Role of novel cardiac biomarkers in prediction, diagnosis, and severity assessment of atherosclerotic coronary artery disease

Atherosclerotic cardiovascular disease is a major health problem around the world. Insulin resistance assessed by homeostatic model assessment of insulin resistance [HOMA-IR], triglyceride/ HDL, serum high sensitive C-reactive protein [hs-CRP], and HbA1c are probably associated with atherosclerosis. The aim of this study was to find if there was an association between HOMA-IR, triglyceride/ HDL ratio and their product as well as hs-CRP and HbA1c with the presence and the severity of coronary artery disease and to find the best cut off value for clinical practice. The study involved 170 consecutive patients with suspected or known CAD referred for coronary angiography divided into two groups; CAD group [Group I] and non CAD group [Group II] based on coronary angiography. The blood samples including HbA1c, hs-c-reactive protein, fasting blood glucose creatinine, urea, insulin and lipid spectrum were obtained after overnight fasting. Patients with CAD had higher HOMA-IR than those no CAD [4.47 +/- 4.26 vs. 2.49 +/- 1.99, p=0.002]. Stepwise multiple logistic regression analysis demonstrated that HOMA-IR > 2.66 was independently associated with CAD [odds ratio: 3.057 ; 95% confidence interval: 1.211-7.717; p=0.018] after adjustment for age, male sex, diabetes and waist circumference. HOMA-IR correlates positively with BMI [p=0.008 and r=0.227], waist circumference [p=0.002 and r=0.267] and HbA1c [p=0.015 and r=0.213]. Also HOMA-IRxTG/HDL was higher in patients with CAD compared to those no CAD [18.35 +/- 22.72 vs, 9.50 +/- 10.50, p=0.018]. However there were insignificant differences in levels of triglyceride/HDL, HbA1c, and hs-CRP among both groups [p= 0.124, 0.523, 0.250 and 0.764 respectively]. HOMI-IR was significantly higher in patients with DVD [Double-vessel Disease] and MVD [Milti-vessel Disease] compared to patients with no CAD [p=0.002 and 0.000 respectively]. Moreover HOMA-IR was significantly higher in patients with DVD and MVD compared to patients with SVD [Single-vessel Disease] [P=0.035, 0.001 respectively]. HOMA-IR x TG/HDL was significantly increased in DVD and MVD patients [P=0.012 and 0.001 respectively] compared to patients with no CAD and also when compared to patients with SVD [P=0.005 and 0.000 respectively]. HOMA-IR is considered as a marker for prediction of CAD and severity assessment

64- row multislice computed tomography assisted percutaneous coronary intervention versus non-assisted percutaneous coronary intervention of chronic total occlusion; a randomized controlled trial

The role of MSCT coronary angiography in assistance and guidance of PCI of CTO has been studied in multiple small registries and prospective studies but up till now there is no randomized trial testing this issue. We performed this randomized trial to study the effect of MSCT coronary angiography on the success rate of PCI of CTO and whether it decreases or increases the exposure to radiation and contrast media during PCI. Forty patients were randomized to direct PCI group and MSCT assisted PCI group [20 patients each]. Although MSCT gave a better understanding of the morphologic CTO characteristics and could predict accurately procedural failure, this was not reflected on the success rate and there was no difference between both groups regarding success rate, radiation exposure nor the used contrast media volume during PCI Moreover the patients in the MSCT group were exposed to an extra-dose of radiation and contrast media during MSCT examination. preprocedural MSCT coronary angiography before PCI of CTO did not affect the success rate of the CTO recanalization. MSCT is an excellent predictor of procedural failure of CTO recanalization but at the expense of high dose of radiation exposure and increased usage of contrast media volume

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

Prognostic significance of high sensitivity C-reactive protein before and after percutaneous coronary intervention in patients with angina pectoris

C-reactive protein is an easily measurable acute phase reactant synthesized by hepatocytes in respone to pro-inflammatory cytokines. Elevated CRP has been identified as a strong predictor of prognosis in healthy individuals, in patients with stable angina, in unstable angina and in patients after acute myocardial infarction. The prognostic significance of high sensitivity CRP level in percutaneous coronary intervention is unclear. We prospectively studied 41 patients with chronic stable angina [28 patients] and unstable angina [13 patients] who underwent elective coronary stenting. All patients had normal troponin level before the procedure. Blood samples for hs-CRP were obtained before the procedure, 24 hours and 1 month after the procedure. Mean hs-CRP before the procedure in all patients who underwent PCI was 2.38 +/- 2.21 microg/ml. the mean hs-CRP 24 hours post procedure was 7.43=10.6 microg/ml. The mean hs-CRP after 1 month was 11.8=13.5 microg/ml. there was significant difference between pre procedural hs-CRP and 24 hours post procedural [P=0.007]and there was significant difference between pre procedural hs-CRP and 1 month post procedural [P=0.000]. At follow up period [1 month]. No major adverse cardiac events [MACE] have occurred. However, 24 patients complained of chest pain. There was no significant correlation between either pre-procedural, or 24 hours post procedure hs-CRP and chest pain [r=0.13, 0.2 respectively] Mechanical disruption of atherosclerotic plaque during coronary stent implantation causesasystemic inflammatory respone. We did not find that measuring hs-CRP level pre or post procedural is useful for predicting 30 days cardiac events

Systemic and transcardiac platelet behaviour in acute coronary syndromes: the link between platelet physical parameters and platelet function

