UA Patients Research Articles

Risk Stratification and in Hospital Morality in Patients Presenting with Acute Coronary Syndrome (ACS) in Bahrain.

Background:Risk factors and short-term mortality in patients presented with Acute Coronary Syndrome (ACS) in Bahrain has not been evaluated before.Aim:In this prospective observational study, we aim to determine the clinical risk profiles of patients with ACS in Bahrain and describe the incidence, pattern of presentation and predictors of in-hospital clinical outcomes after admission.Methods:Patients with ACS were prospectively enrolled over a 12 month period. The rate of incidence of risk factors in patients was compared with 635 non-cardiac patient admissions that matched for age and gender. Multiple logistic regression analysis was used to predict poor outcomes in patients with ACS. The variables were ages >65 years, body mass index (BMI) >28 kg/m2, GRACE (Global Registry of Acute Coronary Events) score >170, history of diabetes mellitus (DM), systolic hypertension >180 mmHg, level of creatinine >160 μmol/l and Heart Rate (HR) on admission >90 bpm, serum troponin rise and ST segment elevation on the ECG.Results:Patients with ACS (n=635) were enrolled consecutively. Mean age was 61.3 ± 13.2 years, with 417 (65.6%) male. Mean age for patients with ST-segment elevation myocardial infarction (STEMI, n=156) compared with non-STEMI (NSTEMI, n=158) and unstable angina (UA, n=321) was 56.5± 12.8 vs 62.5±14.0 years respectively. In-hospital mortality was 5.1%, 3.1% and 2.5% for patients with STEMI, NSTEMI, and UA, respectively. In STEMI patients, thrombolytic therapy was performed in 88 (56.5%) patients and 68 (43.5%) had primary coronary angioplasty (PCI). The predictive value of different clinical variables for in-hospital mortality and cardiac events in the study were: 2.8 for GRACE score >170, 3.1 for DM, 2.2 for SBP >180 mmHg, 1.4 for age >65 years, 1.8 for BMI >28, 1.7 for creatinine >160 μmol/L, 2.1 for HR >90 bpm, 2.2 for positive serum troponin and 2.3 for ST elevation.Conclusion:Patients with STEMI compared with NSTEMI and UA were of younger age. There was higher in-hospital mortality in STEMI compared with NSTEMI and UA patients. The most significant predictors of death or cardiac events on admission in ACS were DM, GRACE Score >170, systolic hypertension >180 mmHg, positive serum troponin and HR >90 bpm.

Clinical characteristics of 487 women inpatients with unstable angina pectoris

Objective To analyze the clinical data, diagnosis and treatment, characteristics of coronary artery disease and short-term prognosis of female unstable angina pectoris (UA) in the First Affiliated Hospital of Shihezi University. Methods Retrospective analysis was used for hospital medical records of 1175 patients with UA admitted in our hospital in February 2012-February 2015, including 487 cases of women (41.45%), and 688 cases of men (58.55%). The generally clinical data, the major risk factors, the results of auxiliary examination, diagnosis, treatment, and characteristics of coronary lesions and short-term prognosis characteristics were compared between female and male patients. Results ⑴ The basic clinical characteristics: women UA patients had a higher average age and with hypertension, dyslipidemia, atrial fibrillation history ratios than men; women showed symptoms of typical chest paina and smoking had a lower proportion than men(P 0.05). ⑵ The main auxiliary examination: The cholesterol, low-density lipoprotein cholesterol were higher than men (P 0.05). Conclusions The age of women patients were higher than men, their symptoms were often untypical, and female had a higher percentage of comorbidities, a lower usage of dual antiplatelet, calcium antagonist and nitrates, a higher multiple vessels, a lower treatment of coronary angiography and revascularization than male. Key words: Angina, unstable/DI/TH; Female

Thrombolysis in myocardial infarction (TIMI) risk score validation in Saudi Arabia

