Methylation of f2rl3, cdkn2a genes and sudden cardiac death

The aim of the study was to evaluate the association of methylation of the F2RL3, CDKN2A gene with sudden cardiac death (SCD). Material and methods. Case-control study design. The SCD group included 150 deceased men (mean age 46.7 ± 9.2 years) with the main pathological diagnoses of acute circulatory failure, acute coronary insufficiency, which meets the SCD criteria of the European Society of Cardiology. The control group included 150 men who died suddenly, but not due to cardiovascular pathology (mean age 42.6 ± 1.2 years). DNA was isolated by phenol-chloroform extraction from myocardial tissue in both groups. The methylation status of the F2RL3 gene (19: 16890405-16890606, GRCh38.p13) and the CDKN2A gene (9: 21974726-21974877, GRCh38.p13) was assessed by methyl-specific polymerase chain reaction. Results. In the SCD group, 17.3 % (26/150) had the F2RL3 gene completely methylated (MM); in 6.0 % (9/150) it is completely unmethylated (UU); 76.7 % (115/150) had both methylated and unmethylated F2RL3 (MU) gene. In the control group, 16 % (24/150) had the F2RL3 gene completely methylated (MM); in 5.3 % (8/150), it is completely unmethylated (UU); 78.7 % (118/150) had both methylated and unmethylated F2RL3 (MU) gene. When comparing the groups, there were no statistically significant differences in the methylation status of the F2RL3 gene between the groups (p > 0.05). In all subjects in the SCD group and the control group, the CDKN2A gene is completely unmethylated. Conclusions. Methylation of genes F2RL3, CDKN2A is not associated with sudden cardiac death.

Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction

Background The previous large‐scale randomized controlled trial showed that routine thrombus aspiration (TA) during percutaneous coronary intervention (PCI) was associated with an increased risk of stroke. However, real‐world clinical evidence is still limited. Methods and Results We investigated the association between manual TA and stroke risk during primary PCI in the OACIS (Osaka Acute Coronary Insufficiency Study) database (N=12 093). The OACIS is a prospective, multicenter registry of myocardial infarction. The primary end point of the present study is stroke at 7 days. A total of 9147 patients who underwent primary PCI within 24 hours of hospitalization were finally analyzed (TA group, n=4448, versus non‐TA group, n=4699 patients). TA was independently associated with risk of stroke at 7 days (odds ratio [OR], 1.92 [95% CI, 1.19‒3.12]; P =0.008) in the simple logistic regression model, while the multilevel random effects logistic regression model with hospital treated as a random effect showed that manual TA was not associated with incremental risk of stroke at 7 days (OR, 0.91 [95% CI, 0.71‒1.16]; P =0.435). The 7‐day stroke risk of manual TA was significantly heterogeneous in different institutions ( P for interaction =0.007). Conclusions Manual TA during primary PCI for patients with acute myocardial infarction was independently associated with the overall increased risk of periprocedural stroke. However, this result was substantially skewed because of institution specific risk variation, suggesting that the periprocedural stroke may be preventable by prudent PCI procedure or appropriate periprocedural management. Registration URL: https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000005464 . Unique identifier: UMIN000004575.

P.149 Spinal Cord Stimulation for Refractory Angina

Background: Refractory angina is defined as a chronic condition characterized by the presence of angina due to coronary insufficiency which cannot be controlled by a combination of medical therapy, angioplasty and coronary bypass surgery. Prevalence in the United States is estimated to be between 300,000-900,000. Spinal cord stimulation for refractory angina pain relief was first described in 1987 but is still not widely used in North America. We report our experience with this treatment. Methods: A retrospective review of patients referred to the St Pauls Hospital neuromodulation program for consideration of SCS for refractory angina was conducted. Patients underwent implantation using a either a two stage approach (percutaneous or permanent lead trial followed by full system implantation) or full system implantation. Results: Bewtween 2004-2020 36 patients underwent full system implantation (2 patients failed the trial and were not implanted). Of the 36 patients undergoing full system implantation, 33 (92%) experienced significant reduction of angina, increased exercise tolerance and/or medication reduction and were considered successful implantation. Most common lead placement location was at C7 T1. Conclusions: Spinal cord stimulation is an effective therapy for patients suffering from crippling angina pain despite medical optimization.

