Case-control study on the association between the GATA2 gene and premature myocardial infarction in the Iranian population.

In recent decades, due to the high prevalence of coronary artery disease (CAD) and myocardial infarction (MI), numerous studies have attempted to elucidate genetic contributing factors in these complex disorders. A very interesting gene in this regard is GATA-binding protein 2 (GATA2), an important regulator of various gene expressions in vascular endothelial cells. Accordingly, the association of different GATA2 polymorphisms with CAD and MI has already been evaluated. Rs2713604 is a genetic marker whose association with CAD has not been reproduced in previous studies. Considering the importance of replicating the initial association, the present case-control study aimed to examine the association of this intronic variant with premature MI in a sample of the Iranian population. In this study, 193 participants from Jahrom Hospital (Jahrom, Iran) were consecutively recruited during a 1.5-year period, and, following blood sampling, genomic DNA was extracted. We then proceeded to genotype rs2713604 using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and statistically analyzed the data. After adjustment for hyperlipidemia, hypertension, and type 2 diabetes mellitus, the results of the multivariate regression analysis showed no significant association between rs2713604 and premature MI. Interestingly, the risk allele (A-allele) of rs2713604 displayed a slightly higher frequency among controls compared to cases.

Role of A Single Nucleotide Polymorphism in Thrombospondine 4 Gene in Premature Myocardial Infarction among Population of Southern Iran.

BACKGROUND: Coronary Artery Diseases (CAD) are the leading cause of Myocardial Infarction (MI). However, their underlying etiology can be found in the interplay between environmental and genetic factors. On the other hand, it has been shown that Extracellular Matrix (ECM) proteins, such as Thrombospondins (TSP), play a crucial regulatory role in vascular pathologies, including atherogenesis. TSPs are extracellular proteins responsible for intercellular and cell-ECM interactions and are involved in regulating functional responses. Recently, a missense mutation in the TSP-4 gene has been reported to potentially increase the risk of CADs. The present study aimed to investigate the role of rs1866389 Guanosine to Cytosine (G/C) Single Nucleotide Polymorphism (SNP) of the TSP-4 gene on the prevalence of premature MI in southern Iran. METHOD: The present case-control study included 100 patients with premature MI and 100 healthy individuals. The DNA extracted from the blood samples of the participants underwent Polymerase Chain Reaction (PCR) for the sequence of the TSP-4 gene. Afterward, the frequency of C (mutated) and G (normal) alleles of the TSP-4 gene was evaluated in the case and control groups. RESULTS: According to our findings, there was no significant intergroup difference in gender, age, and smoking status. However, the case group was significantly higher in the prevalence of Diabetes mellitus (DM), Hyperlipidemia (HLP), and Hypertension (HTN) compared to the control group. Moreover, 22%, 49%, and 29% of the case group had CC, GC, and GG genotypes in the TSP-4 gene, respectively, while the prevalence of CC, GC, and GG genotypes were 10%, 44%, and 46% in the control group. Also, the prevalence of allele C was significantly higher in the case group (47%) compared to the control group (33%, P=0.043), showing its significant association with the increased risk of premature MI (OR = 1.80; 95% CI = 1.01-3.19). CONCLUSIONS: The rs1866389 G/C SNP of the TSP-4 gene significantly increased the risk of premature MI in the population of southern Iran. Thus, such mutated gene can be used as a target for gene therapy or a marker for early detection of individuals at high risk for CADs.

Monster left circumflex artery fistula closure by vascular plug in a patient with post-COVID-19 myocardial infarction.

Herein, we report a man with a huge coronary fistula connecting the left circumflex coronary artery to the right ventricle. During the follow-up, the patient developed progressive symptoms of heart failure nonresponsive to medical treatment. Therefore, an endovascular closure with a vascular plug was successfully done for him. Transcatheter vascular plug occlusion can be considered as an alternative for closure of symptomatic high-flow large coronary artery fistulas in patients with a high risk of surgery and chance of coil dislocation, embolization, or unavailability of proper coils.

Annexin V and anti-Annexin V antibodies: two interesting aspects in acute myocardial infarction.

