Attenuation of atherogenic apo B-48-dependent hyperlipidemia and high density lipoprotein remodeling induced by vitamin C and E combination and their beneficial effect on lethal ischemic heart disease in mice

BACKGROUND AND AIMS: Atherosclerotic cardiovascular disease is highly prevalent and its underlying pathogenesis involves dyslipidemia including pro-atherogenic high density lipoprotein (HDL) remodeling. Vitamins C and E have been proposed as atheroprotective agents for cardiovascular disease management. However, their effects and benefits on high density lipoprotein function and remodeling are unknown. In this study, we evaluated the role of vitamin C and E on non HDL lipoproteins as well as HDL function and remodeling, along with their effects on inflammation/ oxidation biomarkers and atherosclerosis in atherogenic diet-fed SR-B1 KO/ApoER61h/h mice. METHODS AND RESULTS: Mice were pre-treated for 5 weeks before and during atherogenic diet feeding with vitamin C and E added to water and diet, respectively. Compared to a control group, combined vitamin C and E administration reduced serum total cholesterol and triglyceride levels by decreasing apo B-48-containing lipoproteins, remodeled HDL particles by reducing phospholipid as well as increasing PON1 and apo D content, and diminished PLTP activity and levels. Vitamin supplementation improved HDL antioxidant function and lowered serum TNF-α levels. Vitamin C and E combination attenuated atherogenesis and increased lifespan in atherogenic diet-fed SR-B1 KO/ApoER61h/h mice. CONCLUSIONS: Vitamin C and E administration showed significant lipid metabolism regulating effects, including HDL remodeling and decreased levels of apoB-containing lipoproteins, in mice. In addition, this vitamin supplementation generated a cardioprotective effect in a murine model of severe and lethal atherosclerotic ischemic heart disease.

BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit / Associação de BNP com Isquemia na Cintilografia Miocárdica e Morte em Pacientes da Unidade de Dor Torácica

Background: Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events. Objectives: To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS). Methods: This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%. Results: The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia. Conclusions: BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome. .

Fundamentos: Recentes estudos sugeriram que o peptídeo natriurético do tipo B (BNP) seja um importante fator preditivo de isquemia e morte em pacientes com suspeita de síndrome coronariana aguda. Níveis elevados de BNP são observados após episódios de isquemia miocárdica e podem estar relacionados a futuros eventos adversos. Objetivos: Determinar o valor prognóstico do BNP para eventos cardíacos maiores e avaliar sua associação com cintilografia de perfusão miocárdica (CPM) isquêmica. Métodos: Este estudo incluiu retrospectivamente 125 pacientes admitidos na unidade de dor torácica entre 2002 e 2006, quando seus níveis de BNP foram medidos, tendo sido submetidos a CPM para estratificação de risco. Os níveis de BNP foram comparados com os resultados da CPM. O teste do qui-quadrado foi usado para avaliar as variáveis qualitativas e o teste t de Student, para as quantitativas. Curvas de sobrevida foram ajustadas usando-se o método de Kaplan-Meier e analisadas com regressão de Cox. Adotou-se o nível de significância de 5%. Resultados: A idade média foi de 63,9 ± 13,8 anos, e o sexo masculino correspondeu a 51,2% da amostra. Isquemia foi identificada em 44% das CPM. O BNP médio foi maior em pacientes com isquemia do que naqueles sem isquemia na CPM (188,3 ± 208,7 versus 131,8 ± 88,6; p = 0,003). Um nível de BNP acima de 80 pg/ml mostrou-se o mais forte fator preditivo de isquemia na CPM (sensibilidade = 60%, especificidade = 70%, acurácia = 66%, VPP = 61%, VPN = 70%), tendo sido capaz de predizer morte em médio prazo (RR = 7,29, IC 95%: 0,90-58,6; p = 0,045) independentemente da presença de isquemia. Conclusões: Os níveis de BNP estão associados com achados isquêmicos na CPM e prognóstico adverso em pacientes que se apresentam no setor de emergência queixando-se de dor torácica aguda, fornecendo, portanto, importante informação prognóstica para um desfecho clínico desfavorável. .

