OMENTIN-1 AND NONFATAL ISCHEMIC HEART DISEASE IN POSTMENOPAUSAL WOMEN: A POPULATION-BASED STUDY.

OBJECTIVE: There is growing evidence that supports the existence of a link between lower levels of circulating omentin-1 and the pathogenesis of coronary atherosclerosis. However, no population-based study has been performed to elucidate the cardioprotective role of this beneficial adipocytokine. METHODS: A total of 378 healthy, postmenopausal women were randomly selected from 13 clusters in the port city of Bushehr, Iran. The prevalence of nonfatal ischemic heart disease (IHD) was assessed using the Minnesota code with a 12-lead resting electrocardiogram (EKG). EKG with evidence of IHD (IHD-EKG) was defined as myocardial infarction (codes 1.1 and 1.2) and ischemia (codes 1.3, 4.1 to 4.4, 5.1 to 5.3, and 7.1) occurring together. Serum omentin-1 and adiponectin levels were measured using enzyme-linked immunosorbent assay methods. RESULTS: The prevalence of IHD-EKG among the studied population was 41.8% (159 women). Serum levels of omentin-1 were significantly lower in women with ischemic EKG than in normal subjects (geometric mean ×/multiplicative standard deviation, 10.31 ×/2.35 ng/mL versus 12.44 ×/2.12 ng/mL, respectively; P = .038). Multiple logistic regression analysis indicated that higher serum levels of omentin-1 were significantly associated with a lower prevalence of ischemic EKG after adjusting for potential confounders, including classical cardiovascular risk factors and circulating adiponectin levels (odds ratio, 0.48; confidence interval, 0.24 to 0.95; P = .038). CONCLUSION: A higher level of circulating omentin-1 is independently associated with a lower prevalence of nonfatal IHD in postmenopausal women. The cardioprotective role of this novel adipocytokine needs to be further elucidated in large-scale longitudinal studies. ABBREVIATIONS: BMI = body mass index EKG = electrocardiogram ELISA = enzyme-linked immunosorbent assay HDL = high-density lipoprotein IHD = ischemic heart disease LDL = low-density lipoprotein.

Potential Role of Somatostatin Receptor Scintigraphy for In Vivo Imaging of Vulnerable Atherosclerotic Plaques and Its Association with Myocardial Perfusion Imaging Finding: A Preliminary Study.

Objectives: This study was conducted to detect atherosclerotic plaques with somatostatin receptor scintigraphy (SRS) using Tc-99m-octreotide that binds to somatostatin receptor-2. Methods: Of the 783 patients referred for myocardial perfusion imaging (MPI), 52 underwent additional chest single-photon emission computed tomography (SPECT) with Tc-99m-octreotide and participated in this study. In addition, 43 patients who underwent Tc-99m-octreotide scan for neuroendocrine tumor (NET) also received cardiac SPECT. Angiography was performed within 1 month after SRS for 19 patients who showed intensive uptake in SRS and had cardiac risk factors. Results: Of 52 patients who underwent MPI and SRS, 15 showed intensive cardiac uptake in SRS. Moreover, of 43 patients who were referred for NET, 4 patients had marked cardiac uptake in SRS in the heart. Nineteen patients including 12 women and 7 men aged 28 to 84 (58±8.04) years underwent coronary angiography. SRS and angiography in the left anterior descending territory were concordant in 15/19 (79%) patients, whereas only 7/15 (46%) cases had concordant MPI and angiography results. In the right coronary artery territory, SRS and angiography were concordant in 16/19 (84%) cases, while MPI and angiography were concordant in 11/15 (73%) cases. In the left circumflex artery territory, SRS and angiography were concordant in 15/19 (79%) cases, whereas MPI and angiography were concordant in 6/15 (40%) cases. In the remaining 76 patients who did not undergo coronary angiography based on cardiovascular profile and SRS, no cardiac events occurred in a follow-up of 2-11 months (7.52±2.71). Conclusion: Tc-99m-octreotide uptake was more concordant with coronary plaques relative to MPI findings, suggesting a potential role for Tc-99m-octreotide in the evaluation of atherosclerosis.

Evaluating the impact of fractional flow reserve-guided percutaneous coronary intervention in intermediate coronary artery lesions on the mode of treatment and their outcomes: An Iranian experience.

BACKGROUND: Today, the fractional flow reserve (FFR) guides the physician to select suitable patients with intermediate severity coronary lesions in angiography that should be treated or not with stent. The aim of this study was to evaluate the impact of using FFR in the selection of appropriate treatment strategy in angiographic intermediate coronary lesions and their short-term outcome in a sample of Iranian population. METHODS: In a prospective cohort, 34 patients who had intermediate coronary artery lesion(s), defined as having a 40-70% diameter stenosis, as determined by visual estimation or quantitative coronary angiography were enrolled through a convenience sampling method. All patients underwent FFR measurement to decide whether percutaneous coronary intervention should be performed. The results of visual assessment, quantitative coronary angiography, and functional assessment of the severity of coronary stenosis were compared. Significant stenosis was defined as FFR < 0.80. All patients were followed for 6 months for the incidence of major advanced cardiac events. RESULTS: In this study, 34 patients (22 male and 12 female) with mean age of 57 ± 8 (range 45-70) were included. In 26.47% (9/34) of patients, FFR was < 0.80, they underwent coronary angioplasty. The correlation between visual estimation and quantitative assessment of lesion diameter was 0.804 (P < 0.001). During the follow-up period, no major advanced cardiac events were reported. In addition, 5.88 (2/34) of patients had a left main (LM) lesion with FFR > 0.80 and stenting was done to the other vessels with significant coronary lesions. CONCLUSION: Measurement of FFR is a useful approach in making clinical decisions about revascularization procedures in patients with moderate coronary artery lesion severity, especially in LM and multivessel disease. This study showed that not only FFR can change treatment plan of the patients, but also it would improve clinical outcomes.

