Evidence of influenza or influenza-like-illness preceding acute coronary syndrome.

This observational study determined the prevalence of influenza and influenza-like-illness (ILI) in patients hospitalized for acute coronary syndrome (ACS). Serological confirmation and a clinical history of influenza or a recent acute upper respiratory infection were obtained in 376 patients admitted to Maharaj Nakhon Chiang Mai Hospital, Thailand, from June 2006 through May 2007 for ACS. We found evidence of confirmed influenza preceding ACS in 47 patients (12.5%) and for recent ILI in 41 patients (11%). There were more influenza and ILI patients admitted in the winter than in other months. Influenza vaccination may be protective in high risk patients.

Diagnostic level of cardiac troponin T in patients with chronic renal dysfunction, a pilot study.

OBJECTIVE: To find the diagnostic level and rising pattern of cardiac troponin T (cTnT) in patients with chronic renal dysfunction presented with acute myocardial infarction (AMI). MATERIAL AND METHOD: A pilot, cross-sectional study to compare the level of cTnT in adult patients with chronic renal dysfunction who were admitted and later confirmed to have AMI with those in the age and sex-matched controls with chronic renal dysfunction and non-coronary diagnosis. RESULTS: Twenty-three patients were enrolled into each group. The mean cTnT levels in the AMI group were significantly higher than in the control group. Magnitude and rate of post-admission rise of cTnT were not significantly different between both groups. The diagnostic level of cTnT for AMI was 0.1 nanogram per milliliter with 90.90% sensitivity and 84.50% specificity. The sensitivity and specificity of this diagnostic level were 91.30% and 100.00% respectively when patients with chronic renal replacement were excluded. CONCLUSION: The level ofcTnT of at least 0.1 nanogram per milliliter within the first 24 hours of admission was diagnostic for AMI in patients with chronic renal dysfunction. The sensitivity and specificity of the tests were better if the patients with chronic renal replacement were excluded.

The Atorvastatin Goal Achievement Across Risk Levels: (ATGOAL) study in Thailand.

OBJECTIVE: To evaluate the efficacy and safety of atorvastatin at the starting doses of 10, 20, 40 mg and evaluate the effectiveness of 1 step titrate up regimen. MATERIAL AND METHOD: Two hundred and forty two subjects with dyslipidemia were enrolled and assigned the appropriate dose in relation to their individual cardiovascular risk status and baseline LDL-C levels. If the NCEP targets were not achieved, the doses were titrated up at week 4 and the primary efficacy was evaluated at week 8. RESULTS: A majority of subjects (88.8%) achieved their LDL-C goals at week 8. Almost all of the subject's LDL-C levels reached their goals by week 2 and 4 (81.6% and 87.1%, respectively). Only 10.7% (n = 25) required the sole titration. Each dose provided significant decreases in LDL-C (average -46.4%). Only 36 subjects experienced treatment related adverse events, the majority of these were in the high-risk group (n = 22) with only one subject registering a serious adverse event. CONCLUSION: Atorvastatin is effective and safe for Thai patients with dyslipidemia. The appropriate starting dose has contributed in the achievement of cholesterol reduction.

A predictive model for distinguishing ischemic from non-ischemic cardiomyopathy.

OBJECTIVES: To develop a predictive model to distinguish ischemic from non-ischemic cardiomyopathy MATERIAL AND METHOD: The authors randomly assigned 137 patients with LV systolic dysfunction into two subsets--one to derive a predictive model and the other to validate it. Clinical, electrocardiographic and echocardiographic data were interpreted by blinded investigators to the subsequent coronary angiogram results. Ischemic cardiomyopathy was diagnosed by the presence of significant coronary artery disease from the coronary angiogram. The final model had been derived from the clinical data and was validated using the validating set. The receiver-operating characteristics (ROC) curves and the diagnostic performances of the model were estimated. RESULTS: The authors developed the following model: Predictive score = (3 x presence of diabetes mellitus) + number of ECG leads with abnormal Q waves--(5 x presence of echocardiographic characteristic of nonischemic cardiomyopathy). The model was well discriminated (area under ROC curve = 0.94). Performance in the validating sample was equally good (area under ROC curve = 0.89). When a cut-off point > or = 0 was used to predict the presence of significant coronary artery disease, the model had a sensitivity, specificity and positive and negative predictive values of 100%, 57%, 74% and 100%, respectively. CONCLUSION: With the high negative value of this model, it would be useful for use as a screening tool to exclude non-ischemic cardiomyopathy in heart failure patients and may avoid unnecessary coronary angiograms.

Efficacy and safety of rilmenidine, a selective imidazoline I1 receptor binding ligand, in mild-to-moderate Thai hypertensive patients.

BACKGROUND: Rilmenidine is an antihypertensive agent that selectively binds to imidazoline I1 receptor located in the brainstem and kidney. It acts both centrally by reducing sympathetic overactivity and in the kidney by decreasing water and sodium overload. This dual action leads to the immediate and delayed control of blood pressure caused by this drug. OBJECTIVE: The aim of this study was to assess the efficacy and safety of rilmenidine as monotherapy in mild-to-moderate essential hypertensive patients. METHOD: An 8-week, open-labeled, multicenter study was conducted in Thai patients with mild-to-moderate essential hypertension. Rilmenidine 1 mg/day was given for 8 weeks. The dose could be titrated up to 2 mg/day according to the patient's blood pressure response at week 4. The primary efficacy parameters were the mean reductions in systolic and diastolic blood pressure. The proportions of patients whose blood pressure normalized or responded were evaluated as secondary efficacy parameters. Safety parameters were assessed by the changes in heart rate and reported side effects during the treatment period. RESULTS: 103 subjects (44.7% men) with a mean age of 53 +/- 9.7 years completed the 8-week follow-up. At baseline, 46.6 per cent and 53.4 per cent of the patients were classified with mild and moderate hypertension, respectively. The mean blood pressure was 154/93 mmHg. After the 8-week treatment, there was a significant decrease in blood pressure to 140/86 mmHg (p < 0.001), with mean pressure reduction of 14/7.5 mmHg. The normalization rate was 44 per cent and the response rate was 68 per cent. No significant changes were found for mean heart rate and any laboratory parameters tested. Only 17 patients reported mild and transient side effects such as drowsiness and dryness of the mouth and throat, which required no treatment. CONCLUSION: This study has shown that rilmenidine is an effective and well tolerated monotherapy in Thai patients with mild-to-moderate essential hypertension.