Search

Background: Various factors such as age, body mass index (BMI), blood pressure (BP), and serum electrolytes affect ejection fraction (EF) improvement in acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI). Many studies have been done to assess effect of these factors on long-term basis, but none of the studies showed effect of these factors on efficacy of PCI. Aims and Objectives: This study aims to find out the role of BP and serum electrolytes in patients of AMI and to assess the efficacy of PCI as well as to predict the prognosis in AMI patients. Materials and Methods: It is a longitudinal, interventional study. EF of 52 patients of AMI was measured by echocardiography before and after angioplasty who had been admitted in cardiology emergency. Statistical software IBM Statistical Package for the Social Sciences trial version 16 was used for analysis of data. Results: We found that as the age advances, there is less improvement in EF (P = 0.38) also as the BMI increases, improvement in EF decreases (P = 0.53). Tachycardia leads to improvement in EF (P = 0.13), while those patients who had initial abnormal BP showed less improvement in EF (P = 0.93). Serum electrolytes analysis showed that as serum sodium and potassium level increase, improvement decrease (P = 0.06), while those patients who had normal serum calcium level showed less improvement in EF (P = 0.76). Only serum sodium and serum potassium showed some significance statistically (P = 0.06). Conclusion: Increased serum sodium and potassium level are associated with poor prognosis, while lesser age and normal BMI are associated with improved prognosis in AMI patients after PCI.

Atrial myxomas are the most common primary tumors of the heart. Their presentation will vary depending on their anatomical site and many times remain asymptomatic. Local obstruction to atrial outflow can present with dyspnea, orthopnea, syncope, and rarely sudden death. A differential diagnosis of tumor in the left atrium includes thrombus. Echocardiography usually suffices in making a diagnosis, but in difficult cases, cardiac computed tomography and magnetic resonance imaging may be needed. We report a case of left atrial myxoma in an elderly female which was asymptomatic and presented with rapid deterioration of symptoms.

Context: No-flow phenomenon during percutaneous coronary intervention (PCI) is a complex and multifactorial phenomenon with often devastating complications during PCI, especially in acute coronary syndrome (ACS) settings. There is paucity of data on serological predictors of the same. Materials and Methods: This was an open-label, all-comers, observational, prospective study done on 175 patients covering the whole spectrum of coronary artery disease, undergoing PCI at the center. On admission detailed clinical history , general and systemic examination and laboratory investigations in form of hemoglobin, blood urea, serum creatinine, serum sodium, serum potassium, random blood sugar, electrocardiogram(ECG) and tropinin T were also done. Post procedure creatinine protein kinase MB (CPK MB) was done after 24 hrs, and thrombolysis in myocardial infarction (TIMI) flow was assessed during PCI in all patients by the operating interventional cardiologist. Results: The mean value of NT-proBNP among patients with TIMI flow

Background: Left ventricular ejection fraction (LVEF) is a key determinant in decision-making after acute myocardial infarction (MI). Little is known of its relationship with left ventricular Strain and N-Terminal fragment of pro-B-type Natriuretic Peptide (NT-pro-BNP) following acute anterior wall MI (AWMI). Materials and Methods: We conducted a prospective cohort study of patients with a diagnosis of acute AWMI and the absence of overt heart failure (HF). Assessment of LVEF, strain parameters on echocardiography was done, and NT-pro-BNP levels were obtained. Follow-up for adverse cardiac events was done for 30 days postdischarge. Correlation of LVEF and NT-pro-BNP with various strain parameters were ascertained. Results: Of the total of 50 patients of AWMI enrolled, the mean LVEF in the study was 43.46 ± 3.72%.Eleven patients (22%) had adverse events at 30 days of follow-up. Patients with adverse events had significantly higher overall peak systolic longitudinal strain (PSLS), lower mid-region peak systolic longitudinal velocity (PSLV), and basal region PSLV. A significant negative correlation was observed between LVEF and mean Peak PSLS of combined apical plus mid regions of the left ventricle (r = −0.700). Log10-NT-pro BNP also showed a strong negative correlation with overall PSLV (r = −0.792) as well as regional PSLV values of combined apical plus mid (r = −0.763) and basal segments (r = −0.748). Conclusions: In patients with AWMI without HF, PSLS and PSLV are good predictors of adverse outcomes at 30-day follow-up. Furthermore, NT-pro BNP can also be an indirect predictor of strain parameters on echocardiography.

