ABSTRACT
BACKGROUND: Numerous studies have shown a relationship between hyperhomocysteinemia, atherothrombosis and cardiovascular mortality. However, an association between hyperhomocysteinemia and the extent of coronary artery disease (CAD) remains controversial whereas its relationship with left ventricular systolic function has not been established. METHODS: One hundred and fifty-seven patients with angiographically defined CAD were included. The relationships between hyperhomocysteinemia, severity of CAD and left ventricular systolic function were studied. Left ventricular systolic function was determined primarily by ventriculography. The severity of CAD was determined through coronary angiography using the Gensini score and the number of vessels with > or = 50% stenosis. RESULTS: The mean fasting plasma homocysteine level was 13.4 mumol/l+/-0.5 SE. Elevated levels of homocysteine correlated significantly with increased severity of CAD both by the Gensini scores (r-value = 0.344, P < 0.0005) and the total number of diseased vessels (r-value = 0.387, P < 0.0005). The patients with hyperhomocysteinemia were found to have significantly reduced left ventricular ejection fraction (r-value = -0.382, P < 0.0005). A multivariate regression analysis revealed homocysteine level to be an independent predictor of left ventricular systolic function. In addition, adjusted analysis revealed hyperhomocysteinemia to be associated with global left ventricular dysfunction. CONCLUSION: In patients with CAD, homocysteine levels correlate independently with left ventricular systolic function. The mechanism of this association between homocysteine and left ventricular systolic function is unknown but may be due to a direct effect of homocysteine on myocardial function separate from its effects on coronary atherosclerosis.
Subject(s)
Coronary Artery Disease/blood , Homocysteine/blood , Ventricular Dysfunction, Left/blood , Aged , Cholesterol, HDL/blood , Coronary Artery Disease/physiopathology , Diabetes Mellitus, Type 1/physiopathology , Female , Humans , Hyperhomocysteinemia/physiopathology , Male , Multivariate Analysis , Racial Groups , Severity of Illness Index , Stroke Volume/physiology , Systole/physiology , Ventricular Dysfunction, Left/physiopathologyABSTRACT
We describe a case of stenting an unprotected left main coronary artery stenosis in an octogenarian patient with cardiogenic shock complicating acute myocardial infarction. Our patient had no in-stent restenosis of the left main for three years and remains asymptomatic. Since, in the octogenarian patient, the surgical risk for emergent coronary artery bypass graft is extremely high, coronary artery stenting of the unprotected left main for myocardial infarction complicated by cardiogenic shock is an alternative treatment in selected patients.
