Serum levels of soluble CD40 ligand in patients with chronic and acute coronary syndromes and its relation to angiographic extent of coronary arterial narrowing

The aim of this study was to determine serum levels of soluble CD4O ligand [sCD4OL] in patients with chronic and acute coronary syndromes [ACS] and to assess the relation between sCD4OL levels and extent of coronary arterial narrowing in patients with ACS. Acute coronary events commonly result from thrombosis triggered by disruption of an atherosclerotic plaque. Recent studies have localized the receptor CD4O and its ligand in human atheroma. The CD4OL on activated T cells and platelets, by inducing the expression of matrix- degrading proteinases and of tissue factor procoagulant, may contribute to the triggering of acute coronary events. To study the role of CD4OL-CD4O interaction in coronary artery disease, we analyzed serum levels of sCD4OL in the peripheral blood from 10 patients with stable angina [SA]. 26 patients with unstable angina [UA], 22 patients with acute ST-segment elevation myocardial infarction [Ml] and 20 healthy controls by enzyme-linked immunosorbent assay [ELISA]. Coronary angiograms of all the VA patients and 18 Ml patients were reviewed to determine the culprit vessel [CV], CV complexity score [CVCS] [a score of I is given to a simple stenosis, 2: complex stenosis, 3: intracoronary thrombus, 4: total occlusion], type of CV lesion [A, B or C according to the lesion morphology] and vessel score [number of vessels with >/= 50% diameter stenosis]. Both patients with UA and Ml showed significantly higher levels of serum sCD4OL compared to patients with SA and controls; particularly high levels occurred in patients with UA [F ratio 34.9, p <0.001]. No statistically significant difference in sCD4OL levels was noted between VA and Ml patients or between SA patients and controls. Levels of sCD4OL did not show any significant correlation to peak CK. CK-MB in Ml patients or troponin T serum levels in UA patients. Levels of sCD4OL did not also show any significant correlation to CVCS, type of CV lesion or vesset score in VA or Ml patients. This study shows enhanced levels of sCD4OL levels in patients with UA and MI patients suggesting that CD4OL-CD4O interaction plays a pathogenic role in the triggering of ACS. Serum levels of sCD4OL could not however, predict the angiographic extent of coronary arterial narrowing

Percutaneous metal mitral commissurotomy: initial experience

Although balloon mitral valvuloplasty [BMV] is the preferred percutaneous treatment for mitral stenosis, the technique has shortcomings such as obstruction of the mitral valve during balloon inflation, incomplete mitral commissural splitting, relatively high incidence of mitral incompetence, and high cost of the balloon set. We used a new metallic percutaneous mitral commissurotome [PMC] in 32 patients with severe mitral stenosis, to assess its advantages, disadvantages and complications. This study describes the device, the technique used, and the immediate results. PMC was successful in 26 cases [81.2%], failed in 3 cases [9.4%], and was partially successful [an increase of mitral valve area [MVA] <50%] in 3 cases [9.4%]. MVA increased from a mean of 1.0 +/- 0.1 cm2 to a mean of 2.3 +/- 0.5 cm2 in the successful cases. We experienced no complications with PMC, and no increase in mitral regurgitation in any patient in the study