C1019T polymorphism in the connexin 37 gene and myocardial infarction risk in premature coronary artery disease

Background: the C1019T polymorphism of the connexin-37 [GJA4] gene is a single-nucleotide polymorphisms involved in atherosclerotic plaque rupture and atherosclerosis predisposition. We examined the association between the C1019T polymorphism of the GJA4 gene and the occurrence of myocardial infarction [MI] in patients with premature coronary artery disease [CAD]

Methods: our study recruited 1000 patients with the final diagnosis of premature CAD and classified them into 2 groups: with a history of MI [n = 461] and without it [n = 539]. The polymorphism variants were determined via the PCR-RFLP, and then genotyping was conducted through the high-resolution melting method. From a total of 1000 patients, 554 patients, who had been previously followed-up with a median follow-up time of 45.74 months vis-à-vis long-term major adverse cardiac events, were enrolled in this retrospective cohort phase

Results: the frequencies of the wild, heterozygous, and mutant genotypes of the C1019T polymorphism were 54.0%, 40.6%, and 5.4% in the MI group and 49.2%, 43.2%, and 7.6% in the non-MI group [p value = 0.187]. After adjustment for the baseline covariates, no difference was found between the MI and non-MI groups apropos the frequency of the heterozygous genotype [p value = 0.625] and the mutant genotype [p value = 0.452]. Regarding the level of human connexin-37, the serum level of this marker was not different between the MI and non-MI groups

Conclusion: the C1019T polymorphism of the GJA4 gene may not be useful for predicting the occurrence of MI in patients with premature CAD. The presence of this polymorphism in such patients may also have a low value for predicting long-term CAD complications

Association between traditional risk factors and coronary artery ectasia: a study on 10057 angiographic procedures among Iranian population

Whether coronary artery ectasia [CAE] is a unique clinical finding or results from other clinical entities is still unknown. We aimed to determine the CAE prevalence, investigate the relationship between CAE and patients' demographic and clinical characteristics, and assess the prognosis at follow-up in a sample of Iranian population. Totally, 10057 patients who underwent coronary angiography were divided into three categories: normal coronary arteries without co-existing coronary artery disease; CAE without co-existing coronary artery narrowing < 50%; and coronary artery stenosis with > 50% luminal narrowing [CAS]. The prevalence of CAE was 1.5%. Compared to the normal individuals, the CAE patients were older, were more frequently male, and had higher rates of myocardial infarction [MI]. The CAE patients had a lower frequency of diabetes and MI than the CAS group. The CAE patients were largely focused between 40 to 60 years of age. The right coronary and left anterior descending arteries were the most involved arteries, and ectasia was located more frequently in the proximal part of these arteries. Patients with ectasia in the three main vessels had higher rates of MI. After a mean follow-up of 54.23 +/- 18.41 months, chest pain and dyspnea on exertion remained the main complaint in more than 97% of the patients, leading to hospital admission in more than 14%. There was no relationship between the presence of ectasia and conventional risk factors. According to our study, pure CAE may be deemed a benign feature of atherosclerosis; however, it can lead to frequent hospital admissions because of the persistence of cardiovascular symptoms

Evaluation of in-hospital NT-proBNP changes in heart failure patients to identify the six-month clinical response following cardiac resynchronization therapy

