Immunologic burden links periodontitis to acute coronary syndrome.

BACKGROUND AND AIMS: Periodontitis, a common polymicrobial inflammatory disease in the tooth supporting tissues, is a risk factor for coronary artery disease. One of the proposed underlying mechanisms is the systemic immune response to periodontal infection. We studied how serum antibodies against seven periodontal pathogens and their subgingival levels associate with each other, periodontitis, and coronary artery disease. METHODS: The Parogene cohort included 505 Finnish patients (mean age 63 y) who underwent coronary angiography, and clinical and radiographic oral examinations. Coronary diagnosis was defined as no significant coronary artery disease (<50% stenosis, n = 152), stable coronary artery disease (≥50% stenosis, n = 184) and acute coronary syndrome (n = 169). Levels of subgingival Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Tannerella forsythia, Campylobacter rectus, and Fusobacterium nucleatum were determined by checkerboard DNA-DNA hybridization. Serum antibody (IgA/IgG) levels were analyzed with enzyme-linked immunosorbent assay (ELISA). Aggregate IgA/IgG burdens were calculated by summing and standardizing the serum antibody levels. RESULTS: Patients with active periodontitis were characterized by higher levels of subgingival bacteria and corresponding IgA/IgG response. Quartiles 2-4 of serum IgA/IgG burden indicated higher risk for acute coronary syndrome (OR 1.84, 95%CI 1.01-3.35 for IgA; OR 1.87, 95%CI 1.01-3.46 for IgG) independently of established cardiovascular risk factors, body mass index, number of teeth, subgingival bacterial levels and periodontal diagnosis. CONCLUSIONS: Our findings support the hypothesis that the association between periodontitis and cardiovascular diseases is partly mediated by the immunologic response for periodontal pathogens.

Secondary syphilis presenting with aortitis and coronary ostial occlusion.

Aortitis is an established manifestation of tertiary syphilis. We report a rare case of aortitis with ostial occlusion and left ventricular failure in secondary syphilis. Her management required a true multidisciplinary approach from multiple specialities due to complications of concomitant psychosis and a history of anaphylaxis to penicillin. This case illustrates the complexities of diagnosing and managing a rare presentation of this increasingly prevalent infection.

Bilateral coronary ostial stenosis secondary to syphilitic aortitis.

Cardiovascular syphilis is associated with the tertiary stage of syphilis infection; it involves the ascending aorta and can cause aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. We report here a case in which bilateral coronary ostial stenosis and aortic regurgitation due to syphilitic aortitis was diagnosed; coronary artery bypass graft was then performed.

External coronary artery compression due to prosthetic valve bacterial endocarditis.

Acute coronary syndromes in the setting of infective endocarditis may be the result of coronary compression secondary to periannular aortic valve complications, coronary embolism, obstruction of the coronary ostium due to a large vegetation, coronary atherosclerosis, and severe aortic insufficiency. External coronary artery compression as a result of infective endocarditis is a rare and lethal finding with few reported cases available in the medical literature. We present a rare occurrence of an acute coronary syndrome occurring in the setting of a bioprosthetic aortic valve abscess in which there was no complete coronary occlusion visualized and given the patient's recent unremarkable catheterization and findings of diffuse tapering of the proximal left coronary system, the most likely etiology was external compression secondary to the known aortic root abscess, which caused myocardial ischemia, and was confirmed during surgery. Although uncommon, external compression should be considered in the differential diagnosis of acute coronary syndrome in this setting and coronary angiography can be diagnostic of this entity.

Left main compression by an aortic root abscess.

A 79-year-old man with severe aortic stenosis, history of coronary artery disease and a recent hospitalization for sepsis presented at our institution following a syncope and angina at rest. Coronary angiography and aortography showed an aortic root abscess, causing left main coronary artery compression. This life-threatening complication of aortic valve endocarditis is rare and requires immediate surgical correction.

Late presentation of aortic root abscess in endocarditis with coronary ischemia.