Efficacy and safety of antiplatelet-combination therapy after drug-eluting stent implantation

BACKGROUND/AIMS: Combination single-pill therapy can improve cost-effectiveness in a typical medical therapy. However, there is a little evidence about the efficacy and tolerability of combination single-pill antiplatelet therapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). METHODS: From June to November 2012, in total, 142 patients who met the following criteria were enrolled: at least 18 years old; successful PCI with DES at least 3 months earlier; and regular medication of aspirin and clopidogrel with no side effects. After VerifyNow P2Y12 and aspirin assays, the combination single pill of aspirin and clopidogrel was given and laboratory tests were repeated 6 weeks later. RESULTS: At baseline, the incidence of aspirin resistance, defined as aspirin reaction unit (ARU) > or = 550, was 9.2%, that of clopidogrel resistance, defined as P2Y12 reaction unit (PRU) > or = 230, was 46.5%, and that of percent inhibition of PRU < 20% was 32.4%. At follow-up, the incidence of resistance by ARU value was 7.0%, 50.0% by PRU value, and 35.9% by percentage inhibition of PRU, respectively. The mean values of ARU (431.5 +/- 63.6 vs. 439.8 +/- 55.2; p = 0.216) and PRU (227.5 +/- 71.4 vs. 223.3 +/- 76.0; p = 0.350) were not significantly different before versus after antiplatelet-combination single-pill therapy. Five adverse events (3.5%) were observed during the study period. CONCLUSIONS: Combination single-pill antiplatelet therapy, which may reduce daily pill burden for patients after PCI with DES, demonstrated similar efficacy to separate dual-pill antiplatelet therapy.

Relationship of ABO Blood Groups with Ischaemic Heart Disease.

The objective of this study was to find out the relationship of ABO blood groups with ischaemic heart disease in Sikkimese population as well as Bengalee population of North Bengal and South Bengal. Blood groups were studied in 300 diagnosed patients of ischaemic heart disease in Sikkim and North Bengal and South Bengal. Blood grouping was carried out by rapid slide test. The results indicate that incidence of ischaemic heart disease is highest in blood type A in Sikkimese as well as Bengalees of North Bengal and South Bengal.

Trimetazidina na injúria de isquemia e reperfusão em cirurgia de revascularização do miocárdio / Trimetazidine on ischemic injury and reperfusion in coronary artery bypass grafting

FUNDAMENTO: A injúria de isquemia e reperfusão constitui um mecanismo fisiopatológico frequente e de difícil controle durante a Cirurgia de Revascularização do Miocárdio (CRVM) com circulação extracorpórea, sendo o momento crítico o término da cirurgia, quando ocorre o desclampeamento da aorta e a liberação dos radicais hiperóxidos causadores da injúria. OBJETIVO: Avaliar, em estudo prospectivo, duplo-cego randomizado, controlado com placebo, os efeitos da Trimetazidina (Tmz) sobre a injúria de isquemia e reperfusão miocárdica, identificando a variação dos marcadores plasmáticos de agressão miocárdica (troponina T e Cpk-Mb), e as alterações ecocardiográficas da função ventricular. MÉTODOS: Foram estudados 60 pacientes, divididos em dois grupos (Placebo e Tmz) com, no máximo, disfunção ventricular leve, estratificados por ecocardiografia e recebendo medicação/placebo na dose - no pré-operatório sem medicação, 12 a 15 dias de medicação/placebo colhida cinco minutos após o desclampeamento aórtico, e nas 12, 24 e 48 horas seguintes. RESULTADOS: Tanto a troponina T como a CpK-Mb atingiram valores altamente significativos (p = 0,0001) no grupo tratado em relação ao grupo controle nos quatro momentos analisados − 5 min, 12 h, 24 h e 48 h. As variáveis ecocardiográficas não evidenciaram mudanças evolutivas em cada grupo isoladamente e quando comparados em conjunto. CONCLUSÃO: A trimetazidina mostrou-se eficaz na redução da injúria de isquemia e reperfusão, não interferiu na função ventricular esquerda, e não foram observados efeitos colaterais.

