Circulating adhesion molecules as predictors of atherosclerosis and coronary heart disease

Adhesion of leukocytes to endothelial cells via cell adhesion molecules is thought to be pivotal in the initiation of atherosclerosis. This study was designed to determine the value of circulating cell adhesion molecules as a predictors of coronary heart disease and atherosclerosis. This study was conducted on 25 patients with coronary heart disease [CHD], 21 patients with carotid artery atherosclerosis [CAA] and 20 healthy individuals served as control group. The levels of serum soluble[s] adhesion molecules: E-selectin [sE-selectin], intracellular adhesion molecule-l [sICAM-1] and vascular cell adhesion molecule-l [sVCAM-1] were measured in addition to the serum lipids, total cholesterol and triglyceride, HDL-c and LDL-c. The concentration of sE-selectin was significantly higher in the patient groups when compared with the control subjects [CHD 34.9 +/- 19.2 ng/ml; CAA 43.0 +/- 16.7 ng/ml vs. control 18.5 +/- 7.4 ng/ml, p<0.05 and p< 0.001 respectivly]. While there were non significant statistical difference between CHD and CAA [p> 0.05]. The serum level of sICAM-1 was significantly higher in CHD than control [p< 0.05], while there were non significant changes in their values in CAA and control [CHD 318 +/- 85.1 ng/ml, CAA 292.3 +/- 64.2 ng/ml vs. control 240 +/- 68.1 ng/ml]. A significant increase was found in sVCAM-1 among the patient groups when compared with the control [CHD 535 + 227.1ng/ml, CAA 445 + 139.6 ng/ml, control 115+19.7 ng/ml p < 0.001 and p< 0.01 for CHD and CAA respectivly]. The levels of the studied serum lipids were significantly increased in the patient groups when compared with the control [p < 0.001]. When these serum lipids were correlated with the studied adhesion molecules, there were positive correlation between the sE-selectin and LDL-c [r = 0.5, p < 0.02], between sICAM-1 and both of LDL-c [r = 0.51, p< 0.02] and TG [r = 0.39, p<0.05] and between sVCAM-1 and TG [r = 0.62, p< 0.01]. In conclusion, the increase of sE-selectin, sICAM-1 and sVCAM-I levels in patients with CHD and CAA suggests that they would be of beneficial value as markers for preclinical prediction of atherosclerosis and CHD

Value of posterior and right precordial leads in acute myocardial infarction

Evaluation of the diagnostic and prognostic value of posterior chest leads [PCL] [V7, V8 and V9] and right chest lead [RCL] [V3R, V4R and V5R] in acute myocardial infarction [AMI]. 44 consecutive patients with AMI were included in this work; serial PCL [V7, V8 and V9] and RCL [V3R, V4R and V5R [and standard 12 leads ECGs were recorded. Accordingly patients were grouped into two groups; Group I: with inferior AMI and. Group II: with anterior AMI. Each group was subgrouped into A and B according to the presence or absence of changes in PCL and RCL. In-hospital course was assessed and echocardiographic wall motion score index [WMSI] was estimated for every patients. In group I; there were 13 out of 18 patients had changes in RCL and PCL [5 and 8 respectively] and 4 out of 24 patients in group II had changes in RCL and PCL [2 in each]. True isolated posterior AMI was recorded in 2 patients. Patients having changes in RCL and PCL had more frequent in-hospital complications; post MI angina [P<0.05], heart failure [P<0.01], serious dysrrhythmias [P<0.01], mortality [P<0.05]. Also, they had a significant reduction in E.F. [P<0.05] and F.S [P<0.01] and higher WMSI [P<0.01] as compared to those patients without right and posterior precordial leads changes. There were a significant prevalence of right ventricular [RV] and/or posterior myocardial infarction in association with anterior and inferior AMI. The presence of RV and posterior infarction, in addition, had a more adverse outcome. We recommend the routine recording of RV and posterior precordial leads in every patients presented with chest pain. It may improve the identification of the high risk subset of patients and may have an important therapeutic and prognostic implications