Segment Elevation Research Articles

Defective biological activities of high-density lipoprotein identify patients at highest risk of recurrent cardiovascular event.

Low cholesterol efflux capacity and elevated levels of Interleukin-1ß (IL-1ß) are both associated with residual cardiovascular risk in patients with acute myocardial infarction (MI) and may be used as new biomarkers to identify patients at higher cardiovascular risk. We evaluated potential synergetic effect of cholesterol efflux capacity and IL-1ß on recurrent major adverse cardiovascular events (MACE) at one-year in 2012 patients with acute ST- segment elevation MI who underwent primary percutaneous coronary intervention. In addition, we evaluated the contribution to residual risk of HDL biological functions from 20 patients of the two extreme subgroups, focusing on cholesterol efflux capacity and anti-inflammatory properties. Patients with MACE during the first year after the MI had significantly lower serum cholesterol efflux capacity as compared to those without recurrent events and higher level of IL-1ß, both associations were confirmed after multivariate analysis. We found an inverse relationship between CEC and circulating levels of the inflammatory markers IL-1ß, defining a very high risk (Low CEC/High IL-1ß) and a low risk (High CEC/Low IL-1ß) group of patients. Patients combining Low CEC/High IL-1ß exhibited the highest risk of recurrent MACE at one year showing an additive prognostic value of these biomarkers, regardless of all the other clinical or biological factors. In this very high-risk subgroup, patients exhibited reduced HDL-efflux capacity and defective ABCA1 and SR-BI with enhanced pro-inflammatory activity as a potential explanation for our clinical findings. Impaired cholesterol efflux capacity and elevated IL-1β synergistically increase the residual cardiovascular risk in MI patients, which could be explained by reduced HDL-efflux capacity and enhanced HDL pro-inflammatory activity.

Major depression is not associated with higher myocardial infarction rates: insights from a large database.

Background: Depression has been suggested to increase the risk of cardiovascular disease, but many studies assessed depression after heart disease onset. This study evaluated the association between depression and myocardial infarction (MI) using a large inpatient database.Methods: We analyzed patients from the National Inpatient Sample hospitals from 2005 to 2020, selecting those aged >30 with ICD-9 and ICD-10 codes for segment elevation (ST) elevation myocardial infarction (STEMI), non-STelevation myocardial elevation (NSTEMI) and major depression.Results: Our data included 4413,113 STEMI patients (224,430 with depression) and 10,421,346 NSTEMI patients (437,058 with depression). No significant association was found between depression and MI. For STEMI, the 2005 odds ratiowas 0.12(95% CI: 0.10-0.15, p<0.001) and the 2020 odds ratio was 0.71 (95% CI: 0.69-0.73, p<0.001). Similar patterns were observed for NSTEMI.Conclusion: Depression may not independently be a significant risk factor for MI.

Abstract 11956: Arumenamide-787 Suppresses Arrhythmogenesis Associated With the J Wave Syndrome as Well as Hypothermia

Background: The J-wave syndromes (JWS), comprised of Brugada (BrS) and early repolarization syndromes (ERS), increase the risk of life-threatening ventricular arrhythmias in patients resulting in sudden cardiac death. There are limited therapeutic strategies to treat these life-threatening conditions. Present management is via an implantable cardioverter defibrillator and/or medication, including quinidine. However, these treatments may have serious side-effects. Thus, novel therapies are needed to treat JWS. In this study, we investigate the effects of ARumenamide-787 (AR-787) in suppressing the electrocardiographic and arrhythmic manifestations of JWS and hypothermia. Methods: We studied the effects of AR-787 on sodium current (I Na ) and the delayed-rectifier potassium current (I Kr ) in HEK-293 cells stably expressing the α- and β1-subunits of the cardiac (Na V 1.5) sodium channel or the hERG channel. In addition, we studied its effect on the transient outward potassium current (I to ) and calcium current (I Ca ) from dissociated canine ventricular myocytes, along with action potentials and ECG from coronary-perfused right (RV) and left (LV) ventricular wedge preparations. The I to agonist, NS5806, I Ca blocker, verapamil, and sodium current (I Na ) blocker, ajmaline, to induce the electrocardiographic and arrhythmic manifestations of JWS (prominent J waves/ST segment elevation, phase 2 reentry, and polymorphic VT/VF) in right and left canine ventricular wedge preparations. Results: AR-787 exerted pleiotropic effects on the cardiac ion channels. The predominant effect was an inhibition of I to and enhancement of I Na , with subtle effects to inhibit the I Kr and augment I Ca . AR-787 diminished the electrocardiographic J wave and prevented and/or suppressed all arrhythmic activity in canine RV and LV experimental models of BrS, ERS and hypothermia. We observed no arrhythmogenic effects of AR-787 on I Kr . Conclusions: Our findings point to AR-787 as a promising candidate for the pharmacologic treatment of JWS and hypothermia. AR-787 suppresses the electrocardiographic and arrhythmic manifestations of JWS and hypothermia without significant prolongation of the QT interval, as with the classic BrS drug, quinidine.

