The Association Between Hematologic Indices With TIMI Flow In STEMI Patients Who Undergo primary percutaneous coronary intervention.

BACKGROUND: The Primary Percutaneous Coronary Intervention (PPCI) is the preferred therapeutic strategy for patients who experienced ST-Elevation Myocardial Infarction (STEMI). OBJECTIVE: We aimed to evaluate the association of hematological indices, including hemoglobin level, platelets, White Blood Cells (WBCs) count, and MPV before PPCI with the TIMI grade flow after PPCI. METHODS: STEMI patients who experienced PPCI were included in the present retrospective crosssectional study. Then participants were divided into three groups based on their post-procedural TIMI flow grades. Demographic data and hematologic indices of patients before PPCI were collected and their association with the TIMI grade flow after PPCI was evaluated. To compare the quantitative and qualitative variables, chi-square and t-tests were performed, respectively. RESULTS: We found that elevated levels of hemoglobin and decreased levels of MPV had a significant association with an advanced grade of TIMI flow. Interestingly, in the normal range, there was a significant association between higher platelet count and TIMI-flow grade 1. Besides, TIMI flow grades 2 and 3 had a significant association with low and moderate platelets count, respectively. CONCLUSION: In conclusion, evaluating MPV, platelets, and hemoglobin levels before PPCI as easy and accessible parameters may be able to identify high-risk STEMI patients undergoing PPCI.

Effect of a nut-enriched low-calorie diet on body weight and selected markers of inflammation in overweight and obese stable coronary artery disease patients: a randomized controlled study.

BACKGROUND/OBJECTIVES: Weight loss through a low-calorie diet (LCD) could improve low-grade inflammation evident in the obese state. Few studies have evaluated the effect of the mixed nuts consumption in the context of a LCD on inflammatory biomarkers. This study compared the effects of a nut-enriched LCD (NELCD) with a nut-free LCD (NFLCD) on body weight and inflammatory markers in overweight or obese coronary artery disease (CAD) patients. SUBJECTS/METHOD: In this randomized controlled parallel trial, patients with stable CAD of both genders were randomly allocated to 8-week NELCD or NFLCD. Body weight, plasma C-reactive protein (CRP), interleukin-6 (IL-6), interleukin 10 (IL-10), intercellular adhesion molecule-1 (ICAM-1), and monocyte chemoattractant protein (MCP-1) were assessed at baseline and 8 weeks. RESULTS: Overall, 67 patients (aged 58.8 ± 7.4 years; BMI 30.9 ± 3.9 kg/m2) completed the study. Participants in both groups lost weight to a comparable extent. Patients in the NELCD group showed a decrease in ICAM-1 (p = 0.04) and IL-6 (p = 0.02) concentrations compared to NFLCD group. No significant difference in concentrations of MCP-1, IL-10, or CRP was observed between diet groups. CONCLUSIONS: Nuts are healthy energy-dense foods that if included in controlled amounts in a weight management program can still result in weight reduction and may improve some plasma concentration of inflammatory factors, such as ICAM-1 and IL-6.

Dysregulation of autophagy-related lncRNAs in peripheral blood of coronary artery disease patients.