Background: Uncontrolled hypertension (HT), a critical risk factor contributing to rising burden of stroke; 57% of all stroke deaths in India. Elevated mean systolic blood pressure (MSBP) accounts for most cases of uncontrolled HT. Aim: To assess systolic blood pressure (SBP) in patients ≥ 50 years with uncontrolled SBP, to illustrate correlation of MSBP with stroke risk (using Stroke Riskometer TM ), and the management of patients with uncontrolled SBP. Methods: SYSTUP, a non-interventional, observational study, recruited patients with age ≥50 years, with uncontrolled SBP (≥ 140 mm Hg), from 176 centers across India in real-world clinical setting. Descriptive statistics and Logistic regression analysis were used for risk calculation. Results: 3791 patients (men 60 %) - mean age 62 years, mean BMI 27 kg/m 2 and mean BP 157/90 mmHg. A significant positive correlation was found between MSBP and stroke risk. The likelihood of 5 year and 10 year stroke risk increased by approximately 4% with 1 mmHg increase in MSBP (P Majority of the patients were receiving angiotensin receptor blocker (ARB), irrespective of the risk categories - low, moderate, high, very high risk (Table). Conclusion: The SYSTUP India results show that elevated MSBP increases stroke risk in patients ≥ 50 years with uncontrolled HT mainly treated with ARB. These real-world clinical findings call for strengthening BP control in primary care to prevent stroke.

We sought to investigate the incidence and predictors of 30-day mortality associated with ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) in a cohort of patients admitted to a single centre in India.From October 2013 to February 2016, a total of 6560 patients with a diagnosis of AMI were admitted to our institution. Among these patients, those with a diagnosis of VSR were retrospectively included in this registry. Clinical and echocardiographic features were collected in all cases. The primary outcome was 30-day mortality. A Cox proportional hazard regression analysis explored the predictors of 30-day mortality.During the observation period, a total of 51 consecutive patients (mean age 63.8 years (9.1); 51.0% male, 41.2% were patients with diabetes) with a diagnosis of VSR complicating AMI were included. On echocardiography, left ventricular ejection fraction was 42.5% (6.5), and the most frequent location of VSR was apical (78.4%). Overall, 27.4% of the patients received reperfusive therapy (pharmacological, 23.5%; mechanical, 3.9%) and 19.6% of the patients underwent surgical repair. The mean time to surgery was 7.7 days (2.4). At 30-day follow-up, death occurred in 80.4% of patients. Advanced age (HR 1.07, 95% CI (1.02 to 1.13), p=0.004), previous cerebrovascular accident (HR 52.2, 95% CI (3.98 to 685.06), p=0.003) and surgical repair (HR 0.05, 95% CI (0.01 to 0.26), p0.001) were effect modifiers of the 30-day risk of death.In this retrospective cohort of patients with AMI, the occurrence of VSR was not rare and carried a considerable risk of 30-day mortality. Advanced age, previous cerebrovascular accident and surgical repair influenced the risk for 30-day mortality.