BACKGROUND: Early risk stratification plays a pivotal role in the optimal management of non-ST segment elevation myocardial infarction/unstable angina (NSTEMI/UA) acute coronary syndromes and certainly improving patients care and their final outcomes. Thrombolysis in myocardial infarction (TIMI) risk score was developed from randomized clinical trials on patients with NSTEMI and UA, and it has been validated in non-selected Western patient populations. OBJECTIVE: The aim of the present study was to assess the validity of TIMI risk score on NSTEMI and UA patients in King Abdulaziz Medical City, Jeddah, Saudi Arabia. METHODS: This cross-sectional study was undertaken on 194 patients diagnosed with NSTEMI or UA. They were consecutively included over a two-year period. Data were collected from medical records, TIMI score was calculated and 30 days outcome was recorded. Model discrimination and calibration was tested in the overall enrolled population. RESULTS: Validity of TIMI score in predicting in hospital mortality within 30 days of diagnosis of NSTEMI or UA in Saudi population was assessed by ROC curve and binary logistic regression analysis. The accuracy of discrimination of the TIMI risk score was poor; the area under the ROC curve (AUC) or C-index was 0.612 (95% CI: 0.539 to 0.681). Binary logistic regression model revealed good calibration or model fit of TIMI risk score as revealed by the Hosmer and Lemes how test for the constructed logistic model; p value was 0.934 (>0.05) denoting good model fit. CONCLUSION: The generalizability of this single-center study requires further confirmation in a larger sample population allowing stratification of the study participants into different subgroups according to known important risk factors such as diabetes mellitus, renal failure, or age, so that the performance of the TIMI risk score could be comprehensively assessed before deciding its application in our population.

Blood rheology of angina pectoris patients with myocardial injury after ischemia reperfusion and its effect on thromboxane B2 levels.

This study investigated the changes in the blood rheology of patients with angina pectoris and ischemia reperfusion injury and their effect on thromboxane B2 (TXB2) levels to examine their relationship. Forty patients with unstable angina pectoris who underwent elective percutaneous coronary intervention (PCI) were selected for the unstable angina group (UA group) and forty patients deemed free of coronary heart disease by coronary angiography were selected for the control group. Venous blood samples were drawn from all participants; patients in the UA group had blood drawn 1 day before and 1 day after the PCI procedure. Blood samples were used to analyze blood rheology and examine hemodynamic parameters, at the same time radioimmunoassay was applied to measure the concentrations of serum endothelin-1 (ET-1) and TXB2, and an automatic biochemical analyzer was used to detect the content of superoxide dismutase (SOD) and malondialdehyde (MDA). Our results showed the patients in the UA group all presented hyperviscosity; however the levels were higher for the patients in the UA group (after surgery) than for those in the UA group (before surgery). Patients in the control group exhibited normal levels, and the differences among groups were significant in pairwise comparisons (P<0.05). The levels of ET-1 and TXB2 in the UA group were increased compared with those in control group and they were highest after surgery (P<0.05). For the patients in the UA group, the serum TXB2 concentration increased gradually along with the increase in risk stratification. There were significant differences in comparisons between different strata and between UA patients and those in the control group (P<0.05). The serum SOD activity levels were lowest in the UA group (after surgery), higher in the UA group (before surgery) and highest in the control group. Conversely, the MDA content was highest in the UA group (after surgery), lower in the UA group (before surgery) and smallest in the control group; there were significant differences in pairwise comparisons. Based on our findings, a hyperviscosity syndrome was manifested in the blood rheology of patients with angina pectoris and ischemia reperfusion injury. The higher than normal TXB2 levels can be used as a marker of platelet activation and a reference for clinical risk stratification, thus having great significance for the prevention and treatment of ischemia reperfusion injury and assessment of disease progression.

Increased galectin-3 may serve as a serologic signature of pre-rheumatoid arthritis while markers of synovitis and cartilage do not differ between early undifferentiated arthritis subsets