Brugada Syndrome: A Comprehensive Review of Fundamental and Electrophysiological New Findings.

Brugada syndrome is characterized by pronounced J-ST segment elevation in the right precordial leads on surface electrocardiograms. The etiological underpinnings of these distinctive features have been the subject of extensive debate, encompassing various theories related to repolarization anomalies and conduction irregularities. Genetic investigations have unveiled SCN5A, the gene encoding NaV1.5, a critical sodium channel, as the most frequently implicated causative gene, with mutations typically manifesting as loss of function. Nonetheless, the detection rate of SCN5A mutations remains below 20%, underscoring the intricate genetic landscape of the syndrome. Histological analyses have divulged localized structural irregularities, primarily marked by fibrotic alterations, within the right ventricular outflow tract. Electrophysiological inquiries employing direct epicardial mapping techniques have uncovered localized conduction impediments concomitant with modifications in unipolar morphologies within the J-ST segment. Thus, the theory positing conduction abnormalities emerges as a compelling mechanism accounting for J-ST segment elevation. However, the precise mechanisms governing the onset of life-threatening tachyarrhythmias remain shrouded in uncertainty. Recent clinical case reports have proffered evidence supporting the notion that phase 2 reentry, arising from the marked heterogeneity in action potentials within the epicardial domain, may serve as the instigator of premature ventricular contractions, ultimately culminating in ventricular fibrillation. In light of these developments, it becomes increasingly evident that comprehending the mechanisms underlying the electrocardiographic manifestations and lethal arrhythmias in Brugada syndrome necessitates the consideration of a multifaceted perspective, transcending the binary discourse of repolarization versus depolarization anomalies.

Multiscale population demographics and growth responses of trout in the upper Snoqualmie River watershed, Washington

AbstractObjectivePopulation demographics of trout were analyzed across multiple spatial scales to evaluate fishery resources in the three forks and main stem of the upper Snoqualmie River, Washington. Physical habitat and trout species compositions, relative abundances, and sizes were assessed through spatially continuous sampling of the watershed. Fish were also sampled at the segment scale (5–20 km) for more detailed but spatially intermediate assessments of species and genetic origin, size at age, and seasonal diet. To evaluate growth conditions during summer months, bioenergetics simulations of consumption by trout were run using summer water temperatures, and growth and diets were sampled at two life stages.ResultWe found high variability in longitudinal species compositions, genetic origins, relative abundances, and densities within and among forks. While annual growth generally decreased with distance upstream, summer growth efficiency consistently increased. Areal density estimates of age‐0 recruits in the North and Middle forks generally increased with segment elevation, whereas density of recruits was relatively low in upper elevations of the South Fork, where nonnative Westslope Cutthroat Trout Oncorhynchus clarkii lewisi were most abundant. Abundance of trout varied widely among the forks, and a native metapopulation of Coastal Cutthroat Trout Oncorhynchus clarkii clarkii was the most abundantly distributed species across interconnected main‐stem habitats.ConclusionFactors affecting population demographics of trout at the riverscape scale included geologic barriers, habitat diversity, and stocking practices, while summer growth was primarily affected by water temperature. Merging riverscape‐ and intermediate‐scale sampling enhanced watershed‐scale inferences made from intermediate sampling while accounting for continuous variability. This design provided a holistic assessment of the trout resources that would not have been possible using either site‐specific sampling or continuous longitudinal surveys and provided a baseline assessment of trout resources in the upper Snoqualmie River watershed for continued management and conservation of the fishery.

Arrhythmias induced by dextrose-insulin challenge test in nondiagnostic Brugada ECG patterns.

Dynamic ECG changes in Brugada syndrome (BrS) are influenced by several factors, may not be apparent, and can be unmasked by a drug test. Four of six patients with nondiagnostic Brugada ECG index patterns underwent a dextrose-insulin challenge test that resulted in J-ST segment elevation and triggered arrhythmias. Insulin action may be due in part to an outward shift in the K+ current at the end of action potential phase 1 and the dispersion of repolarization, leading to local re-entry with arrhythmogenicity. This effect is likely a phenomenon-specific to BrS.

Intravascular lithotripsy: Making treatment of complex calcified lesions simple.