Transthoracic electrical bio-impedance (TEB) has been proposed as a non-invasive and continuous method of cardiac output (CO) measurement, but it still has not found wide usages in clinics. The present study measured CO, using a new instrument NICOMON, and compared it with Echocardiography (ECHO) in acute myocardial infarction (AMI) patients.In the present study 100 patients of AMI were assessed by both ECHO and NICOMON for cardiac output and ECHO is considered as a reference method for comparison. TEB CO was measured by passing an alternating current and measuring the bio-impedance across the thorax. End diastolic volume (EDV), End systolic volume (ESV)Left ventricular outflow tract (LVOT) diameter, measured by ECHO were used to calculate CO. Various statistical methods like “t”-testcorrelation coefficient (r) were used where found suitable.Results: Mean TEB-CO (4.03±1.11 l/min) was significantly higher (p0.001) than mean ECHO-CO (3.80±1.28 l/min) with a mean difference of 0.25±1.02 l/min.NICOMON measures CO non-invasively but, it needs more elaborative studies on a larger sample to establish it as an alternative method of ECHO for cardiac output measurement on regular basis.

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient's quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

Temporary transvenous pacing is often required as life saving measure in conditions such as Stokes Adams attack and symptomatic bradyarrhythmias. Bradyarrhythmias are also known complications of acute Myocardial Infarction (MI), which can be transient or persistent and often demand temporary pacing too. It is difficult to diagnose underlying MI in the setting of paced rhythm due to secondary ST-T changes. Elevated cardiac enzymes are essential in the scenario of paced rhythm to diagnose underlying acute MI. Remarkable T wave inversion and ST depression {similar to Left Bundle Branch Block (LBBB)} do occur in right ventricular paced ECG and some changes may persist following withdrawal of pacing (cardiac memory T waves) simulating ischaemia. Very rarely arrhythmias can also lead to troponin rise causing diagnostic dilemma in such a setting. Here, we report a case of an elderly female who presented with symptomatic Complete Heart Block (CHB) and developed T wave inversion with Q wave formation in anterior leads in sinus rhythm following temporary pacing. She also demonstrated a dynamic rise in serial cardiac troponin values mimicking an acute coronary syndrome. Ultimately, an invasive coronary angiogram was performed to rule of significant coronary artery disease.

Introduction: Early stent thrombosis is a relatively rare but deleterious complication of Percutaneous Coronary Intervention (PCI). Data on early stent thrombosis from an Indian setting are rare and indistinct. Aim: To determine the incidence and clinical outcomes of early stent thrombosis in patients receiving drug-eluting stents. Materials and Methods: In this retrospective study, data of all consecutive patients who underwent PCI with stenting and reported an incidence of early stent thrombosis between March 2014 and November 2016 at our Tertiary Care Centre (King George’s Medical University, Lucknow, India) were considered. Incidence of early stent thrombosis was determined based on total number of patients who underwent PCI with drug-eluting stents during the study period. Subsequently, the patientrelated, lesion-related, procedure-related, and stent-related characteristics were examined for patients with early stent thrombosis. Clinical outcomes of stent thrombosis were also analysed for these patients. Additionally, a comparative analysis for various characteristics was performed between patients who died and patients who survived. Results: Early thrombosis was noted in 41 (1%) patients out of 3,869 PCI that were performed during the study period. Among this cohort, substantial presence of established risk factors of stent thrombosis was observed including for diabetes (n=12, 29.3%), smoking (n=19, 46.3%), STEMI (n=30, 73.2%), chronic total occlusion (n=8, 16.3%), thrombus-containing lesion (n=24, 49%), Type C lesions (n=36, 73.5%). Although, all patients were aimed to manage appropriately, mortality in patients with early stent thrombosis was reported in 18 (43.9%) patients and re-infarct was reported in 26.8% (n=11) patients. Conclusion: Although, the incidence of stent thrombosis in patients receiving drug-eluting stents was around 1%, it was found to be associated with a higher 30-day mortality rate. Further studies examining a larger cohort of patients, incidence of late and very late stent thrombosis, and a comparative analysis of characteristics between patients with and without stent thrombosis are warranted.

We present a case of hyperthyroidism presenting as Acute Coronary Syndrome (ACS) with marked ST-T changes, classical ischemic chest pain and raised cardiac enzymes, epicardial coronary arteries being completely normal on angiography.