BackgroundUndifferentiated arthritis (UA) is a label applied to patients with joint complaints which cannot be classified according to current criteria, which implies a need for precision diagnostic technologies. We studied serum galectin-3, a proinflammatory mediator, and seromarkers of structural joint elements in patients with early, UA and their associations with disease profile and biochemical and imaging findings.MethodsOne hundred and eleven UA patients were followed-up for at least 12 months and reclassified according to appropriate criteria (TUDAR). At baseline, demographics and laboratory and clinical disease measures, as well as wrist magnetic resonance imaging (MRI) synovitis, erosion, and bone marrow edema scorings, were recorded. Galectin-3, the type IIA collagen N-terminal propeptide (PIIANP), which is a marker of regenerative cartilage formation, and hyaluronan (HYA), which is prevalent in synovial tissue swellings, were measured by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis was carried out to assess the discriminant capacity of galectin-3 against arthritis subsets.ResultsGalectin-3 was increased in pre-rheumatoid arthritis (RA) (4.6 μg/l, interquartile range (IQR) 3.8–5.5) versus non-RA (4.0 μg/l, IQR 3.1–4.9; p = 0.03) and controls (3.8 μg/l, IQR 3.0–4.8; p = 0.009). PIIANP was equally depressed in either subset (p < 0.01). Galectin-3 in non-RA and HYA in UA did not differ from healthy controls. In the entire UA cohort, galectin-3 correlated with the MRI bone marrow edema score, while PIIANP correlated with the MRI erosion score, and HYA with the synovitis and erosion scores. ROC curve analysis showed that baseline galectin-3 discriminated well between pre-RA and non-RA with univariate area under the curve (AUC) of 0.64 (95% confidence interval (CI) 0.53–0.76) while AUC for galectin-3 + anti-CCP increased to 0.71 (95% CI 0.59–0.83).ConclusionsGalectin-3 in serum was increased in patients with early UA of pre-RA origin. Cartilage remodeling assessed by PIIANP was diminished in UA irrespective of subsequent clinical differentiation, while HYA did not differ from controls. ROC analysis showed a potential for galectin-3 to discriminate between pre-RA and non-RA.Trial registrationKF 11 315829. Registered 25 July 2006.

Effect of Guanxin-Shutong capsule combined with western medicine routine treatment on vascular endothelial function in patients with unstable angina

Objective To investigate the effect of Guanxin-Shutong capsule combined with western medicine routine treatment on vascular endothelial function in patients with unstable angina pectoris. Methods A total of 100 UA patients were randomly divided into 2 groups with 50 patients in each group. The control group was treated with routine western medicine therapy. Based on the treatment of control group, the observation group used the Guanxin-Shutong capsule. The two groups were treated for 12 weeks. Vascular endothelial growth factor was determined by enzyme linked immunosorbent assay. Nitrate reductase method was used for the determination of NO. Clinical effects includeed the duration and number of episodes of angina pectoris. Results The serum levels of VEGF (599.22 ± 104.57 ng/L vs. 455.96 ± 99.15 ng/L, t=2.016), NO (42.31 ± 5.84 μmol/L vs. 35.02 ± 5.91 μmol/L, t=2.209) in the observation group were higher than those in the control group (P<0.05). The frequency (3.52 ± 0.68 vs. 4.12 ± 0.70, t=2.103) and duration of angina attack (2.74 ± 1.27 min vs. 4.32 ± 1.53 min, t=2.094) in the observation group were less than that in the control group (P<0.05). The total effect rate of observation group was 86% (43/50), and the control group was 70% (35/50), the difference was statistically significant between the 2 groups (χ2=3.730, P<0.05). Conclusions The Guanxin-Shutong capsule combined with western medicine conventional therapy can improve the symptoms of UA patients with angina pectoris, improve vascular endothelial function, reduce the frequency and duration of angina attack. Key words: Angina, unstable; Endothelium, vascular; Guanxin-Shutong capsule; Integrated Chinese traditional and western medicine therapy

USE OF COPEPTIN IN DIFFERENTIAL DIAGNOSIS OF (ACS) FOR MALES VS FEMALES IN EMERGENCY DEPARTMEN

ABSTRACTDifference between men and women in the treatment and outcome of acute coronary syndromes has been demonstrated with increased deaths rates in women. Treatment of ACS must be revised and related to the sex and race of the patient. The aim of this study was to introduce new copeptin cutoff levels in ACS patients depending of gender. Also, to compare copeptin to hs-cTnI, CRP levels to predict time delayed between ACS symptoms onset and admission to ED. Sixty two consecutive patients with ACS presenting to the emergency department of the National Heart Institute, Giza (Egypt) between March and June 2014, were recruited for the study. The present study involved thirty patients with unstable angina (19 male & 11 females), thirty two MI patients (18 males & 14 females) and twenty healthy subjects (10 males &10 females) on admission and after 6 hours. Results revealed significant difference between cardiac levels on admission with higher values in men on admission only for CPP, disappeared after six hours. Only copeptin levels were diagnosing on admission (higher with clear cut off levels either for men or women) compared to that of six hours (decreased and get non-significant differences). Early measurement of the combination of troponin I and copeptin may revolutionize the diagnostic accuracy and therapeutic decision-making in patients with symptoms suggestive of ACS, differentiate between UA or AMI patients on admission. Female patients require reevaluation criteria for treatment and outcome.