Key Points Historically percutaneous coronary interventions (PCI) of severely calcified lesions is associated with high rate of periprocedural complications and poor long‐term outcomes. Available data from controlled prospective registries reported promising safety and efficacy results of intravascular lithotripsy (IVL) but were limited to restricted inclusion criteria. This multicenter IVL registry in all‐comer patients including very long lesions, S‐T segment elevation myoìcardial infarction, chronic total occlsusion and left main PCI confirmed high procedural success, low rate of periprocedural complications and good long‐term outcome.

Anomalous Coronary Artery Presenting with S-T Elevation Myocardial Infarction: A Case Report

Background: Coronary artery anomalies are very rare congenital conditions. Rarely occurring but potentially fatal abnormalities of the coronary vasculature, abnormalities of the coronary arteries can cause significant cardiac events such as myocardial ischemia (S-T Segment elevation MI) and cardiac arrest.&#x0D; Case Presentation: We are presenting a case of a 60 years old hypertensive female patient who presented with ST-segment elevation in all precordial leads.&#x0D; Management &amp; Results: On angiography, a giant right coronary artery was seen, and no Left coronary artery origin was not appreciated. Hence, Multidimensional CT angiography was done that showed dilated and ectatic left main coronary artery circulation originating from the pulmonary artery just above the pulmonary valve. The patient was declared a high-risk surgical candidate, was advised medical therapy, including beta blockers, dual antiplatelet, and antihyperlipidemic medications, and was advised to restrict physical activity.&#x0D; Conclusion: The rare presentation of an aberrant coronary artery is myocardial infarction with ST-segment elevation, and it might be difficult for doctors and cardiologists to determine the true reason without intervention. To optimize the care of these patients, traditional CAA and MDCT must be integrated with the clinical presentation of the patients.

Analysis of clinical features and coronary angiography in 10 patients with de winter syndrome

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Guohua Ni Objective To investigate the clinical characteristics and electrocardiogram (ECG) changes of patients with de winter syndrome, so as to enhancing the awareness of de Winter ECG pattern and conducting early emergency interventional therapy for the patients. Methods The clinical data of 10 cases of patients with de winter syndrome admitted to a Medical University Hospital from January 2015 to May 2019 were retrospectively analyzed, to summarize the clinical characteristics, de Winter ECG pattern, timing of emergency interventional therapy, prognosis and other factors. Results Among the 10 patients with de winter syndrome, 9 males and 1 female, 3 cases of acute extensive anterior wall myocardial infarction (MI), 3 cases of non-ST -segment elevation MI (NSTEMI), 2 cases of acute anterior wall MI, and 2 cases of acute anterior septal MI. All the cases were in line with de winter ECG pattern, and they all had dynamic evolution characteristics. Of these, 7 patients developed ST-segment elevation MI (STEMI) and 3 patients developed NSTEMI. All cases were performed coronary angiography (CAG) and 9 patients were performed percutaneous coronary intervention(PCI). CAG showed that there were 6 cases of multi-vessel coronary disease, 4 cases of proximal occlusion of left anterior descending artery, 2 cases of subtotal occlusion, 1 case of 95% stenosis in proximal middle segment of stent. There was 1 case of middle occlusion of anterior descending branch and 1 case of subtotal occlusion, all the above 9 cases were performed PCI. One case had 95% stenosis in the middle segment of anterior descending branch, and no interventional therapy was performed due to hematuria. Conclusion de winter ECG pattern should be regarded as an STEMI equivalent, prompt recognition of the de winter ECG pattern and a timely diagnosis is of the utmost importance, in order to perform early emergency medical and interventional therapy. Clinical Implications * My study will enable cardiovascular clinicians to enhancing the awareness of de Winter ECG pattern and conducting early emergency interventional therapy for the patients, so as to improve the outcome and prognosis of the de winter syndrome. Abstract Figure.

Comparison of anti-factorXa assay and rotational thromboelastogram in evaluating the efficacy of enoxaparine treatment in patients with acute coronary syndrome without ST- segment elevation

