Evidence Of Coronary Artery Disease Research Articles

Late gadolinium enhancement CMR in primary mitral regurgitation.

The appropriate timing for surgery in severe asymptomatic primary mitral regurgitation (MR) remains controversial. It has been shown that late gadolinium enhancement on cardiovascular magnetic resonance (LGE CMR), which may identify myocardial fibrosis, is associated with a worse outcome in various cardiomyopathies. We sought to investigate the prevalence and significance of delayed enhancement in primary MR. We prospectively included 41 patients with at least moderate primary MR and without overt signs of left ventricular (LV) dysfunction. Patients with evidence of coronary artery disease, arrhythmias or significant concomitant valvular disease were excluded. All patients were scheduled for transthoracic echocardiography and LGE CMR. A total of 39 patients had interpretable LGE CMR images. Among them, 12 (31%) had late contrast uptake of the LV wall. LGE CMR showed an infarct pattern in three patients, a pattern of mid-wall fibrosis in seven patients and two patients had a combined pattern. Patients with delayed enhancement on CMR had significant higher LV diameters (LV end-systolic diameter 39±4 vs. 34±5mm, P=0·002; LV end-diastolic diameter 57±5 vs. 50±5mm, P=0·001). There was a trend towards a higher indexed left atrial volume (55±21 vs. 44±13mL/m², P=0·06). By contrast, there was no significant association between myocardial contrast uptake and age, LV ejection fraction and MR severity. Left ventricular remodelling seems to be associated with the presence of delayed enhancement on CMR in primary MR. Further data are needed to determine whether LGE CMR can predict a less favourable outcome or could improve risk stratification in asymptomatic primary MR.

Premature coronary artery disease and testosterone in Sri Lankan men

Objective: Recent studies have shown that low endogenous testosterone in men is associated with coronary artery disease (CAD) and its risk factors such as obesity, hypertension, dyslipidaemia, and diabetes mellitus. This study was planned to investigate the association of low total testosterone levels with premature coronary artery disease. Methods: Thirty one men, 45 years of age or below with documented coronary artery disease (mean age 41 ± 3) constituted the cases. Control group consisted of 31 men below the same age, without having clinically evident coronary artery disease (mean age 37 ± 4). Total testosterone, fasting plasma glucose and serum lipid levels were measured. Results: Mean ages of the two groups were significantly different (p = 0.001). Body mass index (p = 0.843) and hip circumferences (p = 0.097) were not significantly different between the two groups, but waist circumference (p = 0.007) and waist to hip ratio (p = 0.002) were significantly higher among cases. Prevalence of hypertension, diabetes mellitus, and smoking among cases was higher compared to controls. Total testosterone levels of cases were significantly lower than those of controls (11.1 ± 3.2 nmol/L vs. 27.1 ± 4.3 nmol/L, p = 0.001), which remained significant, following adjustment for the clinical covariates (age, BMI, smoking, diabetes mellitus). Plasma glucose (p = 0.016) and HDL-cholesterol (p = 0.001) were significantly different between the groups. Conclusion: Serum total testosterone was significantly lower in patients with premature CAD compared to controls. Low level of total testosterone may be related to the development of premature coronary artery disease. DOI: http://dx.doi.org/10.4038/sjdem.v4i1.7242 Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2014; 4 : 17-21

The Current Status of Statins in Stroke Prevention

Statins or 3-hydroxl- 3-methyl glutaryl coenzyme A reductase inhibitors are drugs that are primarily used to treat dyslipidemia. Statins are recommended for use in ischemic stroke related to small and large vessel disease, although studies suggest that their use in primary prevention and in other subtypes of stroke may also be beneficial. The benefits of statins in stroke prevention and improvement of neurologic outcome after acute ischemic stroke are related to their pleiotropic effects. These include expression of endothelial Nitric Oxide Synthase (eNOS), angiogenesis, anti -inflammatory action, stabilization of the endothelial layer and enhancement of tissue plasminogen activator. Numerous randomized controlled trials, meta-analyses and population based studies have highlighted the importance of statins in prevention of stroke and improvement of neurologic outcome. Many concerns have been raised regarding their adverse effects such as myopathy, elevated transaminases and increased risk of intracranial hemorrhage and cancer. However, studies have shown that statins can be used over a long period of time without any significant adverse events. Current stroke prevention guidelines recommend the initiation of statins in patients with evidence of atherosclerosis and an LDL cholesterol level >100mg/dL without known coronary heart disease, and also in patients with elevated cholesterol or comorbid coronary heart disease.

