Chronic Stable Angina Research Articles

Cardiac and renal protective effects of urate-lowering therapy.

Patients with gout often have co-morbidities such as cardiovascular disease, renal failure and metabolic syndrome components. Some studies, but not all, have suggested that hyperuricaemia and gout are associated with increased risk of myocardial infarction, renal failure and death primarily because of increased risk of cardiovascular events. Therefore, knowledge of the effects of urate-lowering therapy (ULT) on co-morbidities, in particular cardiovascular events and chronic kidney disease, is crucial. Randomized controlled trials (RCTs) have suggested that allopurinol, a xanthine oxidase inhibitor, could improve exercise capacity in patients with chronic stable angina and could decrease blood pressure in adolescents. In contrast, a well-designed RCT found no effect of allopurinol in patients with heart failure. The impact of ULT in patients with chronic kidney disease is unclear. Some RCTs found that allopurinol could slow the decline in kidney function, whereas a recent controlled trial found no benefit of febuxostat. Large randomized placebo-controlled trials are warranted to confirm or not the benefit of ULT on co-morbidities.

Is Normal Coronary Arteries on Coronary Angiogram Truly Benign?

Abstract Background Heart disease is the leading cause of death in the world, and coronary angiography (CAG) is the standard test for detection of critical diseases. Nearly 25% patients undergoing angiography are found to have normal coronary arteries (NCAs). Recent publications say that the follow-up of the NCA patients is not benign. Aim The main objective of this study is to know outcomes of patients diagnosed with normal coronaries on conventional angiograms. Methods This is a single-center observational study. The authors collected the data of patients who came for CAG to their institute from January 1 to December 31, 2014. They included the patients who have normal coronaries in this study. The indication to do the CAG is chest pain (angina) for evaluation. The authors contacted every patient telephonically to know the outcomes after 2 years of CAG. The telephonic data were collected either from patients or from attendants by asking the questionnaire about the present status of patients. Results The authors collected the data of 1,526 patients who underwent the CAG during study period. Out of 1,526 patients, 201 patients with mean age of 52.45 ± 10.7 years met the inclusion criteria; 108 (53.73%) were hypertensives and 57 (28.36%) were diabetic. Acute coronary syndrome (ACS) was the presenting symptom in 28 (13.9%) of patients; the remaining patients presented with chronic stable angina (CSA). Left ventricular (LV) dysfunction was present in 15 (7.5%) of patients. At the 2-year follow-up, 12 (5.9%) patients were symptomatic, and out of them, 7 died (mortality 3.5%).The binary logistic regression showed that only blood urea (BU) was determinant factor for mortality (p = 0.022). Even LV dysfunction (p = 0.39) was not a contributor for mortality. A subanalysis of gender also showed similar findings (male, p = 0.02; female, p = 0.05). Conclusion In angina patients with NCA on CAG, the BU showed statistical significance for morality. This is true even on further sex-based analysis (male, p = 0.02; female, p = 0.05). This study helps understand that even the people with normal coronaries, they may have the symptomatic outcomes, not only because of coronaries and also with other associated diseases.

The value of peripheral blood eosinophil count in predicting in-stent restenosis in patients with stable angina pectoris undergoing drug eluting stenting.