N-terminal pro beta-type natriuretic peptide [NT-proBNP] is a valuable marker for monitoring the response to treatment in patients with heart failure. Based on the clinically observed improvement of heart failure symptoms early after cardiac resynchronization therapy [CRT], we sought to investigate whether CRT induce any significant reduction in the plasma level of NT-proBNP in three days after implantation and whether it is correlated with patients' response at six months. In this prospective study, 21 consecutive patients with severe heart failure [New York Heart Association class 3.19 +/- 0.40] who underwent CRT were enrolled. Being alive, no hospitalization due to decompensated heart failure, and improvement of at least one NYHA functional class at six months were classified as clinical responsiveness. The plasma level of NTproBNP was measured before, three days, and six months after CRT. Clinical evaluation, echocardiographic study, and six-minute walking test were performed before and six months after the procedure. At six months' follow-up, 16 [76.2%] patients were responders. The plasma level of NT-proBNP at three days after CRT increased almost equally in both responder and non-responder groups of patients [Delta NT-proBNP was 40.94 +/- 135.74 vs. 54.80 +/- 88.98]; however, at six months' follow-up, the NT-proBNP changes statistically differed across the two groups of patients [P=0.005]. According to our findings, NT-proBNP percent deviation from baseline to three days after CRT appears to be not correlated with the patients' clinical response after six months, which was incongruent to the patients' clinical improvement after CRT

Correlation between plasma adiponectin levels and the presence and severity of coronary artery disease

The existing evidence suggests that plasma adiponectin concentrations can be indicative of the presence and severity of coronary artery disease [CAD]. However, the results of the studies conducted hitherto on this subject are inconsistent. We sought to investigate the possible correlation between plasma adiponectin levels and the presence and severity of CAD in patients undergoing non-urgent coronary angiography. In 399 consecutive patients undergoing non-urgent coronary angiography for CAD survey, plasma adiponectin, triglyceride, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, and fasting blood sugar levels were measured and demographic characteristics such as age, sex, Body Mass Index, diabetes mellitus history, systemic hypertension history, and family history of CAD were collected. According to the angiography results, the patients were divided into two groups of CAD and non-CAD. The severity of coronary atherosclerosis in the CAD group was defined using the Gensini score system. Average age was 61.4 +/- 9.94 years in the CAD group and 57.9 +/- 10.75 years in the non-CAD group. Also, 73.7% of the CAD group and 55.4% of the non-CAD group were male. Totally, 278 [69.7%] patients were found to have CAD. Patients without CAD did not have higher mean plasma adiponectin concentrations than did those with CAD [13.38 +/- 11.96 vs. 14.95 +/- 14.11 mcg/ml; p value = 0. 896]. After adjustment for CAD conventional risk factors, plasma adiponectin levels still were not associated with CAD. No association was found between plasma adiponectin levels and the Gensini score. Furthermore, in contrast to the fairly strong correlation previously reported, there was no correlation between adiponectin levels and conventional CAD risk factors. We could not observe any relationship between plasma adiponectin concentrations and the presence or severity of CAD in patients undergoing coronary angiography

Angiotensin- converting enzyme insertion/deletion polymorphism and its association with coronary artery disease in an Iranian population

The study of the association between genotype and phenotype is of great importance for the prediction of many diseases and pathophysiological conditions. The relationship between angiotensin-converting enzyme [ACE] gene insertion/ deletion [I/D] polymorphism and pathological processes such as coronary artery disease [CAD] has been investigated previously with discordant results. This study was designed to determine the association between ACE gene I/D polymorphism and CAD in an Iranian population. A total of 1050 individuals who were referred to Tehran Heart Center for coronary angiography were recruited. Six hundred seventy-six CAD-positive patients [documented by coronary angiography and Gensini scores higher than 6] and 374 CAD-negative patients were evaluated for ACE gene I/D polymorphism via the Polymerase Chain Reaction Amplification method. The patients' age, sex, smoking status and its duration as well as familial history of CAD, hypertension, and diabetes mellitus were recorded. Five hundred four [74.6%] of the CAD-positive patients were male, and the mean age of this group was 60 [60 +/- 10]. In the CAD-negative individuals, the mean age was 56 [56 +/- 10] and 196 of them were male [52.4%]. After the analysis of all the groups and gender subgroups, neither genotype nor allele frequency was significantly different between the CAD-positive and CAD-negative groups [p values for genotypes and allele frequencies were 0.494 and 0.397, respectively]. ACE gene I/D polymorphism was not associated with an increased risk of CAD in an Iranian population