Early Invasive Strategy for Unstable Angina: a New Meta-Analysis of Old Clinical Trials

Randomized controlled trials (RCTs) were conflicting to support whether unstable angina versus non-ST-elevation myocardial infarction (UA/NSTEMI) patients best undergo early invasive or a conservative revascularization strategy. RCTs with cardiac biomarkers, in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1975–2013 were reviewed considering all cause mortality, recurrent non-fatal myocardial infarction (MI) and their combination. Follow-up lasted from 6–24 months and the use of routine invasive strategy up to its end was associated with a significantly lower composite of all-cause mortality and recurrent non-fatal MI (Relative Risk [RR] 0.79; 95% confidence interval [CI], 0.70–0.90) in UA/NSTEMI. In NSTEMI, by the invasive strategy, there was no benefit (RR 1.19; 95% CI, 1.03–1.38). In the shorter time period, from randomization to discharge, a routine invasive strategy was associated with significantly higher odds of the combined end-point among UA/NSTEMI (RR 1.29; 95% CI, 1.05–1.58) and NSTEMI (RR 1.82; 95% CI, 1.34–2.48) patients. Therefore, in trials recruiting a large number of UA patients, by routine invasive strategy the largest benefit was seen, whereas in NSTEMI patients death and non-fatal MI were not lowered. Routine invasive treatment in UA patients is accordingly supported by the present study.

Higher circulating levels of chemokines CXCL10, CCL20 and CCL22 in patients with ischemic heart disease

Recruitment of leukocytes is one of the earliest events in the pathogenesis of ischemic heart disease (IHD) and chemokines play an important role in the migration of these cells into the inflammation sites. The aim of this study was to evaluate the CXCL10, CCL20 and CCL22 levels and the single nucleotide polymorphisms (SNPs) rs4508917, rs6749704 and rs4359426 in chemokine genes in patients with IHD to clarify any association. A total of 300 patients with IHD as having acute myocardial infarction (AMI; n=100), stable angina (SA; n=100) or unstable angina (UA; n=100) and 100 healthy subjects as a control group were enrolled to study. Serum samples from all participants were tested for the CXCL10, CCL20 and CCL22 levels by using ELISA. The SNPs were determined by polymerase chain reaction–restriction length polymorphism (PCR–RFLP) method. The mean serum concentrations of CXCL10, CCL20 and CCL22 in AMI patients (395.97±21.20Pg/mL, 108.38±10.31Pg/mL and 1852.58±205.77Pg/mL), SA patients (405.48±27.36Pg/mL, 90.20±7.69Pg/mL and 2322.04±231.23Pg/mL) and UA patients (396.69±22.79Pg/mL, 141.87±18.10Pg/mL and 2754.89±211.70Pg/mL) were significantly higher than in the healthy group (179.38±8.85Pg/mL, 51.92±4.62Pg/mL and 451.82±23.76Pg/mL, respectively; P<0.001). Similarly, the serum levels of CXCL10, CCL20 and CCL22 in total IHD patients (399.38±13.77Pg/mL, 113.49±7.48Pg/mL and 2309.84±126.39Pg/mL, respectively) were also significantly higher as compared with healthy subjects (P<0.001). The serum levels of CCL20 and CCL22 in UA patients were significantly higher than those in SA and AMI patients, respectively (P<0.01 and P<0.003, respectively). The serum levels of CXCL10 and CCL20 in diabetic patients were significantly higher in comparison to non-diabetic patients (P<0.05 and P<0.02, respectively). The serum levels of CCL22 in dyslipidemic- and obese patients were also significantly higher in comparison with non-dyslipidemic- and non-obese patients, correspondingly (P<0.05 and P<0.01, respectively). There were no significant differences between men and women or between patients who treated with statin, aspirin, β-blockers or angiotensin converting enzyme (ACE) inhibitors and patients without mentioned treatment regarding the levels of chemokines. The frequency of the GG genotype at SNP rs4508917 in CXCL10 gene was higher, whereas the frequency of the AA genotype at SNP rs4359426 in CCL22 gene was lower in total patients with IHD as compared with healthy subjects (P<0.04 and P<0.002, respectively). These results showed that the higher levels of CXCL10, CCL20 and CCL22 were associated with IHD. The serum levels of chemokines may influence by the certain traditional risk factors of IHD and some studied SNPs, but did not influence by treatment and gender of patients.