In-stent restenosis (ISR) remains a major limitation of percutaneous coronary intervention (PCI). A role for peripheral blood cells as major regulators of immune and inflammatory systems has been proposed. We aim to evaluate the relationship between eosinophil count and development of restenosis after drug-eluting stent (DES) implantation. In this prospective study, all consecutive patients undergoing elective DES implantation for chronic stable angina (CSA) in a university-affiliated heart center within a 6-month period were enrolled and followed for another 6 months. Complete blood count with differentiation was performed 6 weeks after the index procedure. During the follow-up period, the cohort of patients who developed ISR was compared to the cohort of patients without ISR, descriptively and the total number of eosinophilic white cells was used to predict the occurrence of ISR. 153 men and 48 women with CSA underwent PCI with DES implantation, from which, 26 patients needed repeat coronary angiography for recurrent symptoms. There was an established ISR in 17 (8.5%) patients. The total number of eosinophils in their peripheral blood was 267 ± 132 cells/μL in patients with ISR, significantly higher than the number of eosinophils in those without ISR 174 ± 133 cells/μL (P-value < 0.010). Eosinophil count remained an independent predictor of ISR in multivariate analysis as the eosinophil count value over 242 cells/μL had sensitivity of 66.7% and specificity of 84.5% for the presence of ISR. The total number of eosinophils, counted 6 weeks after DES implantation, prevails as the sole predictor of ISR occurrence in our study. This suggests an association between immune sensitivity reaction to DES material and development of ISR in patients after PCI.

The effects of melissa officinalis on echocardiography, exercise test, serum biomarkers, and blood pressure in patients with chronic stable angina

BackgroundCardiovascular disease is one of the major causes of mortality from non-communicable diseases. In recent years there has been a growing interest in herbal medicine as a complementary therapy for the treatment of multiple conditions. The aim of this study was to determine the effects of Melissa officinalis (MO) on the results of echocardiography, exercise stress test, cardiovascular serum biomarkers such as lactate dehydrogenase (LDH) and nitric oxide (NO), and blood pressure in patients with chronic stable angina (CSA). Materials & methodsEighty patients with CSA were randomly divided into case and control groups in a double-blind clinical trial. They received 3 g/d lemon balm or placebo for 2 months. Anthropometric measurements, echocardiography and exercise stress test were performed before and after intervention. Also, LDH and NO were measured as cardiovascular parameters. ResultsThe mean levels of Ejection Fraction (EF) in the echocardiographyand maximum workload in the exercise test were significantly higher in the intervention group compared with placebo (p < 0.01) post intervention. Moreover, the mean serum level of LDH was significantly (p < 0.001) lower in the intervention group compared with control group. Additionally, the mean serum level of NO was higher in the intervention group compared with placebo (p < 0.01) post intervention. Systolic and diastolic blood pressure (SBP, DBP) were also decreased in the intervention group compared with placebo (p < 0.05) post intervention. ConclusionThe results show that MO supplementation may improve EF,maximum workload, cardiovascular serum biomarkers (LDH, NO), and blood pressure in patients with CSA.

Effect of Ticagrelor versus Clopidogrel on Oxidative Stress Bio-markers in Patients with Chronic Stable Angina after Percutaneous Coronary Intervention

Background: Ticagrelor, a reversible P2Y12 receptor inhibitor may represent a significant advancement over currently available oral antiplatelet drugs in treatment of ischaemic heart disease.The study was intended to compare the effect of Ticagrelor and Clopidogrel on oxidative stress markers in patients of chronic stable angina (CSA) following percutaneous coronary intervention (PCI).Methods: The study included a total of 100 CSA patients. Patients were divided into two groups, Ticagrelor and Clopidogrel treated groups (each having 50 patients). The baseline laboratory parameters-Malondihyde (MDA), Reduced glutathione (GSH), bleeding time, clotting time and platelet count, were measured and then patients of both groups underwent PCI. The same parameters were again assessed at follow up after 4 weeks of intervention. Comparisons of the laboratory parameters were made between two groups at baseline and at follow up and also within group before and after intervention.Results: The level of plasma MDA in Ticagrelor group was significantly reduced from baseline to follow up(4.5 ± 1.8 to 1.4 ± 0.7, p &lt;0.001) and in Clopidogrel group (4.2 ± 1.2 to 1.3 ± 0.7, p &lt;0.001). GSH level was increased from 0.7 mg/dl to 2.5 mg/dl (p &lt;0.001) in Ticagrelor group and in Clopidogrel group 0.6 mg/dl to 1.4 mg/dl, p &lt;0.001).Conclusion: The study concluded that both Ticagrelor and Clopidogrel have similar effect on oxidative stress markers, resulting from oxidative injury processes in patients of chronic stable angina.Cardiovasc. j. 2017; 10(1): 40-44

Economic Impact of Subsequent Depression in Patients With a New Diagnosis of Stable Angina: A Population-Based Study.