Cardiac arrest following intravenous administration of metaraminol in Takotsubo cardiomyopathy

SummaryA sixty‐year‐old female presented to the emergency department with a perforated duodenal ulcer. Whilst awaiting surgery she developed chest pain and ST segment changes consistent with an inferior myocardial infarction. It was considered necessary to continue with surgical management, however general anaesthesia was complicated postoperatively by an episode of pulseless ventricular tachycardia, that appeared to be triggered by intravenous metaraminol. Subsequent coronary angiography demonstrated no evidence of coronary artery disease but findings were suggestive of Takotsubo cardiomyopathy, which was probably exacerbated by intravenous metaraminol.

Plasma apelin level after percutaneous coronary intervention

Abstract Objectives The aim of this study is assessment of plasma apelin levels in patients with coronary artery disease (CAD) before and after percutaneous coronary intervention (PCI). Methods The present study is conducted on 40 patients who underwent PCI, beside 20 healthy subjects with no risk factors or any evidence of CAD. After history taking each subject in the study underwent an electrocardiography, echocardiography for calculation of the left ventricular ejection fraction (LVEF). 22 patients underwent PCI with drug eluting stent (DES), while 18 patients underwent PCI with bare metal stents. Plasma apelin level was estimated for the control group, before, and 24 h after PCI in the patient’s group. Results Baseline plasma apelin level was higher in the control group versus the PCI group (385.4 ± 94.86 vs. 286.8 ± 52.93 ng/ml, p Conclusion Apelin level increased after PCI in CAD patients, which could be an adaptive reaction for the endothelium recovery.

Association between the atrial natriuretic peptide rs5065 gene polymorphism and the presence and severity of coronary artery disease in an Iranian population

The atrial natriuretic peptide (ANP) gene expression and some of its related single-nucleotide polymorphisms have been well established as a characterized biomarker of cardiovascular diseases. In the present study, we aimed to evaluate the potential association between one of the introduced ANP gene polymorphisms of 2238 T/C (rs5065) with coronary artery disease (CAD) in an Iranian population. A total of 573 patients with CAD according to angiography reports and 293 controls without any evidence of CAD were enrolled. Allelic discrimination of the single-nucleotide polymorphism rs5065 in both groups was performed using a High Resolution Melt technique in real-time PCR analysis. With respect to the prevalence of different genotypes of rs5065 polymorphism, the frequency of the T allele in the CAD group was significantly lower in CAD than that in the non-CAD group (59.7 vs. 65.1%, P=0.032). A significant inverse association was also found between the frequency of T allele and severity of CAD assessed by the Gensini score; the average of this score in T-allele carriers was 38.6±41.6 and that in C-allele carriers was 57.7±46.3 (P≤0.0001). Using multivariable linear regression modeling with the presence of baseline variables, the presence of the rs5065 ANP T allele could predict decreased severity of CAD assessed by the Gensini score in our population. The presence of the rs5065 ANP polymorphism is potentially associated with a reduced risk of CAD as well as with reduced severity of CAD independent of the general risk factors of CAD.

Effects of sex on coronary microvascular dysfunction and cardiac outcomes.

