Serum neopterin as a marker of severity of unstable angina

The current study aimed to assess serum neopterin level in patients with chronic stable angina and unstable angina and to assess the relation between neopterin concentration and complex coronary artery stenosis in patients with unstable angina. There is increasing evidence that inflammation plays an important role in atherogenesis and may determine plaque vulnerability. At angiography, disrupted or ulcerated plaques appear as complex stenosis. Plaque vulnerability has been shown to be a function of the increased local number of inflammatory cells within plaques, particularly activated macrophages and lymphocytes. Neopterin is a pterydine derivative produced by activated macrophages, so it can be used as a marker for severity in patients with unstable angina. Fourty patients were involved in this study [30 patients with the diagnosis of unstable angina and 10 patients with the diagnosis of chronic stable angina], ten healthy subjects of matched age and sex were involved as control group. All members of the study were subjected to complete medical history, general and local cardiac examination, 12 lead ECG, echocardiography, and the following laboratory investigations: CK and CKMB, C-reactive protien, Neopterin level, serum cholesterol, LDL, HDL, triglycerides, creatinine, urea and blood glucose. Coronary angiography was done to all members of group 1 [patients with the diagnosis of unstable angina]. Our study revealed that: Neopterin level was significantly higher in patients with ischaemic heart disease than in healthy controls. It was also significantly higher in patients with unstable angina than in patients with chronic stable angina. Neopterin and CRP levels were significantly correlated with the presence of multiple complex lesions in angiography. There is a strong association between neopterin level and the number of complex lesions in angiography in patients with unstable angina, so, it can be used in risk stratification in these patients

Assessment of diastolic and systolic left ventricular function by tissue doppler imaging in patients with type 2 diabetes mellitus: predictive value of B-natriuretic peptide

We sought to valuate left ventricular [LV] diastolic and systolic function in asymptomatic patients with type 2 diabetis mellitus [DM] using tissue Doppler [TD] analysis of mitral annulus dynamics and to investigate the potential value of brain natruretic peptide [BNP] as an early marker of systolic and/or diastolic failure in this group of patients. Epidemiologicall data document a greater risk of cardiovascular morbidity and mortality, particularly congestive heart failure [CHF], in patients with DM. Since BNP is a marker of early heart failure, it may serve to identify diabetic patients with preclinical abnormalities before progression to clinically evident diabetic cardiomyopathy. We studied 39 patients with type 2 DM [DM group] aged 37 to 70 years; without evidence of diabetic compications, hypertension, coronary artery disease, CHF, thyroid or overt renal disease and 15 age and sex matched healthy subjects [control]. Peak velocity and time-velocity integral were measured from TD tracings at the septal and lateral borders of the mitral annulus and the timing of the velocities in relation to the electrocardiogram. BNP was measured in plasma by chromatographic purification and separation using microseparation column C18 followed by enzyme immunoassat.The lateral TD systolic[S[ann]] velocity was significantly lower in DM group compared to controls [10.1 +/- 1.9 vs.11.5 +/- 2.0cm/sec.respectively;p> 0.005]. The septal and lateral TD early diastolic velocities E[ann] were significantly lower in DM group compared to controls [8.3 +/- 2.2 vs. 12.1 +/- 3cm/sec and12.1 +/- 3.8 vs. 17.5 +/- 3.8cm/sec respectively; both p> 0.00.01]. Thesetal and lateral TD time-velocity integral of E[ann] were significantly lower in DM group compared to controls [0.7+/0.3 vs.> 0.0001]. The septal and lateral TD early to late diastolic velocity ratio E[ann] /A[ann] were significantly lower in DM group compared to controls [0.8 +/- 0.3 vs. 1.4 +/- 0.5 cm and 1.1 +/- 0.5 vs. 1.9 +/- 0.6 cm respectively; both p> 0.0001]. Septal TD showed significantly prolonged regional ios-volumic relaxation time in DM group compared to controls [78.6 +/- 13.5 vs. 64.3 +/- 13.4msec respectively; p> 0.0001]. Plasma BNP level was significantly higher in DM group compared to controls [311.2 +/- 112.6 vs.38.2 +/- 4.8 pg/ml respectively; p> 0.0001].A significant negative correlation was detected between plasma BNP level and septal TD S[ann] velocity [r = -0.6; p> 0.001].A significant negative correlation was also detected between plasma BNP level and lateral and septal TD E[ann]/A[ann] velocity ratio [both r = -0.5; p> 0.001].Mistral annular contraction and relaxation velocities detected by TD imaging, are reduced in patients with type 2 DM compared to controls. The significantly higher plasma BNP level identified in diabetics correlated well with the degree of systolic and diastolic dysfunction detected by TD analysis of mitral annulus dynamics and so may be a useful marker for early heart failure in this group of patients