Introduction: This study aimed to examine the long-term clinical outcomes of coronary fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in a real-world population in an Asian tertiary centre. Materials and Methods: All patients who underwent FFR measurement for intermediate coronary lesions in our centre from June 2002 to December 2009 were enrolled. A threshold of FFR ≤0.75 was used for revascularisation. All the patients were prospectively followed-up for major adverse cardiac events (MACE) of death, myocardial infarction (MI), target vessel revascularisation (TVR) and stent thrombosis. Results: Based on FFR measurement, 368 (57%) patients were treated medically while 278 (43%) underwent revascularisation. At a mean follow-up duration of 29.7 ± 16 months, 53 (14.4%) patients in the medical therapy group and 32 (11.5%) patients in the revascularised group experienced MACE (P = 0.282). There were no statistical differences in all the clinical endpoints between the 2 groups. Conclusion: Medical therapy based on FFR measurement is associated with low incidences of MACE at long-term follow-up. Key words: Fractional flow reserve, Major adverse cardiac events, Percutaneous coronary intervention

The aim of this study was to examine the allele and genotype of APOA5 -1131T/C (rs662799) and APOA5-56C/G (rs3135506) gene in acute myocardial (AMI) case and control subjects. 304 case and 304 controls were enrolled in this study. DNA was extracted using salting out method followed by polymerase chain reaction amplification and restriction endonuclease digestion (using MseI for -1131T/C and Taq1 for -56C/G). Digested PCR products were identified using agarose gel electrophoresis and stained with ethidium bromide. There was a strong association between APOA5 -1131T/C (TC vs. TT, OR= 1.58 and CC vs. TT OR= 2.43) and APOA5 -56C/G (CG vs. CC, OR= 1.64 and GG vs. CC, OR= 2.44) polymorphisms with AMI. Out of the six potential risk factors for coronary artery disease, only smoking, diabetes and hypertension were found to be associated with APOA5 gene and increased the risk of AMI. Smoking was the most prominent risk factor for both the genes. Other risk factors like history of dyslipidemia, obesity and family history of coronary artery disease did not reveal any potential association with the candidate gene. Our data demonstrate that both the SNPs in the APOA5 gene (-1131T/C, and -56C/G) were strongly associated with AMI in north Indian population.

Article history: Received on: 04/06/2015 Revised on: 19/07/2015 Accepted on: 12/08/2015 Available online: 27/09/2015 Gender differences are increasingly recognized in cardiology. It is also well known that women have higher complications and a higher mortality related to coronary procedures. In arrhythmias, gender-specific variations in the electrophysiological structure of the heart or hormonal effects may explain some of the gender differences. The aim of this study was to evaluate gender differences according to their risk factors, indications and modes of pacing. A total of 267 patients who had pacemaker implantation for bradyarrhythmia indications were enrolled in our study. A pre-designed questionnaire was filled to record their baseline characteristics, clinical indications and mode of pacing. Out of 267 patients 190 were male and 77 were female. Data was analyzed with SPSS 16.0 software (SPSS, Chicago, IL, USA) The pacemaker implantation requirement was 31% significantly lower among males compared with females who were hypertensive (RR=0.69, 95%CI=0.58-0.82, p=0.0001) and 1.57 times (RR=1.57, 95%CI=1.32-1.87, p=0.0001) significantly higher among male patients than females who were the tobacco user in any form. The single chamber requirement was 1.41 times significantly (RR=1.41, 95%CI=1.16-1.71, p=0.0001) higher in males than females. The risk analysis showed that complete heart blockage (p= 0.02) and sick sinus syndrome (p= 0.01) were significantly higher in males as compared with females. In conclusion male patients had more CHB, sick sinus syndrome and syncope as primary pacemaker indication, compared with female patients. Smoking was the most prominent risk factor in male and hypertension in female and most importantly there were significant gender differences in indications leading to pacing.