Single coronary artery with anomalous origin of the right coronary artery from the distal portion of left circumflex artery: a very rare case.

Congenital anomalies of coronary arteries, albeit rare, may be significant contributors to angina pectoris, hemodynamic abnormalities, and sudden cardiac death. A 47-year-old man referred to us with atypical chest pain. Electrocardiography demonstrated no significant ischemic changes, but cardiac troponin I test was positive. The patient underwent coronary angiography, which revealed a single coronary artery from the left Valsalva sinus. In addition, the left anterior descending (LAD) and the left circumflex (LCx) arteries were in normal position with significant stenosis in the mid-portion of the LAD and the distal portion of the LCx. A large branch originated from the distal portion of the LCx and tapered toward the proximal portion as the right coronary artery (RCA). This is a rare coronary anomaly that has no ischemic result. Coronary lesions were the cause of the patient's angina pectoris. Angioplasty and stenting of the LAD and LCx was done, and medical therapy (Clopidogrel, Aspirin, Atorvastatin, and Metoprolol) was continued. The patient was asymptomatic at 8 months' follow-up.

Association of pathogen burden and hypertension: the Persian Gulf Healthy Heart Study.

BACKGROUND: Chronic infection with cytomegalovirus (CMV), Chlamydia pneumoniae, herpes simplex virus 1 (HSV-1), and Helicobacter pylori may contribute to essential hypertension. However, the evidence now available does not clarify whether the aggregate number of pathogens (pathogen burden) may be associated with hypertension. METHODS: Sera from 1,754 men and women aged ≥25 years were analyzed for immunoglobulin G antibodies to C. pneumoniae, HSV-1, H. pylori, and CMV using enzyme-linked immunosorbent assay. The aggregate number of seropositives to the studied viral and bacterial agents was defined as pathogen burden. Hypertension was defined according to World Health Organization criteria. RESULTS: A total of 459 (26.3%) of the subjects had hypertension. In the hypertensive group, 4.2% had 0 or 1 pathogens present, 20.6% had 2, 43.2% had 3, and 32.1% had 4; in the normotensive group, 7.9% had 0 or 1, 28.4% had 2, 42.7% had 3, and 21.0% had 4. Of the 4 studied pathogens, H. pylori seropositivity showed a significant independent association with hypertension (odds ratio (OR) =1.37; 95% confidence interval (CI) =1.05-1.79; P = 0.02). In multiple logistic regression analyses, the pathogen burden did not show a significant independent association with hypertension. Coinfection with H. pylori and C. pneumoniae was significantly associated with hypertension compared with double seronegativity after adjustment for age, sex, chronic low-grade inflammation, and cardiovascular risk factors (OR = 1.68; 95% CI = 1.14-2.47; P = 0.008]. CONCLUSIONS: The pathogen burden was not associated with hypertension. However, coinfection with C. pneumoniae and H. pylori showed a significant association with essential hypertension, independent of cardiovascular risk factors and chronic low-grade inflammation.

Renal artery stenosis and its predictors in hypertensive patients undergoing coronary artery angiography.

BACKGROUND: Renal artery stenosis (RAS) has been increasingly recognized in the recent years, especially in patients with coronary artery disease (CAD). RAS affects the patients with hypertension (HTN), but the exact prevalence is not known. OBJECTIVES: This study was performed to determine the prevalence and to identify the predictors of RAS in hypertensive patients undergoing coronary artery angiography. PATIENTS AND METHODS: In a cross-sectional study from August 2008 to August 2009, 481 patients with HTN and suspected CAD underwent selective coronary and renal angiography for screening and predicting RAS. RAS was defined as a higher than 50% stenosis in the renal artery lumen. Multivariate analysis of factors associated with the presence of RAS were examined using a logistic regression model. RESULTS: The mean ± standard deviation of age was 59.25 ± 10.81 years and 50.3% were men. According to angiographic data, 425 patients (88.4%) had CAD, while 56 (11.6%) had normal coronary arteries. RAS was seen in 94 (22%) patients with CAD. The multivariate logistic regression analysis identified only age (P < 0.001) and the number of significant coronary lesions (P < 0.001) as independent predictors of RAS. Gender, smoking, congestive heart failure, diabetes mellitus (DM), hyperlipidemia (HLP) and body mass index (BMI) were not independent predictors. CONCLUSIONS: This study suggests that in the management of patients with RAS, risk factors should most likely be considered as beneficial. In addition, the clinical and angiographic features are helpful in predicting its presence in elderly patients with CAD.