Anatomy of atrioventricular node artery and pattern of dominancy in normal coronary subjects: a comparison between individuals with and without isolated right bundle branch block

Isolated right bundle branch block [RBBB] is a common finding in the general population. The atrioventricular node [AVN] artery contributes to the blood supply of the right bundle branch. Our hypothesis was that the anatomy of the AVN artery and the pattern of dominancy differ between subjects with and without RBBB. We retrospectively studied the coronary angiography of 92 patients with RBBB and 184 age- and gender-matched controls without RBBB. All the subjects had angiographically proven normal coronary arteries. The dominant circulation and precise origin of the AVN artery were determined in each subject. Obtained data were compared between the two study groups. There was no significant difference between the two groups in terms of dominancy [p value = 0.200]. Origination of the AVN artery from the right circulatory system was more common in both groups, but this pattern was more prevalent in the cases than in the controls [p value = 0.021]. There was a great variation of the AVN artery origin. In the total study population, the AVN artery was more commonly separated from a non crux origin than from the crux area. The prevalence of the non-crux origination of the AVN artery was significantly higher in the cases than in the controls [p value < 0.001]. While the origination of the AVN artery from the right circulatory system was more common in both groups, the prevalence of the right origin of the AVN artery was significantly higher in the cases than in the controls. We observed that the AVN artery most commonly originated from the dominant artery but not necessarily from the crux. The anatomy of the AVN artery but not the pattern of dominancy is somewhat different in subjects with RBBB compared with normal individuals

Characterization of suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy

Differences in the quantity and distribution of coronary veins between patients with ischemic and non-ischemic cardiomyopathy might affect the potential for the left ventricular [LV] lead targeting in patients undergoing cardiac resynchronization therapy [CRT]. In the current study, we assessed and compared the suitability of the coronary venous system for the LV lead placement in ischemic and dilated cardiomyopathy. This single-centre study, performed at our hospital, retrospectively studied 173 patients with the New York Heart Association class III or IV who underwent CRT. The study population was comprised of 74 patients with an ischemic underlying etiology and 99 patients with a non-ischemic etiology. The distribution of the veins as well as the final lead positions was recorded. There was no significant difference between the two groups in terms of the position of the available suitable vein with the exception of the posterior position, where the ischemic group had slightly more suitable veins than did the dilated group [48.4% versus 32.1%, p value - 0.049]. There was also no significant difference with respect to the final vein, through which the LV lead was inserted. Comparative analysis showed that the patients with previous coronary artery bypass grafting surgery [CABG] had significantly fewer suitable veins in the posterolateral position than did the non-CABG group [16.3% versus 38.7%, p value = 0.029]. There was, however, no significant difference between the two subgroups regarding the final vein position in which the leads were inserted. The final coronary vein position suitable and selected for the LV lead insertion was not different between the cases with cardiomyopathy with different etiologies, and nor was it different between the ischemic cases with and without a history of CABG. Patients with a history of procedures around the coronary vessel may have an intact or recovered venous system and may, therefore, benefit from transvenous LV lead placement for CRT

Association between androgenic hormone levels and left ventricular ejection fraction

Androgens have been shown to have diverse effects on the cardiovascular system. The aim of this study was to compare androgenic hormone levels in patients with different left ventricular ejection fractions [EF]. The study population consisted of 515 consecutive men who were referred for angiographic studies and whose results of echocardiography and coronary angiography were available. The patients were classified into four groups: EF < 35%, EF=35-45%, EF=45-54%, and EF >/= 55% to evaluate the trends of baseline characteristics and serum androgens, including free testosterone [fT], total testosterone [tT], and dehydroepiandrosterone sulfate [DHEAS]. To better elucidate the difference in the patients with severe heart failure, the patients were divided into two groups according to their EF level, and comparisons were repeated between those with EF < 35% and the ones with EF >/= 35%. There were statistically significant trends in some characteristics in the patients with different levels of EF. The subjects with higher EF levels were less likely to have diabetes [p value < 0.001], coronary artery lesion [p value < 0.001], or high levels of C-reactive protein [CRP] [p value < 0.001]. As regards the patients with severe heart failure, our regression analysis revealed that the fT level was significantly lower in those with EF < 35% than in the ones with EF >/= 35% [5.82 +/- 2.73 pg/mL vs. 6.88 +/- 3.34 pg/mL, p value < 0.05]. A significant association was found between the level of fT and EF < 35%. There is a need for further controlled prospective studies to delineate any possible causal relationship accurately