BACKGROUND: The ischemia and reperfusion ischemia is a common physiopathological mechanisms, which has difficult control during Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass, the critical moment of which happening by the end of surgery, when there is declamping of aorta and release of hyperoxic radicals causing the injury. OBJECTIVE: Evaluate, in a randomized double-blind prospective study, controlled with placebo, the effects of Trimetazidine (Tmz) on ischemic injury and myocardial reperfusion, identifying the change in plasma markers of a myocardial aggression (troponin T and CPK-MB), and echocardiographic changes of ventricular function. METHODS: We studied 60 patients divided in two groups (placebo and Tmz) with mild ventricular dysfunction at the most, stratified by echocardiography and receiving medication/placebo at a dose of 20 mg/3x/day, starting from 12 to 15 days after pre-operative period up to 5 to 8 days after post-operative period. Troponin T and Cpk-Mb were measured preoperatively without medication, 12 to 15 days of medication/placebo taken five minutes after aortic declamping, and at subsequent 12, 24 and 48 hours. RESULTS: Both Troponin T and Cpk-Mb reached highly significant values (p = 0.0001) in the treated group compared to the control group at the four moments analyzed - 5 min, 12h, 24h and 48h. The echocardiographic variables did not show evolutive changes in each group severally considered and when compared among themselves. CONCLUSION: Trimetazidine was effective in reducing ischemic injury and reperfusion, had no effect on left ventricular function, and no side effects were observed.

Inflamação sistêmica causada pela periodontite crônica em pacientes vítimas de ataque cardíaco isquêmico agudo / Systemic inflammation caused by chronic periodontite in patients victims of acute ischemic heart attack

OBJETIVO: Processos inflamatórios e infecciosos mediados por bactérias em sítios distantes têm sido descritos como fator de risco à doença coronariana isquêmica aguda (DCIA). MÉTODOS: Cento e oitenta e um pacientes com DCIA, com e sem periodontites crônicas, foram incluídos neste estudo. Os pacientes foram admitidos no HC da UNICAMP e estratificados em três grupos: grupo 1 - pacientes com periodontite crônica grave (31 homens e 19 mulheres; média de idade 55,1 ± 11,29 anos); grupo 2 - pacientes com periodontite crônica leve (40 homens e 28 mulheres; média de idade 54,8 ± 10,37 anos); grupo 3 - pacientes desdentados (43 homens e 20 mulheres; média de idade 67,5 ± 8,55 anos). Amostras sanguíneas foram coletadas para mensurar os perfis lipídico, hematológico e glicêmico. Além disso, biópsias de 17 artérias coronárias com aterosclerose e igual número de artérias mamárias internas sem degeneração aterosclerótica no grupo 1 foram investigadas. Para análise estatística utilizou-se a análise de variância (ANOVA) e o teste de Scheffé para comparações múltiplas. RESULTADOS: Triglicérides e LDL estavam elevados no grupo 1 em relação ao grupo 2. O HDL apresentou-se reduzido em 20 por cento dos pacientes do grupo 1, e em 8 por cento nos desdentados. A glicemia estava elevada no grupo 1. DNA de bactérias periodontais foram detectados em 58,8 por cento das artérias coronárias. CONCLUSÕES: Pacientes com DCIA e periodontite crônica grave podem apresentar perfil lipídico alterado, como também microorganismos associados com as periodontites crônicas graves podem permear dentro de vasos coronarianos.

OBJECTIVE: Infectious and inflammatory processes mediated by bacteria in distant sites have been described as a risk factor for acute ischemic heart disease (AIHD). METHODS: One hundred one patients with AIHD with and without chronic periodontitis (CP) were included in this study. Patients were admitted to the HC UNICAMP and stratified into three groups: in group 1, we selected patients with severe chronic periodontitis (31 men and 19 women, mean age 55.1 ± 11.29 years old); the group 2 with mild chronic periodontitis (40 men and 28 women, mean age 54.8 ± 10.37 years old) and group 3 represented by the toothless (43 men and 20 women, mean age 67.5 ± 8.55 years old). Blood samples were collected to measure the lipid profiles, hematological and blood glucose levels. In addition, biopsies of seventeen coronary arteries with atherosclerosis and an equal number of internal mammary arteries without atherosclerotic degeneration in group 1 were investigated. Statistical analysis by analysis of variance (ANOVA) and Scheffé test for multiple comparisons was performed. RESULTS: Triglyceride and LDL levels were elevated in group 1 than in group 2. HDL were reduced by 20 percent in group 1 and remained reduced by 8 percent in toothless. Blood glucose was higher in group 1. DNA of periodontal bacteria was detected in 58.8 percent of the coronary arteries. CONCLUSIONS: Patients with (AIHD) and severe chronic periodontitis may have altered lipid profile, as well as microorganisms associated with CP can permeate into coronary vessels.

