Serum sP-selectin level and brachial artery flow mediated dilation as predictors of no reflow in patients with ST segment elevation myocardial infarction undergoing primary PCI

Background: No reflow phenomenon is associated with major adverse cardiac events, prediction of no reflow using laboratory and noninvasive imaging techniques can help in early prevention and management of this phenomenon

Objectives: To investigate the predictive value of serum sP-selectin and endothelial dysfunction assessed by using brachial artery flow mediated dilation [FMD] in patients with STEMI undergoing primary PCI to address patients with high incidence of no reflow

Methods: The prognostic performance, clinical and angiographic correlates of sP-selectin and FMD was assessed in 96 patients admitted in National Heart Institute and Ain Shams University Hospitals by STEMI and underwent primary PCI as a reperfusion strategy. Each patient was subjected to [history taking, clinical examination, laboratory investigations including withdrawal of serum samples for detection of sP-selectin levels, echocardio-graphy, assessment of endothelial dysfunction by measuring the FMD, assessment of the angiographic results using TIMI flow grade and myocardial blush grade. Follow up of the patients during hospital stay and after one month for the incidence of MACE

Results: A significant correlation between patients with high serum sP-selectin and TIMI flow

Conclusions: Serum sP-selectin level in patients with STEMI treated by primary PCI can predict the patients who will develop no reflow phenomenon after PCI, FMD could not predict the incidence of no reflow among those patients

Short term outcome of carotid artery angioplasty and stenting with cerebral protection devices

Management of carotid bifurcation stenosis is a cornerstone of stroke prevention. Carotid artery stenting [CAS] is now used as an alternative to surgical endarterectomy. To evaluate short term outcome of CAS with the use of cerebral protection devices as well as assess the impact of various adverse anatomical features of the aortic arch and culprit carotid lesion oil difficulty and rate of complication during CAS procedures. The study included consecutive eligible patients with internal carotid artery [ICA] stenosis with >/= 50% in symptomatic stenosis and >/= 70% in asymptomatic stenosis presented to the catheterization labs of Catania and Ragusa hospitals during the period from October 2009 till May 2011. According to the anatomical adverse characteristics, the patients were classified into 4 groups: group I represented the least anatomical complexity while group IV represented the most complex anatomical features. Data of the CAS procedures and intra-procedural complications as well as during the 1st month after the procedures were collected and studied. The study included 104 ICA lesions in 100 consecutive eligible patients. Seventy-one males and twenty-nine females, mean age 71.9 +/- 7.85 years and 21 patients were >/= 80 years old [octogenarians]. Most of the patients had asymptomatic ICA stenosis [76%] while 24% of patients had symptomatic ICA stenosis. Technical success was obtained in 103 procedures [99%], failed one procedure due to complex anatomical features. Combined cerebrovascular events had occurred in 5 patients [1 major stroke, 1 minor stroke and 3 transient ischemic attacks] with estimated rate 4.8%. No cases of amaurosis fugax, myocardial infarction or death had occurred. Symptomatic patients had stroke rate of 4.1% while stroke rate in asymptomatic patients was 1.3%. Adverse events showed significant statistical difference with increased anatomical complexity [P < 0.001]. Cerebrovascular events in symptomatic patients did not show significant statistical difference in comparison to asymptomatic patients [P = 0.064]. CAS procedures in octogenarians [>/=80 years] showed no significant statistical difference with the number of cerebrovascular adverse events [P = 0.285]. CAS is a relatively safe procedure could be done with low incidence of complications when performed by trained operators. Evaluation of the anatomical characteristics has an important impact oil procedural difficulty and complications

Predictors of asymptomatic cardiac events and prognostic value of cardiac biomarkers in chronic kidney disease patients