Successful Decannulation of Hybrid ECMO Circuitry: The First Philippine Experience

We report the first VA-VAV-VV ECMO conversion in a 57-year-old Filipino female with persistent coronary insufficiency from toxic shock syndrome due to Streptococcus pyogenes bacteremia, acute respiratory distress syndrome, and Harlequin syndrome with progressive acute limb ischemia from cone snail venom poisoning. The patient came in via air ambulance transport because deteriorating clinical status after having stepped on a cone snail 3 days prior and developing severe dehydration from vomiting and passage of voluminous watery stools after eating a local delicacy. The patient was admitted at the ICU where after 3 days of treatment, the patient developed cardiac tamponade and underwent stat pleuropericardial windowing with pericardiocentesis. Due to increasing pressor requirements from the combined shock, Swan-Ganz catheterization was inserted and a VA-ECMO system was set up. There was gradual improvement in cardiac hemodynamics, however oxygen requirement was increasing and both lower extremities became progressively violaceous with decreasing pulses. Harlequin syndrome was ruled in, the multidisciplinary team decided to convert to VAV hybrid circuit by adding a venous access by way of the right internal jugular vein. Improvement in oxygenation lead to eventual conversion from VAV to purely VV dedicated circuit. Ultrafiltration via ECMO was likewise done because of worsening azotemia and oliguria. The patient was then gradually weaned off from ECMO and was successfully decannulated after 8 days. Below knee amputation was done to address the progressive acute limb ischemia. The patient was nutritionally built up and physically rehabilitated and was eventually discharged improved on the 28th hospital day.

To the assessment of changes in the electrocardiogram in coronary insufficiency

In the literature there are a number of reports on the effect of physical activity on the coronary circulation, but we did not find any works on the effect of a regimen with restriction of muscle movements on the ECG of patients with coronary insufficiency. This article reports the results of research on this issue. In addition, ECG changes were studied in patients in the subacute stage of myocardial infarction under the influence of walking.

About brain disorders in acute coronary insufficiency

In acute coronary insufficiency, cerebral vascular disorders are not uncommon. NK Bogolepov calls the resulting states a combined coronary-cerebral crisis.

3D Mueller Matrix Reconstruction of the Optical Anisotropy Parameters of Myocardial Histopathology Tissue Samples

Diseases affecting myocardial tissues are currently a leading cause of death in developed nations. Fast and reliable techniques for analysing and understanding how tissues are affected by disease and respond to treatment are fundamental to combating the effects of heart disease. A 3D Mueller matrix method that reconstructs the linear and circular birefringence and dichroism parameters has been developed to image the biological structures in myocardial tissues. The required optical data is gathered using a Stokes polarimeter and then processed mathematically to recover the individual optical anisotropy parameters, expanding on existing 2D Mueller matrix implementations by combining with a digital holography approach. Changes in the different optical anisotropy parameters are rationalised with reference to the general tissue structure, such that the structures can be identified from the anisotropy distributions. The first to fourth order statistical moments characterising the distribution of the parameters of the optical anisotropy of the polycrystalline structure of the partially depolarising layer of tissues in different phase sections of their volumes are investigated and analysed. The third and fourth order statistical moments are found to be the most sensitive to changes in the phase and amplitude anisotropy. The possibility of forensic medical differentiation of death in cases of acute coronary insufficiency (ACI) and coronary heart disease (CHD) is considered as a diagnostic application. The optimal phase plane (θ∗=0.7rad) has been found, in which excellent differentiation accuracy is achieved ACI and CHD -Ac(ΔZ4(θ∗,ΦL,ΔL))=93.05%÷95.8%. A comparative analysis of the accuracy of the Mueller-matrix reconstruction of the parameters of the optical anisotropy of the myocardium in different phase planes (θ=0.9rad and θ=1.2rad), as well as the 2D Mueller-matrix reconstruction method was carried out. This work demonstrates that a 3D Mueller matrix method can be used to effectively analyse the optical anisotropy parameters of myocardial tissues with potential for definitive diagnostics in forensic medicine.

Prospective Descriptive Study to Evaluate the Impact of Clinical Pharmacist in Antiplatelet Utilization and Safety in Coronary Heart Disease Patients

