Effect of Enhanced External Counter Pulsation Treatment on Aortic Blood Pressure, Arterial Stiffness and Ejection Fraction in Patients with Coronary Artery Disease.

INTRODUCTION: Enhanced External Counter Pulsation (EECP) is a non-invasive treatment option for patients with Coronary Artery Disease (CAD). The treatment has shown to augment diastolic pressure and reduce Left Ventricular (LV) after-load by reducing systemic vascular resistance. The effect of EECP in standard brachial blood pressure and central haemodynamic parameters are not known. AIM: We hypothesized that EECP may have differential effect in CAD patients with low systolic blood pressure when compared to normal systolic pressure and the mechanism underlying this differential effect may be due to improvement in LV function. MATERIALS AND METHODS: A total of 72 consecutive patients who underwent EECP treatment for symptomatic CAD with LV dysfunction were divided into two groups based on cut-off value of 100mmHg for systolic blood pressure. First group had patients with brachial systolic blood pressure of >100mmHg and second group had patients with brachial systolic blood pressure of ≤100mmHg. We measured central aortic systolic pressure, pulse pressure, augmentation index and augmentation pressure by SphygmoCor device and Ejection Fraction (EF) was measured by echo-cardiography. All these measurements were carried out prior to and after completion of 35 days of EECP sessions. RESULTS: Central systolic pressure, brachial systolic pressure, aortic pulse pressure, augmentation pressure and augmentation index significantly decreased in patients with normal brachial systolic pressure with baseline moderate LV dysfunction. Brachial systolic, aortic systolic and aortic pulse pressure significantly increased with no change in augmentation index and pressure is observed in patients with baseline severe LV dysfunction associated with low systolic pressure post EECP treatment. CONCLUSION: EECP treatment has haemodynamically favourable differential effect in normal and low brachial systolic pressure and this is mainly driven by improvement in LV function in patients with symptomatic CAD with LV dysfunction.

A systems biology and proteomics-based approach identifies SRC and VEGFA as biomarkers in risk factor mediated coronary heart disease.

Coronary heart disease (CHD) is the most common cause of death worldwide. The burden of CHD increases with risk factors such as smoking, hypertension, obesity and diabetes. Several studies have demonstrated the association of these classical risk factors with CHD. However, the mechanisms of these associations remain largely unclear due to the complexity of disease pathophysiology and the lack of an integrative approach that fails to provide a definite understanding of molecular linkage. To overcome these problems, we propose a novel systems biology approach that relates causative genes, interactomes and pathways to elucidate the risk factors mediating the molecular mechanisms and biomarkers for feasible diagnosis. The literature was mined to retrieve the causative genes of each risk factor and CHD to construct protein interactomes. The interactomes were examined to identify 298 common molecular signatures. The common signatures were mapped to the tissue network to synthesize a sub-network consisting of 82 proteins. Further, the dissection of the sub-network provides functional modules representing a diverse range of molecular functions, including the AKT/p13k, MAPK and wnt pathways. Also, the prioritization of functional modules identifies SRC, VEGFA and HIF1A as potential candidate markers. Further, we validate these candidates with the existing markers CRP, NOS3 and VCAM1 in the serum of 63 individuals, 33 with CHD and 30 controls, using ELISA. SRC, VEGFA, H1F1A, CRP and NOS3 were significantly altered in patients compared to controls. These results support the utility of these candidate markers for the diagnosis of CHD. Overall, our molecular observations indicate the influence of risk factors in the pathophysiology of CHD and identify serum markers for diagnosis.

Isolated Hypoplasia of Left Pulmonary Artery with Agenesis of Left Lobe of Thyroid: A Case Report.

Isolated Unilateral hypoplasia or agenesis of a branch of pulmonary artery is very rare. It is usually seen associated with congenital heart diseases such as tetralogy of Fallot, atrial septal defect, coarctation of the aorta, right aortic arch, truncus arteriosus, patent ductus arteriosus and pulmonary atresia. It occurs as a result of lack of embryological development of either the left or right sixth aortic arch and has been found to present itself with various clinical manifestations as during childhood it presents as contralateral pulmonary hypertension and in adults as haemoptysis. Early diagnosis and early surgical indication avoids the evolution of pulmonary hypertension to unfavourble state of more severe and progressive degrees and also prevents the development of pulmonary systemic collateral circulation, which is mainly responsible for subsequent haemoptysis in the adulthood. We hereby, report the case of an infant who presented with features of lower respiratory tract infection and later diagnosed as isolated congenital hypoplasia of left pulmonary artery and hence planned for proper follow-up for early surgery thereby preventing complications in the future.

CardioGenBase: A Literature Based Multi-Omics Database for Major Cardiovascular Diseases.

