ABSTRACT
Background: Genetic polymorphism in MMPs are associated with multiple adverse CV events. There is little evidence regarding role of MMPs and their genetic polymorphisms in young (<50 years) STsegment elevation myocardial infarction (STEMI) patients. Methods: This study included 100 young (18e50 years) STEMI patients and 100 healthy controls. Serum levels of MMP-3, MMP-9 and TIMP were estimated for both patients as well as controls. Additionally, genetic polymorphisms in the MMP-9 gene (_x0001_1562 C/T and R279Q) & MMP-3 gene (5A/6A-1612) was evaluated. All these patients were followed up for one year and major adverse cardiac events (MACE) were determined. Results: Serum levels of MMP-3 (128.16 ± 115.81 vs 102.3 ± 57.28 ng/mL; P ¼ 0.04), MMP-9 (469.63 ± 238.4 vs 188.88 ± 94.08 pg/mL; P < 0.0001) and TIMP (5.84 ± 1.93 vs 2.28 ± 1.42 ng/mL; P < 0.0001) were significantly higher in patients as compared to controls. Additionally, patients with genetic polymorphisms in the MMP genes (5A/5A, 6A/6A and the AG genotypes) had an increased risk of STEMI. Patients with MACE had significantly higher levels of MMP-9 (581.73 ± 260.93 vs 438.01 ± 223.38 pg/mL; P ¼ 0.012). A cutoff value of 375.5 pg/mL of MMP-9 was best able to discriminate patients with STEMI and MACE with sensitivity of 77.3% and specificity of 57%. Conclusion: Novel biomarkers such as MMP-3, MMP-9 and TIMP and their genetic polymorphism are associated with the susceptibility for STEMI in young individuals. Higher MMP-9 levels in STEMI patients with MACE suggests its potential role in predicting cardiac remodeling and left ventricular dysfunction
ABSTRACT
Background: Overt left ventricular (LV) dysfunction and congestive heart failure are known entities in Takayasu arteritis (TA). Subclinical LV dysfunction may develop in these patients despite normal LV ejection fraction (LVEF). Moreover, effect of treatment of aortic or renal artery narrowing in such patients is unknown. Methods: This study included 15 angiographically confirmed TA patients undergoing aortic and/or renal intervention. A comprehensive clinical, biochemical and echocardiographic (2-dimensional, speckle tracking and tissue doppler imaging) evaluation were done at baseline, 72 h, and six months post intervention. Results: Six patients (40%) had reduced LVEF (<50%) at baseline while rest 9 (60%) patients had reduced global longitudinal strain (GLS) but normal EF. Diastolic filling pattern was abnormal in all the patients. In patients with baseline reduced EF, mean EF improved from 24.62 ± 12.14% to 45.6 ± 9.45% (p ¼ 0.001), E/ e’ ratio decreased from 15.15 ± 3.19 to 10.8 ± 2.56 (p ¼ 0.005) and median NT pro BNP decreased from 1673 pg/ml (970e2401 pg/ml) to 80 pg/ml (40e354 pg/ml) (p ¼ 0.001) at 6 months after interventional procedure. In patients with baseline normal EF, median NT pro BNP decreased from 512 pg/ml (80 e898.5 pg/ml) to 34 pg/ml (29e70.8 pg/ml) (p < 0.01), mean GLS improved from 8.80 ± 0.77% to 16.3 ± 0.78% (p < 0.001) and mean E/e’ decreased from 12.93 ± 2.63 to 7.8 ± 2.73 (p ¼ 0.005) at 6 months follow up. Conclusion: LV dysfunction is common in patients with TA and obstructive lesions in aorta or renal arteries. GLS can be used to assess subclinical systolic dysfunction in these patients. Timely intervention can improve LV dysfunction and can even reverse the subclinical changes
ABSTRACT
Amiodarone induced proarrhythmic effects are rare. We report a case of amiodarone induced torsades de pointes in a young boy aged 16 years occurring early after initiation of oral amiodarone. This case underscores the need of careful electrocardiographic monitoring early during amiodarone therapy to avoid a potentially fatal arrhythmia.
ABSTRACT
Increased left ventricular mass is an important risk factor in hypertension for various cardiovascular complications. We studied 49 patients of essential hypertension and the relationship between QT dispersion (defined as the difference between the maximum and the minimum QT interval in a 12-lead electrocardiogram) and M-mode echocardiographic left ventricular mass was analysed. Criterion of left ventricular hypertrophy was left ventricular mass index above 134 gm/m2 in men and above 110 gm/m2 in women. There were a total of 22 patients with left ventricular hypertrophy (15 men and 7 women). The mean QT dispersion was 82.66 +/- 35.34 milliseconds (ms) in men with left ventricular hypertrophy and 36.66 +/- 15.71 ms in men without left ventricular hypertrophy. The mean QT dispersion was 77.14 +/- 29.27 ms in women with left ventricular hypertrophy and 26.66 +/- 9.99 ms in women without left ventricular hypertrophy. The correlation co-efficient was 0.59 (p < 0.001) and 0.69 (p < 0.01) in men and women, respectively. Hence, we conclude that there is a direct, linear and positive correlation between left ventricular mass and QT dispersion in essential hypertension.