MP44-19 MOLECULAR CHARACTERIZATION OF BLADDER OUTLET OBSTRUCTION IDENTIFIES MICRORNA BIOMARKERS OF BLADDER DYSFUNCTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research & Pathophysiology1 Apr 2016MP44-19 MOLECULAR CHARACTERIZATION OF BLADDER OUTLET OBSTRUCTION IDENTIFIES MICRORNA BIOMARKERS OF BLADDER DYSFUNCTION Ali Hashemi Gheinani, Fiona C. Burkhard, Hubert Rehrauer, Catharine Aquino Fournier, Irene Keller, Rémy Bruggmann, and Katia Monastyrskaya Ali Hashemi GheinaniAli Hashemi Gheinani More articles by this author , Fiona C. BurkhardFiona C. Burkhard More articles by this author , Hubert RehrauerHubert Rehrauer More articles by this author , Catharine Aquino FournierCatharine Aquino Fournier More articles by this author , Irene KellerIrene Keller More articles by this author , Rémy BruggmannRémy Bruggmann More articles by this author , and Katia MonastyrskayaKatia Monastyrskaya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.275AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder outlet obstruction (BOO) induces significant organ remodeling accompanied by urodynamic changes in bladder function causing lower urinary tract symptoms (LUTS) and dysfunction (LUTD). Early diagnosis of BOO-induced LUTS is complicated by the lack of methods of assessing specific molecular changes in the bladder wall. Previously we characterized microRNA (miRNA) and mRNA expression profiles associated with different states of BOO-induced LUTD and studied the regulatory role of miRNAs. Here we examined diagnostic potential of miRNAs for distinguishing the BOO states at the molecular level. METHODS Bladder dome biopsies were collected from controls, and patients with urodynamically established BOO with and without detrusor overactivity (DO and BO groups, respectively) or with detrusor underactivity (UA group). A panel of candidate miRNAs was generated using unsupervised clustering and statistical analysis of differentially expressed miRNAs determined by Next Generation Sequencing (NGS) analysis of 24 samples (n = 6 per group). Receiver operating characteristic curve analysis (ROC) was performed to assess the diagnostic capability of group-specific miRNAs. RESULTS In the initial high throughput screening, 1905 known human miRNAs were tested for differential expression in BOO-induced LUTD samples compared to controls. ROC analysis of miRNA profiles of different BOO states revealed several miRNAs with biomarker potential. Hsa-miR-374a-5p was selected as DO marker with high sensitivity (100%) and specificity (95%) with an area under the curve of 0.98 (P < 0.001). Four microRNAs: hsa-miR-10a-5p, hsa-miR-221-3p, hsa-miR-409-3p, hsa-miR-490-3p with high sensitivity (avg. 87%) and specificity (avg. 80%) with an area under the curve of 0.865 (P < 0.01) were selected for BO group. For UA group, we identified 8 miRNAs: hsa-miR-320a, hsa-miR-15b-5p, hsa-let-7b-5p, hsa-miR-429, hsa-miR-342-3p, hsa-miR-142-3p, hsa-miR-199a-3p, hsa-miR-363-3p with high sensitivity (avg. 92%) and specificity (avg. 76%) with an area under the curve of 0.87 (P < 0.01). These miRNAs were tested in a larger group of patients as well as in urine samples. CONCLUSIONS We identified miRNAs that discriminated between the urodynamically-defined states of BOO-induced LUTD with high sensitivity and specificity. ROC analysis showed that these miRNAs have promising diagnostic performances in DO, BO and UA patients and can be potentially used as a tool to evaluate disease progression. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e606 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ali Hashemi Gheinani More articles by this author Fiona C. Burkhard More articles by this author Hubert Rehrauer More articles by this author Catharine Aquino Fournier More articles by this author Irene Keller More articles by this author Rémy Bruggmann More articles by this author Katia Monastyrskaya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A study of carcinoembryonic antigen concentrations in patients with coronary artery disease

