Leucine Rich Alpha-2-Glycoprotein 1 Is A Novel Predictor Of Diastolic Dysfunction: A Cross-Sectional Study

Background. Leucine-rich α2-glycoprotein (LRG1) mediates cardiac fibrocyte activation. It is upregulated in inflammatory conditions, atherosclerosis, and fibrosis. Diastolic dysfunction (DD) is due to myocardial fibrosis. This study examined the relationship between LRG1 and DD. Methods. Patients with symptoms of chronic coronary ischemia were recruited. Exclusion criteria: symptoms of overt heart failure, ejection fraction (EF) < 55%, impaired renal function, infection, recent trauma. Investigations: SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score, Echocardiographic assessment, and LRG1 levels. Binary stepwise logistic regression to evaluate the relationship between LRG1 and DD. ROC analysis with calculation of optimal cut-off values. Results. 94 patients were included; 47 had diastolic dysfunction. Serum LRG1 was significantly (U = 417.00, p<0.001) higher in the DD group (M=14) compared to the No-DD group (M=8) (U-Mann Whitney Test). There were higher SYNTAX scores in the DD group (M = 24.5) compared with No-DD (M=7). LRG1 had significant predictability of DD (OR =1.30 (95% CI:1.13-1.49)). The ROC for the adjusted model had an AUC=0.89 (95% CI: 0.82-0.95). The cut-off value of “9” LRG1 had a 78% sensitivity (95% CI: 65.3–87.7) and 72.3% specificity (95% CI: 57.4 – 84.4) for predicting DD. Conclusions. We identified LRG1 as a novel independent predictor of diastolic dysfunction. Further studies are warranted to validate the utility of LRG1 in predicting DD.

Pulseless Electrical Activity as the Initial Cardiac Arrest Rhythm: Importance of Preexisting Left Ventricular Function

Background Pulseless electrical activity (PEA) is a common initial rhythm in cardiac arrest. A substantial number of PEA arrests are caused by coronary ischemia in the setting of acute coronary occlusion, but the underlying mechanism is not well understood. We hypothesized that the initial rhythm in patients with acute coronary occlusion is more likely to be PEA than ventricular fibrillation in those with prearrest severe left ventricular dysfunction. Methods and Results We studied the initial cardiac arrest rhythm induced by acute left anterior descending coronary occlusion in swine without and with preexisting severe left ventricular dysfunction induced by prior infarcts in non–left anterior descending coronary territories. Balloon occlusion resulted in ventricular fibrillation in 18 of 34 naïve animals, occurring 23.5±9.0 minutes following occlusion, and PEA in 1 animal. However, all 18 animals with severe prearrest left ventricular dysfunction (ejection fraction 15±5%) developed PEA 1.7±1.1 minutes after occlusion. Conclusions Acute coronary ischemia in the setting of severe left ventricular dysfunction produces PEA because of acute pump failure, which occurs almost immediately after coronary occlusion. After the onset of coronary ischemia, PEA occurred significantly earlier than ventricular fibrillation (<2 minutes versus 20 minutes). These findings support the notion that patients with baseline left ventricular dysfunction and suspected coronary disease who develop PEA should be evaluated for acute coronary occlusion.

Takayasu’s arteritis presenting as acute myocardial infarction: case series and review of literature

This series describes three adolescent females who presented with chest pain and ventricular dysfunction related to acute coronary ischemia secondary to Takayasu’s arteritis with varied courses of disease progression leading to a diverse range of therapies including cardiac transplantation. While Takayasu’s arteritis is rare in childhood, it should be strongly considered in any adolescent female presenting with systemic inflammation and chest pain consistent with myocardial infarction. A high index of suspicion can lead to early detection and aggressive management of the underlying vasculitis reducing associated morbidity and mortality. The purpose of this report is to describe the challenges in the clinical diagnosis and management of Takayasu’s arteritis with myocardial infarction. We also seek to enhance awareness about unique presentations of Takayasu’s arteritis within the paediatric community.