Coronary artery disease (CAD) as a major cause of death has been associated with dysregulation of several processes among them is autophagy. In the current study, we assessed expression of autophagy related gene 5 (ATG5) and three ATG5-associated long non-coding RNAs (lncRNAs Chast, HULC and DICER1-AS1) in the peripheral blood of patients with premature CAD and healthy subjects. Expression levels of ATG5, Chast, HULC and DICER1-AS1 were significantly lower in peripheral blood of CAD cases compared with healthy subjects. Receiver Operating Characteristic (ROC) curve analysis showed that HULC and DICER1-AS1 can properly differentiate CAD patients from healthy subjects (area under curve (AUC) values of 0.90 and 0.87, respectively). Expression levels of ATG5 and Chast were inversely correlated with FBS levels (r = -0.41, P < 0.0001 and r = -0.38, P < 0.0001 respectively) but no other biochemical factors. Expression of DICER1-AS1 was inversely correlated with FBS (r = -0.54, P < 0.0001), TG (r = -0.29, P < 0.0001) and TG/HDL ratio (r = -0.27, P < 0.0001). Expression of HULC was inversely correlated with age (r = -0.24, P < 0.0001), FBS (r = -0.62, P < 0.0001) and TG (r = -0.31, P < 0.0001). There were significant pairwise correlations between expression levels of all genes. The most robust correlations were detected ATG5 and Chast (r = 0.81, P < 0.0001) and between DICER1-AS1 and HULC (r = 0.75, P < 0.0001). The current study further verified associations between dysregulation of autophagy and CAD. Moreover, our results indicate appropriateness of two autophagy-related lncRNAs for differentiation of CAD status.

Dysregulated expression of STAT1, miR-150, and miR-223 in peripheral blood mononuclear cells of coronary artery disease patients with significant or insignificant stenosis.

Coronary artery disease (CAD) is a multicellular disease characterized by chronic inflammation. Peripheral blood-mononuclear cells (PBMCs), as a critical component of immune system, actively cross-talk with pathophysiological conditions induced by endothelial cell injury, reflecting in perturbed PBMC expression. STAT1 is believed to be relevant to CAD pathogenesis through regulating key inflammatory processes and modulating STAT1 expression play key roles in fine-tuning CAD-related inflammatory processes. This study evaluated PBMC expressions of STAT1, and its regulators (miR-150 and miR-223) in a cohort including 72 patients with CAD with significant ( ≥ 50%) stenosis, 30 patients with insignificant ( < 50%) coronary stenosis (ICAD), and 74 healthy controls, and assessed potential of PBMC expressions to discriminate between patients and controls. We designed quantitative real-time polymerase chain reaction (RT-qPCR) assays and identified stable reference genes for normalizing PBMC quantities of miR-150, miR-223, and STAT1 applying geNorm algorithm to six small RNAs and five mRNAs. There was no significant difference between CAD and ICAD patients regarding STAT1 expression. However, both groups of patients had higher levels of STAT1 than healthy controls. miR-150 and miR-223 were differently expressed across three groups of subjects and were downregulated in patients compared with healthy controls, with the lowest expression levels being observed in patients with ICAD. ROC curves suggested that PBMC expressions may separate between different groups of study subjects. PBMC expressions also discriminated different clinical manifestations of CAD from ICADs or healthy controls. In conclusion, the present study reported PBMC dysregulations of STAT1, miR-150, and miR-223, in patients with significant or insignificant coronary stenosis and suggested that these changes may have diagnostic implications.

Expression pattern of miR-21, miR-25 and PTEN in peripheral blood mononuclear cells of patients with significant or insignificant coronary stenosis.