Cardiovascular diseases (CVDs) account for high morbidity and mortality worldwide. Both, genetic and epigenetic factors are involved in the enumeration of various cardiovascular diseases. In recent years, a vast amount of multi-omics data are accumulated in the field of cardiovascular research, yet the understanding of key mechanistic aspects of CVDs remain uncovered. Hence, a comprehensive online resource tool is required to comprehend previous research findings and to draw novel methodology for understanding disease pathophysiology. Here, we have developed a literature-based database, CardioGenBase, collecting gene-disease association from Pubmed and MEDLINE. The database covers major cardiovascular diseases such as cerebrovascular disease, coronary artery disease (CAD), hypertensive heart disease, inflammatory heart disease, ischemic heart disease and rheumatic heart disease. It contains ~1,500 cardiovascular disease genes from ~2,4000 research articles. For each gene, literature evidence, ontology, pathways, single nucleotide polymorphism, protein-protein interaction network, normal gene expression, protein expressions in various body fluids and tissues are provided. In addition, tools like gene-disease association finder and gene expression finder are made available for the users with figures, tables, maps and venn diagram to fit their needs. To our knowledge, CardioGenBase is the only database to provide gene-disease association for above mentioned major cardiovascular diseases in a single portal. CardioGenBase is a vital online resource to support genome-wide analysis, genetic, epigenetic and pharmacological studies.

Angiosarcoma presenting as syncope.

A 31-year-old lady presented with anemia and syncope. Echocardiography revealed massive pericardial effusion with a right atrial mass. Transesophageal echocardiography, computed tomography and magnetic resonance imaging scans confirmed presence of a right atrial mass. Histopathology revealed a high grade angiosarcoma. Complete resection was done and the patient was referred to an oncology unit for further management. After three months the patient had extensive metastasis and succumbed to the disease. This case report highlights the clinical presentation, rapid and aggressive course of cardiac angiosarcomas.

Anomalous origin of left coronary artery from pulmonary artery in adults.

Various techniques have been described for management of anomalous origin of the left coronary artery from the pulmonary artery presenting in adults. Three patients, 1 male and 2 females, aged 27-37 years, underwent transpulmonary pericardial patch closure with concomitant left internal thoracic artery anastomosis to the left anterior descending artery, under standard cardiopulmonary bypass, thus creating a two-coronary system. One patient had concomitant mitral valve repair. All 3 survived the operation. Postoperative angiography in 2 patients revealed good antegrade flow with decreased collaterals in one and competitive inhibition with increased collaterals in the other. This procedure is considered to be the safest and simplest in this subset of patients.

Relationship of left atrial appendage function to left ventricular function.

BACKGROUND: The study was conducted to evaluate the relationship of left atrial appendage function to left ventricular function and to analyze, if left ventricular dysfunction predisposed to left atrial appendage thrombus formation even in the presence of sinus rhythm. METHODS AND RESULTS: The study was conducted in 78 patients with a mean age of 53+/-8.5 years, all of whom were in sinus rhythm. Transesophageal echocardiography was performed to record the left atrial appendage emptying and filling velocity and to look for the presence of spontaneous echo contrast and thrombus. Patients with severe left ventricular dysfunction (Group I--left ventricular ejection fraction < 35%) and patients with moderate left ventricular dysfunction (Group II--left ventricular ejection fraction 35-45%) had lower left atrial appendage emptying velocity (33.6+/-16 and 39.7+/-19.5 cm/s, respectively) and filling velocity (41+/-14.7 and 41+/-17 cm/s, respectively) when compared to patients with preserved systolic function (Group II--left ventricular ejection fraction >45%), who had emptying and filling velocity of 55+/-16 and 56+/-15 cm/s, respectively (p <0.05). Twelve out of 32 (38%) patients with severe left ventricular dysfunction (Group I) and 7 out of 25 (28%) patients with moderate left ventricular dysfunction (Group II) had presence of left atrial appendage thrombus as compared to none of the patients with preserved left ventricular ejection fraction (Group III) (p <0.001). CONCLUSIONS: Patients with left ventricular dysfunction also had left atrial appendage dysfunction as evidenced by lower emptying and filling velocities and had increased incidence of thrombus formation.

Familial cardiac myxoma: Carney's complex.

We report a case of Carney's complex in a 12-year-old boy who had the characteristic features of multiple cutaneous tumors, pigmentation, and biatrial myxoma. His large right atrial myxoma almost occluded the tricuspid valve and presented a life-threatening emergency. Surgery saved his life, but recurrence of myxoma was noted on follow-up. The familial nature of the condition is highlighted by the case of the patient's 44-year-old mother, who also presented with features of Carney's complex: multiple cutaneous tumors and a tiny, asymptomatic, left atrial myxoma, which was detected during routine echocardiographic screening.

Left ventricular pseudoaneurysm caused by coronary spasm, myocardial infarction, and myocardial rupture.

We report a very rare case of a 47-year-old man who had coronary spasm that resulted in a silent myocardial infarction, a ruptured myocardial wall, and a nonruptured left ventricular pseudoaneurysm. The patient presented with a 6-month history of dyspnea on exertion, without evidence of fixed coronary artery stenosis. Coronary angiography showed severe coronary spasm of the left anterior descending and left circumflex arteries; the spasm was relieved promptly by nitroglycerin. Echocardiography and left ventricular angiography revealed the large left ventricular pseudoaneurysm posterolateral to the left ventricle. We performed surgical resection of the pseudoaneurysm and patch repair of the ruptured left ventricular wall, with excellent results. We present this case because of the highly unusual sequence of events. Early surgical intervention resulted in the patient's recovery.

Myocardial infarction due to myocardial bridging.

Myocardial bridging is a rare coronary anomaly which is generally considered to be benign. Although the hemodynamic burden exerted by this entity has been demonstrated by intravascular ultrasound and Doppler studies, there are few reports of bridge-related infarction accompanied by severe hemodynamic compromise. We report one such patient who presented with acute infarction and cardiogenic shock.