Serum neopterin level in patients with coronary artery ectasia with or without stenosis

Coronary artery ectasia [CAE] is an uncommon angiographic finding, the prevalence in most series ranges from 1.2% to 5.3%. CAE was defined as arterial segment with a diameter of at least 1.5 times the diameter of adjacent normal coronary artery segment. Atherosclerosis is the most common cause of CAE and there is a high association of CAE with stenotic coronary artery disease. CAE is not an innocent condition even in the patients with pure ectasia without stenosis. It may present by chronic stable angina pectoris, unstable angina, myocardial infarction and heart failure. Immune cells appear to be critical in development of atherosclerosis. High levels of neopterin were found in patients with chronic stable angina pectoris and acute coronary syndromes. Correlation of serum neopterin levels to the presence of CAE in patients with stable coronary artery disease. Forty patients referred to cardiac catheterization unit for evaluation of typical stable angina pectoris, were divided into three groups: Group A [15 patients] of pure ectasia, Group B [15 patients] of CAE associated with stenosis and Group C [10 patients] of stenotic lesions only. Each patient in the three groups was subjected to coronary angiography, and measurement of serum neopterin level by ELISA technique. Neopterin levels were elevated in the three studied groups but were significantly higher in patients with two and three vessels lesions than in patients with one vessel lesion. Also neopterin levels were significantly higher in ectasia with slow flow than in ectasia without slow flow. Inflammation seems to play a major role in the etiology of CAE as well as coronary artery stenosis. Neopterin level is related to the severity of the disease. Also it seems that there is more activation of the immune system in ectasia with slow flow than in ectasia without slow flow as neopterin level was higher in ectasia with slow flow than ectasia without slow flow

Evaluation of efficacy of beta blockers administered early in acute myocardial infraction

In order to evaluate the efficacy and safety of early intravenous blockers in acute myocardial infarction [AMI], 51 patients with AMI were included and divided into 3 groups. Group 1 [21 patients] who received I.V. Popranolol [P] 0.1 mg/kg, then orally 20 mg in divided doses to keep the heart rate at 60/min. thereafter. Group 2 [10 patients] who received I.V. Metoprolol [M] 15 mg in 3 doses then 100 mg/12 hours orally till discharge, and group 3 [20 patients] who served as control group. No difference was noted between the 3 groups as regards base line to medications,. etc. Chest pain relief was easier in groups 1 and 2 than group 3. Chest pain recurrence was 25% in group 1, 20% in group 2 and 50% in group 3 [P >0.05 + trend]. Infarct extension occurred in 2 patients of control group but no in patients in groups 1 and 2. Ventricular arrhythmia was noted in 21 patients [10%] of group 1, one [10%] of group 2 and 5 [25%] of group 3 [P >0.05 + trend]. Left ventricular failure was noted in 4 patients [20%] of group 1, 2 [20%] of group 2 and 7 [35%] of group 3 [P >0.05 + trend]. Significant reduction of heart rate and blood pressure was noted in groups 1 and 2 versus group 3. Serum CPK level was lower in groups 1 and 2 than in group 3. However, echocardiography failed to identify improved left ventricular function in groups 1 and 2 versus group 3. Despite that the beneficial effects of beta-blockers were not showed to be significant at statistical level in the study [only trends], this may be attributed to the small number of patients in each group. It could be concluded that early use of 4 beta-blockers [P] or [M] is safe and beneficial in AMI resulting in smaller infarct size, less incidence of recurrent angina, infarct extension and lower risk of ventricular arrhythmias