Predictors of left ventricular dysfunction in patients with Takayasu's arteritis: a single centre experience.

OBJECTIVES: To determine the factors (clinical, biochemical, angiographic, and echocardiographic) which predict left ventricular (LV) dysfunction in Takayasu's arteritis (TAK). TAK causes inflammation of the aorta and its large branches. Systemic hypertension, aortic valvular disease, and coronary artery involvement are probable contributors to LV dysfunction in some patients. In other patients, inflammation and resulting myocarditis play an essential role. However, the prevalence and relative contribution of such predictors of LV dysfunction in TAK patients is unknown. METHODS: We enrolled 87 patients with angiographically confirmed TAK in the study after proper informed consent. A complete clinical, biochemical, and echocardiographic evaluation of all the cases was done. We defined LV systolic dysfunction as an ejection fraction below 50% and diastolic dysfunction by ASE 2016 criteria into grades I, II, and III. RESULTS: We evaluated 87 consecutive angiographically proven TAK patients. The incidence of LV systolic and diastolic dysfunction in our study was 19.5% (17/87) and 100% (87/87), respectively. All the patients with LV dysfunction (n=17, 100%) had an ITAS 2010 score of more than two suggestive of active disease. In 15 (88%) out of 17 patients with LV systolic dysfunction, we could identify a significant haemodynamic cause of LV dysfunction (untreated hypertension HTN, descending thoracic or abdominal aorta stenosis, renal artery stenosis, coronary stenosis, significant valvular regurgitation). In the rest 2 cases, no important haemodynamic factor was present, and here LV dysfunction was probably because of myocarditis and its sequalae. CONCLUSIONS: This study represents the largest cohort of TAK patients to estimate LV systolic and diastolic dysfunction. We have found LV systolic and diastolic dysfunction multifactorial, with hemodynamic and inflammatory factors contributing to its pathophysiology.

Relationship between Serum Levels of Pregnancy Associated Plasma Protein A and Coronary Artery Disease in Males.

OBJECTIVES: The availability of a sensitive and specific early marker of plaque instability, whose levels become elevated before or even in the absence of myocardial necrosis, should improve diagnostic and therapeutic decision making in Acute Coronary Syndromes. This analytic cross-sectional study was designed to estimate the serum levels of Pregnancy Associated Plasma Protein A (PAPP-A), highly sensitive C reactive protein (hs-CRP) and creatinine phosphokinase MB (CPK-MB) in patients of old myocardial infarction, unstable angina, non ST elevation and ST elevation myocardial infarction and to assess their correlation with plaque instability. METHODS: Male patients of Coronary Artery Disease aged between 40 to 60 years were recruited in to the four study groups: Healthy controls; Old Myocardial Infarction, not having features of acute coronary syndrome; Unstable Angina, non ST elevation myocardial infarction and ST elevation Myocardial Infarction. Appropriately timed blood sample collection was done and serum levels of PAPP-A, hs-CRP and CPK-MB were estimated. Qualitative cardiac troponin T was done in all patients. Appropriate statistical tests were applied and intergroup comparison was done. RESULTS: Serum levels of PAPP-A were found to be significantly different in all the four groups (p<0.001) with highest values observed in patients of ST elevation myocardial infarction (26.38 ± 4.10 IU/l) as compared to controls (3.29 ± 0.93).The serum levels of PAPP-A has a statistically significant positive correlation with the mean serum levels of CPK-MB with a correlation coefficient (R2) of 0.781 and a p value of <0.001. Thus, it may be useful in diagnosing ACS, especially in cardiac troponin T negative patients. CONCLUSION: Serum levels of PAPP-A is a sensitive and specific early marker of plaque instability, whose levels become elevated before or even in the absence of myocardial necrosis. This marker can improve diagnostic and therapeutic decision making in Acute Coronary Syndromes.