Ablation of focal right upper pulmonary vein tachycardia using retrograde aortic approach

The use of diagnostic and therapeutic methods for assessing pulmonary vein due to its status as a main source of ectopic beats for the initiation of atrial dysrrythmias is strongly recommended. We report the case of a 13-year-old girl who was admitted to our hospital with the electrocardiogram manifestation of an ectopic atrial tachycardia. The focus of arrhythmia was inside the right upper pulmonary vein. The patient underwent successful ablation with a conventional electrophysiology catheter via the retrograde aortic approach. We showed that when the origin of atrial tachycardia is in the right upper pulmonary vein, it is possible to advance the catheter into this vein via the retrograde aortic approach and find the focus of arrhythmia. This case demonstrates that right upper pulmonary vein mapping is feasible through the retrograde aortic approach and it is also possible to ablate the arrhythmia using the same catheter and approach

Drug therapy in atrial fibrillation management: where do we stand in 2010?

Atrial fibrillation [AF] is a commonly encountered arrhythmia in our daily practice. Every year a huge bulk of data is published about different management strategies, new antiarrhythmic drugs, anticoagulation protocols and ablation procedures in these patients. In this review article, we discuss different management strategies and new antiarrhythmic drugs as well as those commonly used. We will also have a brief look at anticoagulation in AF. We try to introduce the most recent publications in this field and we think that this review article may not only give information about the current state of antiarrhythmic therapy of AF, it may also show some progresses that we may anticipate in the near future. New drugs are promising in the management of AF because of better safety profile and also acceptable efficacy. A comparison between the catheter ablation procedure and antiarrhythmic therapy is beyond the scope of this article

Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia: success rates and complications during 14 years of experience

Radiofrequency catheter ablation [RFCA] has been introduced as the treatment of choice for supraventricular tachycardia. The aim of this study was to evaluate the success rate as well as procedural and in-hospital complications of RFCA for the treatment of atrioventricular nodal reentrant tachycardia [AVNRT]. Between March 1995 and February 2009, 544 patients [75.9% female, age: 48.89 +/- 13.19 years] underwent 548 RFCAs for AVNRT in two large university hospitals. Echocardiography was performed for all the patients before and after the procedure. Electrocardiograms were recorded on digital multichannel systems [EP-Med] or Bard EP system. Anticoagulation was initiated during the procedure. From the 548 patients, 36 had associated arrhythmias, atrial flutter [4%], atrial fibrillation [0.7%], concurrent atrial fibrillation and atrial flutter [0.7%], and concealed atrioventricular pathway [0.4%]. The overall success rate was 99.6%. There were 21 [3.9%] transient III-degree AV blocks [up to a few seconds] and 4 [0.7%] prolonged II-or III-degree AV blocks, 2 [0.25%] of which required permanent pacemaker insertion, 3 [0.5%] deep vein thrombosis, and one [0.2%] arteriovenous fistula following the procedure. No difference was observed in the echocardiography parameters before and after the ablation. RFCA had a high success rate. The complication rate was generally low and in the above-mentioned centers it was similar to those in other large centers worldwide. Echocardiography showed no difference before and after the ablation. The results from this study showed that the risk of permanent II or III-degree AV block in patients undergoing RFCA was low and deep vein thrombosis was the second important complication. There was no risk of life-threatening complications