Coronary artery disease (CAD) is primarily caused by atherosclerosis, which is a series of chronic inflammatory processes leading to the initiation and progression of vascular endothelial cell injury enhancing plaque formation. As critical components of the immune system, peripheral blood mononuclear cells (PBMCs) actively cross-talk with pathophysiological conditions induced by endothelial cell injury, reflecting in altered PBMC expression pattern. This study explored PBMC expression levels of miR-21, miR-25 and PTEN in patients with angiographically proven significant coronary stenosis (the CAD group), patients with insignificant coronary stenosis (the ICAD group) and healthy subjects, and assessed potentials of PBMC expressions in discriminating groups of study subjects. In-silico analysis was also performed to obtain insights into CAD-related pathways and biological processes that may be influenced by altered miRNA expressions. A reduced level of PBMC miR-21 was observed in the ICAD group compared to the CAD group (P: 0.004) or healthy controls (P: 0.0001). PBMC miR-21 level was negatively correlated with the PTEN expression (Spearman r: -0.43, P: 3.9e-09). The PTEN expression was increased in the CAD or ICAD group compared to the control group (CAD vs. controls P: 0.0003, ICAD vs. controls P: 0.03). A stepwise increase in PBMC miR-25 levels was observed from healthy controls to ICADs and CAD patients (Kruskal-Wallis P: 7.68e-12). PBMC gene expressions had reasonable power to discriminate between pairs of study groups. PBMC miR-21 levels were able to discriminate ICADs from both CADs and controls and miR-25 levels had potentials to differentiate among all pairs of study groups (i.e. CADs-ICADs, CADs-controls, CADs-all other subjects, ICADs-controls). PBMC PTEN expression was able to discriminate patients with CAD or ICAD from control subjects. Overrepresentation enrichment analysis of experimentally validated targets of miR-21 and miR-25 highlighted key biological processes and pathways, such as "angiogenesis" and "leukocyte cell-cell adhesion", that may be influenced by dysregulation of PBMC miR-21 and miR-25. In conclusion, these findings suggest that patients with insignificant coronary stenosis may have a distinct PBMC miRNA expression profile than those with significant stenosis or healthy controls.

Pentraxin Level is the Key to Determine Primary Percutaneous Coronary Intervention (PCI) or Fibrinolysis.

AIMS: To examine if pentraxin can help identify patients benefitting most from primary Percutaneous Coronary Intervention (PCI) vs. fibrinolysis. METHODS: Patients with acute ST-Elevation Myocardial Infarction (STEMI) were consecutively recruited from a community center without PCI and a tertiary center with PCI facilities. Left ventricular ejection fraction (LVEF) was determined echocardiographically at baseline and 5 days after the index admission; the difference between two measurements was considered as the magnitude of improvement. We used regression models to test the hypothesis that the magnitude of the advantage of PCI over fibrinolysis in preserving LVEF 5 days after STEMI is modified by pentraxin 3 (PTX3). RESULTS: The functional advantage (LVEF) of the PCI over fibrinolysis has been determined by PTX3. LVEF was attenuated and even reversed as PTX3 level increased. The primary PCI of the participants with less than 7 ng.ml-1 PTX3 level, achieved a clinically significant increase in the LVEF as compared to fibrinolysis. At lower levels of PTX3, PCI shows a conspicuous advantage over fibrinolysis in terms of the probability of developing an LVEF <40%. CONCLUSION: We demonstrated not only the functional advantage of PCI over fibrinolysis performed within the recommended time frames but also the relative advantage of its relevance to the baseline PTX3 levels. PTX3 can play a role in determining the choice of best therapy. More than 75% of patients with STEMI who have PTX3 levels ≤7 ng.ml-1 imply the need of PCI.

The severity of coronary artery disease was not associated with non-alcoholic fatty liver disease in a series of 264 non-diabetic patients who underwent coronary angiography.

BACKGROUND: It is now suggested an association between non-alcoholic fatty liver disease (NAFLD) and the occurrence of coronary artery disease even in non-diabetic patients. We will determine the rate of NAFLD and its main determinants in non-diabetic patients undergoing coronary angiography. METHODS: This cross-sectional study was accomplished on 264 patients who were candidates for coronary angiography during the year 2016. Coronary angiography has been done to depict the presence or absence of coronary involvement, and the severity of coronary artery disease by determining the number of vessels involved and also the SYNTAX score. During 48 hours after coronary angiography, the patients underwent abdominal ultrasonography for detection of NAFLD. RESULTS: The overall prevalence of NAFLD in the patients was 72.3%. The prevalence of NAFLD in those with and without coronary involvement was 71.9% and 73.1% respectively, with no notable difference (p = 0.837). The mean SYNTAX score in the patients with and without NAFLD was 22.32 ± 11.10 and 21.75 ± 10.71 respectively with no difference (p = 0.702). According to the multivariable regression models, the presence of NAFLD could not predict the likelihood of coronary artery disease (OR = 0.879, p = 0.669) or its severity assessed by the SYNTAX score (beta = 0.046, p = 0.456). NAFLD grade was also not a determinant for coronary artery disease (OR = 1.139, p = 0.178) or its severity (beta = 0.058, p = 0.165). CONCLUSION: It seems that the presence and grade of NAFLD may not be correlated with atherosclerotic involvement of coronary arteries and its severity in non-diabetic patients. Future large studies and trials could elucidate the independent role of fatty liver in nondiabetic non-alcoholic patients.