Amaç: Tromboelastogram parametrelerindeki değişiklerin standart olarak önerilen AntiFXa aktivitesi ile karşılaştırılarak bu testin enoksaparin tedavisinin monitörizasyonundaki rolünün incelenmesidir.&#x0D; Gereç ve Yöntem: ST segment yükselmesi olmayan miyokard infarktüsü tanısıyla koroner yoğun bakım ünitesine yatırılan 25 hasta çalışmaya alınmıştır. Hastalara yatış anında iki tüp kan alınmış ve 1mg/kg enoksapirinin üçüncü dozu yapıldıktan 4 saat sonra iki tüp kan daha alınmıştır. Hastalara AntiFXa, tromboelastogram, aktive koagülasyon zamanı bakılmıştır.&#x0D; Bulgular: Enoksoparin uygulaması sonrası aktive koagülasyon zamanı değerinde bir miktar artış izlenmekle birlikte bunun anlamlı olmadığı görüldü (p₌0.094). Enoksoparin sonrası tromboelastogram parametrelerinden maksimum amplitüde(MA) azalmış (MA bazal 65.4±11.9 sonra 63.4±7.8), R zamanı artmış (5±1.7 den 8.4±4.6,), K zamanı artmış (1.89±1.06 dan 2.56±1.4), açı azalmıştır. (66.34±5.6 dan 57.9±11.4). AntiFXa artmıştır (0.122±0.06 dan 0.501±0.359).&#x0D; Sonuç: Tromboelastogram parametreleri değerlendirildiğinde tipik artmış bir prokoagülan aktivite olmamakla birlikte kısmen artmış bir fibrinolitik aktivite saptanmıştır.

Symptomatology, prognosis, and clinical findings of COVID 19 induced myocarditis: a systematic review

Abstract Background With the advent of the novel coronavirus (COVID-19) in December 2019, numerous case studies have been reported on its impact on cardiac cells, and we purpose to perform a systematic review that explains the symptomatology, prognosis, and clinical findings of COVID-19-related myocarditis patients. Methods PRISMA guidelines were employed and peer–reviewed journals in English related to COVID – 19 were included. Exclusion criteria included &amp;lt;50 y, known heart problems. Age criteria was guided by prior systematic report by Kariyanna et al (2020). Search engines included Pubmed, Google scholar, Cochrane Central and Web of Science database using “SARS-CoV-2” or “COVID 19” and “myocarditis”. The data were analyzed and synthesized qualitatively using MS Excel PIVOT and quality was rated using the “Research and Quality Scoring Method” by Sackett and Haynes, the Jadad scale, and the items published by Cho and Bero (Han et al., 2011). Results A total of 22 studies on 37 patients were included; 6 were confirmed myocarditis while the rest have possible myocarditis. Among all these 62% were male and showing dominance. The most common presenting symptoms appear to be fever, chest pain, shortness of breath, and cough. Most of the patients have shown elevation in cardiac biomarkers (troponin levels, CRP, CK level, CK-MB, NT-pro BNP). Electrocardiogram changes include sinus rhythm, tachycardia, and non specific ST - segment elevation and T wave changes. Echocardiography results commonly found were left ventricular dysfunction and increased wall thickness. CMR was performed in 8 patients, with features of reduced ejection fraction, myocardial edema, and hypokinesia, whereas biopsy has been performed among 3 patients due to the invasive nature of the procedure and common findings include inflammatory biomarkers were raised. Overall Prognosis appears to be bad in which 25% of patients were not able to survive and 75% of them were recovered. Conclusions Myocarditis-related COVID-19 mortality continues to be high and under-estimated. The patient manifestations are identical and difficult to distinguish from COVID-19-related symptoms. Just a limited number of patients undergo confirmatory tests, such as an MRI or an endomyocardial biopsy, which may not be available. Further studies are needed to confirm and quantify the actual prognosis and outcomes of patients with COVID-19 myocarditis. Moreover, available data on the usage of glucocorticoids in the coronavirus infection is controversial to our knowledge. Corticosteroid therapy is unsuccessful in the treatment of viral myocarditis, according to a Cochrane systematic review conducted in 2013. It also allows viral clearance to be overdue. Corticosteroids, on the other hand, reduce the chance of mortality for ICU patients in Wuhan. To concede, more studies, clinical trials, and duration is needed for a thorough understanding of COVID – 19, and its impact on cardiac health Funding Acknowledgement Type of funding sources: Other.

Earlysurgical treatment of acu te coronary syndrome in patients with ST -segm ent elevation (at &lt; h24), arrhy thm iccomp lications and severe mitral regu rgitation

