Comparing Trimetazidine with Allopurinol in Prevention of Contrast Induced Nephropathy After Coronary Angiography.

OBJECTIVES: Contrast-induced nephropathy is considered a serious complication following coronary angiography increasing morbidity and mortality. Various drugs have been assessed to reduce the incidence of contrast-induced nephropathy. In this study, we compared trimetazidine and allopurinol as a pharmacological measure to reduce the incidence of contrast-induced nephropathy. METHODS: One hundred and twenty patients undergoing coronary angiography with baseline creatinine clearance more than 30 ml/minute were divided into three groups, 40 patients each. Group 1 received standard parenteral intravenous hydration in the form of isotonic saline at a rate of 1 ml/kg body weight per hour started 12 hours before angiography and up to 12 hours after the procedure. Group 2 received trimetazidine 35 mg twice per day for 72 hours starting 48 hours before the procedure in addition to intravenous hydration. Group 3 received allopurinol 300 mg once daily for 72 hours starting 48 hours before the procedure in addition to intravenous hydration. Serum creatinine and creatinine clearance were measured before and 72 hours after the procedure in addition to the volume of contrast media used. RESULTS: Trimetazidine and allopurinol failed to reduce contrast-induced nephropathy significantly. Among patients with contrast-induced nephropathy volume of contrast media was significantly higher. CONCLUSION: Adding trimetazidine or allopurinol in addition to regular intravenous hydration with isotonic saline without targeting selectively high-risk patients did not reduce contrast-induced nephropathy following coronary angiography.

Colchicine ameliorates the chronic inflammatory state in patients with chronic rheumatic valvular heart disease: a pilot study.

BACKGROUND: Inflammation is an important contributor to the pathogenesis of rheumatic heart disease (RHD). High serum levels of C-reactive protein (CRP) and interleukin-6 (IL-6) are commonly seen in patients with chronic (RHD) and indicate the presence of a chronic inflammatory state. The aim of this study was to assess the effect of colchicine as anti-inflammatory drug on the serum levels of the inflammatory markers (CRP) and (IL-6) in patients with chronic (RHD). RESULTS: This is a prospective controlled study that enrolled thirty-five patients with chronic (RHD) visiting Ain Shams University Hospital's outpatient clinic for receiving regular long acting penicillin as rheumatic fever prophylaxis. Ten matched healthy individuals were taken as control group. Blood samples for serum levels of CRP and IL-6 were collected before and 1 month after receiving colchicine 0.5 mg BID. Mean (CRP) level was 6.09 ± 4.39 IU/ml versus 0 IU/ml in the control group respectively (P = 0.0001). Mean (IL-6) level was 113.57 ± 37.41 ng/l versus 10.50 ± 5.99 ng/l, in the control group (p = 0.0001). Mean (CRP) was 6.09 ± 4.39 IU/ml before and became 3.34 ± 3.07I U/ml 1 month after colchicine therapy. Mean (IL-6) level was 113.57 ± 37.4 ng/l before and became 45.57 ± 20.39 ng/l 1 month after colchicine therapy (P = 0.001). CONCLUSION: In this pilot study, using colchicine as anti-inflammatory drug in patients with chronic (RHD) significantly reduced the serum inflammatory markers (CRP) and (IL-6), thus helping in ameliorating their chronic inflammatory state.

Assessment of apolipoprotein B/apolipoprotein A-I ratio in non-ST segment elevation acute coronary syndrome patients.

