Serum Vitamin D Level in Patients Undergoing Coronary Artery Catheterization

Background: Vitamin D deficiency may be a risk factor for coronary artery disease (CAD). We aimed to measure the prevalence of vitamin D deficiency in CAD and its association with severity of angiographic proven CAD. Methods: This prospective, cross-sectional study included 106 consecutive patients who were admitted for typical angina and had signs of myocardial injury (ECG findings and/ or elevated troponin I or CK-MB) and who underwent coronary angiography at the university hospital of BPKIHS from August 2020 to April 2021. Patients were categorized into angiographic proven CAD group and angiographic normal coronary artery group. Serum vitamin D level was classified as normal (≥ 30 ng/ml) and deficiency (< 30 ng/ml). Results: Out of 106 patients, 78 patients (73.6%) had vitamin D deficiency and 28 (26.4%) had normal vitamin D level (p = 0.39). Vitamin D level (mean ± SD) in patients with angiographic normal coronary artery and angiographic proven CAD were 25.94 ± 11.63 ng/ml and 26.07 ± 12.90 ng/ml respectively (p = 0.97). Prevalence of vitamin D deficiency was 75.0% and 64.3% in significant CAD group and normal coronary artery group respectively (p = 0.39). Similarly, frequency of vitamin D deficiency were 68.6%, 78.3% and 88.90% in single, double, and triple vessel disease respectively (p = 0.21). The vitamin D level (mean ± SD) in single, double and triple vessel disease were 27.31 ± 14.02 ng/ml, 25.69 ± 12.72 ng/ml, 23.08 ± 9.45 ng/ml respectively. Conclusion: The prevalence of vitamin D deficiency in both angiographic normal coronary artery and angiographic proven CAD were high but comparable. There was no association of vitamin D deficiency with severity of angiographic proven CAD.

Atypical Takotsubo Cardiomyopathy With Persistent Left Ventricular Aneurysm After Cardiac Surgery

A 57-year-old man was admitted to the hospital because of severe mitral regurgitation. Minimally invasive mitral valvuloplasty was performed. Six months after surgery, he presented with discomfort. Urgent coronary angiography showed a normal coronary artery and large left ventricular aneurysm. After atypical Takotsubo cardiomyopathy was diagnosed, his clinical symptoms and heart function were improved with medication for his persistent left ventricular aneurysm. After 24 hours, Hotler showed a lethal ventricular arrhythmia. Surgical treatment was recommended and refused. After four years of observation, he died of asystole. Takotsubo cardiomyopathy is considered a severe complication after surgery. The prognosis is very poor if it has catastrophic complications.

A Suspected COVID-19-associated Myocarditis Case Mimicking Life-threatening STEMI: a Shark Fin Appearance

Some cases of myocarditis have been reported associated to Covid-19. The presence of proinflammatory response from immune cells suggested occurs by binding to membrane protein ACE-2 leading to myocardial damage. Our hospital got a refferal from a non-PCI-capable hospital with a 51-years-old woman chest pain and progressive heavy breath with history of fever two days ago. She was diagnosed with anterior STEMI and cardiogenic shock on vassopressors. Her electrocardiogram showed shark fin appearance suggesting life-threatening STEMI. Her rapid test for covid-19 are non-reactive for both IgM and IgG. Her NCCT-thorax showed ground glass opacity in both lungs. Her laboratories finding showed elevated inflammatory markers and elevated cardiac biomarker. We took her naso-oro-pharingeal swab in the same day and process her with emergency PCI. Surprisingly, her angiography showed normal coronary artery without any significant stenosis. From There was no SARS-CoV-2 detected. In myocarditis, patient can mimick the same symptoms as STEMI such as chest pain and heavy breath with elevated cardiac biomarker, but the electrocardiogram usually shows widespread concave ST-elevation with PR-segment depression. Shark fin appearance is usually seen in life-threatening STEMI. In our patient, the NCCT-thorax showed GGO suggested Covid-19 involvement. But, the first swab was negative for SARS-CoV-2. Unfortunately, the patient was discharged without doctor’s consent, so we can not process the second swab and echocardiography to evaluate the function of myocardium. We still can not confirmed this case if it is true myocarditis-associated covid-19 and how was the involvement of the myocardium creating a shark fin mimicking life-threatening STEMI.

Prevalence of Coronary Artery Ectasia and Associated Risk Factors

Objectives: This study aimed to evaluate the incidence of coronary artery ectasia (CAE) and its associated factors in the East of Iran. Methods: A cross-sectional study was conducted on 2,795 patients undergoing coronary angiography between 2011 and 2017. Patients were categorized into three groups: Coronary artery ectasia, normal coronary artery, and coronary artery stenosis. Patients' demographic data, cardiac risk factors, and angiographic results were extracted from medical records. Then, information on CAE patients was evaluated. Data were analyzed by the independent t-test, Mann-Whitney test, and chi-square test. Statistical significance was defined by a P-value ≤ 0.05. Results: The prevalence of CAE was 3.04%. The mean age of CAE patients was significantly higher than that of normal coronary artery patients (53.98 ± 9.97). The proportion of men was significantly lower in the CAE group (48.2%) than in the CAS group (62.1%) but higher than in the normal group (32.3). Body mass index (BMI) and low HDL (high-density lipoprotein) were higher in the CAE group, but diabetes mellitus was lower than in the CAS group. Conclusions: The prevalence of CAE was low in our study. Old age, male sex, obesity, and low HDL were CAE risk factors, but diabetes mellitus was a preventing factor in our study.

Coronary flow reserve and microcirculatory resistance in patients with coronary tortuosity and without atherosclerosis

Objective Coronary tortuosity may affect epicardial coronary arterial blood flow. This study aimed to investigate the effect of coronary tortuosity on coronary flow reserve and the coronary microcirculation in patients without apparent coronary atherosclerosis. Methods Prospective patients (n = 8, 3 men, mean age: 58 ± 6.0 years) with coronary tortuosity and without apparent coronary atherosclerosis were enrolled. Coronary tortuosity was defined by the finding of ≥three bends (defined as a ≥45° change in vessel direction) along the main trunk of the left anterior descending artery or left circumflex artery. Coronary flow reserve and the index of microcirculatory resistance were measured by the thermodilution technique. Results A total of eight coronary arteries with coronary tortuosity were analyzed. The mean fractional flow reserve was 0.98 ± 0.007. The mean coronary flow reserve was 1.5 ± 0.3, which is much lower than that in the normal coronary artery as reported in the literature. The mean index of microcirculatory resistance was 26.7 ± 2.3, which is much higher than that in the normal coronary artery. Conclusions Coronary tortuosity is associated with decreased coronary flow reserve and an increased index of microcirculatory resistance. Trial registration: This study is registered at the Chinese Clinical Trial Registry, NCT No: ChiCTR2000033671