BACKGROUND: Myocardial infarction is the combined result of environmental factors and personal predispositions. Prothrombotic factors might play an important role in this phenomenon. Annexin V (ANV) is a calcium-dependent glycoprotein widely present in various tissues exerting a potent anticoagulant effect in vitro by reducing plaque adhesion and aggregation. Anti-annexin V antibodies (aANVAs) are detected in various diseases like rheumatoid arthritis, systemic lupus erythematosus and anti-phospholipid antibody syndrome. The study of ANV in Acute Myocardial Infarction (AMI) might shed light on hypercoagulability mechanisms in the pathogenesis of acute coronary syndromes. This study was conducted to investigate the association of plasma ANV, aANVAs and anti-cardiolipin antibodies (aCLAs) with AMI. METHODS: This study recruited 45 patients with the diagnosis of AMI according to WHO criteria in their first 24 hours of admission. 36 matched individuals were studied as the control group with normal coronary artery angiography. Plasma levels of ANV, aANVAs and aCLAs were determined by enzyme-linked immunosorbent assay and the results were compared. RESULTS: Plasma ANV levels in the patients with AMI on admission were significantly lower than those in the control group (p = 0.002). Positive test for aANVAs were found to be present in a significant number of our patients (p = 0.004). The studied groups were similar in their rate of patients with positive aCLAs tests. ANV, aANVAs and aCLAs were not correlated with hypertension, diabetes mellitus, hyperlipidemia, sex, age and smoking. CONCLUSION: Our findings suggest that low plasma ANV levels along with positive aANVAs tests in patients with AMI are indicative of hypercoagulable state that is not related to the traditional cardiovascular risk factors.

Is adiponectin associated with acute myocardial infarction in Iranian non obese patients?

BACKGROUND: Adiponectin is an adipose tissue-derived mediator with significant anti-atherogenic properties. A few studies were done in acute phase of myocardial infarction especially in non obese patients. We design a study to investigate the association between adiponectin concentration and acute phase of myocardial infarction in non obese patients. METHODS: This case-control study was done in Paymaneah Hospital (Jahrom, Iran) from Feb 2007 to May 2008. Plasma adiponectin levels were measured in 43 patients with AMI (mean age: 62.7 +/- 13.3 years, male: 67.4%) at the first 24 hours of admission and 43 normal controls (mean age: 62.1 +/- 12.3 years, male: 55.8%) matched for age, sex and other CAD risk factors. RESULTS: Adiponectin levels in patients with AMI (3.36 microg/mL) were significantly lower than that of the control group (5.03 microg/mL) (p < 0.0001). Lower adiponectin were independently associated with higher risk of AMI (odds ratio = 8.97; 95% CIs: 2.3-34.5; p = 0.001). Adiponectin levels negatively correlated with triglyceride (r = -0.46, p = 0.002) and total cholesterol (r = -0.32, p = 0.03) in the case group and with body mass index (BMI) in control subjects. CONCLUSION: The present study showed that adiponectin was associated with AMI in non obese patients but it is not related to sex, age and other CAD risk factors.

Stress Cardiomyopathy (Takotsubo syndrome) Following Accidental Methadone Poisoning; Report of Two Pediatric Cases.

Methadone poisoning has become more common in the pediatric population due to extensive use of methadone maintenance therapy (MMT). It is associated with decreased level of consciousness, coma, respiratory distress and cardiac intoxication. The cardiac complications have been reported to be QT prolongation, torsade de pointes, coronary artery disease, arrhythmia, stress cardiomyopathy and death. We herein report two pediatric patients with accidental methadone poisoning who developed stress cardiomyopathy and cardiac failure. The first case was a 4-yaer-old girl and the second one was an 18-month-old girl both being accidentally poisoned with methadone syrup and were brought with decreased level of consciousness. Both were diagnosed to suffer from congestive heart failure based on echocardiography. However, the first case passed away despite appropriate treatment, while the second one survived the condition and was discharged with good condition and was symptom free at 6-month follow-up.

Dehydroepiandrosterone sulfate as a risk factor for premature myocardial infarction: a comparative study.

BACKGROUND: This study aimed to evaluate some of the major risk factors of myocardial infarction including dehydroepiandrosterone sulfate in patients with premature myocardial infarction (age <50 years old) and myocardial infarction (age ≥50 years). METHODS: This is a parallel case-control study on 50 premature myocardial infarction patients and 50 myocardial infarction patients. We also recruited 50 matched participants for each of the two groups. Patients and their control groups were assessed for dehydroepiandrosterone sulfate serum level, diabetes mellitus, hyperlipidemia, hypertriglyceridemia, and hypertension. In addition, family history of cardiovascular disease and current smoking was recorded. Univariate and multivariate logistic regression analyses were performed to evaluate predictors of premature myocardial infarction and myocardial infarction. RESULTS: No significant differences were observed between the demographic data of patients and their controls. The dehydroepiandrosterone sulfate serum level was significantly higher in patients with premature myocardial infarction compared with controls. Multivariate logistic regression analysis revealed only serum dehydroepiandrosterone sulfate dehydroepiandrosterone sulfate level to be significantly associated with premature myocardial infarction (odds ratio, 2.65; 95% confidence interval, 1.44 to 4.877; P = 0.002). Additionally, hypertension was found to be associated with myocardial infarction. CONCLUSION: Higher levels of serum dehydroepiandrosterone sulfate level are associated with premature myocardial infarction but not with myocardial infarction, and this association is independent of the effects of other risk factors.

