Usability of myocardial work parameters in demonstrating myocardial involvement in INOCA patients.

BACKGROUND: Myocardial work (MW) is a novel echocardiographic modality, which has been shown to have diagnostic and prognostic values in patients with cardiovascular diseases, patients with obstructive coronary artery disease, in particular. However, only a handful of studies have examined the MW analysis in ischemia with nonobstructive coronary artery (INOCA) disease. This study, therefore, aimed to detect the early left ventricular involvement in INOCA patients diagnosed by an invasive coronary angiography performing the MW analysis. METHODS: This study included a total of 119 patients with nonobstructive coronary artery disease diagnosed by invasive coronary angiography, who were checked for prior ischemia tests performing myocardial perfusion scintigraphy. Out of these 119 patients, 49 patients developed ischemia (i.e., ischemic group) diagnosed using cardiac single-photon emission computed tomography, whereas 70 patients did not (i.e., nonischemic group). The subjects were divided into three groups based on the global MW tertiles. The groups were compared in terms of the conventional, longitudinal strain, and MW findings by conducting echocardiographic examinations. RESULTS: The study subjects were divided into three groups based on the global constrictive work (GCW) value. The three groups were not statistically different in terms of the mean age of the patients (53.0 ± 12 vs. 52.4 ± 13.3 vs. 52.1 ± 12.3; p = 0.96). Furthermore, the three groups were not statistically different regarding the gender, height, weight, and laboratory parameters of the patients except albumin. There was no statistically difference among the tertiles of GCW groups in the measurements of cardiac chambers, LA diameter, interventricular septum, E wave, and A wave. Also, there was no statistical difference in tissue Doppler recordings. The parameters associated with MW were examined, three groups were not statistically different in terms of the global waste work (GWW) (116 ± 92, 122 ± 73, 135 ± 62, p = 0.52, respectively). In contrast, the three groups were different regarding the Global work index (GWI) (1716 ± 300, 1999 ± 130, 2253 ± 195, p < 0.001, respectively), GCW (1888 ± 206, 2298 ± 75, 2614 ± 155, p < 0.001, respectively), and Global work efficiency parameters (92.8 ± 3.6, 94.4 ± 3.2, 95.1 ± 1.8 p = 0.004, respectively). CONCLUSION: It was concluded that the MW parameters GCW and GWI may have been used for predicting INOCA in patients.

Obesity Paradox in Coronary Thrombus Burden of Patients with Acute Coronary Syndrome.

Background: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Although obesity is a risk factor for ACS, decreased mortality has been shown in overweight individuals. This study aims to determine the association of body fat parameters such as body fat percentage (BFP), relative fat mass (RFM), and coronary thrombus burden with angiographic thrombotic grade in a series of patients presenting with ACS. Methods: Three hundred ninety patients who underwent percutaneous coronary intervention were enrolled in the study. BFP was calculated using the U.S. Navy formula. RFM index was calculated using gender, height, and waist circumference regardless of weight. Body mass index (BMI) is calculated as the weight in kilograms divided by the square of body length in meters (kg/m2). Two experienced interventional cardiologists reviewed coronary angiograms according to the TIMI thrombus scale. Patients were divided into groups according to thrombus classification and clinical status. Results: RFM, which is an anthropometric measurement parameter for obesity, was inversely related to thrombus burden in patients with ACS. There were no significant differences between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups according to demographic, clinical characteristics, and coronary risk factors. Likewise, RFM, BFP, and BMI were comparable between the two groups. BFP and RFM were lower in patients with thrombus present STEMI group compared with no thrombus group. Thrombus presence was also compared in the NSTEMI group, and BMI, BFP, and RFM were lower in patients with thrombus present NSTEMI group. Conclusions: Our analysis demonstrated that RFM was better than BFP and BMI for predicting thrombus presence in patients with ACS.

Role of Nitric Oxide in the Antipruritic Effect of WIN 55,212-2, a Cannabinoid Agonist.

INTRODUCTION: For centuries, cannabinoids are known to be effective in pain relief. Itch is an unpleasant sensation that provokes a desire to scratch. Since itch and pain are two sensations sharing a lot in common, we aimed to investigate whether the cannabinoid agonist WIN 55,212-2 reduces serotonin-induced scratching behavior and also observe whether modulation of Nitric Oxide (NO) production mediates the antipruritic effect of WIN 55,212-2. METHODS: Scratching behavior is induced by intradermal injection of serotonin (50 µg/50 µL/mouse) to BALB/c mice. The cannabinoid agonist WIN 55,212-2 (1, 3, 10 mg/kg, IP) was given 30 min before serotonin injection. To observe the effect of NO modulation on the antipruritic effect of cannabinoids, the endothelial nitric oxide synthase (NOS) inhibitor L-NAME (3 mg/kg, IP), the neuronal NOS inhibitor 7-nitroindazole (3 mg/kg, IP), and the NO precursor L-arginine (100 mg/kg, IP) were administered together with WIN 55,212-2. RESULTS: WIN 55,212-2 reduced serotonin-induced scratches at higher doses (3, 10 mg/ kg; P<0.0001). The endothelial NOS inhibitor L-NAME, the neuronal NOS inhibitor 7-nitroindazole, and the nitric oxide precursor L-arginine did not influence the antipruritic action of WIN 55,212-2. When NO modulators were used alone, only the neuronal NOS inhibitor 7-nitroindazole attenuated serotonin-induced scratches (P<0.0001). CONCLUSION: Our findings indicate that exogenous cannabinoids may attenuate serotonininduced scratches and NO does not mediate the antipruritic effect of WIN 55,212-2. On the other hand, neuronal NOS inhibition may play a role in the production of serotonin-induced scratches.