BackgroundDepression is strongly linked to increased morbidity and mortality in patients with chronic stable angina; however, its associated healthcare costs have been less well studied. Our objective was to identify the characteristics of chronic stable patients found to have depression and to determine the impact of an occurrence of depression on healthcare costs within 1 year of a diagnosis of stable angina.Methods and ResultsIn this population‐based study conducted in Ontario, Canada, we identified patients diagnosed with stable angina based on angiogram between October 1, 2008, and September 30, 2013. Depression was ascertained by physician billing codes and hospital admission diagnostic codes contained within administrative databases. The primary outcome was cumulative mean 1‐year healthcare costs following index angiogram. Generalized linear models were developed with a logarithmic link and γ distribution to determine predictors of cost. Our cohort included 22 917 patients with chronic stable angina. Patients with depression had significantly higher mean 1‐year healthcare costs ($32 072±$41 963) than patients without depression ($23 021±$25 741). After adjustment for baseline comorbidities, depression was found to be a significant independent predictor of cost, with a cost ratio of 1.33 (95% confidence interval, 1.29–1.37). Higher costs in depressed patients were seen in all healthcare sectors, including acute and ambulatory care.ConclusionsDepression is an important driver of healthcare costs in patients following a diagnosis of chronic stable angina. Further research is needed to understand whether improvements in the approach to diagnosis and treatment of depression will translate to reduced expenditures in this population.

Coronary dominance and predictors of adverse events during coronary interventional procedures: an observational study

Background: Coronary dominance is associated with adverse peri-procedural events during coronary interventions. There are limited data regarding events during coronary angiography in Nepal.Aims and methods: The aim of this article is to get information regarding events during invasive procedures of this region which has a large feeder population. All the cases undergone cardiac interventional procedures were included and analyzed.Results: Out of 200 cardiac interventional procedures, 160 cases underwent coronary angiography (CAG) and 20 percutaneous coronary intervention (PCI). 54% of the study populations were male. The mean age of study population was 61.2 years (range: 29-85 years). Most common indication for performing CAG was for post ACS (69%) followed by chronic stable angina (CSA) (16%). Most common finding in CAG was SVD (35%) LAD was the commonest (55% of SVD), DVD (19%), non-critical CAD (13%), TVD (14%) and left main (2%). Myocardial bridging was seen in 2% and 15% had normal coronaries. Commonest risk factor for CAD was Hypertension (45%) followed by smoking (35%) and diabetes (16%). CAG was most commonly performed from right radial (70%) followed by right femoral (24%), left radial (5%) and left femoral (1%). 78% of patients had right dominance, 16% had left dominance while 6% had co-dominance. Out of 40 non-right dominant (left or co-dominant) patient twenty three (57.5%) were female. There was no significant association of left dominance with the gender although the odds ratio was high (1.8) in female gender (P=0.12). Considering Left dominant patients only, the odds ratio of Tiger catheter versus Judkins Right (JR) is 8.33 but not statistically significant (P=0.17). Major complications encountered were ventricular tachycardia (VT) in 4 cases. The odds for VT with left dominance and right dominance was high with statistical significance [OR: 53.48, C.I :( 2.79-1023.4); P=0.002].Conclusion: Ventricular tachycardia which is among the major complication is found to be significantly associated with left dominance. Further studies are necessary to evaluate the evidence provided by this study.