Coronary microvascular dysfunction (CMD) is a prevalent and prognostically important finding in patients with symptoms suggestive of coronary artery disease. The relative extent to which CMD affects both sexes is largely unknown. We investigated 405 men and 813 women who were referred for evaluation of suspected coronary artery disease with no previous history of coronary artery disease and no visual evidence of coronary artery disease on rest/stress positron emission tomography myocardial perfusion imaging. Coronary flow reserve was quantified, and coronary flow reserve <2.0 was used to define the presence of CMD. Major adverse cardiac events, including cardiac death, nonfatal myocardial infarction, late revascularization, and hospitalization for heart failure, were assessed in a blinded fashion over a median follow-up of 1.3 years (interquartile range, 0.5-2.3 years). CMD was highly prevalent both in men and women (51% and 54%, respectively; Fisher exact test =0.39; equivalence P=0.0002). Regardless of sex, coronary flow reserve was a powerful incremental predictor of major adverse cardiac events (hazard ratio, 0.80 [95% confidence interval, 0.75-086] per 10% increase in coronary flow reserve; P<0.0001) and resulted in favorable net reclassification improvement (0.280 [95% confidence interval, 0.049-0.512]), after adjustment for clinical risk and ventricular function. In a subgroup (n=404; 307 women/97 men) without evidence of coronary artery calcification on gated computed tomography imaging, CMD was common in both sexes, despite normal stress perfusion imaging and no coronary artery calcification (44% of men versus 48% of women; Fisher exact test P=0.56; equivalence P=0.041). CMD is highly prevalent among at-risk individuals and is associated with adverse outcomes regardless of sex. The high prevalence of CMD in both sexes suggests that it may be a useful target for future therapeutic interventions.

Breast arterial calcification in chronic kidney disease: absence of smooth muscle apoptosis and osteogenic transdifferentiation

The pathophysiology of medial arterial calcification in chronic kidney disease (CKD) is unclear but has been ascribed to phenotypic changes in vascular smooth muscle, possibly in conjunction with intimal proliferation and atherosclerosis. As the prevalence of calcification in breast arteries is increased in women with CKD and end-stage renal disease (ESRD), this was examined histologically in mastectomy specimens from 19 women with CKD or ESRD. Arterial calcification was present in 18, was exclusively medial, and occurred in vessels as small as arterioles. Intimal thickening was common but unrelated to calcification. There was no evidence of atherosclerosis. The earliest calcification presented as small punctate lesions scattered throughout the media, often with calcification of the internal elastic lamina. Arterial calcification was present in all samples from an age- and diabetes-matched cohort without CKD but was much milder. While smooth muscle cell density was reduced one-third in arteries from patients with ESRD, the cells appeared normal, expressed SM22α, and exhibited no apoptosis. Staining for the bone-specific protein osteocalcin, the osteoblastic transcription factors Runx2 or osterix, or the chondrocytic transcription factor SOX9 was absent in regions of early calcification. Thus, medial calcification in breast arteries of patients with CKD can occur in the absence of smooth muscle cell apoptosis and/or osteogenic transdifferentiation. This suggests that the pathologic mineralization process may differ from one arterial type to the other.

Lipid profile in children with coronary artery disease in Sindh, Pakistan.

To evaluate lipid profile in children with coronary artery disease (CAD) in Hyderabad, Sindh, Pakistan. The study included 100 children (6-15 years), of which 43 were children of young parents (one or both) with recognized CAD, while the other 57 were children with no evidence of CAD (controls). All were evaluated for fasting blood lipid profile. Blood samples were collected from patients with CAD and healthy controls and analysis of the levels of lipid profile were carried out using a kit method on Microlab 300. Children with CAD had significantly higher levels of total serum cholesterol and triglycerides and decreased levels of high density lipoprotein and low density lipoprotein compared to children in the control group. Systolic and diastolic blood pressures were significantly higher, without any significant difference. CAD risk factors are significant regarding abnormal lipid levels. Genetic tendency seems to be important in the development of CAD in children.

Serum osteocalcin is associated with dietary vitamin D, body weight and serum magnesium in postmenopausal women with and without significant coronary artery disease.

