Association of Coronary Heart Disease and CRP - as a Noble Marker of Inflammation - A Case Control Study.

BACKGROUND: Attention has increasingly turned towards the role of factors, such as inflammation in the development of atherosclerosis and CHD. C-reactive protein (CRP) has emerged as one of the most important novel inflammatory marker. Subsequent risk modification and treatment strategies of CHD keeping on pointer towards inflammation may be the appropriate approach. AIM: The aim of this study was to determine the association of CHD with CRP, a sensitive marker of inflammation. MATERIAL AND METHODS: This is a case control study amongst 300 subjects (150 cases and 150 controls), conducted in the Department of Cardiology at Sri Aurobindo Medical College and P.G Institute, Indore, M.P. Subjects with definite diagnosis of CHD established by coronary angiography (CAG) was taken as cases, subjects matched with age, gender with no conventional risk factor and past history of CHD from the relatives and accompanying persons were enlisted as controls. RESULTS: Estimation of CRP reveals ≥0.6 mg/dl in 88(58.7%) subjects out of 150, compared to 26 (17.3%) control subjects out of 150 which is statistically significant (p value<0.0001) (OR=6.7). CONCLUSION: CRP as a noble marker of inflammation was significantly higher in subjects of CHD and thus supported adequately the hypothesis of an activation of inflammatory cascade for coronary atheromatous plaque formation and causation of CHD.

Evaluation of Long Term Effect of RV Apical Pacing on Global LV Function by Echocardiography.

INTRODUCTION: We very often face pacemaker implanted patients during follow-up with shortness of breath and effort intolerance inspite of normal clinical parameters. AIM: The aim of our study is to evaluate the cause of effort intolerance and probable cause of sub-clinical Congestive Cardiac Failure (CCF) in a case of long term Right Ventricular (RV) apical pacing on global Left Ventricular (LV) function non- invasively by echocardiography. MATERIALS AND METHODS: We studied 54 patients (Male 42, Female 12) of complete heart block (CHB) with RV apical pacing (40 VVI and 14 DCP). Mean duration of pacing was 58+4 months. All patients underwent 24 hours Holter monitoring to determine the percentage of ventricular pacing beats. 2-D Echocardiography was done to assess the regional wall motion of abnormality and global LV ejection fraction by modified Simpson's rule. These methods were coupled with the Doppler derived Myocardial Performance Index (MPI), tissue Doppler imaging, and mechanical regional dyssynchrony with 3-D Echocardiography. Data were analysed from 54 RV- apical paced patients and compared with age and body surface area of 60 controlled subjects (Male 46, Female 14). RESULTS: Evaluation of LV function in 54 patients demonstrated regional wall motion abnormality and Doppler study revealed both LV systolic and diastolic dysfunction compare with control subjects (regional wall motion abnormality 80±6% vs 30±3% with p-value<0.0001) which is proportional to the percentage of ventricular pacing beats (mean paced beat 78%). Global LVEF 50±4% vs 60±2% (p-valve <0.0001) and MPI 0.46 ±0.12 v/s 0.36±0.09 (p-value <0.0001). CONCLUSION: RV-apical pacing induces iatrogenic electrical dyssynchrony which leads to remodeling of LV and produces mechanical dyssynchrony which is responsible for LV dysfunction. Alternate site of RV pacing and/or biventricular pacing should be done to maintain biventricular electrical synchrony which will preserve the LV function.

Evaluation of Coronary Artery Status by Coronary Angiography after First Survival of Acute Myocardial Infarction.

INTRODUCTION: Acute Myocardial Infarction (AMI) is a life threatening medical emergency which needs urgent medical attention. It is one of the major cause of mortality and morbidity throughout the world. AIM: The aim of the present study was to assess the coronary artery status by Coronary Angiography (CAG) after first survival of the Acute Myocardial Infarction (AMI) and to correlate the CAG findings with Coronary Artery Disease (CAD) Risk Factor (RF) and effect of early thrombolysis. MATERIALS AND METHODS: CAG was done on 870 patients consecutively from June 2013 to May 2015. Age, Gender, Body Mass Index (BMI), CAD risk factors (RF) such as Type 2 diabetes mellitus (T2 DM), hypertension, dyslipidaemia, smoking status and history of thrombolyctic status were recorded. The correlation between the CAD risk factors (RF) and the CAG findings were statistically analyzed. RESULTS: Coronary heart disease risk factors analysis revealed ≥ three RF in 23.88%, two RF in 29.88% and one RFin 45.86% of patients. CAG showed Single Vessel Disease (SVD) in 236 (27.1%) patients, double vessel disease (DVD) in 220(25.2%) patients, Triple Vessel Disease (TVD) in 252 (28.9%) patients. Multiple coronary artery involvement were found in the high risk group patients, which was found statistically significant (p-value<0.0001). A total of 348/870 (40%) patients were thrombolysed amongst them 80 (22.9%) revealed minimal and/or normal coronary artery which was found statistically significant (p-value<0.0001). CONCLUSION: Higher the coronary risk factors, more the chance of the multiple coronary arteries involvement. All AMI patients should be thrombolysed as early as possible to get the benefit of recanalization of the culprit vessel.