Abstract Background & aims Carcinoembryonic antigen (CEA) is a tumour marker whose role is now being evaluated as a biomarker for early diagnosis of acute coronary syndromes. Its levels may rise even prior to rise of established biomarkers of myocardial necrosis. Methods Serum CEA concentrations were measured by double sandwich ELISA method in four groups of subjects with STEMI, NSTEMI/UA (24 patients of NSTEMI and 18 patients of unstable angina), stable angina and healthy controls with 42 males between 40 to 60 years of age in each group. Also qualitative Troponin T assay and CPK-MB concentrations measurement was done in groups with STEMI and NSTEMI/UA and correlations between CEA concentrations and Troponin T and CPK-MB were made. Results Mean serum CEA concentrations were 5.19 ± 0.39, 3.84 ± 0.34, 3.91 ± 1.40, 1.84 ± 0.35 and 2.12 ± 0.40 ng/ml respectively in groups with STEMI, NSTEMI/UA, UA alone, stable CAD and healthy controls respectively. STEMI, NSTEMI/UA and UA patients had significantly higher concentrations than stable CAD and healthy controls (p Conclusions CEA is a sensitive biomarker for early diagnosis of ACS. Its levels correlate with severity of ACS. It may play a crucial role in diagnosis of ACS in patients who present with atypical manifestations or when traditional biomarkers such as CPK-MB and Troponins are not raised.

N-Terminal Pro-B-Type Natriuretic Peptide Levels Inversely Correlated With Heart Rate Variability in Patients With Unstable Angina Pectoris.

We explored the relationships between heart rate variability (HRV) and levels of N-terminal Pro-B-type natriuretic peptide (NT-proBNP) in patients with unstable angina pectoris (UA).A total of 90 consecutive patients admitted < 48 hours for UA were included. Serum levels of NT-proBNP were measured from blood samples. The cohort was divided into tertiles according to NT-proBNP levels. HRV parameters including SDNN, RMSSD, LF, HF, TP, and VLF were assessed by 24-hour Holter ECG monitoring.The median (IQR) NT-proBNP level was 177.02 (64.76, 740.70) pg/mL. Patients with SDNN < 100 ms had higher levels of NT-proBNP than those with SDNN > 100 ms (P = 0.003). With increasing levels of NT-proBNP, both the 24hour monitoring HRV and night-monitoring HRV showed that SDNN and VLF gradually decreased (P < 0.01), and patients in the NT-proBNP lowest tertile group had higher LF values than the other two groups (P < 0.05); however, no difference was found in RMSSD, HF, and TP. During the daytime, the LF, VLF, and TP values were lower in the NTproBNP highest group compared with the lowest tertile group (P < 0.05). NT-proBNP levels correlated negatively with SDNN (r = -0.314, P = 0.003) and VLF (r = -0.397, P < 0.001) but not with other HRV parameters. Multiple regression analysis showed that serum levels of NT-proBNP remained predictive of SDNN (β = -0.060, P = 0.001) and VLF (β = -0.145, P < 0.001), even after adjustment for confounders.Our study showed that the elevated serum levels of NT-proBNP predict reduced HRV parameters, and the increased NT-proBNP levels combined with decreased HRV represent the degree of neurohormonal dysfunction and may be better prognostic predictors for risk stratification in UA patients.

Influence of Lipid Transport System Gene Polymorphism on the Dyslipidemia and Coronary Lesions in Patients with Unstable Angina

