International Journal of Cardiovascular Practice

Review Article

9P21.3 locus; An Important Region in Coronary Artery Disease: A Panel Approach to Investigation of the Coronary Artery Disease Etiology

Soodeh Omidi, Fatemeh Ebrahimzadeh, Samira Kalayinia

International Journal of Cardiovascular Practice, Vol. 4 No. 2 (2019), 7 May 2019, Page 21-35

Coronary artery disease (CAD) is a disease of major concern worldwide. It is the main cause of mortality in many societies and improving the understanding about the CAD mechanism, progression and treatment, is necessary. Recent discovery of genetic factors underlying CAD has improved our knowledge of the disease in support of well-known traditional risk factors. Genotype-environment interaction is known as the main risk factor. Loci on many different chromosomes have been identified as a risk factors that increase CAD susceptibility. Here we performed a comprehensive literature review pinpointing hotspot loci involved in CAD pathogenicity. The 9p21.3 locus is the most common region associated with CAD and its specific structure and function have been remarkable in many studies. Moreover, the variations in the 9p21.3 locus have been implicated in CAD patients in different populations around the world. According to conclusions from this the 9p21.3 locus can be the first point of focus in etiology investigations of CAD patients.

Original Articles

Introduction: Strain (S) and Strain Rate (SR) as echocardiography parameters are important in assessing changes in myocardial tissue and global and regional evaluation of systolic and diastolic functions and in detection of myocardial disorders as they change in early stages of myocardial ischemia. Therefore, the aim of this study was to compare changes of S and SR indices in systolic phase in patients with a significant stenosis of left anterior descending (LAD) before and after percutaneous coronary intervention (PCI).
Methods: 48 patients candidate for PCI with significant lesion in LAD were enrolled in this study. Echocardiographic images taken one day before and a week after PCI. Echocardiographic scope of the LAD was defined as mid, basal, anteroseptal and mid-septal and apical segments then, S and SR parameters in all segments measured separately during systolic phase before and after PCI and compared together.
Results: there was a significant increase after PCI only in two segments and SR values showed significant increase after PCI in four segments. In the analysis of sum of mean parameters, a significant increase was observed in SR values (10.12 to 11.30; P = 0.001), but not in S values (149.54 to 143.36; P = 0.1)
Conclusions: The remedial effect of PCI on deformation values was observed in the first week. In early reperfusion period, S/SR indices have potential to be used as determinants of favorable response to revascularization therapy.

Serum Cortisol Level as a Predictor of In-Hospital Mortality in Patients Undergoing Primary Percutaneous Intervention for ST Segment Elevation Myocardial Infarction

M Sudhakar Rao, Tom Devasia, Hashir Kareem, Padmakumar R, Ashwal AJ

International Journal of Cardiovascular Practice, Vol. 4 No. 2 (2019), 7 May 2019, Page 41-44

Introduction: Various laboratory markers have been proposed to assess prognosis in myocardial infarction. Serum cortisol is one such laboratory marker. There are only few studies done in the recent past which prove that cortisol is a prognostic marker in STEMI.
Methods: We studied a total of 168 patients who presented with STEMI and underwent primary percutaneous intervention (PPCI) within 12 hours of symptom onset between April 2016 and November 2016.
Results: The average age of study population was 61 ± 0.12 years. Males were predominant (n = 132, 78.57%). 155 patients survived, whereas 13 patients died in the hospital. Mean syntax score was 16.65 ±5. 33 among patients who died, whereas it was 13.11 ± 5.62 among survivors (P = 0.03). Mean cortisol was significantly higher among the patients who died (46.13 ± 14.61 mcg/dl) than the survivors (31.16 ± 13.16 mcg/dl) (P = 0.003). The ROC AUC for in-hospital mortality was 0.77 (95% confidence interval [CI], 0.645–0.897). An optimal cut-point identified from the ROC curve was a random serum cortisol concentration of 33.66 mcg/dl, with corresponding sensitivity and specificity of 69.2 % and 64 %, respectively. At a cut-point of 29.55 mcg/dl, sensitivity and specificity were 84.6 and 50 %, respectively.
Conclusion: This study showed that serum cortisol level is a strong predictor of mortality in patients undergoing PPCI for STEMI. Levels more than 33.66 mcg/dl can predict mortality with a sensitivity of almost 70 percent and specificity of 64 percent.

