Predictor Of Future Cardiovascular Mortality Research Articles

Hyperuricemia and Hypertension, Coronary Artery Disease, Kidney Disease: From Concept to Practice

Since the publication of the Framingham Heart Study, which suggested that uric acid should no longer be associated with coronary heart disease after additional adjustment for cardiovascular disease risk factors, the number of publications challenging this statement has dramatically increased. The aim of this paper was to review and discuss the most recent studies addressing the possible relation between sustained elevated serum uric acid levels and the onset or worsening of cardiovascular and renal diseases. Original studies involving American teenagers clearly showed that serum uric acid levels were directly correlated with systolic and diastolic pressures, which has been confirmed in adult cohorts revealing a 2.21-fold increased risk of hypertension. Several studies involving patients with coronary artery disease support a role for serum uric acid level as a marker and/or predictor for future cardiovascular mortality and long-term adverse events in patients with coronary artery disease. Retrospective analyses have shown an inverse relationship between serum uric acid levels and renal function, and even a mild hyperuricemia has been shown to be associated with chronic kidney disease in patients with type 2 diabetes. Interventional studies, although of small size, showed that uric acid (UA)-lowering therapies induced a reduction of blood pressure in teenagers and a protective effect on renal function. Taken together, these studies support a role for high serum uric acid levels (>6 mg/dL or 60 mg/L) in hypertension-associated morbidities and should bring awareness to physicians with regards to patients with chronic hyperuricemia.

EFFECT OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION ON THE INCIDENCE AND SEVERITY OF ISCHEMIC MITRAL REGURGITATION IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION.

Ischemic mitral regurgitation (IMR) is mitral incompetence resulting from coronary artery disease in the absence of intrinsic valve lesions. This common complication of acute myocardial infarction (AMI) (1) occurs in 15–64% of patients after this event, (2) and is an independent predictor of future cardiovascular mortality(3). The pathophysiology of ischemic MR is complex, and its presence may be related to several underlying processes that are often difficult to separate in a given patient(4). It may result from altered ventricular geometry(5,6,7), incomplete mitral leaflet coaptation, papillary muscle dysfunction and regional wall motion abnormalities (8). IMR severity is positively associated with development of heart failure after AMI.(9).Because of its complex pathophysiology and heterogeneous clinical presentation, the proper treatment of ischemic MR is often debated, and the relative utility of revascularization with and without concomitant mitral valve surgery is uncertain(4). Although primary percutaneous coronary intervention (PCI) for AMI is known to improve outcome(10,11,12), and that IMR after myocardial infarction (MI) worsens outcome, (13) the effect of primary PCI on IMR incidence has not been specifically studied. Aim of the work: To detect the impact of Primary PCI on the development and severity of ischemic mitral valve regurgitation in patients presenting with acute ST segment elevation myocardial infarction. Patients and methods: This study included 60 patients presenting for the first time with Acute ST segment elevation myocardial infarction The patients were divided into two groups group A: Included 30 patients who were treated with primary PCI group B included 30 patients who were treated by thrombolytic therapy..All patients had echocardiography after reperfusion , during the hospital stay then reevaluation after one month period. Results:. During hospital stay the mean LV EF in the PCI group was 46.17± 7.51 % while in the SK group the mean EF was 41.67±6.06 %.In the PCI group the mean wall motion score index during the hospital stay was 1.25± 0.15 while in the SK group it was 1.39 ±0.14 with P value less than 0.001.At one month follow up. In the PCI group there were 6 patients with mitral regurgitation the mean jet area was (1.33±0.63) cm2, while in the SK group there were 25 patients with mitral regurgitation the mean jet area was( 4.45 ±2.17) cm2 with P value <0.0001In the PCI group the severity of mitral regurge was positively correlated with the age of the patient P value less than 0.01,door to needle P value less than 0.01 and pain to hospital times P value 0.04.In the streptokinase group, the severity of mitral regurgitation was positively correlated with door to needle time delay with P value of 0.03. Conclusion: Primary PCI decreased the incidence and severity of chronic ischemic mitral regurgitation when compared with medical reperfusion in patients with acute ST segment elevation myocardial infarction. Key words : Ischemic mitral regurgitation, Acute ST elevation myocardial infarction, Primary PCI. * Corresponding author : Email address :Dr_Ahmedkamel@hotmail.com (Ahmed Kamel) Cardiology department,National heart institute,Cairo, Egypt

Gamma-glutamyltransferase is associated with cardiovascular and all-cause mortality: A meta-analysis of prospective cohort studies

ObjectiveThe purpose of the present study was to investigate whether gamma-glutamyltransferase (GGT) is an independent predictor for future cardiovascular (CV) and all-cause mortality with prospective observational studies by meta-analysis. MethodsElectronic literature databases (Cochrane Library, Medline, and Embase) were searched for relevant prospective observational studies on the association between baseline GGT and CV and all-cause mortality published prior to June 2012. Pooled adjust relative risk (RR) and corresponding 95% confidence intervals(CI) were calculated separately for categorical risk estimates(highest vs. lowest GGT quartile) and continuous risk estimates (per unit-log GGT increment). ResultsSeven studies with 273,141 participants were identified and analyzed. The pooled RR of CV mortality for highest vs. lowest GGT quartile was 1.52 (95% CI 1.36–1.70). The pooled RR of CV mortality for per unit-log (GGT) increment was 1.76 (95% CI 1.60–1.94). The pooled RR for all-cause mortality for highest vs. low GGT quartile was 1.56 (95% CI 1.34–1.83). Subgroup analyses based on region, gender, follow-up duration, and sample size showed that the positive association between GGT and risk of CV mortality was consistently observed in each subgroup except for the Asia subgroup (RR=1.59, 95% CI 0.76–3.30). ConclusionsGGT is an independent predictor for future CV mortality and all-cause mortality, and might be independent of alcohol intake.