Obstructive sleep apnea (OSA) has been shown to be associated with accelerated coronary atherosclerosis (1–3). In the multicenter Sleep and Stent Study, we found that OSA was an independent predictor of major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular mortality after percutaneous coronary intervention (PCI), with adjusted hazard ratios (HR) of 1.57 (95% CI 1.10–2.24) and 2.11 (95% CI 0.91–4.91), respectively (4). Diabetes mellitus (DM) is an established risk factor of MACCE after PCI and was present in 42% of the patients in the Sleep and Stent Study (4). In this post hoc analysis, we hypothesized that patients with combined OSA and DM were at a particularly high risk of developing MACCE after PCI. The Sleep and Stent Study was an observational study evaluating the effects of OSA on cardiovascular outcomes in patients undergoing PCI. The detailed methodology and inclusion and exclusion criteria have been published previously (5). After an overnight sleep study, the recruited patients were classified as OSA(+) (apnea-hypopnea index ≥15 events per hour) or OSA(−) (

Combined hereditary thrombophilia is an uncommon entity associated with higher risk of early onset thrombosis. We report a case of 39-year-old male with combined deficiency of natural anticoagulants (protein C, S and anti thrombin) along with hyper homocystenemia and factor V Leiden mutation, presenting with life threatening bilateral pulmonary embolism. The clinical implications of combined thrombophilia are also discussed.

Objectives: To compare the safety and diagnostic efficacy of coronary computed tomography angiography (CTA) with exercise electrocardiography (XECG) in triaging patients of low risk acute chest pain. Background: Noninvasive assessment of coronary stenosis by CTA may improve early and accurate triage of patients presenting with acute chest pain to the emergency department (ED). Methods: Low risk patients of possible acute coronary syndrome (ACS) were included in the study. The patients in CTA arm with significant stenosis (≥50%) underwent catheterization, while those with no or intermediate stenosis (

A substantial proportion of patients with symptomatic bradycardia have a reversible etiology, the long-term prognosis and recurrence is not well understood. Current guidelines did not recommend permanent pacemaker implantation (PPI) in patients with bradyarrythmia due to reversible cause (BRC).we

There is limited national-level data on the prevalence of hypertension among Indian adults; with few studies reporting prevalence according to the 2017 ACC/AHA criteria. This study was conducted to study the impact of a lowered cut-off on hypertension prevalence. A national-level survey was

Bioresorbable vascular scaffolds represent the next revolution in stent technology. They serve the dual purpose of antiproliferative drug delivery to vascular lumen like a drug-eluting stents (DES) as well as phased strut resorption over time leading to virtual elimination of stent thrombosis. The ABSORB GT-1 stent was the prototype bioresrbable vascular scaffold with maximum clinical experience and initial promising results. However, reports of stent thrombosis emerged with ABSORB too. Although the use of intracoronary imaging and proper implantation technique has the potential to reduce stent thrombosis rates, the device has been withdrawn from the market for now. We report a case of late stent thrombosis with ABSORB which was managed with DES-supported intracoronary imaging.

Background: The presence or absence of collateral circulation to the infarct-related artery territory significantly impacts the infarct size and resulting left ventricular function and hence the prognosis. However, the determinants of collateral formation have been poorly understood. Materials and Methods: The present single-center observational study examined 200 patients with acute ST-elevation myocardial infarction (STEMI), irrespective of the status of thrombolysis, undergoing coronary angiogram within 48 h showing complete occlusion of infarct-related coronary artery. Results: High-grade collaterals (Rentrop Grade 2 and 3) were seen in 17% of patients (n = 34). High-grade coronary collaterals were more often seen in patients belonging to the age group of 46–70 years compared to elderly individuals >70 years of age (38.2% vs. 2.9%,P < 0.009). The occurrence of collaterals to culprit coronary artery either left anterior descending artery or right coronary artery was similar. There was a lower prevalence of high-grade collaterals to infarct-related artery territory in smokers versus nonsmokers (5.9% vs. 43.4%,P < 0.001). The prevalence of collaterals in patients with diabetes was lower compared to nondiabetics (11.8% vs. 47.6%,P < 0.001). There was a significantly higher prevalence and recruitment of collaterals in patients with a history of angina before they developed acute coronary syndrome (88.2% vs. 16.9%,P < 0.001). There was no significant association between hypertensive status and the prevalence of coronary collateral circulation. Conclusions: The finding of high-grade coronary collaterals was seen more in patients who had angina prior to STEMI. High-grade collaterals were significantly more in middle-aged individuals compared to the elderly. Diabetes mellitus and smoking status were negative predictors of high-grade collaterals.