Efficacy of two streptokinase formulations in acute myocardial infarction: a double-blind randomized clinical trial

We sought to evaluate the efficacy and safety of the different trade forms of streptokinase available in our country, namely Heberkinasa [Heberbiotec, Havana, Cuba] and Streptase [Aventis Behring GmbH, Marburg, Germany]. We conducted a double-blind randomized clinical trial to compare the two streptokinase formulations, i.e. Heberkinasa [HBK] or Streptase [STP], in patients with acute myocardial infarction who needed thrombolysis. Thrombolysis success was evaluated angiographically and/or clinically. Clinical follow-up was done 30 days after thrombolysis. We randomly allocated 221 patients with a mean age of 56.9 +/- 10.8 years [males: 88.2%] to HBK [n = 119] and STP [n=102] groups. Baseline clinical and demographic characteristics were similar between the two groups, and the two groups were not significantly different in terms of door-to-needle and pain-to-needle intervals. The rate of complications was not significantly different between the groups [44.1% [HBK] vs. 42% [STP]]. Angiography was done for 158 [71.5%] patients in the first 24 hours [9%] and in the first 72 hours [38.8%] after thrombolysis. Lesion morphology and lesion/patient ratio were not significantly different between the two groups [1.87[HBK] vs. 1.67[STP]]. The two groups were similar with respect to angiographic patency rate [67.5% [HBK] vs. 67.6% [STP]]. The study groups were also similar as regards clinical outcome and complications of both streptokinase formulations. The present study demonstrated that Heberkinasa is as effective and as safe as a standard streptokinase, namely Streptase, in a clinical setting

Comparison of benefits from cardiac resynchronization therapy between patients with ischemic Cardiomyopathy and patients with idiopathic dilated cardiomyopathy

Cardiac resynchronization therapy [CRT] is an effective treatment for patients with moderate to severe heart failure. However, 20-30% of patients remain non-responders to CRT. We sought to identify which patients benefit the most from CRT in regard to the etiology of heart failure. Eighty-three consecutive patients [62 men] who had a biventricular pacemaker inserted at Tehran Heart Center between May 2004 and March 2007 were evaluated retrospectively. The inclusion criteria were comprised of New York Heart Association [NYHA] class III or IV, left ventricular ejection fraction<35%, and QRS>120ms. After 6 months, response was defined as being alive, no hospitalization for cardiac decompensation, and an improvement in NYHA class>1 grade. After 6 months, 60 patients out of the 83 patients were responders. Amongst the 83 patients, 48 had ischemic cardiomyopathy and 35 had non-ischemic cardiomyopathy. A cross-tabulation of response versus etiology showed no significant difference between ischemic versus non-ischemic cardiomyopathy with regard to response to CRT [P=0.322]. According to our study, there was no difference in response to CRT between ischemic versus non-ischemic cardiomyopathy at six months' follow-up

Significant improvement in severely stunned left ventricle after percutaneous coronary intervention

This is a case of severely stunned left ventricle which occurred after a non-ST elevation myocardial infarction in a 76-year-old woman who was a known case of three-vessel disease. Her symptoms and cardiac function responded well to revascularization

Comparison of Specifications, Short Term Outcome and Prognosis of Acute Myocardial Infarction in Opium Dependent Patients and Nondependents

The effects of opium dependence on prognosis and short term outcome of patients with acute myocardial infarction [AMI] are not clear yet. From March 2004 to August 2004 all male patients admitted with diagnosis of AMI were enrolled. Patients who fulfilled DSM- IV-TR criteria were chosen as opium dependent patients [ODP]. Demographic data, risk factors, peak enzyme levels, location of MI, mortality and ejection fraction were collected and analyzed. We studied the mortality, readmission, functional class, performed revascularizations and coronary angiogram results in a short term follow-up [184 +/- 37 days]. A total number of 160 patients were enrolled, of which 45 [28.1%] were opium dependent. In 137 patients 6 months follow up was completed. Duration of admission was higher in O.D.P [11.3 days versus 8.7, P= 0.03] There was no significant difference in age, EF, location of MI, peak enzymes levels, angiographic findings, risk factors [except for cigarette smoking and triglyceride level], in-hospital mortality, need for readmission, 6 months mortality, functional class, and the need for revascularization. In an unselected cohort of patients admitted with AMI, there was no significant difference in specifications, short term outcome and prognosis of AMI between ODP and nondependents except for duration of hospitalization

