ABSTRACT
Percutaneous balloon mitral valvotomy [BMV] is the gold standard treatment for rheumatic mitral stenosis [MS] in that it causes significant changes in mitral valve area [MVA] and improves leaflet mobility. Development of or increase in mitral regurgitation [MR] is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association [NYHA] functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient [MVPG and MVMG], left atrial [LA] pressure, pulmonary artery systolic pressure [PAPs], and MR severity before and after BMV, were evaluated. Totally, 105 patients [80% female] at a mean age of 45.81 +/- 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure [p value < 0.001] MVA significantly increased [mean area = 0.64 +/- 0.29 cm[2] before BMV vs. 1.90 +/- 0.22 cm2 after BMV; p value < 0.001] and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 [78.1 %] patients, but it increased in 18 [17.1%] and decreased in 5 [4.8%] patients. Patients with increased MR had a significantly higher calcification score [2.03 +/- 0.53 vs. 1.50 +/- 0.51; p value < 0.001] and lower MVA before BMV [0.81 +/- 0.23 vs. 0.94 +/- 0.18; p value = 0.010]. There were no major complications. In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV
ABSTRACT
Paraoxonase is a HDL-associated enzyme implicated in the pathogeneses of atherosclerosis by protecting lipoproteins against peroxidition in numerous studies. Its biallelic gene polymorphism at codon 192Q>R has been associated with coronary artery disease [CAD]. Therefore, in the present study the role of polymorphism paraoxonase 1 gene was evaluated for CAD in diabetic patients. In this case- control study, peripheral blood was taken from 105 CAD patients diagnosed with angioplastically and 95 CAD individuals with no history of diabetes from Northwest of Iranian population. The abundance of mutant alleles of the 192Q>R paraoxonase were determined by PCR-RFLP. The abundance of RR allele in diabetic group was significantly higher than in selected group with no diabetic history [41.1% in diabetic vs. 24.5% in non-diabetic individuals]. Regarding significant prevalence of RR allele and considering ethnic diversities like Turk, Kurd, Lore and others living in Iran, it appears that other polymorphism of this gene like 163T>A and 55L>M is needed to be studied in diabetic patients, which their relations to atherosclerotic problem has been already determined.
ABSTRACT
Drug-eluting stents [DES] have significantly decreased the need for repeat coronary revascularization but concerns remain regarding the safety of first and second generation DES. We compared the safety and efficacy of a biolimus-eluting stent [with biodegradable polymer] with an everolimus-eluting stent [with durable polymer] one We performed a randomized trial to compare the two types of stents. Two hundred patients undergoing PCI for de novo lesions were randomly assigned 1:1 to treatment with either biolimus-eluting [BioMatrix] or everolimus -eluting [Xience V] stent. The primary endpoint was a composite of cardiac death, myocardial infarction, and clinically driven target vessel revascularization within 12 months. Demographics, clinical, and lesion characteristic were comparable between two groups. The 30-day major adverse cardiac event [MACE] rate was 2% in BioMatrix group versus 0% in Xience group [p > 0.05]. After 12 months, the rates of cardiac death [0% in both groups], MI [2% versus 0%, p=0.49] and clinically -driven target vessel revascularization [0% in both groups] were similar for BioMatrix and Xience. No stent thrombosis was reported at 1, 6, 9 or 12 months after intervention in either group. BES [Biolimus-eluting stent] with biodegradable polymer and EES [Everolimus-eluting stent] with durable polymer appear similar with respect to MACE and stent thrombosis in this patient population. Many studies with longer follow up are needed to define better the role of BES with biodegradable polymer in treatment of coronary artery lesions
ABSTRACT
Considering the high incidence of patients with coronary artery disease [CAD] in the Iranian population and a preventive role of serum paraoxonase [PON1] in development of CAD, the present study was designed to determine the distribution of PON1 phenotypes in patients with CAD. A total of 61 patients with coronary stenosis of <50% and 63 patients with coronary stenosis of >70% were included in this study. Paraoxonase and arylesterase activities were measured using paraoxon and phenylacetate as substrate, respectively. Phenotyping of the PON1 Q192R polymorphism was determined by calculating the ratio of salt-stimulated paraoxonase activity to arylesterase activity [double-substrate method]. Patients with stenosis of <50% were separated into three distinct phenotypes at ratios of 2.14 and 5.99 and the population with stenosis of >70% at ratios of 2.42 and 5.91. In patients with stenosis of <50%, PON1 phenotype frequencies were 41% [Q phenotype], 46% [QR phenotype] and 13% [R phenotype]. Frequencies of Q, QR and R phenotypes in patients with stenosis of >70% were 48%, 41% and 11%, respectively. Based on this study and other studies conducted in Iran, it can be concluded that in the Iranian population there is no statistically difference in phenotype distribution of PON1 between patients with CAD [with severe stenosis or mild stenosis] and healthy individuals
Subject(s)
Humans , Aryldialkylphosphatase/blood , Phenotype , Substrate Specificity , Coronary Stenosis , Carboxylic Ester HydrolasesABSTRACT
Paraoxonase [PON1] can prevent oxidized low-den sity lipoprotein formation and development of atherosclerotic lesions. However, studies on the association between PON1 activity and the extent of coronary stenosis and underlying mechanism[s] are limited. In this study, the relationship between paraoxonose and arylesterase activities of PON1 with extent of coronary stenosis together with determination of PON1 phenotypes in the studied have been investigated. Paraoxonase and arylesterase activities were measured in 61 patients with coronary stenosis of 50% and 63 Patients with coronary stenosis of 70% Individual human serum phenotype for the PON1 Q192R polymorphism was achieved through dividing the Paraoxonase activity in the presence of IM NaCL by arylesterase activity. Patients with stenosis of 50% had significantly higher PON1 activity [p0.05] and HDL-Cholesterol [p 0.03] compared to those with stenosis of 70%. No significant difference [p 0.05] was observed in the phonotype distribution of males and females. According to the current study, there are significant differences in paraoxonase and arylesterase activates and also HDL-C levels between patients with coronary stenosis of 50% and those with coronary stenosis of 70% therefore, this study provides further support for the important role of paraoxonase activity in coronary atherosclerosis
ABSTRACT
Diagnosis of coronary artery disease [CAD] in patients with left bundle branch block [LBBB] is considered as a challenge in cardiology due to the low accuracy of noninvasive methods such as basal and stress electrocardiography [ECG]. This diagnostic challenge can be reduced but not eliminated using dipyridamole as a stress method instead of exercise. The aim of this study was to assess the diagnostic value of dipyridamole stress Tc-99m Sestamibi single photon emission computed tomography [SPECT] myocardial perfusion imaging in patients with complete LBBB. We studied 40 patients with permanent and complete LBBB using Tc-99m Sestamibi SPECT and dipyridamole stress to evaluate CAD. Perfusion defect was considered fixed when there was no difference between rest and stress score, while reversible defect was defined as a segment with higher score on stress images. All patients underwent coronary angiography. Eleven patients [27.5%] had normal myocardial perfusion SPECT and 29 patients [72.5%] had reversible perfusion defects. Angiography was positive in 30 patients, while 10 cases showed normal angiography. The sensitivity, specificity, positive predict value and negative predict value of our study for detecting >50% coronary stenosis was 86.6%, 70%, 89% and 64% respectively. We found 33 [82.5%] patients with concordant angiography and myocardial perfusion SPECT results [p=0.002]. Angiography was positive in 90% of patients with reversible perfusion defects on myocardial perfusion SPECT. In summary, Tc-99m Sestamibi SPECT in patients with LBBB showed high accuracy [82.5%] in detecting >50% coronary stenosis