Gender differences in genotypic distribution of endothelin-1 gene and endothelin receptor A gene in pulmonary hypertension associated with rheumatic mitral valve disease

Introduction: The female gender is a risk factor for idiopathic pulmonary arterial hypertension. However, it is unknown whether females with rheumatic mitral valve disease are more predisposed to develop pulmonary hypertension compared to males. Aim: We aimed to investigate whether there was a difference in genotypic distribution of endothelin-1 (ET-1) and endothelin receptor A (ETA) genes between female and male patients of pulmonary hypertension associated with rheumatic mitral valve disease (PH-MVD). Methods: We compared prevalence of ET-1 gene (Lys198Asn) and ETA gene (His323His) polymorphisms according to gender in 123 PH-MVD subjects and 123 healthy controls. Results: The presence of mutant Asn/Asn and either mutant Asn/Asn or heterozygous Lys/Asn genotypes of Lys198Asn polymorphism when compared to Lys/Lys in females showed significant association with higher risk (odds ratio [OR] 4.5; p ¼0.007 and OR 2.39; p ¼0.02, respectively). The presence of heterozygous C/T and either mutant T/T or heterozygous C/T genotypes of His323His polymorphism when compared to wild C/C genotype in females showed a significant association with higher risk (OR 1.96; p ¼0.047 and OR 2.26; p ¼0.01, respectively). No significant difference was seen in genotypic frequencies in males between PH-MVD subjects and controls. Logistic regression analysis showed that mutant genotype Asn/Asn (p ¼0.007) and heterozygous genotype Lys/Asn of Lys198Asn polymorphism (p ¼0.018) were independent predictors of development of PH in females.

Left atrial function by two-dimensional speckle tracking echocardiography in patients with severe rheumatic mitral stenosis and pulmonary hypertension

We studied left atrial (LA) function in severe rheumatic mitral stenosis (MS) patients using twodimensional speckle tracking echocardiography (STE). Eighty patients with isolated severe MS in sinus rhythm and 40 controls underwent comprehensive echocardiography including STE derived LA strain [reservoir strain (LASr), conduit strain (LAScd) and contractile strain (LASct)]. The mean MVA was 0.93 ± 0.21 cm2 . The mean values of LASr (14.73 ± 8.59%), LAScd (±7.61 ± 4.47%) and LASct (±7.16 ± 5.15%) in patients were significantly lower (p < 0.001) vs. controls 44.11 ± 10.44%, ±32.45 ± 7.63%, -11.85 ± 6.77% respectively and showed decreasing trend with increasing MS severity and higher NYHA class. In conclusion, LA dysfunction is prevalent in severe MS irrespective of NYHA functional class.

Value of CRP in coronary risk determination.

Initial studies showed that C-reactive protein (CRP) may have a role in the genesis of atherosclerotic lesions and as a novel biomarkers of patients at risk of developing coronary heart disease (CHD) events. Most of these studies had methodologic limitations, and recent data contradict these findings and suggest that inflammatory markers, such as CRP, have limited usefulness in the prediction of CHD events over and above conventional risk factors. Its low predictive value creates difficulty in interpreting the CRP data in an individual patient. Current scientific literature does not support measurement of CRP in individual patients in clinical medicine. In this review, we critically appraise role of CRP in cardiovascular medicine.

Revascularization of chronic total occlusion of coronary artery: a challenge and an opportunity.

Remarkable progress has been achieved in the percutaneous management of coronary artery disease over the last decade. In the early 1990s, the primary success rate with the use of bare metal stents was 86-88% and the restenosis rate, 30%-40%. Over the last decade, drug-eluting stents have been developed to check the high rates of in-stent restenosis following percutaneous coronary revascularization. In randomized trials, polymer-coated sirolimus- and paclitaxel-eluting stents, when compared to bare metal stents, have been shown to markedly reduce the incidence of both angiographic restenosis and repeat revascularization. The effectiveness of drug-eluting stents in the prevention of restenosis has been confirmed in patients with stable stenotic lesions, as well as many patients with specific lesions, such as those with in-stent restenosis and acute myocardial infarction. Currently, the primary success rate using drugeluting stents has risen to over 95% and the restenosis rate to less than 10%. In spite of remarkable technological advances and improved outcomes with percutaneous coronary revascularization, chronic total occlusions of the coronary artery remain a source of procedural frustration and clinical uncertainty. With continued developments in catheterbased technologies, there is an opportunity to achieve recanalization of chronic total occlusions with drug-eluting stents; this subset of patients is now recognized as the last formidable barrier to the success of percutaneous revascularization. This review provides an overview of the pathophysiology of chronic total occlusions and the clinical outcomes associated with chronic total occlusion revascularization, and provides future directions for clinical investigation.