Treatment outcomes of acute coronary syndrome in 108 patients with ST-segment elevation (after more than 24 hours) complicated by arrhythmias (atrial fibrillation and atrial flutter) and subsequently developed severe (degrees 2 and 3) mitral insufficiency were analyzed. We elaborated an algorithm for the sequence of interventions. All the patients had coronary angiography and stenting of the symptom-dependent artery during the first 2 days after the admission. Depending on the localization of the left ventricular myocardial infarction zone, the patients were divided into 3 groups: 68 (63%) patients with anterior wall and apex infarction; 23 (21.3%) patients with posterior wall infarction; 17 (15.7%) patients with lower wall infarction. It was revealed that patients, who had undergone revascularization in the early stages, had a statistically significant increase in the main indicators of myocardial contractility, in contrast to patients receiving only conservative therapy. In the observation group, sinus rhythm was restored in all patients 1–4 days after hospitalization. 12 patients underwent emergency electrical cardioversion on the day of admission. In 31 patients, sinus rhythm was restored within the first 24 hours during therapy prior to revascularization. In 39 patients, sinus rhythm was restored during therapy on days 3–5 after primary revascularization. In 26 patients, sinus rhythm was restored 2–4 days after complete revascularization. Based on the study, several conclusions can be drawn: in conditions of heart failure, revascularization is best to perform at the earliest possible stage. The optimal values of vital functions for performing revascularization can be considered: systolic blood pressure ≥ 80 mm Hg; heart rate ≤ 110 beats per minute. In primary surgical treatment, it is most optimal to revascularize only the symptom-dependent artery. Reintervention for complete revascularization is most effective and safe 10–14 days after the initial intervention. The use of emergency electrical cardioversion in those patients in the preoperative period is fully justified, despite the existing risks. Application of our algorithm helps to restore sinus rhythm, reduce the degree of mitral regurgitation and reduce mortality.

Prognostic Value of Residual Coronary Artery Lesions on the SYNTAX Scale in Patients with Acute Myocardial Infarction without SТ Segment Elevation in the Mid-Term Period.

Aim To study the effect of residual coronary injury after a percutaneous coronary intervention (PCI), as evaluated with the SYNTAX scale (residual SYNTAX score, RSS), on the mid-term prognosis for patients with non-ST elevation acute myocardial infarction (NSTEMI) and also to determine threshold RSS values for patients at high and low risk of adverse cardiac events.Material and methods A single-center, retrospective study was performed. From 421 patients with NSTEMI after PCI with stenting, 169 patients were selected who originally had multivessel coronary disease and who had undergone a repeated inpatient examination, including mid-term (11.7±3.0 mos.) coronary angiography. The endpoints were recurrent clinical manifestations of angina, repeat revascularization (RR), unstable angina (UA), recurrent acute myocardial infarction (AMI), cardiac death, and also a composite endpoint (major adverse cardiac events, MACE) that included UA, recurrent AMI, and cardiac death. After revealing a significant direct correlation between RSS and the probability of recurrent AMI, UA, MACE, or RR (p &lt;0.05) using the ROC analysis, we have established threshold RSS values that divided patients into groups with high and low risk of the cardiac events listed above.Results For a significantly high risk of recurrent AMI (area under the curve, AUC 0.79±0.05; 95 % confidence interval, CI 0.68-0.89; р=0.048), the threshold RSS score was 8 (sensitivity 100 %, specificity 70.9 %). For UA and MACE, the RSS scores were both 3 (AUC 0.68±0.5; 95 % CI 0.58-0.79; p=0.005 and AUC 0.71±0.05; 95 % CI 0.61-0.8; p=0.001, respectively). The probability of UA during the observation period with RSS &gt;3 was 4.07 times higher and that of MACE was 5.23 times higher than with RSS&lt;3 (95 % CI 1.44-11.49; р=0.01 and 95 % CI 1.88-14.53; р=0.001, respectively).Conclusion The study demonstrated a significant, direct correlation between the RSS and the risk of adverse cardiac events in patients with NSTEMI during one year of observation. Specific threshold values were obtained, which may help in choosing both the extent of revascularization and the tactics for postoperative management of patients.

Abstract 17500: A Crisis of the Heart

A 59 year old female with past medical history of metastatic neuroendocrine tumor without cardiac involvement was admitted for transarterial catheter embolization (TACE) procedure of liver lesions. During the TACE procedure, she developed hypertensive urgency treated with intravenous beta blocker therapy and continuous octreotide for carcinoid reaction. The following day she developed acute pulmonary edema and labile blood pressures requiring low dose norepinephrine. Octreotide infusion was up-titrated to 500 mcg/hour with concern for carcinoid crisis. On physical exam, she was tachycardic and regular without notable murmurs or extra cardiac sounds, no elevated jugular venous distension, and no lower extremity edema. She had bilateral crackles on pulmonary exam and was diaphoretic and delirious. There were sub-millimeter lateral ST- segment elevations on her electrocardiogram but her troponin levels were elevated to 14 ng/dL. Point of care cardiac ultrasound demonstrated severely impaired left ventricular systolic function without regional wall motion abnormalities. Coronary angiogram revealed diffuse coronary vasospasm and elevated left ventricular end-diastolic pressure. On right heart catheterization, she had elevated filling pressures, pulmonary arterial oxygen saturation of 25%, and cardiac index of 1.42 L/min/m2. Our patient was diagnosed with cardiogenic shock secondary to octreotide mediated coronary vasospasm causing diffuse myocardial injury. Continued multidisciplinary discussions were needed to determine appropriate vasopressor and inotropic agent use to support cardiac function without triggering further hormonal dysregulation during carcinoid crisis. Her cardiac function eventually improved with left ventricular Impella support and gradual down-titration of octreotide dose. Norepinephrine, epinephrine, and phenylephrine were avoided in favor of vasopressin, and dobutamine was switched to milrinone to prevent further sympathetic activation. She was able to wean off Impella and pressor support and had improvement of her left ventricular function on repeat echocardiography one month later. She has not had recurrence of heart failure symptoms and continues to follow up with oncology via tele-visits.