Anticoagulant Therapy in Atrial Fibrillation for Stroke Prevention: Assessment of Agreement Between Clinicians' Decision and CHA2DS2-VASc and HAS-BLED Scores.

INTRODUCTION: To prevent stroke, anticoagulants should be administered after calculation of CHA2DS2-VASc and HAS-BLED scores in patients with Atrial Fibrillation (AF); nonetheless, these scores are sometimes neglected in clinical settings. AIM: The present study was designed to assess agreement of anticoagulant therapy according to clinicians and CHA2DS2-VASc and HAS-BLED scores in Iranian AF patients in Moddares Hospital. METHODS: AF patients were diagnosed according to clinical history, clinical examination, and electrocardiogram. Data including the anticoagulant prescription according to clinicians were recorded. CHA2DS2-VASc and HAS-BLED scores were then calculated for each patient. Agreement of anticoagulant therapy according to clinicians and CHA2DS2-VASc and HAS-BLED scores was analyzed using Cohen's kappa coefficient. RESULTS: 97.5% of the patients (n = 117) were appropriately (according CHA2DS2-VASc and HAS-BLED scores) treated with anticoagulants by clinicians, notwithstanding a 2.5% of patients with inappropriate anticoagulant therapy (n = 3). The Cohen's kappa coefficient was 0.81 (P = 0.0). CONCLUSIONS: The findings of the present study suggest an almost perfect agreement between anticoagulant therapy according to clinicians and that according to CHA2DS2-VASc and HAS-BLED scores in the studied population.

Takotsubo cardiomyopathy following recurrent doses of albuterol due to asthma attack: a very rare case report.

To present an unusual case in order to clarify one of the most important differential diagnoses of ST-elevation myocardial infarction in a postmenopausal woman. A 72-year-old woman with asthma attack and retrosternal chest pain was presented to our emergency unit. She had used albuterol spray ten-times before admission due to accentuated dyspnea. Initial ECG revealed ST-segment elevation in leads V1-V6, I and aVL. Emergent coronary angiography indicated normal coronary arteries, and left ventriculography showed significant akinesia of apical segments. This unusual case emphasizes the fact that emergency physicians and cardiologists should be familiar with Takotsubo cardiomyopathy following overuse of ß2-agonist due to asthma attack that can mimic ST-elevation myocardial infarction.

ST-Elevation Myocardial Infarction 33 Days after Lung Transplant in a Patient with Non-Significant CAD before Transplantation: A Case Report.

Acute myocardial infarction after lung transplantation is not well illustrated in the literature. We present a patient with documented non significant Coronary Artery Disease (CAD) in coronary angiography before lung transplant who was referred to our hospital with acute Myocardial Infarction (MI) 33 days following lung transplantation.

Comparison of fractional flow reserve measurements using intracoronary adenosine versus intracoronary sodium nitroprusside infusions in moderately stenotic coronary artery lesions.