This study investigated the link between platelet physical parameters [platelet count, mean platelet volume, platelet volume distribution and platelet function in vitro [as platelet aggregation] and in vivo [as cutaneous bleeding time]] in twenty patients with unstable angina [UA] and thirty patients with acute myocardial infarction [AMI] on admission and serially for two weeks. Twenty patients with stable angina [SA] and twenty normal volunteers [NV] were used as controls. Ten patients with UA and frequent spontaneous attacks of chest pain were instrumented with left coronary artery and coronary sinus catheters for simultaneous measurements of platelet parameters. Comparison of platelet parameters in coronary arterial and venous blood indicated that large platelets are the likely consumed platelets across the ischemic zone. This was partially response for the lower platelet count, the smaller mean platelet volume, the leftward shift of platelet volume distribution and reduced platelet aggregability in coronary sinus blood. Strikingly, in patients with UA and AMI, garlic intake in a dose of 600 mg tds for two weeks was associated with a consistent increase in platelet count, decrease in platelet volume and leftward shift of volume distribution as well as a concomitant improvement of platelet function. Conversely, patients with AMI who received no garlic showed less significant changes during the follow up period

Identification of cardiovascular abnormalities in children with empyema thoracis by two-Dimensional and doppler echocardiography

Echocardiographic assessment of children with empyema has not previously been reported in the literature. Two-dimensional and Doppler echocardiography were performed in 47 children with acute [n=23] and chronic [n=24] empyema and 34 control subjects. Echocardiography demonstrated pericardial effusion in 11/47 patients [23%]. Those with acute empyema had significantly thicker pericardium [p < 0.009] than control subjects. tricuspid regurgitation was present in 21/47 patients [45%]. The mean right ventricular internal dimension in diastole [RVID] was significantly larger in acute [p < 0.006] empyema than that of control subjects. the mean tricuspid pressure gradients indicated on elevated mean right ventricular systolic pressure with increased calculated mean pulmonary arterial systolic pressures of children with acute empyema [38.5 +/- 6.4 mmHg] and chronic [39.8 +/- 5.6 mmHg] empyema than the normal mean [20 +/- 4 mmHg] reported by Krovetz and Goldblom. Children with chronic empyema had significantly less mean left ventricular internal dimension in diastole [LVID] [p < 0.005] and in systole [LVIS] [p < 0.02] than control subjects. strikingly, their mean left ventricular mass was also significantly less [p < 0.05] than that of either acute empyema or control subjects. these results provide base line data for follow up of children with acute and chonic empyema

Pulmonary heart disease in children with obstructive apnea syndrome: postoperative follow-up

Sporadic reports of advanced cor pulmonale secondary to obstructive sleep apnea syndrome [OSAS] in children were found in literature. Therefore, the present study was designed to evaluate early cardiopulmonary changes in 35 children with OSAS secondary to adenotonsillar hypertrophy using M-mode, two-dimensional and Doppler echocardiography and arterial blood gas analysis. A group of 35 age and sex-matched healthy Children were used as a control group. Their mean age was 4.3 +/- 1.5 years. Clinical, electrocardiographic and chest rontgenographic evaluation revealed evidence of right ventricular hypertrophy in 6 and cardiomegaly in and children with OSAS. Twenty seven children showed no clinical evidence of cardiac involvement. Tricuspid regurgitation was detected in 65.7% of cases. The right ventricular end diastolic diameter [RVD] was greater than the upper confidence limit of normal in 17 children. Pulmonary systolic pressure [PSP] ranged from 17.2 to 55 mmHg [mean 37.2 +/- 10.6 mmHg] and was above the 95% condifence limit of normal in 18 [51.4%] children. Arterial blood gas analysis revealed alveolar hypoventilation. Children with hypoxaemia had increased both RVD [P < 0.004] and PSP [P < 0.002] but decreased left ventricular egection fraction [EF] [p < 0.05] compared with those without hypoxaemia. Children with hypercapnia [PaCO2 > 45 mmHg] has large RVD [P < 0.009] and increased PSP [P < 0.007] and lower EF [P < 0.04] than those without. Tonsillectomy performed in 10 children was followed by complete resolution of sleep disturbances and significant decrease in RVD and PSP. Increased awareness about OSAS and subclinical cardiopulmonary changes should result in early treatment and less morbidity for these children

Increased platelet derived mitogenic activity in patients with acute myocardial infarction

Much evidence suggests that platelets are involved in atherogenesis. Furthermore, it was postulated that intimal migration and proliferation of mooth muscle cells [SMC], partially responsible for the occlusive lesions of atherosclerosis, are affected by platelet-derived mitogens. In this study, the platelet mitogenic activity [PMA] of circulating platelets in patients with acute myocardial infraction [AMI] and unstable angina [UA] were investigated. Mean platelet volume [MPV], platelet count [PC] and PMA were studied within 24 hours of onset of chest pain. PMA was assesses by increased 3H-Labeled thymidine incorporation as an index for DNA synthesis of cultured aortic SMC after incubation with platelet-releasates. MPV was significantly increased in AMI [8.04 +/- 0.19 fl] compared with UA [6.53 +/- 0.06 fl; p 0.001]. PMA was increased by 2.3 fold in patients with AMI compared to those with UA. Also, PMA per unit platelet mass was increased in patients with AMI [20.85 +/- 2.52 cpm10/flx10-3] compared with UA group [9.04 +/- 1.28 cpm10/flx10-3; p 0.001]. Platelets from AMI patients appear to release more mitogenic factor [s] than those from UA. It is argued that circulating platelets may affect the progression of the underlying coronary atherosclerotic lesions and likely its sequelae