong-Sit, P., Sarrazin, J., Sturmer, M., Patterson, S., Morillo, C., Amit, G., Roux, J., Essebag, V. LIPPINCOTT WILLIAMS & WILKINS. 2017
  • EVALUATION OF LONG-TERM SUCCESS RATE OF OUTFLOW TRACT ABLATION IN PATIENTS WITH VENTRICULAR TACHYCARDIA Alipour, P., Khaykin, Y., Azizi, Z., Michailidis, D., Sharifzad, A., Nath, N., Michaelov, E., Mallany, P., Conti, S., Pantano, A., Verma, A. ELSEVIER SCIENCE INC. 2017: 403
  • EFFECTS OF INDUCTION BEFORE VENTRICULAR TACHYCARDIA ABLATION ON LONG-TERM SUCCESS RATE Alipour, P., Khaykin, Y., Azizi, Z., Sharifzad, A., Michailidis, D., Mallany, P., Michaelov, E., Nath, N., Pantano, A., Verma, A. ELSEVIER SCIENCE INC. 2017: 542
  • DETERMINATION OF THE IDEAL CONTACT FORCE REQUIRED DURING PULMONARY VEIN ANTRUM ISOLATION (PVAI) Alipour, P., Khaykin, Y., Azizi, Z., Pirbaglou, M., Conti, S., Ritvo, P., Pantano, A., Verma, A. ELSEVIER SCIENCE INC. 2017: 402
  • A Feasibility Pilot Study to Assess the Efficacy of NavX Guided Detection of Pulmonary Vein Electrograms during Atrial Fibrillation Ablation Int J Clin Cardiol Khaykin, Y., Alipour, P., Ritvo, P., Azizi, Z., Wulffhart, Z., et al 2017; 4 (3)
  • Determination of Ideal Radiofrequency Delivery Parameters, and Areas With High Risk of Pulmonary Vein Reconnection in Patients With Atrial Fibrillation Undergoing Pulmonary Vein Antrum Isolation Alipour, P., Khaykin, Y., Conti, S., Azizi, Z., Pirbaglou, M., Ritvo, P., Pantano, A., Verma, A. LIPPINCOTT WILLIAMS & WILKINS. 2016
  • SHORT TERM AND LONG TERM FOLLOW UP OF CORONARY ARTERY BYPASS GRAFT(CABG) PATIENTS BY 256-SLICE MULTI-DETECTOR CT ANGIOGRAPHY: ASSESSMENT OF PATENCY AND PREDICTORS OF GRAFT OCCLUSION Azizi, Z., Ghavidel, A., Mohammadzadeh, A., Salehian, R. ELSEVIER SCIENCE INC. 2016: 1746
  • Association of colonic mucosal infiltration of IgG4 plasma cells with ulcerative colitis activity and presence of primary sclerosing cholangitis Alborzi, F., Azizi, Z., Daryani, N., Ardalan, F., Aletaha, N., Taslimi, R., Roshan, N. OXFORD UNIV PRESS. 2016: S125
  • Risk factors of primary sclerosing cholangitis and cirrhosis in ulcerative colitis Azizi, Z., Farbod, Y., Javid, S., Daryani, N., Basirat, V. OXFORD UNIV PRESS. 2016: S202
  • Tricuspid Regurgitation Dilemma: A Comparison Study between Surgical Versus Medical Management of Patients with Tricuspid Regurgitation Multidisciplinary Cardiovascular Annals Sadeghpour, A., Alizadehasl, A., Azizi, Z., Alizadeh Ghavidel, A. 2016; 7 (1)

    View details for DOI 10.17795/mcardia.9469

  • WHAT IS THE SUCCESS RATE OF PULMONARY VEIN ISOLATION? Alipour, P., Khaykin, Y., Azizi, Z., et al 2016