Abstract 15549: Esophagopleural Fistula Associated Regional Pericarditis Mimicking Inferior Myocardial Infarction

Introduction: Regional pericarditis is a rare clinical entity that may mimic myocardial infarction (MI) and occurs most frequently after myocardial injury. We describe a unique case of regional pericarditis secondary to esophagopleural fistula (EPF) in a patient presenting to the catheterization lab for suspected ST-segment MI. Results: A 75-year-old man with non-small cell lung cancer presented with hypotension, weakness, dyspnea, and chest pain. The initial electrocardiogram (ECG: Figure 1) revealed normal sinus rhythm with inferior lead ST- segment elevations, a chest X-ray showed a left pleural effusion, and troponin I was &lt;0.01 ng/ml. The patient underwent emergent coronary angiography showing no evidence of obstructive coronary disease. Subsequently, the patient reported palpitations and new onset dysphagia. An ECG revealed atrial fibrillation with rapid ventricular response. A barium esophagram (Figure 2) was performed to evaluate the dysphagia and revealed the presence of an EPF with fluid collection adjacent to the inferior heart border. The patient was treated for pericarditis with colchicine and definitive treatment with esophageal stenting was performed. Conclusions: We describe a case of regional pericarditis secondary to EPF masquerading as inferior MI. Given the prevalence and severity of MI, remaining cognizant of its mimickers such as regional pericarditis is important in clinical practice. This case report highlights the utility of maintaining a broad differential and performing a thorough history and physical both at initial presentation and when new information challenges the initial diagnosis.

VALUE OF ST-SEGMENT ELEVATION IN LEAD aVR IN NON STELEVATION MYOCARDIAL INFARCTION/UNSTABLE ANGINA IN PREDICTING DISEASE EXTENT, SEVERITY AND OUTCOMES.

Background: ST -segment elevation (STE) in lead aVR has been associated with three vessel disease and left main coronary stenosis in acute coronary syndrome, but prognostic relevance of this finding as an independent predictor in patients with non ST elevation myocardial infarction(NSTEMI) or unstable angina (UA) remains unknown. Methodology: We prospectively evaluated the initial electrocardiogram (ECG) in 112 patients with NSTEMI or UA. ST-elevation in lead aVR was measured. Echocardiography was performed, mitral regurgitation and left ventricular ejection fraction (LVEF) were assessed. Selective coronary angiography was performed at median of 3 days after admission, SYNTAX and Gensini scores were calculated. All the patients were followed up in hospital and 3 months after discharge. Results: Overall, 34 patients (30.3%) had STE in lead aVR (group A) and remaining 78 patients (68.7%) had NSTE (Group B). Group A patients had a higher prevalence of lateral leads ST–segment depression (p=0.001). However, group A peak troponin I (p =0.14) and LVEF ( p= 0.22) were not significantly different, but had a higher incidence of mitral regurgitation (MR) (p=0.02). The incidence of single vessel disease, double vessel disease and triple vessel disease in group A were 41%, 29.3% and 23.5%, whereas in group B they were 49%, 33.3% and 10% respectively (p=0.43, p=0.67 and p=0.06 respectively). The mean SYNTAX score was 24.56±16.43 in group A and 19.46±14.39 in group B (p = 0.47). The mean Gensini score was 64.73±40.70 in group A as compared to 46.32±39.43 in group B (p =0.53). There was no significant difference in 3 months clinical outcomes in the two groups. Conclusion: Our study showed that in NSTEMI/Unstable angina, ST elevation in aVR is associated with ST depression in lateral leads and significant MR. Readmission due to acute coronary syndromes was significantly higher in patients with STE in aVR. However, there was no significant difference in troponin I levels, LVEF, disease extent by Gensini and SYNTAX score between the two groups.