The purpose of this study was to identify the features of lipid metabolism and coronary lesions in view of the combined carrier of the e4 allele of APOE e2/e3/e4 polymorphism and the S2 allele of APOC3SstI polymorphism in UA patients. Materials and Methods: The study included 141 Uzbek patients with UA class IIB (Braunwald E. et al., 1989) who had coronary atherosclerosis of varying degrees, according to coronary angiography. The control group consisted of 50 healthy, agematched, randomly selected Uzbek persons without clinical and instrumental signs of CHD according to the exercise test. Coronary angiography was performed using Allura CV-20 (Philips, Netherlands). Genotyping of the APOE (e2/e3/e4) gene polymorphism and the APOC3 (SstI) gene polymorphism was performed by the PCR-RFLP method. Results: Our analysis revealed a significant prevalence of carriers of the S2 allele of APOC3SstI polymorphism and carriers of the e4 allele of APOE e2/e3/e4 polymorphism among UA patients compared to healthy ethnic Uzbeks. A combination of these two “damaging” alleles was observed in 26.2% of UA patients, which was accompanied by significantly higher blood levels of TC and LDL-C (P<0.05), a higher APOB/APOAI ratio (P<0.05), and a lower level of HDL-C (P<0.05). According to coronary angiography, a three-vessel lesion and more significantly predominated among these UA patients (OR: 2.25, 95% CI 1.05-4.84, χ2 3.66, P<0.05). (Int J Biomed. 2015;5(4):188-191.)

Patterns of heart rate variability and cardiac autonomic modulations in controlled and uncontrolled asthmatic patients.

BackgroundPrevious heart rate variability (HRV) studies in asthmatic subjects (AS) demonstrate predominance of parasympathetic drive concomitant with low HRV, which is against the general belief that enhanced parasympathetic modulation improves HRV. The aim of this study was to compare patterns of HRV and cardiac autonomic modulations of AS to healthy control subjects (HS).MethodsEighty AS and forty HS were enrolled in the study. Asthma control test and spirometry were used to discriminate uncontrolled (UA) from controlled (CA) asthmatic patients. Natural logarithmic (Ln) scale of total power (TP), very low frequency (VLF), low frequency (LF) and high frequency (HF) were used to evaluate HRV. Normalized low frequency (LF Norm) and high frequency (HF Norm) were used to determine sympathetic and parasympathetic autonomic modulations respectively.ResultsCA patients achieved significantly higher LnTP, LnLF, LnHF and HF Norm but lower LF Norm and LnLF/HF compared with UA patients (p < 0.05). Although CA patients showed increased HRV and augmented vagal modulation compared with HS, these findings were no longer significant following adjustment for mean heart rates and anti-asthma treatment. All measured HRV parameters were not significantly different in UA patients compared with the HS (p > 0.05).ConclusionsCA is associated with enhanced parasympathetic modulations and higher HRV compared with UA. However, neither CA nor UA patients had different autonomic modulations and/or HRV compared with HS.

The diagnostic utility of High-Sensitivity Cardiac Troponin T in acute coronary syndrome

Abstract Background Coronary artery disease (CAD), its acute form, and acute coronary syndrome (ACS) are the leading cause of death all over the world. For initial assessment of a patient with ACS, ECG, imaging techniques and serum biomarkers all contribute in confirming the diagnosis. Cardiac Troponin (cTn) I and T are the current gold standard for the detection of myocardial necrosis. However, there is also emerging evidence suggesting that with the use of sensitive or high-sensitive cTn assays, a blood sample collected 2 or 3 h after presentation might be appropriate for an earlier rule in and rule out diagnosis of AMI compared with the recommended second blood draw 6–9 h after admission using conventional Troponin assay. Aim The aim of this study was to examine the ability of High-Sensitivity Cardiac Troponin T for early detection of AMI in comparison with conventional Troponin assay. In addition, to study the clinical utility of kinetic changes of High-Sensitivity Cardiac Troponin T for diagnosis of ACS. Methods This study was conducted on sixty subjects. Fifty patients who presented to emergency department in Ain-Shams University Hospital complaining of chest pain were highly suspicious to have acute cardiac ischemia, having no or non-specific ECG changes and their Cardiac Troponin I level on admission was below the test threshold value (100 ng/L). In addition, ten subjects serving as a healthy control group were also recruited. The fifty patients were subdivided into subgroup A which included 16 patients, with hs-TnT n = 17) and group D, representing cases of NSTEMI ( n = 33). Results Results of the current study revealed that median serum levels of hs-TnT showed highly significant difference between patients with ACS and healthy subjects, and also between patients with NSTEMI and those with UA. Receiver operating characteristic (ROC) curve analysis was applied to assess the diagnostic performance of hs-TnT in discriminating patients from control group. The best cutoff was 4.8 ng/L. This cutoff had a diagnostic sensitivity, specificity, PPV, NPV and efficiency of 96%, 100%, 100%, 83.3% and 96.7% respectively. Another receiver operating characteristic (ROC) curve analysis was applied to assess the diagnostic performance of hs-TnT for discriminating NSTEMI patients from UA patients. The best diagnostic cutoff for hs-TnT was 13.7 ng/L. This had a diagnostic sensitivity, specificity, NPV, PPV and efficiency of 97%, 88.2%, 93.8%, 94.1% and 94% respectively. Conclusion Our study demonstrated highly significant absolute and relative kinetic changes in hs-TnT levels in patients with AMI. The hs-TnT can be used for early rule in patients with MI as it could detect 97% of cases with MI whose Troponin I was negative and could detect 100% of cases of MI after 6–8 h compared to Troponin I which could detect only 21.2% of cases. This can be of great importance in the future introduction and use of the new high sensitive assay as a non-invasive reliable diagnostic tool to replace the currently used invasive diagnostic techniques for patients with ACS.