BACKGROUND: The apolipoprotein B/apolipoprotein A-I ratio was shown to be strongly related to the risk of myocardial infarction in several large-scale studies. The current study aimed at exploring the diagnostic and short-term prognostic values of apolipoprotein B/apolipoprotein A-I ratio in patients presenting with non-ST segment elevation acute coronary syndrome. One hundred patients with non-ST segment elevation acute coronary syndrome were prospectively enrolled, in addition to a matched group of 100 patients with chronic stable angina. Serum levels of total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and apolipoproteins B and A-I were quantified in both groups. Patients with non-ST segment elevation acute coronary syndrome underwent coronary angiography. RESULTS: The mean age of the study population was 57 ± 6 years, 65% being males. The non-ST segment elevation acute coronary syndrome group showed significantly unfavorable lipid profile parameters, including apolipoprotein B/apolipoprotein A-I ratio. Higher apolipoprotein B/apolipoprotein A-I ratio was associated with more coronaries showing significant stenosis and more complex lesion morphology. Receiver operating characteristic curve analysis reached an optimal cut-off value of 0.93 for diagnosis of non-ST segment elevation acute coronary syndrome (sensitivity 70% and specificity 88%) and 0.82 for predicting the presence of multi-vessel disease (sensitivity 90% and specificity 97%). CONCLUSION: Apolipoprotein B/apolipoprotein A-I ratio is a useful tool of risk assessment in patients presenting with non-ST segment elevation acute coronary syndrome including prediction of coronary multivessel affection. Apolipoprotein B/apolipoprotein A-I ratio was shown to be strongly related to risk of myocardial infarction. Higher ratios of apolipoprotein B/apolipoprotein A-I were recorded in NSTE-ACS patients (versus stable angina patients). Higher apolipoprotein B/apolipoprotein A-I ratios were associated with more diseased coronaries and complex lesions. Apolipoprotein B/apolipoprotein A-I ratio is a useful tool for acute risk assessment in cardiac ischemic patients.

Echocardiographic assessment of aortic pulse wave velocity as a diagnostic and prognostic parameter for left ventricular diastolic dysfunction.

BACKGROUND: Aortic pulse wave velocity (PWV) is a standard measurement of aortic stiffness. It has been suggested that increased arterial stiffness promotes left ventricular diastolic dysfunction (LVDD). We designed this study to evaluate role of aortic PWV as a new diagnostic parameter for LVDD by correlation with echocardiographic LVDD indices and to evaluate its prognostic value in patients with LVDD by correlation with brain natriuretic peptide (BNP). METHODS: One hundred patients with age >50 were divided into two groups: case group consisted of 80 patients with asymptomatic LVDD with EF ≥50% while controlgroup consisted of 20 patients with normal LVDD. BNP blood test and echocardiography with assessment of aortic PWV were done. RESULTS: Mean age was 59±7.47 vs. 57±6.35 years in case and control groups respectively (P= 0.73), 38 (47.5%) males in case vs. 9 (45%) in control (P=0.84). Aortic PWV showed positive correlation with E/e' (r=0.957, P<0.001), tricuspid regurgitation (TR) velocity (r=0.941, P<0.001), and LA volume index (r=0.947, P<0.001). Negative correlation with septal e' (r=-0.970, P<0.001) and lateral e' (r=-0.932, P<0.001) were reported. Moreover, positive correlation with plasma BNP (r=0.958, P<0.001) was reported. The area under the ROC curve for aortic PWV to detect DD was 0.86 (95% CI, 0.76-0.98; P<0.001) and the optimal cutoff point of 12.5 m/s produced 92.3% sensitivity and 75.0% specificity with an accuracy of 89.0%. CONCLUSIONS: Echocardiographic assessment of aortic PWV appears not only to be a sensitive and reliable for LVDD detection but also has a promising prognostic value in patients with LVDD.

Detection of positively remodeled coronary artery lesions by multislice CT and its impact on cardiovascular future events.

BACKGROUND: Positive arterial remodeling may be a characteristic of early proliferative lesions. The study was done to identify the different morphological characteristics of the positively remodeled coronary lesions, and causing non-significant arterial stenosis, as detected by multislice computed tomography coronary angiography (MSCT CA) and its predictors of cardiovascular clinical events at 90-day follow-up. The study included 55 patients who were candidate for MSCT CA and found to have a single-vessel disease with less than 70% stenosis positively remodeled lesions. The most expansive or solitary lesion was selected for each patient. Positive remodeling defined as remodeling index (RI) > 1.05. We followed the patients clinically for 90 days. RESULTS: Twenty-four patients had a history of acute coronary syndrome at initial presentation with normal LV systolic function for all studied patients. Dyslipidemia was found in 37 patients (67.3%) while diabetes was found in 29 patients (52.7%). The majority of the lesions were found in the proximal LAD (43.6%). The mean calculated remodeling index was 1.41 ± 0.25. At the end of 90 days, 25 patients had clinical events in the form of unstable coronary syndromes, coronary interventions, or coronary angiography related to the index lesion. The predictors of clinical events were duration of DM, higher degree of luminal narrowing, calculated wall/lumen area percentage, plaque burden, plaque-specific calcification, and total calcium score at remodeling site as well as a lower percentage of low-attenuation plaque area. The mean calculated wall/lumen area percentage was 263.72 ± 122.71%. A cut-off value of > 226% was found a predictor for clinical events. The mean plaque burden percentage was 69.72 ± 9.71%, a value of > 69% was found a predictor for clinical events. Both values had a sensitivity of 68% and specificity of 86.6% and PPV of 81%. Positively remodeled lesions with a high RI > 1.4 were correlated with patients who had acute coronary syndrome on their initial presentation. CONCLUSION: Different morphological characteristics of positively remodeled non-occlusive atherosclerotic plaques as detected by multislice CT coronary angiography may be good potential predictors of future cardiovascular events.