Hypertension is a major public health problem of modern era. Fimasartan is a new Angiotensin Receptor Blocker approved for treatment of hypertension. It is more potent and longer acting angiotensin receptor blocker with effects lasting over 24 hours. Many clinical studies have affirmed its role in pharmacotherapy of hypertension. Further, it is renoprotective and has proven beneficial in diabetes also. This article briefly discusses the pharmacology and clinical evidence with fimasartan with a short summary of previous angiotensin receptor blockers.

Background:Symptoms in mitral stenosis (MS) are heart rate (HR) dependent. Increase in HR reduces diastolic filling period with rise in transmitral gradient. By reducing HR, beta-blockers improve hemodynamics and relieve symptoms, but the use may be limited by side effects. The present randomized cr

Spontaneous coronary artery dissection (SCAD) is an uncommon entity, frequently presenting as ST-elevation myocardial infarction (MI) or sudden cardiac death. It is usually reported in association with pregnancy and has a high mortality. We present here a case of asymptomatic dissection of the right coronary artery, incidentally detected, in a young normotensive male when coronary angiography was done following acute anterior wall MI. This patient had none of the risk factors to which SCAD is generally ascribed. While management of the infarct-related artery was clear-cut, whether or not to intervene for this nonocclusive dissection was a difficult decision. A conservative approach was finally adopted for the spontaneous dissection and the patient is faring well till date.

Submitral left ventricular aneurysms are a rare nonischemic aneurysm thought to be developmental in origin. These aneurysms invariably occur at the site of posterior mitral annulus and lead to mitral valve incompetence. We hereby describe a case of a 30-year-old adult with a rare form of submitral left ventricular aneurysm involving whole of the posterior mitral annulus. Multimodality imaging with two-dimensional echocardiography, three-dimensional echocardiography, computed tomography and invasive left ventriculography helped the patient to undergo successful resection of the aneurysm along with mitral valve replacement.

OBJECTIVES: Coronary artery aneurysm is a rare condition with a reported incidence of 0.14–4.9% in patients undergoing coronary angiography and 0.3–5.3% in patients after percutaneous transluminal coronary angioplasty (PTCA). Optimum surgical therapy for this entity is difficult to standardize. We present here a series of 4 cases with the aim of establishing an optimal surgical therapy for this rare entity. METHODS: Four cases of coronary artery aneurysm were admitted in the Department of Cardiology and Department of Cardiothoracic and Vascular Surgery, King George’s Medical University, Lucknow, from April 2010 to April 2012. All patients underwent a surgical procedure that involved ligation and plication of the aneurysm with coronary artery bypass grafting. RESULTS: Out of the four coronary artery aneurysm patients, 1 was atherosclerotic and the remaining 3 patients developed coronary artery aneurysm after PTCAwith a drug eluting stent to the left anterior descending artery. After surgery, all patients recovered uneventfully without any recurrence of symptoms in the follow-up. CONCLUSIONS: Coronary artery aneurysm is a rare entity and is being seen more frequently with the increasing use of stents during PTCA. Proximal ligation and plication of the aneurysm with coronary artery bypass grafting in the present series provided good results. With this case series, we seek to establish an optimal surgical therapy for this rare entity.