Medical management and evaluations of stable angina patients in tertiary care centre without invasive treatment

Background: Ischemic heart disease is the important cause of morbidity and mortality in the community, it may present with wide variety of clinical entities. Chronic stable angina is a common condition and results in a considerable burden for both the individual and society. There are two approaches to the management of stable angina - percutaneous coronary intervention (PCI) and optimising medical therapy (OMT). Our study is focused on management of stable angina in tertiary care centre without invasive investigation.Methods: This study carried out in Medicine Department, SIMS, Shimoga for 7 months from January 2017 to July 2017. 100 patients of chronic Stable Angina attending OPD of Mc Gann Hospital. A detailed history was taken in all the patients and a through physical examination was done. ECG, Blood investigations, 2D- Echocardiography and TMT is done.Results: The mean age was (54.67±8.56) years. With male to female ratio being 1.2:1. ECG was normal in majority of patients (39%), followed by ST, T changes (33%), LVH (35%) and Hemiblock (36%). Hyperlipidemia (48%), Hypertension (42%) and Diabetes mellitus (37%) are major diseases associated with stable angina. Most of the patients are taking clopidogrel (96%) and aspirin (88%). Followed by ACE/ARB’s (70%) and statins (72%). Normal 2D-Echo is seen in 82% of cases. Diastolic dysfunction in 69%. Decreased ejection fraction in 23%. TMT is done in only 75 patients out of whom 9 could not complete the test. Inducible ischemia is positive in 48 patients.Conclusions: Our study showed ECG changes, 2D Echo findings, TMT results and medication usage similar to other studies. However, there is less compliance with medication and risk factors are under controlled. Stable Angina is a common initial manifestation of coronary heart disease. It needs to be treated more aggressively to prevent complications. Increasing education regarding stable angina both among patients and physicians is need of the hour.

RANOLAZINE FOR SYMPTOMATIC MANAGEMENT OF MICROVASCULAR ANGINA IN A CANADIAN SPECIAL ACCESS PROGRAM

Ranolazine is currently approved in the United States and Europe as a second-line agent for chronic stable angina but is available in Canada only through special access (SA). Microvascular angina (MVA) is defined as angina with no obstructive coronary artery disease (< 50% stenosis of a major epicardial artery) and is secondary to impaired vasodilation of arterioles leading to inadequate blood flow. Treatment of MVA consists of standard anti-anginal medications and risk factor management; however, 20-30% of patients remain symptomatic. Our objective was to assess the effectiveness of ranolazine at improving angina scores and quality of life (QOL) in Canadian patients with severe refractory angina due to MVA. We administered questionnaires consisting of the Seattle Angina Questionnaire (SAQ) and the Quality of Life Enjoyment and Satisfaction Questionnaire – Short Form (Q-LES-Q-SF) at baseline and after at least 6 weeks of ranolazine treatment in 31 patients with refractory angina secondary to MVA in the SA program. Refractory angina was defined as Canadian Cardiovascular Society (CCS) >3 angina after at least 2 anti-anginal medication trials. Validated, clinically significant changes for each SAQ domain were obtained from the literature and a Wilcoxon rank test was performed to test the change in scores between baseline and post-ranolazine use. Patients in our cohort were mostly female (27/31 patients) with a median age of 57. At baseline, 48.4% of the patients were on 3 anti-anginal medications. The median length of time on ranolazine at the time of the post-ranolazine questionnaires was 17 weeks. After initiation of ranolazine treatment, patients experienced a significant clinical improvement in Q-LES-Q-SF and in three of the four selected domains of the SAQ except for angina frequency (Table). 73.3% of patients reported improvement in physical limitation (P < 0.001), 80.6% of patients reported improved treatment satisfaction (P < 0.001), 77.4% of patients reported improved disease perception (P = 0.002) and 80.6% of patients had improved Q-LES-Q-SF scores (P < 0.001) compared to baseline. The Figure depicts the average change, as well as each patient’s experience on ranolazine, in three domains of the SAQ. Ranolazine obtained by a SA program in Canada significantly improves symptom control and QOL in patients with MVA and severe refractory angina after at least 6 weeks of use. Given the potentially debilitating effect of chronic angina in MVA, ranolazine is an effective treatment option.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effect of Ticagrerol versus Clopidogrel on Oxidative Stress Bio-markers in Patients with Chronic Stable Angina after Percutaneous Coronary Intervention