Osteoporosis and atherosclerosis often present atypically in postmenopausal women, making clinical recognition difficult. Prospective studies suggest independent associations between bone mass and vascular calcification through vitamin D deficiency as an established predictor of both conditions. We aimed to examine the relationship between serum osteocalcin and vitamin D status in postmenopausal women with and without angiographic evidence of coronary artery disease (CAD). One hundred and eighty postmenopausal women undergoing coronary angiography were selected sequentially from the Catheterization unit of King Abdulaziz University Hospital. Socio-demographic, anthropometric parameters and dietary habits were measured. Biochemical variables were estimated in blood samples. Half of the postmenopausal women did not have significant CAD, 24% had significant CAD in a single and/or double coronary vessels, 26% had significant CAD in three coronary vessels. Mean serum vitamin D concentrations showed that vitamin D deficiency was a common finding in the whole population. Vitamin D and calcium intakes were uniformly low in the study cohort. Serum osteocalcin was significantly correlated with dietary vitamin D in all subgroups (r=-0.172, p<0.05) and positively correlated among the patients (r=0.269, p=0.01). Serum magnesium, alkaline phosphatase, dietary vitamin D, and body weight were independent variables of serum osteocalcin level. In conclusion, elevated levels of serum C reactive protein and vitamin D were associated with low serum osteocalcin levels. Therefore, osteocalcin may be a potential cardiovascular risk marker. However, further studies are needed to clarify the pathophysiological processes underlying the relationship between serum osteocalcin level and atherosclerosis parameters.

Echocardiographic Changes in Patients with ESRD on Maintenance Hemodialysis-A Single Centre Study

Objective: To evaluate and analyze the echocardiographic changes in end stage renal disease patients on maintenance hemodialysis. Material and methods: End stage renal disease (ESRD) patients on maintenance hemodialysis for at least 3 months were included in the study. We performed M-mode echocardiography in 35 ESRD patients during interdialytic period usually after 18 hours, without obvious clinical evidence of coronary artery disease, valvular heart disease, congenital heart disease and pericardial effusion. Results: Echocardiography revealed LV dilation and diastolic dysfunction in 18 (51.2%), left ventricular hypertrophy (LVH) in 17 (48%), systolic dysfunction and pericardial effusion in 10 (28.57%) and 6 (17.14%) patients respectively. RWMA was present in 8.5% and valvular calcification was not seen in our patient group. In sub-group of patients with Hb<10 gm%, LVH was present in 71.42% (15) vs 14.28% (2) in patient group with Hb ≥ 10 gm% (p=0.002). Hypertensive patient population also had higher prevalence of LVH (51.85%)] and systolic dysfunction and RWMA was absent in normotensive group. Conclusion: LV diastolic dysfunction and hypertrophy were most common echocardiographic findings. There was statistically significant correlation between anemia and presence of LVH and positive correlation between presence of hypertension and LVH.

Association between androgenetic alopecia and coronary artery disease in young male patients.

Background:Several studies have demonstrated an association between androgenetic alopecia (AGA) and cardiovascular disease. Still controversies exist regarding the association. Are they truly associated?Objective:The purpose of the present study was to assess the prevalence of AGA and establish its association in young (<45 years) Asian Indian Gujarati male patients having coronary artery disease (CAD).Materials and Methods:Case-control prospective multicentric study was carried out on 424 men. Case group consisted of 212 male subjects having CAD (Group 1) and another 212, either sibling or first degree male relative of the case subjects (having no evidence of CAD) were considered as the control group (Group 2). Age, total cholesterol, incidence of diabetes mellitus, and hypertension were similar in both groups. The degree of alopecia was assessed using the Norwood-Hamilton scale for men. Statistical analysis was performed using Chi-square test.Results:AGA was found in 80 (37.73%) young CAD patients (Group 1), whereas 44 (20.7%) of patients had alopecia in the control group (Group 2). There was statistically significant association between male AGA and CAD (P = 0.001). Odds ratio was 2.70 (95% confidence interval [CI], 1.72 ± 4.26). Statistically significant association was found between high grade baldness (Grades IV-VII) and CAD in young men (P < 0.05). Odds ratio = 2.36 (95% CI, 1.108 ± 5.033). There is statistically significant association of AGA in young Asian Gujarati male with CAD and the prevalence of AGA in young CAD patient is 37.73%.Conclusion:This study implies early onset AGA in male is independently associated with CAD, though mechanisms need to be investigated.