INTRODUCTION: The aim of this study was to investigate the efficacy and safety of intracoronary (IC) sodium nitroprusside infusion in comparison to IC adenosine for fractional flow reserve (FFR) measurement in moderately diseased coronary artery lesions for functional assessment. METHODS: During a nine month period, a consecutive of 98 patients with suspected or known coronary artery disease with moderate stenosis found during angiography (40% to 70% stenosis), were enrolled in this study. Hyperemia was induced by bolus doses of IC adenosine followed by sodium nitroprusside for FFR measurement. RESULTS: Both IC adenosine and IC sodium nitroprusside induced similar and significant reduction in FFR. There was no statistically difference in FFR values between adenosine vs sodium nitroprusside infusions (mean FFR 84.3±6.3 vs 85.7±6.2, p=0.1) respectively. Furthermore, comparing different FFR cut-off points between the groups (FFR<0.75, 0.75-0.8 and >0.8) showed no significant differences (p value=0.7). CONCLUSION: An IC bolus of sodium nitroprusside (0.6µg/kg) infusion induces a similar degree of hyperemia to IC bolus of 100-300µg of adenosine. Therefore, IC sodium nitroprusside could be considered as an alternative drug to adenosine for FFR measurement with lower side effect profile.

MiRNA-Related Polymorphisms in miR-146a and TCF21 Are Associated with Increased Susceptibility to Coronary Artery Disease in an Iranian Population.

AIMS: Recent studies have suggested that single-nucleotide polymorphisms (SNPs) in miRNA genes or their binding sites may alter an individual's susceptibility to coronary artery disease (CAD). In the present study, the association between two such SNPs (rs2910164 in miR-146a and rs12190287, which disrupts miRNA binding to TCF21) and CAD, in an Iranian population, was evaluated and in silico analyses were conducted to predict disease-related effects of miR-146a rs2910164. METHODS: The study population consisted of angiographically confirmed CAD patients (n = 300) and asymptomatic controls (n = 300). Genotyping was performed using the TaqMan genotyping assay. RESULTS: A multivariate regression analysis revealed that rs2910164 was associated with an increased CAD risk in the dominant model. In comparison to GG homozygotes, individuals who carry at least one C allele had a significantly higher risk of CAD (GC+CC vs. GG, odds ratios [OR]: 1.82, 95% confidence intervals [CI]: 1.18-2.80, p = 6.358e-3). Similarly, TCF21 rs12190287 was observed to be associated with CAD in a log-additive model (OR: 0.63, 95% CI: 0.45-0.88, p = 6.584e-3). An in silico analysis revealed that rs2910164 may modify the miR-146a-3p-mediated regulation of several biological processes that are implicated in CAD, like those that are related to the regulation of apoptosis and immune response. CONCLUSIONS: Our data provide the first evidence for the association of miR-146a rs2910164 and TCF21 rs12190287 with CAD in an Iranian population, encouraging further research to elucidate the disease-related effects of miR-146a rs2910164.

Acute myocardial infarction in a 35-year-old man with coronary artery aneurysm most probably caused by Kawasaki disease.

We present a 35-year-old man with history of Kawasaki disease who referred with myocardial infarction, and angiography, revealing aneurysm of left main and left anterior descending coronary arteries. The patient underwent percutaneous coronary intervention and thrombectomy and was discharged after 6 d. Coronary artery sequels of Kawasaki disease should be considered as one of the underlying causes of acute myocardial infarction in young adults.

Fundus autofluorescence in chronic essential hypertension.

PURPOSE: To evaluate fundus autofluorescence (FAF) changes in patients with chronic essential hypertension (HTN). METHODS: In this case-control study, 35 eyes of 35 patients with chronic essential HTN (lasting >5 years) and 31 eyes of 31 volunteers without history of HTN were included. FAF pictures were taken from right eyes of all cases with the Heidelberg retina angiography and then were assessed by two masked retinal specialists. RESULTS: In total, FAF images including 35 images of hypertensive patients and 31 pictures of volunteers, three apparently abnormal patterns were detected. A ring of hyper-autofluorescence in the central macula (doughnut-shaped) was observed in 9 (25.7%) eyes of the hypertensive group but only in 2 (6.5%) eyes of the control group. This difference was statistically significant (P = 0.036) between two groups. Hypo- and/or hyper-autofluorescence patches outside the fovea were the other sign found more in the hypertensive group (22.9%) than in the control group (6.5%); however, the difference was not statistically significant (P = 0.089). The third feature was hypo-autofluorescence around the disk noticed in 11 (31.4%) eyes of hypertensive patients compared to 8 (25.8%) eyes of the controls (P = 0.615). CONCLUSION: A ring of hyper-autofluorescence in the central macula forming a doughnut-shaped feature may be a FAF sign in patients with chronic essential HTN.