Background: Ischemic heart disease remains the leading cause of death in both developed and under developed countries. The use of antiplatelet drugs specifically the thienopyridine has become a standard for the treatment of acute coronary syndrome. These drugs irreversibly inhibit the platelet aggregation by blocking the P2Y12 receptor. But currently this therapeutic choice has become limited due to potential interaction with other drugs, slow hepatic conversion, genetic resistance and narrow therapeutic safety margin. Ticagrerol, a reversible P2Y12 receptor inhibitor may represent a significant advancement over currently available oral antiplatelet drugs.Objectives: The study was intended to compare the effect of Ticagrelor and Clopidogrel on oxidative stress markers in patients of chronic stable angina (CSA) following percutaneous coronary intervention (PCI).Materials &amp; Methods: The present prospective observational study was carried out in the Department of Pharmacology, Cardiology and Microbiology, BSMMU, Dhaka from September 2014 to February 2016. The study included a total of 100 CSA patients. Patients were divided into two groups, Ticagrelor and Clopidogrel treated groups (each having 50 patients). The baseline laboratory parameters-Malondihyde (MDA), Reduced glutathione (GSH), bleeding time, clotting time and platelet count, were measured and then patients of both groups underwent PCI. The same parameters were again assessed at follow up after 4 weeks of intervention. Total 12 patients from Ticagrelor and 14 patients from Clopidogrel groups were dropped out. Comparisons of the laboratory parameters were made between two groups at baseline and at follow up and also within group before and after intervention.Result: In the present study at baseline characteristics of patients treated with ticagrelor and clopidogrel were almost identical in terms of age, sex, diabetes and hypertension. The level of plasma MDA in ticagrelor group was significantly reduced from baseline to follow up(4.5 ± 1.8 to 1.4 ± 0.7, p &lt;0.001) and in clopidogrel group (4.2 ± 1.2 to 1.3 ± 0.7, p &lt;0.001). GSH level was increased from 0.7 mg/dl to 2.5 mg/dl (p &lt;0.001) in ticagrerol group and in clopidogrel group 0.6 mg/dl to 1.4 mg/dl, p &lt;0.001).Conclusion: The study concluded that both ticagrelor and clopidogrel are similar effect on oxidative stress markers, resulting from oxidative injury processes in patients of chronic stable angina.University Heart Journal Vol. 12, No. 1, January 2016; 26-30

Angiographic predictors of success in antegrade approach of Chronic Total Occlusion interventions in a South Indian population in the contemporary era

Chronic Total Occlusion (CTO) intervention is a challenging area in interventional cardiology. Presently about 70% of CTO interventions are successful. Materials and methodsThis was a single center prospective study of a cohort of all patients undergoing percutaneous coronary intervention (PCI) as elective or adhoc procedure for CTO from August 2014 to June 2015. Only antegrade CTO interventions were included. In all patients the following data were recorded. ResultsA total of 210 (8.9% of total PCI (2353) during the study period) CTO patients were followed up. The mean age was 56.54±8.9. In the study sixty nine patients (32.9%) presented with chronic stable angina and rest of the patients had history of acute coronary syndrome of which 22.9% (n=48) had unstable angina (UA) or non ST elevation myocardial infarction (NSTEMI) and 44.2% (n=93) had ST Elevation Myocardial Infarction (STEMI). In those with history of ACS, 64.78% (n=92) had ACS during the previous year and remaining 35.22% (n=49) had ACS prior to that. Single vessel CTO was seen in 89.5% (n=188) and two vessel CTO in 10.5% (n=22). LAD was involved in 36.7% (n=77), RCA in 48.1% (n=101), and LCX in 15.2% (n=32). Procedural success in the first attempt was 68.1% (n=143), which increased to 71.42% (n=150) after the second attempt. CTO interventions were more frequently successful when the calcium was absent or minimal (p-0.05), CTO length was <10mm (p<0.01) and good distal reformation (p<0.01).