Coronary Endothelial Dysfunction, Obesity and Metabolic Syndrome

Objective To define the impact of metabolic syndrome (MetS) and obesity on coronary vascular function, with the hypothesis that subjects with MetS will have endothelial dysfunction. Background: Obesity or the metabolic syndrome (MetS) is associated with a higher risk of diabetes and coronary artery disease (CAD). Endothelial dysfunction is a common causal pathway in the initiation and progression of CAD. Methods: A total of 418 patients (165 obese, 239 MetS) with and without angiographic evidence of CAD underwent coronary vascular function testing by measuring coronary blood flow (CBF) velocity in response to intracoronary infusion of acetylcholine (ACH) and sodium nitroprusside (SNP) and coronary flow reserve with adenosine. Results: Endothelium-dependent microvascular vasodilation correlated with BMI (r=-0.12, p=0.02), with ACH responses significantly lower in overweight, obese and MetS subjects (p=0.003). The number of MetS components correlated with the response to ACH in both the coronary microcirculation and the epicardial coronary arteries, and with impaired coronary microcirculatory responses to adenosine. No significant correlation was observed with SNP. In multivariable analysis, beyond age, only the total number of MetS components, and not BMI, emerged as an independent predictor of impaired microvascular response to ACH (CBF: β=−0.18, P<0.001). Low-grade inflammation (C-reactive protein) was higher in patients with MetS, but was not associated with coronary vascular function. Conclusions: We demonstrate that the clustering of MetS components is an important and independent determinant of coronary endothelial dysfunction in subjects with and without CAD.

Atherosclerosis, Segmental Involvement and Grading of Luminal Narrowing of Coronary Artery: A Autopsy Study

Background and Objectives: Atherosclerosis is a complex disease contributing to increased mortality. The exact global incidence of atherosclerosis is beyond calculation. Autopsy studies can provide information about the impact and course of atherosclerosis. Methods: 50 heart specimens with aorta up to its bifurcation were obtained from medico-legal autopsies. Sections from representative areas were studied for gross and microscopic evidence of atherosclerosis. Percentage of variations compared with other studies. Results: Heart specimens were obtained from medico-legal autopsies. Sections from representative areas were studied for gross and microscopic evidence of atherosclerosis. Interpretation and Conclusion: Among the 50 cases studied, 35 were males and 15 were females. Coronary arteries of 24 males (72.72%) and 9 females (27.27%) showed atherosclerosis. Males were affected more than females. Age has a dominant influence on atherosclerosis. Among coronaries, left anterior descending artery is most commonly involved. Autopsy studies give occurrence of atherosclerosis. This study will help radiologists and interventional cardiologists, in diagnosis and treatment. The incidence of atherosclerosis in developing countries is same as developed countries.

Central Hemodynamics Could Explain the Inverse Association Between Height and Cardiovascular Mortality

Mechanisms underlying the inverse relationship between height and cardiovascular mortality are unknown but could relate to central hemodynamics. We sought to determine the relation of height to central and peripheral hemodynamics, as well as clinical characteristics. The study population was comprised of 1,152 randomly selected community-dwelling adults (aged 67.7 ± 12.3 years; 48% men). Brachial blood pressure (BP) was recorded by sphygmomanometry; central BP and aortic pulse wave velocity were estimated by applanation tonometry. Stepwise multiple regression analysis was used to determine associations between height and central and peripheral hemodynamics. Height was not significantly associated with aortic pulse wave velocity in men or women. The relationship with height and brachial systolic BP was borderline in women (β = -0.115; P = 0.051) but not significant in men (β = -0.096; P = 0.09). Conversely, central systolic BP, estimated by transfer function (β = -0.139 for men [βM]; β = -0.172 for women [βW]) or radial second systolic peak (β M = -0.239; β W = -0.281), augmentation index at 75 bpm (β M = -0.189; β W = -0.224), and aortic pulse wave timing (β M = 0.224; β W = 0.262) were independently associated with height in both sexes (P < 0.003 for all). Both men and women of greater than median height were less likely to have coronary artery disease (P < 0.05), to have systemic hypertension (P < 0.01), or to be taking vasoactive medication (P < 0.001) compared with participants of less than median height. Even after correcting for conventional cardiovascular risk factors, taller individuals have more favorable central hemodynamics and reduced evidence of coronary artery disease compared with shorter individuals. These findings may help explain the decreased cardiovascular risk associated with being taller and also have important clinical consequences regarding therapy.