Background: Lipoprotein (a) [Lp (a)] is an established risk marker of coronary artery disease which is independent from other risk factors. Objective: The aim was to address the association between Lp (a) and CAD risk in North Indians. To evaluate whether high levels of lipoprotein (a) [Lp (a)] is a predictor of risk and is related to the severity of CAD. Materials and Methods: This was a cross-sectional study done on 360 patients presenting with chest pain. Coronary angiography revealed CAD in 270 patients and 90 patients without CAD. Lipoprotein (a) level, lipid profile, fasting blood glucose, anthropometric and clinical parameters were analyzed. Results: Lipoprotein (a) 21.0 mg/dL is associated with the presence of coronary lesions ( P = 0.0001). A highly significant difference in Lp (a) levels was observed between normal coronaries vs. single-vessel disease, double-and triple-vessel disease ( P < 0.0001). Body mass index (BMI) was significantly raised in CAD group compared to normal coronary. Conclusion: Multivariate analysis found that Lp (a) was considered an independent predictor for severity of CAD and Lp (a) levels 21.0 mg/dL are associated with severe patterns of coronary atherosclerosis.

Introduction: Several Single Nucleotide Polymorphisms (SNPs) in lipid transport genes have been shown to be associated with Coronary Artery Disease (CAD). The Hepatic Lipase (HL) glycoprotein is a key component that catalyzes the hydrolysis of triglycerides and phospholipids in all major classes of lipoproteins. Aim: We studied whether the HL gene-250G/A polymorphism affect blood lipid level and the CAD in a North Indian population. Materials and Methods: A total number of 477 subjects were enrolled in the study after approval of the Institutional Ethics Committee. Out of 477 subjects, 233 were with coronary artery disease as study group and 244 subjects without coronary artery disease as control group. All subjects recruited with matched ethnicity in age group of 40-70 years. Blood samples were collected in EDTA vials and genomic DNA was extracted from blood using the phenol-chloroform method. Lipid profile was estimated by using a commercially available kit. Polymorphisms in the HL (-250 G/A) gene were analysed by using restriction fragment length polymorphism-polymerase chain reaction (PCR-RFLP) method. The effect of this polymorphism on plasma lipids, lipoproteins and coronary artery disease was determined. Results: In Human Hepatic Lipase (LIPC)-250G/A genotype, the frequencies of GG, GA and AA genotype in CAD group was 80.69%, 15.45% and 3.86%, respectively; in the control group, the corresponding frequencies were 90.16%, 9.02% and 0.82%, respectively. A significant difference was found in the genotype (LIPC-250G/A) distribution between the two groups. Further logistic regression analysis indicated that the GA and AA genotypes in SNP-250G/A were significantly associated with CAD in all genetic models (In codominant model- GA vs. GG, OR=1.91, 95% CI=1. 09-3.37, p=0. 03 and AA vs. GG, OR= 5.26, 95% CI= 1.10-24.60, p=0.04; in dominant modelGA+AA vs. GG, OR=2.19, p=0.004 and in recessive model- AA vs. GG+GA, OR=5.26, p=0.04 whereas, A allele at nucleotide -250G/A in the LIPC gene had an association with increased risk of CAD (OR=2.33, p=

Objectives: This cross-sectional study investigated the association of lipoprotein(a) [Lp(a)] levels as an atherosclerosis predictor and their relationship to the severity of coronary artery disease (CAD). Methods: 360 consecutive patients at Sanjay Gandhi Postgraduate Institute of Medical Sciences and King George’s Medical University hospitals, Lucknow, North India, with chest pains, CAD symptoms and on lipid-lowering therapy were enrolled between June 2009 and October 2011. Before coronary artery angiography (CAG), a fasting blood sample was assessed for lipid and Lp(a) levels. The synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score was calculated according to the CAG results. Patients were divided into 3 groups based on CAD severity and SYNTAX scores. Results: Angiography revealed CAD in 270 patients. Lp(a) levels were higher in CAD compared to non-CAD patients (48.7 ± 23.8 mg/dl versus 18.9 ± 11.1 mg/dl [ P 30 (88.0±24.0 mg/dl). Lp(a) levels correlated significantly with SYNTAX scores (r = 0.70, P