Percutaneous Repositioning of Dislodged Pacing Lead

The overall rate of atrial pacing lead dislodgement is estimated to be about 3%. These leads are generally repositioned via a second operation through opening the pacemaker pocket. Some operators have introduced percutaneous techniques using snare system or deflectable catheters for this purpose. In this article we present our experience with five cases of percutaneous lead repositioning. Three cases were performed using deflectable ablation catheters and in two cases we used a specially designed urologic basket. The procedural success rate was 100% at the beginning but the long term success rate was 60%

Predictors of Long-term Outcome in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a single center registry [THCR]

This study sought to access differences in long-term [9 months] outcomes between Acute Coronary Syndrome [ACS] patients who undergo early intervention compared to Percutaneous Coronary Intervention [PCI] in stable and refractory conditions. Data originated from Tehran Heart Center Registry- interventional cardiology [THCR-IC] and consisted of 1267 patients divided into two categories; 227 patients had features corresponding to acute coronary syndromes [17.9%] and 1040 patients suffered from stable angina [82.1%]. They were admitted between April 3, 2003 and April 25, 2004. The clinical success rate of PCI was higher in ACS [97% vs. 94%; P=0.037], while In-hospital complications was similar in both groups. During the follow-up period, clinical restenosis was not significantly different and the overall number of re-interventions caused by restenosis or progression was not more frequent in ACS patients. Also, 1.3% of ACS and 0.4% of SA patients died, but the difference was not statistically significant [P=0.16]. Finally, Major Adverse Cardiac Events [MACE] showed no significant difference [5.2% vs. 3.9%; P=0.42]. Multivariate analysis showed that female sex [OR=25.6; P=0.003] and previous history of PCI [OR=8.4; P=0.016] were the only strong independent risk factors for major adverse cardiac events. Analyzing ACS patient outcomes using Mantel-Hanzel analysis showed that the female sex was the only factor which strongly increased the incidence of MACE. Both ACS and SA patients who underwent coronary intervention had similar in-hospital and composite major adverse cardiac events, nevertheless female gender must be considered as an independent risk factor for major adverse cardiac events especially in patients with acute coronary syndrome who undergo PCI

[Correlation of body mass index [BMI] and waist-to-hip ratio with risk of acute myocardial infarction]

Background: obesity is associated with many metabolic and cardiovascular diseases, for example, a direct and indirect relation has been established between obesity and diabetes, dyslipidemia, hypertension and atherosclerosis. But whether regional fat distribution contributes independently to risk remained unclear. This study was designed to determine relation between central obesity and acute myocardial infarction [AMI]

Methods: in this case-control study, body mass index [BMI] and waist to hip ratio [WHR] were calculated in 420 participants [140 cases and 280 controls]. BMI and WHR means were evaluated in subgroups according to age, sex and cardiac risk factors. Odds ratio [95% CI] of the MI incidence in obese participants [BMI>/=27 and/or WHR>/=0.85] were compared with non obese subjects in each subgroups

Results: mean BMI mean in the case group [27.9+/-4.9] was more than control group [25.8+/-4.9] P

Conclusion: there is a strong association between BMI, WHR and risk of AMI. Central obesity comparing with general obesity has stronger relation with AMI incidence especially in women and younger subjects. In addition, cardiac risk factors except smoking aggravated correlation between obesity and AMI