Multiple Progressive Thermopreconditioning Improves Cardiac Ischemia/Reperfusion-induced Left Ventricular Contractile Dysfunction and Structural Abnormality in Rat.

Triple progressive thermopreconditioning (3PTP) may induce high Hsp-70 expression to maintain cardiac function. We suggest that 3PTP may reduce myocardial ischemia/reperfusion (I/R) injury during organ transplantation through Bag3/Hsp-70 mediated defense mechanisms. Male Wistar rats were divided into sham control group and 72 h after 3PTP in a 42°C water bath (3PTP) group. Rats underwent 60 min of ischemia by occlusion of the left anterior descending coronary artery followed by 240 min reperfusion. Hemodynamic parameters, including the electrocardiogram, microcirculation, heart rate, left ventricular end-diastolic pressure, maximal rate of rise (+dp/dt), and fall (-dp/dt) in the left ventricular pressure for index of contraction and relaxation were determined. Myocardial infarct size was evaluated by the Evans blue-2,3,5-triphenyltetrazolium chloride method. 3PTP-induced protective mechanisms were determined by Western blot and immunohistochemistry. Cardiac I/R depressed cardiac microcirculation, induced S-T segment elevation, and R-R and P-R interval elongation increased infarct size associated with erythrocyte extravasation, leukocytes and macrophage/monocyte infiltration, granulocyte colony-stimulating factor, poly(ADP-ribose) polymerase 1 stain, and transferase-mediated dUTP-biotin nick end labeling positive cells. However, 3PTP evoked significant cardioprotection against I/R injury, characterized by the increased +dp/dt value and the decreased elevated left ventricular end-diastolic pressure, erythrocyte extravasation, leukocyte and macrophage/monocyte infiltration, granulocyte colony-stimulating factor expression, poly(ADP-ribose) polymerase 1 expression, transferase-mediated dUTP-biotin nick end labeling positive cells, and fragmentation and infarct area. In addition, 3PTP increased Hsp-70 and Bag3 expression and decreased Bax/Bcl-2 ratio, but did not affect the Beclin-1 and LC3-II/LC3-I ratio in the heart with I/R injury. 3PTP therapies may through Bag3 upregulation alleviate I/R injury-induced left ventricular structural deterioration and dysfunction.

Richness, Diversity And Evenness Of Birds In Small Island

Birds play an important role as bioindicators of climate change. For this reason, it is important to know the species richness, diversity and evenness of birds found on small islands. The location of the study was in Haruku Island Maluku. Bird data collected included all bird species, taking into account certain bird species that are sensitive to environmental changes. Bird data collected by the Line Transect method is to use work lines on rectangular data plots in the specified location. This method was chosen because it can trace the plot area of data in a short time and allow repetition of data collection in one day according to the desired time. This method of analysis is to determine the level of diversity in the form of diversity indices, then to scale up the species abundance and then to calculate the estimated population density. The results of the study found 23 species of birds. There were 2 large families recorded, namely: Family Columbidae of 4 types, and Family Psittacidae as many as 5 types, while the other Family groups only had 2 or 1 types.The overall value of the bird species wealth index in 5 data transects is MEDIUM with the value of the Type Wealth Index 3.975863. Then the five Diversity Index of data transects is Medium with the Diversity Index value 2.710911452. Furthermore, the evenness index on five data transects has a fairly good value, which is included in the High Equity Index category with the Evenness Index value of 0.864588 which approaches the number one. From the analysis simulation results, it was found that the temperature aspect, in this case the temperature range at the study location when the data collection did not affect the number of bird species at all, while the estimated altitude aspect has the potential to influence the bird species encounter rate. This condition is quite reasonable because if we look at the data on the number of bird species collected on different transects of data placed in different segment elevations, there seems to be a tendency to increase altitude, so the number of species recorded tends to decrease.

IMPACT OF DIABETES MELLITUS ON MICROVASCULAR MYOCARDIAL PERFUSION AND LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PRIMARY CORONARY INTERVENTION