High-sensitivity C-reactive protein, adiposity, and blood pressure in the Yakut of Siberia

C-reactive protein (CRP), an acute-phase reactant and marker of inflammatory response, is known to be an important predictor of future cardiovascular mortality, independent of other risk factors. The purpose of this research was to investigate the association between CRP, adiposity, and blood pressure in the Yakut, an indigenous Siberian population undergoing rapid cultural change. We conducted a cross-sectional study of 265 healthy Yakut adults in six villages in rural northeastern Siberia. Plasma CRP was measured by high-sensitivity immunoturbidimetric assay. The median CRP value was 0.85 mg/l, with values for the 25th, 50th, and 75th percentiles of 0.30, 0.85, and 2.28 mg/l, respectively. CRP was positively associated with age (r = 0.19; P = 0.002), but not plasma lipids or smoking status. CRP was associated with measures of central adiposity and characteristics of the metabolic syndrome, particularly in women. We found significantly higher CRP across quintiles (Q) of waist circumference for women (difference = 0.7 mg/l; P = 0.035), but not men (difference = 0.36 mg/l; P = 0.515). CRP was significantly associated with systolic blood pressure in men (difference, Q1 vs. Q5 = 1.1 mg/l; P = 0.044) but not women (difference, Q1 vs. Q5 = 0.03 mg/l; P = 0.713) after adjusting for age, waist circumference, and smoking status. CRP in the Yakut was considerably lower than was reported for other populations. The low CRP levels may be explained in part by a low prevalence of abdominal obesity. Among the Yakut, the high physical-activity demands of a traditional herding lifeway likely play a role through high energy expenditure and maintenance of negative energy balance. Our findings underscore the need for further research on the metabolic activity of adipose tissue, blood pressure, and inflammatory activation in non-Western populations.

Analysis of the effect of hemodialysis on peripheral and central arterial pressure waveforms

Arterial stiffening is very pronounced in renal patients. Carotid artery stiffening is a powerful predictor of future cardiovascular mortality, and measures of arterial compliance correlate much better with left ventricular mass (LVM) in dialysis patients than does brachial artery blood pressure (BP). The aim of our study was to describe the influence of a hemodialysis (HD) session on arterial cushioning function and to correlate the potential different types of behavior with echocardiographic derived parameters. Radial artery pressure waveforms were measured and recorded noninvasively by applanation tonometry in 51 healthy patients on regular three times weekly HD. The data were then converted into aortic pressure waveforms using a regression equation (SphymoCortrade mark apparatus). Measurements were done pre- and post-HD in order to ascertain the effect of a single HD session on arterial hemodynamics. The augmentation index (AGI; the difference between early and late pressure peaks divided by the pulse pressure amplitude) was used as an index for vascular compliance. Reproducibility was assessed in 20 young healthy subjects by determining the aortic pulse wave augmentation index twice from radial artery BP measurements one minute apart. Intraobserver error was 2.4%. For 10 dialysis patients similarly studied, the intraobserver error was 1.6%. AGI was correlated with subjects' height (r = -0.37, P = 0.009), weight (r = -0.41, P = 0.002), and BP levels: radial systolic BP (r = 0.33, P = 0.018), radial diastolic BP (r = 0.29, P = 0.036), and central systolic BP (r = 0.51, P < 0.001). Comparing the pre- with the post-HD AGI values, four patterns of evolution became apparent: (1) The AGI was negative before the HD session and became even more negative afterward (N = 3 out of 51). (2) The AGI was positive before the HD session but became negative after dialysis (N = 19 out of 51). (3) The AGI was positive before the HD session and, although diminished afterward, remained positive (N = 23 out of 51). (4) The AGI was positive before the HD session and increased afterward (N = 6 out of 51). We also found that in some patients, AGI remained at lower than predialysis levels for at least 24 hours. Significant relationships between echocardiographic parameters and pulse wave contour (PWC) variables included pre-HD AGI and LVM (r = 0.47, P < 0. 001). There was better correlation between LVM and derived predialysis aortic systolic BP (r = 0.56, P < 0.001) than measured brachial (peripheral) systolic BP (r = 0.35, P = 0.04). Patients whose waveform remained abnormal (AGI remained positive) after HD had a more dilated LV (LV-EDD = 52.07 +/- 3.48 mm) than did those patients for whom HD restored "normal" arterial hemodynamics (LV-EDD 46.86 +/- 4.06 mm, P < 0.05). A standard HD session profoundly affected aortic BP waveform characteristics, with a reduction in wave reflection in 88% of patients. However, restoration by HD of a normal aortic waveform was unusual. Patients whose waveform remained abnormal after HD had larger more dilated LV chambers than did those patients for whom HD restored "normal" arterial hemodynamics.