Formation of a large aortic root abscess is an infrequent complication of aortic valve endocarditis in adults. Extrinsic compression of the coronary arteries by this abscess is still rarer. Here, we report a case of a 22-year-old male with aortic root abscess, who presented 2 months after the completion of treatment of endocarditis with exertional angina. Coronary angiogram revealed compression of proximal left anterior descending and left circumflex arteries by the abscess. The patient was successfully treated with pericardial patch exclusion of the abscess cavity and coronary artery bypass graft. The presentation of aortic root abscess with myocardial ischemia as a late complication of treated endocarditis has not been reported earlier.

The relationship between Chlamydophila pneumoniae IgG titer and coronary atherosclerosis.

BACKGROUND: The role of Chlamydophila pneumoniae (CP) in the progression of atherosclerosis is controversial. Also no sufficient angiographic study is available about the impact of CP infection on severity and intensity of coronary atherosclerosis. We investigated the relation between CP IgG antibody titers and severity and intensity of coronary atherosclerosis METHODS: The study population consisted of 516 consecutive patients who underwent a coronary angiography. The group included 353 patients who had coronary artery disease; a control group included 163 subjects with angiographically proven normal coronary arteries. Chlamydophila pneumoniae IgG antibody titers were measured by an enzyme immunoassay method in all patients. Gensini scores and extent scores were used to evaluate the angiographic extent and severity of atherosclerosis. RESULTS: The mean value of IgG antibody titer was 44.3 +/- 28.8 IU/mL in the patients and 39.8 +/- 27.4 IU/mL in the control group (p = 0.14). There was no statistically significant correlation between the Gensini scores, extent scores and CP IgG titers (Gensini score: r = +0.103, p = 0.07, extent score: r = +0.110, p = 0.31). When we grouped the patients as high (> 50 IU/mL) and low (< 50 IU/mL) IgG antibody titers, the number of diseased coronary arteries was higher in patients with high IgG antibody titers (respectively: 2.6 +/- 1.1 vs. 2.2 +/- 0.8, p = 0.01). While the Gensini score was significantly higher in patients with high IgG antibody titers (7.5 +/- 4.0 vs. 6.17 +/- 4.0, p = 0.01), the extent score did not change with IgG titers (29.8 +/- 15.9 vs. 25.8 +/- 15.4, p = 0.08). CONCLUSIONS: In our study, we investigated the relation between CP infection and coronary atherosclerosis and found that CP IgG antibody titers are associated with the severity of coronary stenosis at higher antibody levels. However, there is no association between CP antibody titers and clinical presentation of coronary artery disease. We suggest that CP has limited effect on coronary atherosclerosis.

Interaction between Chlamydia pneumoniae seropositivity, inflammation and risk factors for atherosclerosis in patients with severe coronary stenosis.

OBJECTIVE: To investigate whether Chlamydia pneumoniae (Cpn) seropositivity in patients with suspected coronary artery disease (CAD) (n = 81) is associated with increases in markers of inflammation, the severity of coronary atherosclerosis, and traditional risk factors for cardiovascular events. MATERIAL AND METHODS: The severity of coronary atherosclerosis was ranked by Gensini score. Inflammation and endothelial dysfunction were evaluated using white blood cell counts and levels of high-sensitivity C-reactive protein (hs-CRP), ferritin, tumour necrosis factor-alpha (TNF-alpha), interleukins 1beta and 6 (IL-1beta, IL-6), soluble intercellular adhesion molecule-1 (sICAM-1), E-selectin and oxidized LDL (oxLDL), and these were compared between Cpn-seropositive and seronegative individuals. RESULTS: IgA and IgG Cpn seropositivity were significantly associated with the presence of CAD (p = 0.005) and were independent predictive factors for the severity of coronary atherosclerosis (p = 0.005). Elevated levels of IL-6 (p = 0.027) and triglyceride (p = 0.038) and low levels of high-density lipoprotein cholesterol (HDL-C) (p = 0.038) were significantly predicted by Cpn IgA and IgG seropositivity. CONCLUSIONS: Seropositivity for Cpn is a risk factor for patients with significant angiographically documented coronary stenosis. Additionally, Cpn seropositivity was significantly associated with dyslipidemia and elevated IL-6, known risk factors for CAD. These observations indicate that Cpn infection may be one entry point to the causal or contributory pathways that lead to atherosclerosis and its clinical manifestations.