Role of speckle tracking echocardiography in detecting early left atrial dysfunction in hypertensive patients.

BACKGROUND: Arterial hypertension adversely affects left atrial (LA) size and function, effect on function may precede effect on size. Many techniques were used to assess LA function but with pitfalls. OBJECTIVES: Early detection of left atrial dysfunction with speckle tracking echocardiography in hypertensive patients with normal left atrial size. PATIENTS AND METHODS: The study was conducted on 50 hypertensive patients and 50 age matched normotensive controls, all with normal LA volume index and free from any other cardiovascular disease that may affect the LA size or function. They were all subjected to history taking, clinical examination and echocardiographic study with assessment of LA functions [total LA stroke volume, LA expansion index by conventional 2D echocardiography and Global peak atrial longitudinal strain by speckle tracking (PALS)], left ventricular (LV) systolic and diastolic functions, and LV mass. RESULTS: Different indices of LA dysfunction (Total LA stroke volume, LA expansion index and global PALS) were significantly lower in the hypertensive group despite the normal LA volume index in all the studied subjects. The presence of diabetes mellitus (DM) and higher grade of LV diastolic dysfunction were significantly associated with lower global PALS. The higher age, systolic blood pressure (BP), body mass index (BMI), LA volume index, and LV mass index and the lower LA expansion index were associated with lower global PALS. CONCLUSION: Speckle tracking echocardiography is a useful novel technique in detecting LA dysfunction in hypertension even before LA enlargement occurs.

Prevalence and characteristics of tricuspid valve endocarditis among patients presented to Ain Shams Hospital echocardiography lab; one year study.

BACKGROUND: Isolated Tricuspid valve infective endocarditis is an infrequent diagnosis, the incidence of Tricuspid valve infective endocarditis accounts for 5% and up to 15% of IE cases. AIM: To assess the prevalence and the echocardiographic characteristics of tricuspid valve endocarditis among patients presented to the echo lab of Ain Shams hospital from 1-1-2016 to 1-1-2017. METHODS: This is a retrospective study which included all patients presented to the echo lab of Ain Shams university hospital from 1st January 2016 to 1st January 2017, the total number of patients were 8376, patients with infective endocarditis were 278, and patients with tricuspid valve endocarditis were 51 patients respectively. Complete transthoracic echocardiography was done for all patients and data was retrieved from a locally designed electronic database of cardiology department at Ain shams hospitals. RESULTS: The incidence of TVIE was (17.7%) of all cases of IE, and (0.67%) of all cases attending the echo lab during the study period. The mean age group in our study was (31.1 ±â€¯7.8) and about 84.3% of patient's age was between 20 and 40 years. Higher incidence of IE was in males (90.2%) than in females (9.8%) with a ratio of 9:1. The vegetations were detected in one leaflet in 33 patients (64.7%), two leaflets in 9 patients (17.6%) and in the three TV leaflets in 7 patients (13.7). The most affected leaflet was the anterior leaflet that was affected in 38 patients constituting about 74.5% of patients. The size of vegetations was large >15 mm in 40 patients (78.4%).The most encountered echocardiographic complication was severe TR, detected in 40 patients (78.4%) and abscess formation was the least present, detected in only 2 patients (3.9%). CONCLUSION: The incidence of TV IE is increasing with male gender predominance, and affects mainly young age groups. TV IE represented 0.6% of all patients, and 17.7% of IE cases. The main echocardiographic feature of TV IE is vegetations which were characterized by being large, highly mobile, and affecting mainly anterior TV leaflet. The main echocardiographic complication is severe TR, but abscess formation was infrequent.