Therapeutic role of L-arginine on free radical scavenging system in ischemic heart diseases.

Increased production of free radicals under oxidative stress conditions plays a vital role in the impairment of endothelial function and also in the pathogenesis of ischemic heart diseases. Ischemia, followed by reperfusion, leads to the exacerbated formation of oxy- free radicals. These reactive oxygen species through a chain of reactions damage the cardiomyocytes and cause more injury to the myocardium. L-Arginine is reported to act as free radical scavenger, inhibits the activity of pro-oxidant enzymes and thus acts as an antioxidant and these roles of L-arginine are mediated by nitric oxide (NO). In the present study, the effect of oral administration of L-arginine (3 g/day for 7 days) on some antioxidant enzymes, total thiols, lipid peroxidation measured as malondialdehyde (MDA), and plasma ascorbate levels in myocardial ischemic patients was investigated. We observed an increase in the activity of superoxide dismutase (SOD), total thiols (T-SH) and plasma ascorbate levels and a decrease in the activity of xanthine oxidase (XO), MDA levels, carbonyl content and serum cholesterol in the patients on oral administration of L-arginine. The present study demonstrates that L-arginine administration may be beneficial to patients with myocardial ischemic disorders, such as acute myocardial infarction and acute angina.

Marcadores pro y antiinflamatorios en la enfermedad arterial coronaria y el síndrome isquémico coronario agudo / Pro-inflammatory and anti-inflammatory markers in coronary artery disease and acute ischemic coronary syndrome

Inflammation plays an important role in the development of atherosclerotic lesions, affecting several stages of the atheroma's development going from the initial leukocyte recruitment to the eventual rupture of the unstable atherosclerotic plaque. The inflammatory reactions within coronary atherosclerotic plaques influence the clinical outcome of acute coronary syndromes and coronary artery disease. Recent studies suggest that inflammation markers may reflect different aspects of the atherothrombotic process in relation to the stages of acute coronary syndrome. These markers play an important role in the risk of developing coronary artery disease, and may correlate with its severity. Some cytokines, acute phase proteins, acute phase reactants proteins, and adhesion molecules released from the inflammatory cells may reflect the inflammatory process in atherosclerotic plaques. However, it remains to be determined whether these pro- and anti-inflammation markers may confer risk or protection for cardiovascular disease, or simply reflect the underlying disease process. The analysis of the markers may be useful for the development of new strategies for coronary disease prevention and treatment. Therefore, we need a well-designed evaluation of these markers before their use in the clinical practice.

Purines and oxypurines in myocardial ischemia

To evaluate the plasma levels of purine nucleosides and oxypurines in the presence of other risk factors as additional markers for the diagnosis of myocardial ischemia and severity of myocardial infarction. A case control study was conducted on 101 patients with ischemic heart disease [stable angina, n=19: unstable angina, n=29: acute myocardial infarction [AMI]; n=53 patients] admitted to the Cardiology Unit at Al-Kadhimyia Teaching Hospital, Baghdad, Iraq from January to November 2007 in addition to 31 healthy controls. Blood samples were aspirated from those with AMI within the first 12 hours of onset of chest pain. Plasma adenosine [ADO], inosine [INO], hypoxanthine [HYP], and xanthine [XAN] were analyzed by high-performance liquid chromatography. The mean plasma ADO, INO, HYP, and XAN levels were raised in unstable angina over the control values. More increase in all nucleosides and oxypurines was reported in the plasma of patients with AMI as compared to the controls and those of stable angina. The INO [p = 0.01] and HYP [p = 0.001] values were increased significantly in diabetic men with AMI and at age of Conclusion: The levels of purines and their catabolites could be used as additional indices for prior or current ischemia. Pretreatment with such nucleosides, or their oxypurine derivatives, is suggested to improve the regional ventricular function after coronary artery occlusion