Background: Diabetes mellitus (DM) is associated with a greater risk of cardiovascular disease and almost one third of patients with acute myocardial infarction (AMI) may have undiagnosed DM on admission. DM is associated with abnormal endothelial function, increased inflammatory response, increased platelets and leukocytes plugging and seems to be an important factor deteriorating microvascular reperfusion in acute phase of MI. Objective: The purpose of this study was to evaluate the impact of diabetes mellitus on: (1) Myocardial microvascular reperfusion after primary PCI in patients with acute myocardial infarction utilizing two well validated measures of myocardial reperfusion, resolution of ST- segment elevation and myocardial blush grade (MBG) and (2) Left ventricular systolic function recovery and incidence of remodeling after primary PCI in patients with acute myocardial infarction. Patients and Methods: The study population consisted of 100 patients with STEMI (50 diabetic and 50 non-diabetic) conducted at coronary care unit of El-Zyton specialized hospital .All patients underwent Primary percutaneous coronary intervention (1ry PCI), ECG (pre and post PPCI) to assess ST segment resolution and Conventional 2D echocardiography to asses left ventricular ejection fraction ( LVEF) (by M-Mode and Simpson rule), end diastolic volume (EDV) and end systolic volume (ESV) and wall motion score index(WMSI) was done within 72hr of admission and after 3 months later and patients with LV remodeling, i.e. an increase >20% in LV end-diastolic volume (LVEDV), were identified. Results: No significant difference was found regarding baseline demographic, clinical and lab data except in dyslipidemic number of patients (92% in diabetic group vs. 36% in non-diabetic group. There was a statistically significant difference between both studied groups as regard ECG post PPCI finding, no significant difference between 2 groups as regard baseline ECHO (EF by M-Mode, EF by Simpsons rule, LVEDV, LVESV, E/A ratio, deceleration time (DT) and wall motion score index). As regard coronary angiography and 1ry PCI data there was a significant difference between diabetic and non-diabetic group as regard number of diseased vessel and myocardial blush grade (MBG): MBG(0) was 1 % in diabetic group and was 1% in non-diabetic group, MBG (1) was 12 % in diabetic group and was 4% in non-diabetic group ,MBG(2) was 48 % in diabetic group and was 14% in non-diabetic group and MBG(3) was 38 % in diabetic group and was 80% in non-diabetic group . Conclusion: The microvascular reperfusion in STEMI patients with diabetes was worse than STEMI patients without diabetes. The incidence of remodeling was more in STEMI patients with diabetes than STEMI patients without diabetes.

IMPACT OF DIABETES MELLITUS ON MICROVASCULAR MYOCARDIAL PERFUSION AND LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PRIMARY CORONARY INTERVENTION

Background: Diabetes mellitus (DM) is associated with a greater risk of cardiovascular disease and almost one third of patients with acute myocardial infarction (AMI) may have undiagnosed DM on admission. DM is associated with abnormal endothelial function, increased inflammatory response, increased platelets and leukocytes plugging and seems to be an important factor deteriorating microvascular reperfusion in acute phase of MI. Objective: The purpose of this study was to evaluate the impact of diabetes mellitus on: (1) Myocardial microvascular reperfusion after primary PCI in patients with acute myocardial infarction utilizing two well validated measures of myocardial reperfusion, resolution of ST- segment elevation and myocardial blush grade (MBG) and (2) Left ventricular systolic function recovery and incidence of remodeling after primary PCI in patients with acute myocardial infarction. Patients and Methods: The study population consisted of 100 patients with STEMI (50 diabetic and 50 non-diabetic) conducted at coronary care unit of El-Zyton specialized hospital .All patients underwent Primary percutaneous coronary intervention (1ry PCI), ECG (pre and post PPCI) to assess ST segment resolution and Conventional 2D echocardiography to asses left ventricular ejection fraction ( LVEF) (by M-Mode and Simpson rule), end diastolic volume (EDV) and end systolic volume (ESV) and wall motion score index(WMSI) was done within 72hr of admission and after 3 months later and patients with LV remodeling, i.e. an increase >20% in LV end-diastolic volume (LVEDV), were identified. Results: No significant difference was found regarding baseline demographic, clinical and lab data except in dyslipidemic number of patients (92% in diabetic group vs. 36% in non-diabetic group. There was a statistically significant difference between both studied groups as regard ECG post PPCI finding, no significant difference between 2 groups as regard baseline ECHO (EF by M-Mode, EF by Simpsons rule, LVEDV, LVESV, E/A ratio, deceleration time (DT) and wall motion score index). As regard coronary angiography and 1ry PCI data there was a significant difference between diabetic and non-diabetic group as regard number of diseased vessel and myocardial blush grade (MBG): MBG(0) was 1 % in diabetic group and was 1% in non-diabetic group, MBG (1) was 12 % in diabetic group and was 4% in non-diabetic group ,MBG(2) was 48 % in diabetic group and was 14% in non-diabetic group and MBG(3) was 38 % in diabetic group and was 80% in non-diabetic group . Conclusion: The microvascular reperfusion in STEMI patients with diabetes was worse than STEMI patients without diabetes. The incidence of remodeling was more in STEMI patients with diabetes than STEMI patients without diabetes.