GW25-e4537 Statin effects on UA patients microRNA expression profile and regulatory functional network analysis

GW25-e4537 Statin effects on UA patients microRNA expression profile and regulatory functional network analysis

Correlation study of serum hs-CRP, UA level and the correlation of disease in elderly acute myocardial infarction patients

Objective To investigate correlation study of serum hs-CRP,UA level and the correlation of dis-ease in elderly acute myocardial infarction patients , and provide a reference basis for clinical judgment for patients with illness development and prognosis prediction .Methods 40 aged patients with acute myocardial infarction pa-tients were selected as the research object ,and protionally random according to time admission the same period ran-domly selected were 40 cases of elderly patients with unstable angina pectoris ,40 cases of elderly patients with stable angina,40 cases of clinic medical normal healthy old people for controlled object .The levels of serum hs-CRP,UA and correlation was analyzed.Results The serum hsCRP,UA in the myocardial infarction group were （34.67 ±12.18）mg/L, （412.46 ±68.93）μmol/L,which in the unstable angina pectoris group were （17.21 ±8.39） mg/L,（274.19 ± 46.62）μmol/L,which in stable angina pectoris group were （5.25 ±1.40） mg/L,（297.41 ±37.43）μmol/L,which in the health group（4.96 ±1.24）mg/L,（279.64 ±34.78）μmol/L,the differences among the myocardial infarction group,unstable angina pectoris,stable angina pectoris group had statistical significance （P〈0.05）, the differences between myocardial infarction group and health group had statistical significance （P〈0.05）;Myocardial infarction patients prognosis group hs-CRP,UA group was obviously higher than that of the prognosis was good ,compared with statistical significance difference （ P 〈0.05 ）;In myocardial infarction group , unstable angina pectoris group , the hsCRP was associated with positive correlation exists between UA （P〈0.05）,stable angina pectoris group no correla-tion（P〉0.05）;Different prognosis in patients with myocardial infarction hsCRP is associated with UA has positive correlation between （ P〈0.05） .Conclusion Elderly acute myocardial infarction patients serum hs-CRP,UA obviously increased ,and illness development correlation ,a high level of hs-CRP,UA patients often indicates poor prognosis . Key words: Myocardial infarction; C-reactive protein; Uric acid; Aged

FRI0511 Detection of Anti-Th/To Antibodies in Patients with Various Rheumatic Diseases and their Clinical Features

BackgroundAnti-Th/To were initially reported to be specific for SSc or Raynaud's disease with a short duration. Clinically, anti-Th/To were associated with features like puffy fingers, hypothyroidism and a significantly lower...

Anti-citrullinated protein antibodies acquire a pro-inflammatory Fc glycosylation phenotype prior to the onset of rheumatoid arthritis

ObjectiveTo determine whether anticitrullinated protein antibodies (ACPA) exhibit specific changes in Fc glycosylation prior to the onset of arthritis.MethodsSerum samples of patients with ACPA-positive arthralgia (n=183) were collected at baseline...

GW24-e2497 Circulating MicroRNAs as Potential Biomarkers of Coagulation Dysfunction in Patients with Vulnerable Coronary Artery Disease

ObjectivesThe activation of coagulation and fibrinolysis plays a critical role in the incidence of coronary events. MicroRNAs (miRNAs) are small non-coding ribonucleic acids (RNAs) that negatively regulate gene expression on...