Is Lipoprotein (a) a Risk Factor for Coronary Artery Ectasia?

BACKGROUND: The pathophysiology of coronary artery ectasia (CAE) is under investigated and not well understood. Atherosclerosis is considered as the main etiologic factor for CAE in adults where more than 50% of CAE patients have atherosclerosis. Recently, lipoprotein (a) (Lp(a)) has emerged as a powerful risk factor for atherosclerosis and coronary artery disease (CAD). Serum levels of Lp(a) in patients with CAE have not been investigated. We assumed that Lp(a) may play a role in the pathogenesis of CAE. Principally, our study aims to identify whether Lp(a) is an independent risk factor for CAE. METHODS: Our study is a prospective pilot study. Study population was collected prospectively from pool of patients referred for elective cardiac catheterization at Jordan University Hospital (JUH) in the period extending from February 17, 2018 to June 31, 2018. Patients were referred for elective coronary angiography after being interviewed and physically examined by a cardiologist (HA). Patients with known history of CAD or who are already on anti-lipidemic drugs either documented in the medical records or by interviewing patients for history of revascularization were excluded from the study. RESULTS: Regarding the primary outcome, there was no significant difference in Lp(a) concentrations between normal and ectasia groups in the general sample (median: 17.5mg/dL vs. 20.4 mg/dL, P value = 0.38). CONCLUSIONS: Our study concludes that there is no detected relationship between elevated Lp(a) levels and developing CAE. CAE was more common in patients with low high-density lipoprotein (HDL) level (compared with patients with normal coronaries), higher total cholesterol level (compared with patients with non-obstructive stenosis) and higher hemoglobin A1c (HbA1c).

Assessment of segmental left ventricular thickening in diabetic type II obese patients with normal myocardial perfusion scan.

OBJECTIVE: The aim of this study is to investigate whether gated single photo emission tomography (gSPET) can be used to detect subclinical left ventricular systolic dysfunction (LVSD) in obese diabetic type II patients. SUBJECTS AND METHODS: We retrospectively reviewed gSPET images of 190 patients with diabetes mellitus type II (DM II) (137 females and 53 males) with normal myocardial perfusion and normal ejection fraction (EF). Standardized twenty segment polar maps of thickening and motion were generated. Correlation between body mass index (BMI) and thickening for each segment was performed. RESULTS: Statistically significant results were reported in female patients including: negative correlation between BMI and EF (-0.19, P=0.03). End diastolic volume (EDV) also significantly increased with increasing BMI (0.25, P<0.01). There was also statistically significant negative correlation between septal thickening and BMI segment 15 (-0.19, P=0.02), segment 16 (-0.22, P=0.01), segment 18 (-0.20, P=0.01), segment 19 (-0.25, P=0.003), segment 20 (-0.2, P=0.02)]. No statistical significant correlation was found between thickening and BMI in male patients. CONCLUSION: This is the first time where thickening as measured by gSPET has been used to demonstrate subclinical LVSD in DM II obese patients. The relationship between gender and obesity on cardiovascular function and structure needs further investigations.

Standardization of quantitative single photon emission computed tomography in control individuals and in patients with condylar hyperplasia.

OBJECTIVES: The aim of the study was to evaluate the diagnostic accuracy of various single photon emission computed tomography (SPECT) quantitative methods in patients with condylar hyperplasia (CH) and to investigate whether normal condylar activity changes with age. PATIENTS AND METHODS: We analyzed the SPECT images of 33 patients with CH and those of 16 control individuals. Regions of interest (ROIs) were drawn on whole condyle, or fixed-size ROIs were drawn on both condyles and the clivus on the slice with higher activity [a two-dimensional (2D) approach] and on the summation of five adjacent transaxial slices [a three-dimensional (3D) approach]. A percentage difference between both condyles of above 10% or a cutoff value of 1.44 or 1.88 for abnormal condyle/clivus ratio was considered abnormal. RESULTS: Seventeen patients with active CH, 16 with inactive CH, and 16 control individuals were evaluated. The highest sensitivity and highest specificity were observed for the whole-condyle approach (88 and 87%, respectively), followed by the percentage 2D maximum condyle/total (82.4 and 81.3%, respectively). The condyle/clivus ratio yielded low sensitivity for both 2D and 3D approaches. No effect of age on condylar activity was demonstrated. No statistically significant difference in condyle/clivus ratio was evident between patients with active and those with inactive CH. CONCLUSION: Use of 2D maximum fixed-size ROI and percentual difference in condylar activity offers optimal diagnostic accuracy in patients with CH and should be encouraged in future studies. The condyle/clivus ratio offers suboptimal results and cannot, therefore, be recommended. No effect of age on normal condylar activity was demonstrated.

Comparison of gastric emptying parameters between asymptomatic volunteers and patients with functional dyspepsia in Middle Eastern population.

OBJECTIVE: To derive the normal reference values for Middle East population using a standard method, and to validate its performance in functional dyspepsia. METHODS: A prospective study was designed to derive gastric emptying parameters in 36 healthy control subjects. We measured the lag phase, half time, and gastric retention at the first, second, and third hours. Values were compared to 49 patients with functional dyspepsia. This study was carried out between July 2005 and August 2009 at Jordan University Hospital, Amman, Jordan. RESULTS: There were no statistically significant differences between the 2 groups at lag phase. Dyspeptic patients had significantly higher gastric retention at the first, second, and third hours (p=0.045, p=0.003, p=0.002). Gastric retention at the third hour was the most sensitive parameter detecting 16 patients (32.6%). Only 3 patients (6.1%) had increased gastric retention at the first hour and normal retention at the third hour. Twelve patients (24.5%) had delayed half time; these patients had increased gastric retention either at the first or third hour. CONCLUSION: Measurement of gastric retention at the first, second, and third hour is enough to identify delayed-early and late phases of gastric emptying in functional dyspepsia patients.