Study of exercise treadmill test in type 2 diabetes mellitus patients

Background: The aim of this study was to assess the prevalence and clinical predictors of silent myocardial ischemia in patients with type 2 diabetes mellitus, and the early diagnosis of coronary artery disease.Methods: A cross sectional prospective study was conducted including all confirmed diabetic patients in the age group between 40-60 in Bharati medical college hospital Pune in western Maharashtra. A detailed clinical examination and history was taken and relevant laboratory investigations, Electrocardiogram and Treadmill Stress test was done using Bruce protocol. The quantitative data was represented as their mean ± SD. Categorical and nominal data was expressed in percentage. All analysis was carried out by using SPSS software version 21.Results: Male preponderance was seen in the study with 64% of the study subjects. The mean age of the study subjects was 50.67±5.51 years. A p<0.001 was obtained showing positive correlation between BMI and TMT positivity. TMT positivity steadily increased with the duration of diabetes mellitus. Obtained p<0.001. The correlation between dyslipidemia and TMT positivity was significant, with a p=0.007. Correlation of Fasting as well as Post-prandial blood glucose levels with TMT positivity proved to be statistically significant, with a p<0.001.Conclusions: Exercise Treadmill test in diabetic patients has a significant role in screening diabetic individuals for coronary ischemia. The results obtained clearly indicate that an exercise treadmill test may be proposed as the first test for screening for coronary ischemia in diabetic population as it is safer, cheaper and non-invasive.

Bilateral coronary ostial atresia in a patient with pulmonary atresia and ventricular septal defect

This is a case of a female infant with bilateral coronary ostial atresia associated with pulmonary atresia and ventricular septal defect. She developed coronary ischemia at 1-month of age, when she underwent an aortopulmonary shunt and an aorta-right ventricle shunt. The double-orifice tricuspid valve was separating the right ventricle from the left ventricle. She required extracorporeal cardiopulmonary support because of ventricular dysfunction and mitral regurgitation. Although she was temporarily weaned off the support after mitral valvuloplasty, she died from multiple organ failure. To the best of our knowledge, bilateral coronary ostial atresia associated with pulmonary atresia with ventricular septal defect has not been reported previously.

Two cases of intraoperative hemodynamic instability during combined thoracoscopic-laparoscopic surgery for esophagogastric junction carcinoma

Background Intraoperative complications during combined thoracoscopic-laparoscopic surgery for esophagogastric junction (EGJ) carcinoma have not been reported as compared to those during surgery for esophageal carcinoma. We present two cases which had surgery-related hemodynamic instability during laparoscopic proximal gastrectomy and intra-mediastinal valvuloplastic esophagogastrostomy (vEG) with thoracoscopic mediastinal lymphadenectomy for EGJ carcinoma. Case presentation In case 1, the patient fell into hypotension with hypoxemia during laparoscopic vEG due to pneumothorax caused by entry of intraabdominal carbon dioxide. In case 2, ventricular arrythmia and ST elevation occurred during laparoscopic vEG. Pericardium retraction to secure surgical field during reconstruction compressed the coronary artery, which caused coronary malperfusion. These two events were induced by the surgical procedure, characterized by the following: (1) connection of the thoracic and abdominal cavities and (2) cardiac displacement during vEG. Conclusion These cases indicated tension pneumothorax and coronary ischemia are possible intraoperative complications specific to combined thoracoscopic-laparoscopic surgery for EGJ carcinoma.

Oxidants and antioxidants in myocardial infarction (MI); Investigation of ischemia modified albumin, malondialdehyde, superoxide dismutase and catalase in individuals diagnosed with ST elevated myocardial infarction (STEMI) and non-STEMI (NSTEMI)

Background: Coronary ischemia can lead to myocardial damage and necrosis. The pathogenesis of cardiovascular diseases often includes increased oxidative stress and decreased antioxidant defense. The study aimed to assess levels of ischemia modified albumin (IMA), malondialdehyde acid (MDA), superoxide dismutase (SOD), and catalase in individuals diagnosed with ST elevated myocardial infarction (STEMI) and non-STEMI. Methods: The present study prospectively included 50 STEMI patients, 55 NSTEMI patients, and 55 healthy subjects. Only patients who were recently diagnosed with STEMI or NSTEMI were included in this study. IMA, MDA, SOD, and catalase activities were measured spectrophotometrically. Significant coronary artery lesions were determined by angiography. Results: Patients with ACS had significantly greater IMA and MDA values than the healthy controls (p<0.001). In addition, patients with STEMI had IMA levels that were significantly greater than those of the patients with NSTEMI (p <0.001), while the reverse was true for MDA levels (p<0.001). The healthy controls had the highest levels of SOD and catalase levels, followed by patients with STEMI and patients with NSTEMI, respectively (p <0.001). There was a significant negative correlation among MDA and SOD with catalase levels (r = -0.771 p <0.001 MDA vs catalase; r = -0.821 p <0.001 SOD vs catalase). Conclusions: Data obtained in this study reveals that compared to healthy controls, STEMI and NSTEMI patients had increased levels MDA and IMA, and decreased levels of SOD and catalase.