Comparison of iron stores in healthy individuals and patients with ischemic heart disease

Excess body iron has been linked to atherosclerosis owing to its pro-oxidative properties. However, inconsistent results have emerged from the epidemiological studies linking iron status and the risk of cardiovascular diseases [CVD]. Objective of the present study is to compare iron stores of healthy individuals and patients with ischaemic heart disease [IHD]. A total of 137 subjects were included in the study, 90 patients of IHD and 47 healthy subjects with no history of IHD as controls. We compared body iron stores of patients and controls. Serum ferritin, serum transferrin receptor [sTfR] and sTfR/ferritin ratio were used as measures of body iron stores. Our results revealed that mean serum ferritin concentration of cases was significantly higher than controls. Moreover, mean sTfR and sTfR/ferritin ratio of controls was significantly higher than the patients. We conclude from our results that IHD patients have higher iron stores than healthy subjects suggesting a possible association between high iron stores and the risk of IHD

Metabolic syndrome in patients with ischemic heart disease

To determine the frequency of metabolic syndrome in patients with Ischemic Heart Disease [IHD]. Cross-sectional, descriptive study. Cardiology Department of Punjab Institute of Cardiology, Lahore, from June 2006 to June 2007. A total of 100 subjects with ischemic heart disease, fulfilling the inclusion criteria, were enrolled in the study. Demographic data [age and gender] and the 5 component conditions of the metabolic syndrome were noted. Subjects were physically assessed for the abdominal obesity, based on waist circumference. Fasting blood samples for glucose and lipid profile in first 24 hours after acute coronary insult were drawn and tested in central laboratory. Variables were processed for descriptive statistics. In this study population, 68% were male and 32% were female with mean age of 52 +/- 13.6 years in men and 56 +/- 12.5 years in women. Frequency of metabolic syndrome was 32% in men and 28% in women. It increased with age. The highest rate of metabolic syndrome was in men diagnosed as STEMI [odds ratio: 3.39, 95% Cl=1.36-8.41]. Frequency of metabolic syndrome was high among the patients with IHD. It supports the potential for preventive efforts in persons with high-risk of IHD

Medico-legal and serological study of the role of C-reactive protein and anticholesterol auto-antibodies in the diagnosis of ischemic heart disease

No previous Iraqi study was done on the role of C - reactive protein [CRP] and anticholesterol autoantibodies [ACHA] in the diagnosis of ischemic heart disease [IHD] especially from the medico-legal point of view. To determine the role of CRP and ACHA in the diagnosis of IHD particularly myocardial infarction [MI] with special attention to the medico- legal aspect. Forty four lived patients from Al- Kadhimiya hospital and 20 cadavers in medico-legal institute of Baghdad were included in this study, in addition to 18 apparently healthy persons and 3 cadavers as controls. A number of risk factors were studied such as age, sex, smoking, and others. CRP and ACHA detected and estimated in the sera of the lived and dead patients. Histopathological examination was done on cardiac tissue specimens taken from the cadavers. Patients with anterior MI have higher CRP values than in patients with other types of MI. ACHA of IgM type was higher in controls than in lived and patients, while that of IgG was higher in lived patients as compared with dead patients and controls. Elderly males are affected more by MI. CRP is elevated in acute coronary syndrome. ACHA are present in healthy individuals, but high in CAD

Ischemia-modified albumin (IMA) is not useful for detecting myocardial ischemia during symptom-limited exercise stress tests

