Correlation between total plasma homocysteine level and grading of coronary artery disease

Elevated total plasma homocysteine [tHcy] levels constitute a risk factor for coronary artery disease [CAD]. A possible relationship was investigated between admission plasma homocysteine level and the angiographic severity and extension of coronary artery disease in patients with CAD. This study looks at the relationship between total plasma homocysteine and severity of coronary artery disease. From April 2006 to December 2006, 100 consecutive patients [65 male and 35 female] that referred to our institute for coronary artery bypass graft surgery enrolled. Fasting blood samples for homocysteine were obtained on admission. Plasma homocysteine concentration was measured with high-performance liquid chromatography [HPLC]. Our patients presented in Group 1, total plasma homocysteine >12 micromoles per liter and Group 2, total plasma homocysteine 60 years was correlated with high tHcy, but gender, hypertension, history of smoking, hypercholesterolemia, family history, and diabetes mellitus were not statistically difference between two groups. A positive correlation was found between abnormal plasma homocysteine level and vessel score [r = 0.35; p=0.002]. Moreover, a positive correlation was also found with extent score [r = 0.46; p =0.002]. As results of these scoring, there was a better correlation between the tHcy level and the extent of CAD when compared with the vessel score [r = 0.68, p < 0.001]. Abnormal elevated homocysteine levels in patients with coronary artery disease correlated with the extent of atherosclerotic disease

Therapeutic effect of transmyocardial laser revascularization [TMLR] in patients with chest pain and normal coronary angiography [cardiac syndrome X]

Patients with syndrome X coronary disease represent a heterogeneous group of patients. Medical treatment with dilators and calcium channel blockers are not very effective. We evaluated the use of transmyocardial laser revascularization [TMLR] in treating 5 patients with this syndrome. Between May 2002 to December 2005, 5 patients with cardiac syndrome X [mean age of 49.7 years] underwent TMLR. All our cases were postmenopausal women. Mean class of Canadian class of angina was 3.4. Patients were none responding to maximum medical treatment. Angiograms showed small coronary arties with a large gap between branches which corresponded with severe ischemic on Thallium scan. We used Co2 laser between 35 to 45 joules of energy and we made 20 to 30 channels on the beating heart controlled by trans-esophagus echocardiography. Our patients were followed for 2.8 years. During follow up our patients remained asymptomatic and without any need medical treatment. Mean of Canadian class of angina after intervention was 1.8. Our patients returned to full activities. TMLR is an effective treatment in patients with syndrome X and coronary insufficiency