Risk factors and angiographic profile of coronary slow flow (CSF) phenomenon in North Indian population: An observational study

Background“Coronary slow flow’’ (CSF) is delayed vessel opacification in the absence of epicardial stenosis. Studies in different ethnic groups have found variable risk factors associated with CSF. Aimof present study was to analyze the risk factors and angiographic profile of CSF in North Indian population, not studied till date. Methods40 patients with CSF and 40 controls were studied. CSF was determined quantitatively by thrombolysis in myocardial infarction (TIMI) frame count method. Various clinical risk factors (age, sex, body mass Index (BMI), diabetes, hypertension, dyslipidemia, smoking), hematological and biochemical parameters (hematocrit, platelet count, uric acid, homocysteine, fibrinogen, high sensitivity C reactive protein (hsCRP), glycosylated hemoglobin (HbA1c) were assessed. ResultsOf the 40 patients with CSF, 37 (92.5%) were males. While 20 patients (50%) presented with chronic stable angina, rest 20 (50%) presented with acute coronary syndrome. [15 (37.5%) with unstable angina and 5 (12.5%) with non ST elevation myocardial infarction (NSTEMI)]. Patients with CSF had significantly higher BMI (27.27±2.82 vs. 24.12±2.35, p<0.001), fibrinogen levels (398.48±120.96 vs. 331.55±162.6, p=0.04) and smoking (24(60.0%) vs 14(35.0%), p=0.02). On multivariable regression analysis, only BMI was found to have an independent association with CSF (odds ratio 1.613, 95% confidence interval 1.265–2.057, p<0.001). ConclusionThis is the first study to analyze clinical presentation, angiographic profile and risk factors associated with CSF in North Indian population. In this study, we found only BMI to have an independent association with CSF.

LB.02.01] ATHEROSCLEROTIC PLAQUE INFLAMMATION SYNCHRONIZE WITH INFLAMMATORY ACTIVITY OF VISCERAL FAT

Objective: Visceral adipose tissue is thought to confer increased cardiovascular risk through leukocyte infiltration and increased adipose macrophage activity. Previous positron emission tomography (PET) studies using fluorodeoxyglucose (FDG) demonstrated that increased FDG uptake could reflect the severity of inflammation in atherosclerotic plaque. We hypothesized that active atherosclerotic change in the major arteries would accompany increased inflammation within visceral fat and it could be detected in humans using combined FDG PET/computed tomography (CT). Design and method: We observed 44 consecutive subjects with cardiovascular disease. For all of them, an one-hour PET/CT (from brain to foot) was performed after injection of FDG (370–555 MBq). FDG uptake in the aorta or its major branches was evaluated visually and semiquantitatively. Maximal standard uptake values (SUV) of the highest regions of interest were calculated in the subcutaneous fat and visceral fat area, separately. Results: Significant FDG uptake in the arterial wall was noted in 21 patients (plaque positive; PP group), all of whom have experienced acute cardiovascular events (acute coronary syndrome or ischemic stroke) within a week. The other 23 patients (plaque negative; PN group) had chronic stable angina or asymptomatic carotid stenosis. Visceral fat SUV was significantly higher as compared to subcutaneous fat SUV (0.49 ± 0.15 vs. 0.15 ± 0.05, p < 0.001) in PP group, whereas there was no significant difference in PN group (0.18 ± 0.07 vs. 0.16 ± 0.03, p = 0.622). When we compared two groups, PP group showed higher visceral fat SUV than PN group (p < 0.001). In terms of subcutaneous fat SUV, the results were similar in two groups (p = 0.773). Conclusions: We demonstrated that atherosclerotic plaque inflammation was associated with increased inflammation within visceral fat. Our results need to be confirmed by comparison with histologic or other imaging findings. Further evaluation to determine whether metabolic activity of visceral adipose tissue is a marker or mediator of vascular inflammation is also needed.

