relationship between age and risk profile in patients with acute coronary syndrome

There is general agreement on multi factorial etiology of coronary artery disease [CAD] and that the incidence of disease increases with age. Nevertheless, it has been recognized in young age groups more frequently in recent years. Worldwide, about 4% of patients with myocardial infarction [MI] are younger than 40 years of age. These patients frequently have characteristics that are different from those seen in older patients. The relationship between age categories and risk profile in ACS patients remain to be identified. 298 patients with ACS, [230 males and 68 females], with age ranged from [32-85 years] with mean age 51.9 years, were included in the study. The risk factors, lipid profile, cardiac enzymes, ejection fraction [EF%] and angiographic data were analyzed and were compared in different age groups. The study groups were classified as group I [n=83] with age <40 years, group II [n=125] with age >/= 40-<75 years and group Ill [n=90] >/= 75 years. Young ACS patients [group I had more prevalence of male sex, smoking, family history, hyper triglyceridemia and low levels of HDL, higher incidence of ST elevation acute myocardial infarction [STEMI] and lower prevalence of unstable angina pectoris [UA] compared with group II and III. Diabetes Mellitus, hypertension, obesity and female sex were more common in older groups [II and Ill]. As regards angiographic analysis group I showed a preponderance of single-vessel disease and prevalent left anterior descending coronary vessel [LAD] involvement compared with older age groups. Male gender and smoking were correlated positively with more severe CAD in young patients, while diabetes was related significantly to CAD extent in patients >40 years. Stepwise multiple regression analysis showed that age, male gender, cardiac enzymes and EF% were common predictors of multi vessel disease. Smoking was independent predictors in young patients <40 while Diabetes was the key predictors in older patient groups. In acute coronary syndrome there is an ageassociated difference in patient's related variables including different clinical and risk factors in addition to angiographic data. These variables might improve risk stratification

Doppler pressure half-time and catheter pressure gradient half-time in the calculation of mitral valve area

The use of Doppler derived measurements in the assessment of mitral stenosis [MS.] was evaluated in 45 patients [pts] with rheumatic heart disease and the data were compared with that obtained by cardiac catheterization and direct measurement of the valve orifice area [MVA] at surgery. Results showed that Doppler derived measurements of MVA by pressure half-time method were of particular value in 24 pts in whom technically adequate cross-sectional images and MVA measurements were difficult to obtain.Eighteen of these cases [40%] had heavily calcified and disorganized valves and six pts [13%] had a poor acoustic window. The Doppler data were more accurate than standard two-dimensional measurements in 30 pts.[66%] with atrial fibrillation. The comparison with Gorlin's formula for catheter-derived MVA was poor, especially in the presence of mitral regurgitation or irregular rhythm. Excellent comparisons were obtained with a catheter-derived pressure half-time and surgical assessment of MVA. Thus, The Doppler examination proved to be an invaluable adjunct to a complete assessment of MVA and replaces the need for haemodynamic assessment in most pts with MS