Assessment of left ventricular volumes and primary mitral regurgitation severity by 2D echocardiography and cardiovascular magnetic resonance

BackgroundTwo-dimensional transthoracic echocardiography (2DTTE) remains the first-line diagnostic imaging tool to assess primary mitral regurgitation although cardiovascular magnetic resonance (CMR) has proven to establish left ventricular function more accurately and might evaluate mitral regurgitation severity more reliably. We sought to compare routine evaluation of left ventricular function and mitral regurgitation severity by 2DTTE with assessment by CMR in moderate to severe primary mitral regurgitation without overt left ventricular dysfunction.MethodsWe prospectively included 38 patients (79% of male, age 57 ± 14 years) with at least moderate primary mitral regurgitation, a left ventricular ejection fraction ≥60% and a left ventricular end-systolic diameter ≤45 mm. Patients with evidence of coronary artery disease, arrhythmias or significant concomitant valvular disease were excluded. All patients were scheduled for 2DTTE and CMR.ResultsLeft ventricular end-diastolic and end-systolic volumes were significantly underestimated by 2DTTE in comparison with CMR, although there was a strong correlation (Pearson r = 0.81, p < 0.00001 and r = 0.7, p < 0.00001, respectively). Measurement of the regurgitant orifice was similar between 2DTTE PISA method and planimetry by CMR (47 ± 24 vs. 42 ± 16 mm2, p = 0.12) with a strong correlation between both imaging techniques (Pearson r = 0.76, p < 0.0001). By contrast, assessment of the regurgitant volume by 2DTTE and by phase contrast velocity mapping by CMR showed poor agreement.ConclusionsIn moderate to severe primary mitral regurgitation without overt left ventricular dysfunction, 2DTTE significantly underestimates left ventricular remodelling in comparison to CMR. Measurement of the regurgitant orifice with planimetry by CMR shows good agreement with the PISA method by 2DTTE and thus may be a valuable alternative to assess mitral regurgitation severity.

Risk Factors for Coronary Artery Diseases: A Study Among Patients With Ischemic Heart Disease in India (Kerala)

Summary Coronary artery disease (CAD) is a condition that develops due to accumulation of atherosclerotic plaque in the epicardial coronary arteries, leading to myocardial ischemia. It is the leading cause of death worldwide and is a common complex disease. A study was carried out in a group of 496 patients with acute coronary syndrome or with angiographic or stress test evidence for coronary artery disease, admitted to the Department of Cardiology at Lourdes Heart Institute and Neuro Centre during the period June-August 2012. The risk factors studied were hypertension, diabetes mellitus, dyslipidemia, body mass index, smoking and family history of CAD. The results demonstrated that in both males and females of the Indian population studies, diabetes and dyslipidemia were major risk factors for CAD, while hypertension was not a major risk factor. Therefore, early detection and treatment of diabetes mellitus and dyslipidemia play a vital role in prevention of CAD in Indian population.

Abstract 19113: Invasive Evaluation of Chest Pain in Patients With Angiographically Normal Coronary Arteries

Background: More than 20% of patients with angina have no angiographic evidence of coronary artery disease (CAD). Our aim was to investigate alternative etiologies for chest pain in these patients. Methods: In patients with angina who were referred for coronary angiography and had no angiographic CAD, endothelial function testing, intravascular ultrasound (IVUS), and physiology measurements were performed. Results: A total of 139 patients were enrolled. The average age was 54.0±11.4, with 107 women (77%). Seventy four patients (53.2%) had hypertension, 32 (23.2%) diabetes, 87 (62.6%) dyslipidemia, 10 (7.2%) tobacco use, and 45 (32.4%) a family history of CAD. Endothelial dysfunction (a decrease in luminal diameter of &gt;20% with intracoronary acetylcholine) was present in 61 patients (43.9%). Five patients (3.6%) had fractional flow reserve &lt;0.80. Microcirculatory impairment (an index of microcirculatory resistance ≥25) was present in 29 patients (20.9%). Myocardial bridging (an echolucent halo found on IVUS with systolic arterial compression &gt;10%) was present in 54 patients (43.9%). Thirty eight patients (27.3%) had no coronary explanation for their chest pain, with normal endothelial function and coronary physiologic assessment, and no myocardial bridging. There was no complication. Conclusion: Many patients with angina and no angiographic evidence of CAD have occult coronary circulatory abnormalities, while a minority has no coronary etiology to explain their symptoms. A complete invasive assessment of these patients at the time of coronary angiography provides important diagnostic information which may affect treatment.