The prevalence of pre-hypertension and its association to established cardiovascular risk factors in south of Iran.

BACKGROUND: Pre-hypertension is associated with an increased risk of the development of hypertension and subsequent cardiovascular disease and raises mortality risk. The aim of this study was to determine the prevalence of pre-hypertension and to explore the associations between pre-hypertension and established cardiovascular risk factors in a population-based sample of Iranian adults. METHODS: In this cross-sectional study a representative sample of 892 participants aged ≥ 30 years was selected using a multistage cluster sampling method. After completion of a detailed demographic and medical questionnaire (gender, age, history of diabetes mellitus and hypertension, taking antihypertensive or hypoglycemic agents and history of smoking), all participants were subjected to physical examination, blood lipid profile, blood glucose, anthropometric and smoking assessments, during the years 2009 and 2010. Variables were considered significant at a p-value ≤ 0.05. Statistical analysis was performed using SPSS version 11.5 software. RESULTS: Pre-hypertension was observed among 300 (33.7%) subjects, 36.4% for men and 31.4% for women (p > 0.05). The pre-hypertensive group had higher levels of blood glucose and triglycerides, higher body mass index and lower percentage of smoking than did the normotensive group. Multivariate logistic regression analysis showed that obesity and overweight were the strongest predictors of pre-hypertension [odds ratio, 2.74: 95% CI (Confidence Interval), 1.62 to 4.62 p < 0.001; odds ratio, 2.56, 95% CI, 1.74 to 3.77, p < 0.001 respectively]. CONCLUSIONS: Overweight and obesity are major determinants of the high prevalence rate of pre-hypertension detected in Iranian population. Therefore, primary prevention strategies should concentrate on reducing overweight and obesity if the increased prevalence of pre-hypertension is to be diminished in Iranian adults.

Fibrinogen as a risk factor for premature myocardial infarction in Iranian patients: a case control study.

BACKGROUND: Premature myocardial infarction with life-threatening complications may become epidemic in some Asian and African countries and especially Iran. Fibrinogen is considered as one of the probable risk factors of myocardial infarction. The aim of our study was to assess fibrinogen levels as an etiology of premature myocardial infarction in young Iranian men. FINDINGS: A case-control study was conducted between May 2005 and May 2007 to investigate the association between serum total fibrinogen level and myocardial infarction in men aged younger than 55 years admitted to the cardiac care units of Peymanieh and Motahari Hospitals affiliated to Jahrom University of Medical Sciences, Iran. The mean age of patients was 45.2 +/- 4 years in patients with premature myocardial infarction and 47.06 +/- 4.5 years in the control group (p = 0.085). There were no statistically significant relationships between the two groups in history of premature myocardial infarction in their first-degree relatives (p = 0.05), cigarette smoking (p = 0.46), diabetes (p = 0.49), or hypertension (p = 1). The mean plasma fibrinogen in patients (354.9 +/- 60 mg/dL) was elevated markedly compared with the control group (329 +/- 73 mg/dL). Hyperfibrinogenemia (>340 mg/dL) was detected in 81.8% of patients and 57.5% of controls (95% confidence interval, odds ratio = 3.3; p = 0.036). CONCLUSION: This study introduced fibrinogen as a risk factor for premature coronary artery disease in Iranian men.

Single left coronary artery with origin of right coronary artery from left circumflex: a case report.

BACKGROUND: A 40-years-old female presented with intermittent chest pain and dyspnea on exertion. CASE PRESENTATION: Electrocardiography showed sinus rhythm with ST-depression in inferior and lateral leads. Subsequent exercise treadmill testing revealed significant ST-depression in V4-V5 and V6 leads. Coronary angiography later showed a single left coronary artery with right coronary artery arising from left circumflex artery, a rare anomaly of coronary arteries. No atheromatous lesion was seen during angiography. CONCLUSION: The dignosis of this anomaly is importsnt because the symptoms cannot be differentiated from atherosclerotic coronary artery disease.

Primary hypothyroidism presenting with Torsades de pointes type tachycardia: a case report.

BACKGROUND: Hypothyroidism can manifest with cardiac abnormalities, often consisting of a combination of morphologic and functional changes. Low voltage, sinus bradycardia, and slowed conduction are usually found on electrocardiography.There are few reports of occurrence of torsades de pointes as the first presentation of long QT syndrome in the course of hypothyroidism. CASE PRESENTATION: In present report we briefly describe a 50-years-old woman with severe hypothyroidism who presented with presyncope, prolongation of the QT interval, and polymorphic ventricular tachycardia (torsades de pointes). CONCLUSION: Our patient responded well to treatment with levothyroxine and QT intervals normalized and ventricular tachycardia was abolished two months after levothyroxine therapy.