Qualitative and quantitative coronary angiography in patients with acute coronary syndrome [ACS]

Acute Coronary Syndrome [ACS] encompasses several diseases, previously thought to be separate and defined disease states. In this syndrome, Unstable Angina [UA], Non-ST Elevation Myocardial Infarction [NSTEMI], and ST-Elevation Myocardial Infarctions [STEMI] are all part of this category. The pathogenesis begins with plaque rupture which activates the platelets and coagulation cascade leading to thrombus formation. The thrombus leads to partial or complete coronary artery occlusion leading to various clinical manifestations of ACS. The aim of the present study is to assess the extent of coronary artery disease and characterizes plaque morphology and lesion severity in patients with ACS in comparison with patients with chronic stable ischemic heart disease. To achieve this aim, we studied 100 patients with symptomatic coronary artery disease admitted to Mansoura medical Hospital, where they were subjected to full clinical evaluation; 12 lead electrocardiogram, full laboratory investigations and Coronary angiography was done to every patient, then we analyses the results both qualitative [eye ball description of angiographic lesions] and quantitative [computer-based]. Those patients were classified into two main groups, the first group of patients were those with ACS [50 patients] as a test group while the second one included patients chronic stable ischemic heart disease [50 patients] as a control group. Both groups were comparable and no significant difference was present as regard age, sex, diabetes mellitus, hypertension, smoking, left ventricular function, prior PTCA, prior CHF and angina class while, prior MI more frequent among test group. One hundred, forty-seven lesions [66 in test group and 81 in control group] were available for detailed qualitative angiographic analysis. Out of seven criteria analyzed only presence of lumen irregularity and thrombus were more frequent among patient who presented with ACS [17 [26%] vs. 2 [2.5%] p < 0.05; 9 [13.6%] vs. 0 [0%] p < 0.05] respectively], and this represents the main finding in the current study. No significant difference was present in Quantitative Coronary angiographic characteristics in both groups. The qualitative angiographic assessment represents an essential tool in the evaluation and risk stratification of patients with ACS, through the demonstration of the presence of thrombus and lumen irregularity that correlated more with ACS than the other studded criteria. In addition, QCA although added accurate assessment of the degree of luminal narrowing, thus helping in assessment of the severity of the disease

Study of endothelial function in relation to haemorrheologic and haemodynamic abnormalities in patients with dilated cardiomyopathy

In order to study the alteration in hemostatic, hemorrheologic and endothelial functional parameters in patients with dilated cardiomyopathy [DCM] a test group of 30 patients suffering from this cardiac disorder were studied in comparison to 20 healthy individual of matched age and sex. All patients and control subjects were subjected to through history taking, full clinical examination and the and the following investigations; ECG, x-ray chest, Echo-Doppler study and laboratory investigation including blood picture, hematocrit value, ESR, plasma viscosity, prothrombin time and activity [PT] activated partial thromboplastin time [APTT], plasma fibrinogen and von Willebrand factor [vWF]. The study revealed significant alterations in most of the studied hemostatic and hemorrheological parameters and endothelial functions. A significant negative correlation between plasma vWF and echocardiographic EF and FS which points to an intimate relation of endothelial dysfunction and deterioration of LV function in patients with DCM

Echo-doppler study of left ventricular diastolic function in patients with psoriasis

This work was performed to assess left ventricular [LV] diastolic and systolic performance in 50 psoriatic patients diagnosed clinically and with skin biopsy, as well, as 20 healthy individuals by using electrocardiographic and Doppler-Echocardiographic techniques. All the studied psoriatic subgroups showed subclinical alteration of LV performance both systolic performance in the form of prolonged QTc., reduction of LVEF [Ejection fraction] and% FS and the diastolic performance in the form of significant reduction of M-mode mitral-EF slope: and non-significant decrease in E peak velocity: significant increase in A peak velocity as well as significant decrease of E/A ratio of the transmitral Doppler flow study. The duration of psoriasis has more deleterious effect on the parameters reflecting LV systolic performance while the severity and extent of psoriatic lesion alter more the parameters of LV diastolic performance. The presence or absence of psoriatic arthritis or nail pitting does not affect the changes observed in LV performance. For the first time; pericardial effusion and tricuspid valve prolapse to be observed in psoriatic patients [4% and 6% respectively]. In conclusion cardiac examination is advised in psoriatic patients

Regional left ventricular functions in diabetics with acute myocardial infarction

The present study comprised 48 patients with acute myocardial infarction, divided into a test group [32 diabetic patients] and a control group [18 non-diabetic patients without other identifiable risk factors]. Left ventricular segmental wall motion was evaluated in all patients by the use of 2D echocardiography. The study revealed that in diabetic patients with acute myocardial infarction total segmental score and wall motion index are both significantly increased in patients with anterior than in those with inferior myocardial infarction, in patients with heart failure than in those without heart failure, and in the whole diabetic group as compared with non- diabetic. The institution of thrombolytic therapy at the proper time resulted in a significant improvement in the total segmental core and wall motion index, in diabetic patients with acute myocardial infarction