The effect of percutaneous coronary revascularization on plasma N-terminal pro-B-type natriuretic peptide levels in stable coronary artery disease

BackgroundThis study was conducted to assess the effect of percutaneous coronary revascularization (PCR) on plasma NT-proBNP concentration in patients with chronic stable angina (CSA). MethodsThis prospective open label interventional study included 22 patients with moderate to severe CSA, normal left ventricular (LV) systolic functions and critical (>90%) proximal stenosis in one of the three major epicardial coronary arteries. After stabilization of medications for 8 weeks, resting supine plasma NT-proBNP levels were measured and patients underwent PCR of the involved vessels. Eight weeks later, with medications unaltered; plasma NT-proBNP levels were repeated and compared with the baseline levels. LV systolic and diastolic functions were assessed before and after PCR. ResultsThe mean age of the patients was 61.27±8.87years. Out of 22 patients, 20 were male and 2 were female. PCR was performed on left anterior descending coronary artery (LAD) in 12 patients and in a non-LAD vessel in 10 patients. After 8 weeks of successful PCR, there was a significant overall reduction in mean plasma NT-proBNP levels (from 244.36±218.99 to 168.68±161.61pg/mL, p=0.016). The patients who underwent PCR of LAD demonstrated significantly reduced NT-pro-BNP levels after PCR (p=0.009). In the non-LAD group, NT-proBNP levels also decreased, albeit insignificantly (p=0.432). Reduction in NT-proBNP was independent of change in LV systolic functions. ConclusionSuccessful PCR, by relieving myocardial ischemia, significantly reduced plasma NT-proBNP levels in majority of the patients with chronic stable angina secondary to critical epicardial coronary artery stenosis.

Do ANGPTL-4 and galectin-3 reflect the severity of coronary artery disease?

Coronary artery disease (CAD) is one of the leading causes of mortality and morbidity worldwide. We thereby sought to investigate whether the biomarkers, angiopoietin-like 4 (ANGPTL-4) and galectin-3, reflect the severity of CAD. Patients were screened based on inclusion/exclusion criteria and written informed consent was obtained from the patients. Serum ANGPTL-4 and galectin-3 was quantified using enzyme-linked immunosorbent assay (ELISA) and correlated with the Global Registry of Acute Coronary Events (GRACE) and GENSINI score using Spearman's rank correlation coefficient and multivariate analysis. A total of 226 patients consisting of ST-segment elevation myocardial infarction (STEMI), non-STEMI/unstable angina (USA), chronic stable angina (CSA) and normal controls (NCs) participated in the study. ANGPTL-4 and galectin-3 were significantly higher in CAD than the NC group. ANGPTL-4 showed significant negative correlation with GRACE score in acute coronary syndrome (ACS) ( r = -0.211, p = 0.03) patients. ANGPTL-4 showed significant positive correlation with serum creatinine ( r = 0.304, p = 0.056) and body mass index (BMI) ( r = 0.424, p = 0.009) in CSA patients. A modest positive correlation was observed between the serum galectin-3 levels and GRACE score ( r = 0.187, p = 0.055) in ACS patients. However, on multivariate analysis the positive correlation relationship between ANGPTL-4 and galectin-3 with the severity of CAD was not sustained. In conclusion, ANGPTL-4 and galectin-3 do not appear to have a promising role for assessing the severity of CAD. Nevertheless these biomarkers do warrant further exploration in improving the management of CAD.