BACKGROUND/AIMS: We examined the ischemia-modified albumin (IMA) level during exercise in patients with coronary artery disease (CAD). METHODS: Forty patients with a history of chest pain underwent both symptom-limited treadmill exercise stress testing and coronary angiography within one week. During the treadmill tests, blood samples were obtained at baseline and 5 min after exercise to measure the serum IMA level. RESULTS: Of the 40 patients, fourteen (35%, CAD group) had significant coronary artery stenosis, while the other 26 (65%, non-CAD group) did not. The baseline and post-exercise IMA levels in the two groups did not differ significantly (105.2+/-7.2 vs. 107.7+/-6.7 U/mL at baseline and 93.1+/-10.1 vs. 94.8+/-5.7 U/mL at post-exercise in the CAD and non-CAD groups, p=0.29 and 0.57, respectively). The changes in IMA after exercise did not differ either (-10.4+/-7.5 vs. -14.0+/-7.6 U/mL in the CAD and non-CAD groups, respectively, p=0.10). Similarly, the change in IMA between the exercise ECG test positive (TMT positive, n=9) and negative (TMT negative, n=20) groups did not differ (-14.63+/-5.19, vs -8.50+/-9.01 U/mL, p=0.15, in the TMT positive and negative groups, respectively). CONCLUSIONS: Our results suggest that IMA has limitation in detecting myocardial ischemia during symptom-limited exercise stress tests.

Apoyo metabólico del corazón isquémico en cirugía cardíaca / Metabolic support of the ischemic heart during cardiac surgery

We examine [IBM1] the basic principles and clinical results of the metabolic intervention with glucose-insulin-potassium (GIK) solutions in the field of cardiovascular surgery. On the basis of many international publications concerning this subject, and the experience obtained in the operating room of the Instituto Nacional de Cardiologia [quot ]Ignacio Chávez[quot ], we conclude that the metabolic support wit GIK is a powerful system that provides very useful energy to protect the myocardium during cardiac and non-cardiac surgery. The most recent publications indicate their effects in reducing low output syndromes, due to interventions on the coronary arteries, as well as producing a significant reduction of circulating fatty acids. These effects are produced also in the field of interventional cardiology, where GIK solutions protect the myocardium against damage due to impaired microcirculation. It is evident that these solutions must be utilized in higher concentrations that the initial ones, equal to those employed in laboratory animals. On the other side, it is worthy to remember that it has been always underlined that this treatment represents only a protection for the myocardium. Therefore, its association with other drugs or treatments favoring a good myocardial performance is not contraindicated--on the contrary, it yields better results. The present review presents pharmacological approaches, such as the use of glutamato, aspartate, piruvato, trimetazidina ranolazine and taurine to optimize cardiac energy metabolism, for the management of ischemic heart disease.

Influência do gênero no valor prognóstico da troponina I após angioplastia coronariana eletiva / Influence of gender on the prognostic value of troponin I after elective percutaneous coronary interventions

OBJETIVO: Avaliar a associação entre níveis de troponina I (TnI) em pacientes submetidos, eletivamente, a intervenções coronárias percutâneas (ICP) com ocorrência de eventos cardíacos adversos (ECA) no seguimento de 6 meses. MÉTODOS: No período de um ano, foram selecionados consecutivamente 111 pacientes submetidos a ICP eletiva, com angina estável (AE), instável (AI) ou isquemia silenciosa (IS), assintomáticos por mais de 72 horas antes do procedimento. As dosagens de TnI foram realizadas entre 8 e 24 horas após a ICP. Cada paciente foi contatado por telefone, após seis meses, e questionado quanto à ocorrência de ECA, definidos como morte, infarto do miocárdio, nova revascularização e recorrência de isquemia. RESULTADOS: Ocorreu elevação de TnI em 24 (21,6 por cento) pacientes após a ICP, independente de características clínicas e complicações do procedimento. O surgimento de eventos foi mais freqüente em quem apresentou elevação de TnI: 66,7 vs. 42,5 por cento (RR=1,57; IC95 por cento=1,08-2,28). Este risco parece ser maior nos subgrupos de gênero feminino e naqueles com diagnóstico prévio de AI. Após análise multivariada, apenas gênero se confirmou como co-variável modificadora de efeito com risco de ECA maior em mulheres com elevação de TnI (OR=7,22. IC95 por cento=1,4 -36,9) e similar em homens (OR=1,26. IC95 por cento=0,35-4,55). CONCLUSÃO: Elevação de TnI foi freqüentemente encontrada após ICP e é um fator associado ao surgimento de ECA a médio prazo. Entretanto, quando ajustada para outras variáveis, este efeito só se manteve em pacientes do gênero feminino.