Predictive Value of Absent Septal q Wave in Patients with Significant Stenosis of Proximal Left Anterior Descending Coronary Artery.

AIMS: There is conflicting data about the predictive value of absent septal q wave in patients with significant stenosis of proximal Left Anterior Descending coronary artery. To clarify the exact role of this simple electrocardiographic sign we conducted this prospective descriptive study. METHODS: Patients who were referred for coronary angiography in Milad Hospital between December 2008 and September 2009 were chosen randomly. Standard ECG was performed and reviewed for presence or absence of septal q wave, and then the coronary angiography was done and reported by another cardiologist. RESULTS: Of 148 patients with absent septal q wave in ECG, 85 patients (57%) had significant stenosis of proximal LAD in coronary angiography. Statistical analysis showed that significant stenosis of proximal LAD could be predicted by absence of septal q wave in ECG with sensitivity of 59% and specificity of 47%. However, Kappa statistic (Kappa = 0.36) showed low agreement between them. CONCLUSION: Absence of normal septal q wave in ECG could be a low value predictor of coronary artery disease mainly significant proximal LAD stenosis.

Changes of left ventricular mass index among end-stage renal disease patients after renal transplantation.

PURPOSE: The aim of this study was to determine left ventricular (LV) mass index via echocardiography in end-stage renal disease patients (ESRD) before and after renal transplantation, and its association with one-year survival. MATERIALS AND METHODS: Forty-seven patients with ESRD who were candidate for renal transplantation were evaluated with echocardiography before and 4 months after the operation. Left ventricular ejection fraction (EF), LV mass, and LV mass index were determined. All of the patients were followed up for 1 year. RESULTS: Mean LVEF was 51.6% which increased to 53.7% after renal transplantation (P = .001). Mean LV mass was 209 gr before the operation which decreased to 189 gr after the operation (P = .001). Mean LV mass index before the operation was 120 gr/m2 which decreased to 110 gr/m2 following the operation (P = .002). All of the patients survived during 1-year follow-up, and no death was reported. CONCLUSION: Renal transplantation had beneficial effects in terms of LV function in young patients with ESRD.

Percutaneous mitral valvuloplasty--a new method for balloon sizing based on maximal commissural diameter to improve procedural results.

BACKGROUND: Since the introduction of the Inoue technique for percutaneous balloon mitral valvuloplasty (PBMV), various criteria have been proposed for ideal balloon sizing. In routine practice, balloon size is chosen based on the patient's height according to a simple formula. We tried to define a simple and practical echocardiographic measure for adjusting balloon catheter size to achieve better success rates and fewer complications. METHODS: Patients with moderate to severe mitral stenosis who were candidates for PBMV were selected. Maximal mitral commissural diameter at a fully opened state during diastole was measured by transthoracic echocardiography and compared with the values from the height-based formula. Data were compared by paired sample t-test. RESULTS: Eighty-three patients (mean age 45±13.2 years; 77 female) participated. The median balloon size was 28 mm (standard deviation [SD] 1.2) according to the height-based formula and 26 mm (SD 1.6) according to echocardiography (p<0.001). Using a Bland-Altman plot, an excellent agreement was observed between the two methods. Regression models were fitted to estimate the balloon size using the patients' height, commissural diameter, and mitral valve score. CONCLUSION: Selection of balloon size according to echocardiographic commissural diameter is a good alternative method. Assuming the possible discrepancy between height-based and commissural-based estimated balloon sizes in some cases, adjustment of balloon sizes according to the maximal commissural diameter may result in acceptable results and fewer complications.