P5595Gender and quality of life in stable chronic angina patients. Is it still a relevant variable? Results from a National Survey

P5595Gender and quality of life in stable chronic angina patients. Is it still a relevant variable? Results from a National Survey

P895Revascularisation and quality of life in stable chronic angina patients. Is it a relevant variable? Results from a National Survey

P895Revascularisation and quality of life in stable chronic angina patients. Is it a relevant variable? Results from a National Survey

Stable Coronary Syndromes: The Case for Consolidating the Nomenclature of Stable Ischemic Heart Disease

Angina pectoris, first described by William Heberden in the Royal College of Physicians, London, in 1768, is chest pain of cardiac origin. Despite being a symptom, angina is a disease-based diagnosis ( International Classification of Diseases , I20). Practice guidelines use somewhat different terms. The nomenclature of the American guidelines includes chronic stable angina (2002) and stable ischemic heart disease (2012), whereas the guidelines of the European Society of Cardiology (2013) refer to stable coronary artery disease. Thus, there are multiple terms and abbreviations for stable ischemic heart disease and cohesion is lacking. By contrast, acute coronary syndrome is a unifying hierarchical term that subtends the distinct subgroups of unstable angina and myocardial infarction and is used consistently worldwide. The established diagnostic pathways for patients with suspected angina have been appropriately developed to identify obstructive coronary artery disease (CAD) with a view to evidence-based treatment. In recent years, however, multiple clinical studies have disclosed that more than one-third of symptomatic patients do not have obstructive CAD.1 Furthermore, ischemia may be substantial in this subgroup, and the prognosis is not benign.2 Exclusion of obstructive CAD in a patient with angina presents a conundrum. Angina without obstructive CAD may be frustrating for the patient and the clinician, and, in the absence of a unifying diagnosis, treatment becomes empirical and potentially suboptimal. The lack of evidence from randomized controlled clinical trials in this …

Xanthine oxidase inhibitors in ischaemic heart disease.

SummaryIncreased uric acid levels are correlated with cardiovascular disease, particularly with ischaemic heart disease. Xanthine oxidase inhibitors, especially allopurinol, lower the risk of ischaemic heart disease due to their effects on reactive oxygen species and endothelial function. In chronic stable angina pectoris, allopurinol increases the median time to ST depression, time to chest pain, and total exercise time. On the other hand, it has been reported that allopurinol has a beneficial effect on ischaemic patients referred for angioplasty, but there are insufficient data regarding its effect on acute myocardial infarction patients. Moreover, other important actions of allopurinol are regression of left ventricular hypertrophy and improvement in the results of cardiac rehabilitation. The efficacy of allopurinol has recently been acknowledged by the European Society of Cardiology guidelines for stable angina pectoris, but the particular role of allopurinol in ischaemic heart disease patients is not fully established.

Effect of chronic administration of nicorandil (a potassium channel activator) on body weight of two different experimental animal species

Background: Potassium channel openers (Nicorandil being the prototype) are a distinct class of drugs, used in the management of chronic stable angina pectoris. Obesity is a frequent co-morbid condition and also a risk factor for angina pectoris. Anti-obesity drugs are used more frequently these days than ever before. Therefore, it is more likely that physician would be prescribing at least 2 or more drugs while treating such comorbid conditions. This generates a need for the development of a new drug which would work against both angina and obesity. The resultant effect would be a reduction in the cost burden, incidences of side effects and possible drug- drug interactions as compared to multidrug therapy. The purpose of this study is evaluating the chronic effect of Nicorandil (graded doses) on the body weight in 2 different species of animals i.e. rabbits and mice.Methods: In this study, 30 experimental animals of each species were selected. Pretreatment weight (Mean body weight±SEM) of each group were recorded and compared with the post-treatment values of the respective group in every week up to a period of 4 weeks. The route of administration was an intraperitoneal injection.Results: Chronic administration of nicorandil causes a significant reduction in body weight at moderate to high doses in both species of the study group. (p &lt;0.05).Conclusions: Body weight reducing, an effect of nicorandil in animals, if established in human, could enhance its acceptability in obesity with various ischemic heart diseases including angina.