Impact of endothelial dysfunction on stable angina versus unstable angina

Endothelial dysfunction is a systemic disorder and a key variable in the pathogenesis of atherosclerosis and its complications. Current evidence suggests that endothelial status is not determined solely by the individual risk factor burden but rather, an integrated index of all atherogenic and atheroprotective factors present in an individual, including known as well as yet-unknown variables and genetic predisposition. The aim of the present study is to examine the relation of impaired endothelial dependent dilatation of the brachial artery which is a sensitive marker of endothelial dysfunction and occurs early during development of atherosclerosis with stable and unstable angina pectoris. One of those new techniques is assessment of the peripheral vascular endothelial function testing as a non invasive indicator of coronary artery disease using brachial artery ultrasound. This study was carried out in Zagazig University hospitals, and included 120 patients divided into three groups; group I: chronic stable angina pectoris, group II: unstable angina pectoris and group III: control group. All the results were analyzed statistically to detect their significance. The study showed that there was a significant correlation between the FMD and the results of the coronary angiography and both systolic and diastolic functions of the cit ventricle. It also showed significant correlations between the brachial artery flow-mediated dilation of the brachial artery and most of the cardiovascular risk factors. The results support the notion that evaluation of peripheral vascular endothelial function can accurately exclude CAD in subjects undergoing noninvasive assessment for atherosclerosis. Determination of peripheral endothehial function can confirm a low probability of CAD in low-risk individuals and, thus, may obviate the need for more elaborate testing. Systemic endothelium-dependent vasoreactivity predicts recurrence of instability and cardiovascular event rates in patients with ACS. Assessment of systemic vasoreactivity measured by a minimally invasive test, provides important prognostic information in addition to that derived from traditional risk factor assessment in patients with ACS. Also, endothelium-dependent dilation of the brachial artery is a strong in dependent predictor of adverse outcome in survivors of ACS without ST-segment elevation

Significance of stress induced myocardial ischemia in young hypertensive Egyptians

Normal ECG does not exclude significant coronary artery disease or left ventricular hypertrophy. Silent ischemia is common in hypertensive patients. Nowadays there is increase in the prevalence of essential hypertension in young adults. Is to test the significance of exercise ECG in detection of CAD, and its prevalence in young hypertensive patients. This study included 100 patients with age range between 16-35 year. A control group of 20 healthy adult volunteers of the same age range. All patients were subjected to thorough History taking, Clinical assessment, Laboratory investigations [FBS, Lipid profile], Baseline ECG, Echocardiographic study, Exercise stress testing. The resting systolic blood pressure, mean maximum systolic blood pressure and The recovery heart rate were significantly correlated with LV mass in hypertensive patients. There was a significant dyslipidemia and impaired diastolic function in hypertensive patients, and this dyslipidemia correlated with LV mass. LV mass, dyslipidemia, and diastolic dysfunction were the most determine, related to abnormal exercise response in hypertensive patients. Patients with ST-segment depression showed a sign of increased LV mass, increased recovery heart rate and dyslipidemia

Non-invasive assessment of endothelial function in offspring of patients with type-2 diabetes mellitus

Objective:- The present study aimed at evaluation of the non invasive assessment of endothelial function in offspring of patient with type 2 diabetes mellitus [type 2 DM]

Subject and methods:-The study include 36 healthy subject [mean age 25 +/- 12 year] with one or both parents were type 2 diabetes mellitus, 48 patient with type 2 DM [mean age 58 +/- 10 years] and 12 healthy control subject matched for age [23 +/- 10 years] with no history of diabetes in any of their parents The brachial artery diameter and its vascular reactivity was measured with high resolution ultrasound at rest, endothelial dependant after reactive hypereamia [Flow mediated dilatation [FMD]] and endothelial independent after administration of sublingual nitrate [NMD]

Result:- The result of our study demonstrated that The FMD was significantly low in patient with type 2 DM as compared to the control subjects 14.7 +/- 1.0, 13.9 +/- 1,8, P <0.001]. Also the NMD was significantly lower in diabetic patient compared to control subject [10.1 +/- 3.1, 21.2 +/- 22 P<0.001] The FMD and NMD were comparable among offspring of diabetic patients and their parents On the other hand the rate of blood flow was also significantly decreased in diabetic and their offspring as compared to control subjects

Conclusion:- Study of brachial artery dilatation with high resolution ultrasound is a simple non invasive index of endothelial function FMD and NMD was significantly impaired in diabetic patient FMD and NMD was significantly impaired in offspring of diabetic patient So we recommend that brachial artery reactivity study should be performed in offspring of diabetic patient in regular fashion to pick-up early impairment in endothelial function and dealt with