Syphilitic coronary artery ostial stenosis resulting in acute myocardial infarction and death.

Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections. Most notable in this regard is syphilitic aortitis, which tends to result in aortic root dilatation and its associated complications. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. Herein, we present the case of a 32-year-old female who died of a myocardial infarct due to coronary artery ostial stenosis secondary to syphilitic aortitis.

Close association of Chlamydia pneumoniae IgA seropositivity by ELISA with the presence of coronary artery stenosis in haemodialysis patients.

BACKGROUND: Traditional risk factors of cardiovascular disease do not fully explain the accelerated atherosclerosis present in patients with end-stage renal disease (ESRD). The goal of this study was to identify the association of clinical and laboratory factors including seropositivity for Chlamydia pneumoniae determined by a specific enzyme-linked immunosorbent assay (ELISA) with the presence of coronary artery disease identified by coronary angiography in ESRD patients. METHODS: We prospectively enrolled 161 consecutive ESRD patients undergoing haemodialysis for >6 months (106 men, 55 women; mean age 63.1+/-10.2 years; mean dialysis duration 91.3+/-90.1 months). All patients underwent coronary angiography within 1 week after blood sampling. The associations of coronary artery disease with clinical parameters including C. pneumoniae IgA and IgG seropositivity were analysed using multiple logistic regression models. RESULTS: Coronary stenosis >50% was found in 102 of 161 haemodialysis patients (63.4%). Of the 102 patients, 75.5% were asymptomatic. Seropositivity for C. pneumoniae IgA was found in patients with coronary stenosis (77 out of 102, 75.5%) more frequently (P<0.001) than in patients without coronary stenosis (10 out of 59, 16.9%). Seropositivity for C. pneumoniae IgA but not IgG was strongly associated with the presence of coronary stenosis in multiple logistic regression analysis (odds ratio, 18.440; 95% confidence interval, 7.500-45.337), independently of the Framingham coronary risk factors, factors peculiar to ESRD or serum C-reactive protein levels. CONCLUSIONS: C. pneumoniae IgA seropositivity determined by ELISA is an independent laboratory factor indicating the presence of coronary artery stenosis in ESRD patients undergoing maintenance haemodialysis.

Seroprevalence of antibodies to microorganisms known to cause arterial and myocardial damage in patients with or without coronary stenosis.

Infections are assumed to play a role in coronary artery disease (CAD) and cardiomyopathies. It is unknown whether the seroprevalence of antibodies to these microorganisms is higher in patients with than without CAD. The seroprevalence of antibodies to Bartonella henselae, Borrelia burgdorferi, Chlamydia pneumoniae, Coxiella burnetii, Helicobacter pylori, human granulocytic Ehrlichia, Leptospira, Rickettsia conorii, and Treponema pallidum was assessed prospectively in patients with exertional dyspnea or anginal chest pain who underwent coronary angiography because of suspected CAD. Patients with normal angiograms (NA) were those in whom no more than 50% stenosis of any coronary artery was found. Patients with CAD were patients who underwent percutaneous transluminal coronary angioplasty. There were 50 patients with CAD (9 female) and 62 with NA (25 female), with a mean age of 62 years. All patients had antibodies to at least one microorganism: to B. henselae, 8% of CAD patients and 5% of NA patients; to B. burgdorferi IgG, 14% CAD and 6% NA; to B. burgdorferi IgM, 6% CAD and 3% NA; to C. pneumoniae lipopolysaccharide (LPS) IgA, 76% CAD and 77% NA; to C. pneumoniae LPS IgG, 80% CAD and 90% NA; to C. burnetii, 0% CAD and 5% NA; to H. pylori, 92% CAD and 68% NA; to human granulocytic Ehrlichia, 8% CAD and 3% NA; to Leptospira IgG, 4% CAD and 2% NA; to R. conorii, 10% in both groups; and to T. pallidum, 2% CAD and 0% NA. The seroprevalence of antibodies to micro-organisms known to induce arterial and myocardial damage does not differ between patients with CAD and NA.