Patients with chronic kidney disease [CKD] are at increased risk of cardiovascular events; cardiovascular disease is a leading cause of death in patients with chronic kidney disease; Circulating biomarkers play a major role in the early detection of cardiovascular disease in those patients. To clarify the prevalence of asymptomatic different cardiac events in CKD and to explore the degree of elevation of N- terminal-pro-B-type Natriuretic Peptide [NT-pro-BNP] in asymptomatic cardiac patients with varying degree of CKD and the relationship between the elevation of this biomarker and the occurrence of these cardiac complications. This case-control study included 40 CKD patients and 40 controls; patients were recruited from nephrology unit of internal medicine department; Assiut university hospital; known to have chronic kidney disease in different grades [grade I- grade V]. Resting transthoracic echocardiography [TTE] and plasma NT-pro-BNP concentrations were measured in patients who were asymptomatic for clinical evidence of any cardiac events, [n=40; mean age 47.63 +/- 17.93 years; 52.5%were males] as well as healthy volunteers n=40; mean age 42.00 +/- 13.25; 62% were males]. In addition, the correlation between plasma NT-pro-BNP concentration and parameters of echocardiography was examined. Increased prevalence of left ventricular hypertrophy [LVH] [70%]; left ventricular diastolic dysfunction [77.5%], left ventricular systolic dysfunction [17.5%] and coronary artery disease [27.5%] in CKD patients as well as serum NT-pro-BNP levels in the patients were significantly higher [6703.75 +/- 2947.68 pg/ml] than those in healthy volunteers [124.83 +/- 140.40 pg/ml] [p=0.000]. NT-pro-BNP level was higher also in patients who had hypertension [p=0.002]; anemia [p-0.004]; hypoalbuminamia [p=0.000];left ventricular hypertrophy [LVH] [7873. 57 +/- 2719. 31 pg/ml] [p = 0.000], diastolic dysfunction [7524. 52 +/- 2824.74 pg/ml] [p= 0.000]; systolic dysfunction [10371.43 +/- 2771.71] [p=0.000] and patients who had segmental wall motion abnormality [SWMA] [8709.0.9 +/- 3512.3.9] [p=0.000] and correlate Positively with C reactive protein [CRP] level [r-0.751 p=0.000]; left ventricular mass [LVM] [r=0.772 p=0.000] and left ventricular mass index [LVMI] [r=0.715 p=0.000] and negatively with ejection fraction [EF] by echocardiography [r=-0.483 p=0.000]. NT-pro-BNP level elevation in asymptomatic patients with CKD reflects underlying cardiac dysfunction, ischemic heart disease and hypertrophy independent of renal function

combination of lowest hematocrit during cardiopulmonary bypass and acute renal injury after coronary artery bypass surgery

Acute renal insult is a common serious complication of cardiopulmonary bypass. Moderate hemodilution is thought to reduce the risk of kidney injury but the current practice of extreme hemodilution [hematocrit 22% to 24%] during cardiopulmonary bypass has been linked to adverse outcomes after cardiac surgery. Therefore we tested the hypothesis that lowest hematocrit during cardiopulmonary bypass is independently associated with acute renal injury after cardiac surgery. Demographic perioperative, and laboratory data were gathered for 140 primary elective coronary bypass surgery patients, preoperative and daily postoperative creatinine values were measured until hospital discharge. Stepwise multivariable linear regression analysis was performed to determine whether lowest hematocrit during cardiopulmonary bypass was independently associated with peak fractional change in creatinine [defined as the difference between the preoperative and peak postoperative creatinine represented as a percentage of the preoperative value]. A p value of less than 0.05 was considered significant. Multivariable analysis including preoperative hematocrit and other perioperative variables revealed that lowest hematocrit during cardiopulmonary bypass demonstrated a significant interaction with body weight and was highly associated with peak fractional change in serum creatinine [parameter estimate [PE] = 4.5; p 0.008] and also with highest postoperative creatinine value [PE = 0.06; p = 0.004]. Other renal risk factors were significant covariates in both models. These results add to concerns that current cardiopulmonary bypass management guidelines accepting extreme hemodilution may contribute to postoperative acute renal and other organ injury after cardiac surgery