Aim To evaluate the interventions associated with integration of a clinical pharmacist for antiplatelets best utilization and safety as multidisciplinary team approach is recommended to improve patient outcomes. Methods prospective observational study on coronary heart diseases patients (stable angina, unstable angina, MI, post PCI or post CABG) on antiplatelets therapy (single antiplatelet; SAPT, or dual antiplatelet; DAPT) at governmental and private hospitals. Detailing pharmacist-initiated interventions targeting pharmacotherapy optimization (Dose, duplicate and interactions), also adverse effects detection, and hospital re-admission (re-event of coronary insufficiency). Collecting patients' data by interviews and hospital records using validated check list. Statistical software IBM SPSS software package version 20.0, The Kolmogorov-Smirnov was used to verify the normality of distribution of variables, Mann Whitney test was used to compare between two categories for not normally distributed quantitative variables. Kruskal Wallis test was used to compare different categories for abnormally distributed quantitative variables. Spearman coefficient was used to correlate between quantitative variables. Linear Regression was used to detect the most affecting factor for affecting DAPT score and Precise DAPT. Significance of the obtained results was judged at the 5% level, calculate sample size by G Power3. Results There is a significant correlation between cardiac related readmission and Precise DAPT score (P = 0.013).A statistically significant correlation is found between smoking and DAPT score (p = 0.015) but not with precise DAPT (P = 0.152). Also a significant linear association exists between DAPT type and DAPT score, for Aspirin + Clopidogrel (P = 0.010) (95%CI=-1.000 (-1.754 – -0.246), Aspirin + Ticagrilor (P = 0.012) (95%CI= 1.001 (0.228 – 1.774). The highly significant influencing variable in both scores, is the dose value, for DAPT score (P = 0.038), Precise DAPT (P = 0.001). The distribution of Myocardial infarction as cardiac related readmission and smoking are higher in males than females without statistically significant difference (P = 0.08), (P = 0.39), the absence of adverse effects and bleeding events is statistically significant in DAPT score (P = 0.041, 95%CI=1.706 (0.071 – 3.341) & precise DAPT score (P = 0.002, 95% CI= -15.95 (-25.832 – -6.074). Conclusions Impact of a clinical pharmacist within cardiology department generated substantial pharmacotherapy optimization which improve the medication adherence, safety and clinical outcomes. Our study suggests pre-calculating DAPT and precise DAPT for all patients before treatment and commitment on DAPT period administration may decrease re-admission rate of patients.

The prospects for NT-pro BNP level determining in physical activity conditions in patients during the rehabilitation period after the myocardial infarction, complicated with decompensated heart failure

The aim of the study was to determine the futility of NT-pro BNP level analysis during dosed physical exercise for diagnosing decompensated HF in the postinfarction period and the possibility to determine the HF functional class. Materials and methods. 160 patients with previous MI were examined, patients’ average age was (56.67±5.72) years. The patients were randomized in 2 groups dependently on the presence of the signs of II А-B according to V. Kh. Vasylenko and M. D. Strazhesko classification and FC III-IV (according to NYHA) decompensated chronic HF. Group I consisted of 120 patients with Q-QS and non-Q MI; group II (the control one) had 40 patients with MI without signs of decompensated HF; 20 healthy people made up a norm group. Results. Signs of coronary insufficiency such as dizziness and signs of poor peripheral perfusion (cyanosis/paleness) occurred in 104 (86.7 %) and 79 (65.8 %) cases that differ from the same values in the second group 4 (10.0 %) and 14 (35.0 %) respectively. 88 (73.3 %) patients with the signs of decompensated HF felt general weakness, fatigue, and expressed a request to stop the test. The HR in the postinfarction patients with the signs of decompensated HF was before the exercise (88.2±3.18) bpm (p≤0.05); in the patients with past MI without the signs of decompensated HF, it was (75.32±3.41) bpm (p≤0.05); and in the practically healthy people, it was (77.73±3.02) bpm. We found out a reverse moderate correlation between the distances that had been covered by a patient during the 6MWT NT-proBNP level in blood serum of examined patients. Conclusions. Inadequate response to dosed physical exercises and increased immunological parameters as quantitative HF markers could be useful not only for diagnostics, but also for the risk stratification for decompensated HF that had occurred in patients on different rehabilitation stages after an acute MI.

Forensic medical evaluation of hemorrhages into the brain of traumatic and non-traumatic genesis by the Mueller matrix microscopy of circular dichroism

The aim of the work is to develop forensic criteria for differentiation of hemorrhages of traumatic and non-traumatic genesis by digital Mueller matrix (MM) polarization microscopy of histological sections of human brain substance (HBS).Material and methods. Native histological preparations of HBS from 32 corpses with ischemic stroke (1 group), 35 corpses with hemorrhages of traumatic origin (2 groups), 33 corpses with hemorrhages in HBS of non-traumatic genesis (3 group) and 30 corpses caused by acute coronary insufficiency (4 control group). The method of research is azimuthal-invariant MM microscopy of circular dichroism (CD) of histological sections of the brain.Results. The results of studies of the coordinate and statistical structure of maps of the size of values at the points of digital microscopic images of histological sections of HBS of the dead of all groups revealed a coordinate-inhomogeneous structure of all distributions of the size of the CD of microscopic images of histological sections of the dead of all groups. Probable distributions that characterize MM invariants CD maps of histological sections of brain samples from all groups have a small scatter of values of the statistical moment of the 2nd order, as well as significant values of statistical moments of the 3rd and 4th orders.Conclusion. The efficiency of using the Mueller-matrix mapping method in diagnosing of hemorrhage genesis in the brain substance in the differentiation of the set of samples of control and experimental groups reaches a satisfactory level - 77% - 78%.