Abstract 18568: Normal Angiographic Appearance of the Coronary Arteries is Common in Antiphosopholipid Syndrome Patients Presenting With Acute Coronary Syndrome

Background: Antiphospholipid syndrome (APLS) is known to be associated with Acute Coronary Syndrome (ACS) due to coronary artery thrombosis or embolism. Because individual cases of ACS with normal angiographic appearance of the coronary arteries have been reported in this population, we aimed to determine the prevalence of this presentation amongst patients with known APLS at our institution. Methods: Our institutional database was queried for all patients testing positive for antiphospholipid antibodies (n=575) between 2000 and 2012. From this sample, we identified 46 patients having cardiac catheterization. ACS (n=32) was defined as the presence of angina chest pain, ECG with ST segment or T-wave abnormalities and troponin-I &gt; 0.1 mg/dL. Results: Normal appearing coronary arteries, without evidence of atherosclerosis or embolism, were found in 8 patients (52±7 years, 5 female) with APLS (lupus anticoagulant n=5; anti-cardiolipin n=5; anti-B2-GP1 n=3) presenting with ACS. All 8 patients had history of prior arterial (stroke n=5) or venous thrombosis (n=3). Median troponin-I was 0.30 mg/dL [range 0.15, 0.50]. One subject was found to have diffuse coronary artery spasm, which reversed following administration of intra-coronary nitroglycerine. One patient had a regional wall motion abnormality in a single territory and another patient had global ventricular dysfunction. Median left ventricular ejection fraction was 60% [range 30, 60]. Conclusions: A high proportion of patients with APLS presenting with ACS did not have evidence of either coronary thrombosis or embolism on angiography. This clinical presentation is suspicious for either coronary artery spasm or myopericarditis.

Early accelerated senescence of circulating endothelial progenitor cells in premature coronary artery disease patients in a developing country - a case control study

BackgroundThe decreased number and senescence of circulating endothelial progenitor cells (EPCs) are considered markers of vascular senescence associated with aging, atherosclerosis, and coronary artery disease (CAD) in elderly. In this study, we explore the role of vascular senescence in premature CAD (PCAD) in a developing country by comparing the numerical status and senescence of circulating EPCs in PCAD patients to controls.MethodsEPCs were measured by flow cytometry in 57 patients with angiographically documented CAD, and 57 controls without evidence of CAD, recruited from random patients ≤ 50 years of age at All India Institute of Medical Sciences. EPC senescence as determined by telomere length (EPC-TL) and telomerase activity (EPC-TA) was studied by real time polymerase chain reaction (q PCR) and PCR– ELISA respectively.ResultThe number of EPCs (0.18% Vs. 0.039% of total WBCs, p < 0.0001), and EPC-TL (3.83 Vs. 5.10 kb/genome, p = 0.009) were markedly lower in PCAD patients compared to controls. These differences persisted after adjustment for age, sex, BMI, smoking and medications. EPC-TA was reduced in PCAD patients, but was statistically significant only after adjustment for confounding factors (1.81 Vs. 2.20 IU/cell, unadjusted p = 0.057, adjusted p = 0.044).ConclusionsWe observed an association between increased vascular cell senescence with PCAD in a sample of young patients from India. This suggests that early accelerated vascular cell senescence may play an important mechanistic role in CAD epidemic in developing countries like India where PCAD burden is markedly higher compared to developed countries.