OBJECTIVE: To evaluate the association between troponin I concentrations (TnI) in patients submitted to elective percutaneous coronary interventions (PCI) and adverse coronary events (ACE) during a six month follow-up period. METHODS: One hundred and eleven patients who had been submitted to an elective PCI were consecutively selected during a one year timeframe. The patients had stable angina (SA), unstable angina (UA) or silent ischemia (SI) and were asymptomatic for at least 72 hours before the procedure. TnI concentrations were measured between 8 and 24 hours after the PCI. Each patient was contacted by telephone six months later and interviewed regarding ACE which were defined as death, myocardial infarction, new revascularization and recurrent ischemia. RESULTS: Twenty-four patients showed elevated concentrations of TnI (21.6 percent) after the PCI regardless of clinical characteristics or procedure complications. Those who presented elevated TnI concentrations had higher event rates: 66.7 vs. 42.5 percent (RR=1.57; CI 95 percent=1.08-2.28). This risk seems to be higher in the subgroups of females and patients with a previous diagnosis of unstable angina. Multivariate analysis confirmed that gender was the only effect modifying co-variable associated with ACE risk, which is higher for females with elevated TnI concentrations (OR=7.22; CI 95 percent=1.4 -36.9) and unaltered for males (OR=1.26; CI 95 percent=0.35-4.55). CONCLUSION: Elevated TnI concentrations were a common occurrence after PCI and is a factor related to the development of ACE in the mid term. However, when adjusted for other variables, this effect is only maintained in female patients.

Utilidad de la determinación cualitativa de troponina I y creatinfosfocinasa isoenzima MB en los síndromes isquémicos coronarios agudos / Usefulness of rapid bedside assay of cardiac troponin I and creatine phosphokinase-MB in acute ischemic coronary syndromes

Recently, a rapid bedside assay for quantitative determination of cTI and CPK-MB has been developed that provides a positive or negative result in 10 to 15 minutes allowing for a better therapeutic approach. The objective of our study was to validate the diagnostic usefulness of cardiac troponin I in patients with chest pain. We determined sensitivity, specificity, positive and negative predictive values in 40 patients that arrived to the hospital with chest pain. These patients were assigned to four different groups: Group A: Patients with acute myocardial infarction. Group B: Patients with unstable angina and normal ECG. Group C: Patients with atypical chest pain and normal ECG. Group D: Control. Eighteen (45%) patients were woman and 22 (55%) were men; age 54.1 +/- 26, range 32 to 85 years. In Group A, sensitivity, specificity, positive and negative predictive values for cTI were 95%, for CPK-MB, they were 40, 50, 90, 7.1%. For Group B, cTI: 64, 90, 90, 64%; CPK-MB: 50, 90, 87, 56%. Group C, cTI and CPK MB 25, 95, 50, 86%. Group D, cTI and CPK-MB: 50, 95, 50, 95%. This study suggests that the rapid bedside qualitative test through cardiac troponin I assessment is a test with higher predictive value for early diagnosis of acute myocardial infarction than CPK-MB.

Correlação entre marcadores bioquímicos e a cineangiocoronariografia em portadores de síndromes isquêmicas agudas sem supradesnivelamento de segmento ST / Correlation between biochemical markers and coronary angiography in patients with non-ST elevation acute coronary syndromes