The endothelial progenitor cell (EPC) capture stent is an innovative device that makes use of the ability of bone marrow-derived EPCs to migrate to injured arterial segments to facilitate healing. The EPC antibody surface, consisting of a covalently coupled polysaccharide intermediate coating with anti-human CD34 antibodies, is attached to a stainless steel stent. Upon stent placement, the anti-human CD34 antibodies will attract circulating EPCs, which are expected to develop into mature functional endothelium. This accelerated healing strategy aims to lower the risk of restenosis and stent thrombosis, as well as obviate prolonged dual antiplatelet therapy. Since the first-in-man study in 2003, a number of small-to-medium size registry and postmarketing studies that confirmed the good safety profile of the EPC capture stent have been published. However, due to lack of large-scale randomized trials, its effectiveness, compared with bare metal stents and drug-eluting stents, cannot be ascertained. Based on restudy angiographic data, instent late loss was approximately 0.7-0.9 mm, which compares unfavorably with that of drug-eluting stents. In order to improve the effectiveness of the EPC capture stent in reducing restenosis--while maintaining its pro-healing property--a bioengineered sirolimus-eluting stent known as the Combo stent was recently designed to combine the EPC capture technology with the abluminal elution of sirolimus. Data from animal studies have been encouraging. The first-in-man study of the Combo stent has been completed and results were presented.

Background : Periodontitis is a chronic inflammatory condition believed to cause a low but long lasting systemic inflammatory reaction which in turn contributes to the development of atherosclerosis. Recent data suggests that around 40% cases of coronary artery disease remain unaccounted despite the identification of the classical risk factors. Objectives: T0 o evaluate the efficacy of non surgical periodontal therapy on the levels of serum inflammatory markers in subjects with chronic periodontitis and known coronary artery disease. Materials and Methods: T0 wenty subjects with known coronary artery disease (CAD) were recruited from the Department of Cardiology, CSM Medical University, Lucknow, India, for this study. Periodontal disease was measured through the clinical parameters bleeding on probing (BOP) and probing depth (PD). All subjects received non surgical periodontal therapy that included oral hygiene instructions and meticulous scaling and root planing. Systemic levels of inflammatory markers such as high-sensitivity C reactive proteins (hsCRP), tumor necrosis factor-α (TNF-α), and white blood cell (WBC) counts were measured prior to and 1 month after periodontal therapy. Results: S0 ubjects experienced significant reductions in bleeding on probing (BOP) and probing depth (PD), indicating improvement in overall periodontal health. In all subjects, high-sensitivity C reactive proteins (hsCRP), and WBC counts were reduced significantly,; however, tumor necrosis factor-α (TNF-α) levels showed no statistically significant reduction. Conclusion: In this study, periodontal treatment resulted in a significant decrease in bleeding on probing (BOP) and probing depth (PD), and this treatment lowered the serum inflammatory markers (hsCRP and WBC counts) in patients with coronary artery disease. This may result in a decreased risk for coronary artery disease in the periodontally treated patients. Key words: Coronary artery disease,high-sensitivity C-reactive protein,periodontitis,tumor necrosis factor-∝.

A coronary artery fistula (CA F) is a direct connection between a coronary artery and any one of the cardiac chambers, the coronary sinus or superior vena cava, or a pulmonary artery or pulmonary vein close to the heart. CAF accounts for 48.7% of all congenital coronary anomalies.1 The most common drainage sites in a decreasing frequency are the right ventricle (41%), right atrium (26%), pulmonary artery (17%), coronary sinus (7%), left atrium (5%), left ventricle (3%) and superior vena cava (1%).2 Further occurrence of this CAF along with the presence of aortic sinus to pulmonary artery fistula is very rare. We present a case of a 53-year-old, hypertensive man who had presented with a first episode of chest pain of 8 hours’ duration. …