Introduction: Early atherosclerosis mainly involves carotid artery, which leads to increased carotid artery intima media thickness (CIMT).The potential value of CIMT improving the predictive capacity of traditional risk factors of CAD is an understudied and underutilized issue. Because of increasing availability of highly sensitive ultrasonography probes and for a noninvasive procedures, we can predict coronary artery disease (CAD) more precisely in patients having multiple traditional risk factors so it may reduce morbidity and mortality due to CAD and elevated CIMT can be used as surrogate marker of underlying CAD.
Methods: This study enrolled 250 admitted patients as a case of CAD. The patients were assessed by detailed history taking, thorough clinical examination, measurement of CIMT, blood sugar and lipid level.
Results: Carotid artery disease was present in 88 (35%) of 250 CAD patients. All modifiable cardiovascular risk factors were statistically significantly high in patients of CAD with carotid artery disease. In obese, diabetic, hypertensive, dyslipidemia and smoker patients, carotid artery disease was present in 55% (P = 0.00), 41% (P = 0.00), 43% (P = 0.007), 47% (P = 0.002) and 43% (P = 0.003) respectively. CAD patients who had 1 risk factor, 29% were associated with carotid artery disease. Comparison of single risk factor with patients who had no risk factor, there was non-significant correlation for carotid artery disease. CAD patients who had 2, 3, 4 and 5 risk factors, carotid artery disease was present 24 (32%) (p = 0.02), 15 (55%) (P = 0.0003), 17 (61%) (P = 0.00006) and 6 (67%) (P = 0.0008).
Conclusion: elevated CIMT can be used as one of the important risk factor for early diagnosis of CAD and to reduce morbidity and mortality due to CAD.

Prevalence of Coronary Artery Disease and Its Risk Factors in Patients Undergoing Permanent Pacemaker Implantation

Ashwal Adamane Jayaram, Jerry Iype, Deeksha Karkera, Sudhakar M Rao, Tom Devasiya, Padmakumar Ramachandran, Umesh Pai, Jyothi Samanth, Ganesh Paramasivam

International Journal of Cardiovascular Practice, Vol. 4 No. 2 (2019), 7 May 2019, Page 50-54

Introduction: Some pacemaker implanted patients have an atherosclerotic disease which promotes conduction system ischemia and conduction disturbances. The aim of this study was to determine prevalence of coronary artery disease (CAD) and its risk factors in patients undergoing permanent pacemaker implantation (PPI).
Methods: This prospective, single-center hospital based study examined patients older than 40 years who required PPI. Presence of atherosclerotic risk factors and CAD was examined.
Results: Of 258 patients undergoing PPI, CAD was present in 50 (19.37 %) patients. CAD was more common among middle age and elderly patients (P = 0.03). Patients older than or equal 76.5 years had specificity of 78.8% for an association with CAD. Multivariate analysis showed that age (odds ratio: 1.042; 95% confidence interval: 1.009–1.075; P = 0.01) and diabetes (odds ratio: 3.437; 95% confidence interval: 1.618–7.303; P = 0.001) had a statistically significant association with CAD. Of 169 patients with involvement of the atrioventricular (AV) node, 28 (16.6 %) had associated left anterior descending artery (LAD) involvement with P = 0.01, suggesting an association between LAD disease and chronic degenerative changes in the AV node.
Conclusion: CAD was present in 19.4% of patients undergoing PPI. Age and diabetes had a strong association with CAD. LAD stenosis was significantly more prevalent in AV nodal/ infra-hisian disease compared with sinus nodal disease.

Pulmonary thromboemboli in smokers and nonsmokers; Risk factors and anatomic disturbution of emboli in CT angiographies

Mehdi Pishgahi, Leila Zarei, Pegah Mohaghegh, Rama Bozorgmehr

International Journal of Cardiovascular Practice, Vol. 4 No. 2 (2019), 7 May 2019, Page 55-58

Introduction: Recognition of risk factors in different high-risk groups such as smokers in comparison with non-high risk groups would help to develop good preventive strategies for pulmonary thromboemboli (PTE). The purpose of this study was to investigate and compare clinical findings and risk factors in smoker and nonsmoker patients with pulmonary thromboembolism and assessing anatomical variant in pulmonary computerized tomography angiographies.
Methods: In this descriptive study 260 consecutive patients suspected to have PTE underwent pulmonary computerized tomography angiographies in a training hospital since 2015 to 2018. Patient with documented PTE were enrolled. Clinical finding and risk factors were determined and compared between them.
Results: From 260 patients 172 subjects (66.15%) had PTE and enrolled in the study. Fifty-six (32%) were smoker and 116 (68%) non-smoker. The smoker group was younger and male gender was more predominant. Oxygen saturation and inspired oxygen partial pressure differed between smokers and non-smokers (P < 0.05). The predisposing factors of thromboembolism and anatomic distribution of emboli were the same in smokers and non-smokers.
Conclusion: Regarding different factors responsible for PTE in smokers and non-smokers, clinical presentation and anatomic distribution of PTE are comparable.

Case report

Coronary Vasospasm after Giving Adenosine for Supraventricular Tachycardia

Mohit Naredi, Anil Bharani

International Journal of Cardiovascular Practice, Vol. 4 No. 2 (2019), 7 May 2019, Page 59-61

Palpitations due to supra-ventricular tachycardia are a common mode of presentation to the emergency department. A 12 lead electrocardiography usually leads to immediate diagnosis and prompt management of this condition. Adenosine injection is the treatment of choice for rapid termination of supra-ventricular tachycardia which is widely used. It is generally considered safe and serious side effects are rare. We presented a rare case of a post-menopausal female admitted with supra-ventricular tachycardia and after injection of Adenosine, chest pain with a transient elevation of ST segment occurred. The ST segment changes reverted back to normal after a few minutes spontaneously without any therapy. This phenomenon could be explained due to coronary vasospasm produced by Adenosine. A review of literature revealed anecdotal cases of adenosine induced possible coronary vasospasm.