OBJETIVO: Investigar associação entre marcadores bioquí¡micos (TN-I, PCRt e fibrinogênio) e achados cineangiocoronariográficos em portadores de síndrome isquêmica aguda sem supradesnivelamento de segmento ST (SIA sem supra ST). MÉTODOS: Obtida amostra sangüínea única para dosagem dos marcadores, e cineangiocoronariografia (CINE) realizada até 72 horas da internação. Análise univariada para investigar relação dos três marcadores com os achados na CINE, no grupo com artéria responsável pela isquemia (ARI) identificada, e análise multivariada para investigar relação desses marcadores com a presença de lesão aterosclerótica instável, apenas no grupo com obstrução coronariana >50 por cento. RESULTADOS: Estudo prospectivo, com 84 pacientes, 65,5 por cento do sexo masculino. No grupo onde identificou-se a ARI, os valores séricos dos três marcadores foram superiores, quando comparados aos grupos sem ARI identificada ou com coronárias normais. No grupo com ARI identificada, houve correlação entre fluxo TIMI e TN-I (p = 0,006), lesão aterosclerótica instável e TN-I e fibrinogênio (p = 0,02 e p = 0,01, respectivamente) e doença multiarterial e PCRt (p = 0,0005). Na análise multivariada, os três marcadores foram preditores independentes da presença de lesão aterosclerótica instável (p = 0,002, p = 0,003 e p = 0,007, respectivamente, para PCR, fibrinogênio e TN-I). CONCLUSÃO: Em portadores de SIA sem supra ST, a dosagem sérica de TN-I, PCR e fibrinogênio nas primeiras dez horas da internação se correlacionou a achados angiográficos.

Does epidural analgesia for thoracotomy reduce biochemical,markers of myocardial damage in ischemic heart patients?

Cardiovascular morbidity and mortality after cardiac surgery continue to be an area of active investigative interest because of its clinical and economic impact. is prospective randomized controlled study, we investigate the effect of thoracic epidural anesthesia/analgesia] on the release of troponin I [cTnI] and creatine kinase enzyme [CK-MB], ECG changes and postoperative anal-during elective thoracie surgery in ischemic heart patients. 20 patients with stable ischemic heart disease scheduled for elective thoracic surgery were randomized into 2 equal groups, a general anesthesia [GA] group and a general :hesia plus thoracic epidural analgesia [TEA]. The GA > received an initial IV loading dose of morphine 0.1mg/kg before induction followed by infusion of 75 mg morphine 250 ml normal saline at a rate 5ml [l.5mg]/h till 48 hours] post operative. The TEA group received 8 ml ropivacaine 0.2% and fentanyl 50mcg epidurally. And then epidural infusion of ropivacaine 0.2% and fentanyl 2mcg/ml was Tienced at a rate 6ml/h till 48hours postoperative. We monitored [cTnI and CK-MB], ECG changes, visual analogue, cardiopulmonary parameters and any side effects. There were no differences in troponin I and CK-levels between both groups. There were transient ischemic episodes 30% in GA group and 10% in TEA group. Analgesia improved in the TEA group compared with the GA group. mean arterial blood pressure was significantly lower in iA group. Also there were no differences between both is as regard sedation score or nausea score and there was patients who developed itching in both groups. Thoracic epidural analgesia for elective [cic surgery in ischemic heart patients improved post operative analgesia but had no effect on the release of biochemical markers of myocardial damage [Troponin I and CK]

Serum homocysteine concentration in patients with acute MI and chronic IHD.

This was an observational study carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka; with the active co-operation of Coronary Care Unit (CCU) of BSMMU & National Institute of Cardiovascular Disease (NICVD), Dhaka. This study was carried out from March 2002 to January 2003. Total seventy (70) subjects were studied. Out of them 20 were of Acute MI, 20 were Chronic ischemic heart disease (CHD) and 30 were age and sex matched healthy controls. Hospitalized diagnosed patients were selected by taking history, clinical examination and several investigations like ECG. Echocardiogram, Angiogram and several enzymes assay. Several studies in many countries showed that serum homocysteine (Hcy) was elevated in IHD Patient. Cardiovascular disease is alarmingly increasing in Bangladesh. So our aim and objective of the study was to find out the association of serum Hcy with Acute MI and chronic ischemic heart disease (CHD) patients in our population. Mean Hcy level of Acute MI were 21.16 +/- 4.56 (micromol/l), 27.55 +/- 10.40 (micromol/l) and that of control was 13.03 +/- 10.51(micromol/l). Serum Hcy was significantly higher in both cases than control. But insignificant difference was found between AMI vs CHD (P> 0.05). Quantitative measurement of serum Hcy was measured by fluorescence polarization Immunoassay (FPIA) in IMX analyzer (Abbott-USA).