Correlation between coronary artery calcification and COVID-19.

Background: Coronary heart disease (CHD) is an underlying cardiac condition contributing to increased COVID-19 mortality and morbidity which can be assessed by several diagnosis methods including coronary artery calcification (CAC). The goal of this study was to find out if there were potential links between CAC, clinical findings, severity of COVID-19, and in-hospital outcomes. Methods: This retrospective study evaluated 551 suspected patients admitted to teaching hospitals of the Babol University of Medical Sciences, Babol, Iran, from March to October 2021. Data included previous diseases, comorbidities, clinical examinations, routine laboratory tests, demographic characteristics, duration of hospitalization, and number of days under ventilation were recorded in a checklist. Results: Findings of current study provide evidence of a significant relationship between coronary artery calcification (CAC) and in-hospital mortality. Additionally, we observed significant correlations between CAC and several clinical parameters including age, duration of hospitalization, pulse rate, maximum blood pressure, erythrocyte sedimentation rate (ESR), blood urea nitrogen (BUN), neutrophil count, white blood cell (WBC) count, and oxygen saturation. However, we did not observe a significant association between CAC and the severity index of COVID-19. In addition, logistic regression tests did not find a significant value of CAC to predict in-hospital mortality. Conclusion: Our findings showed a significant relationship between CAC and in-hospital mortality.

Coronary artery calcification score as a prognostic indicator for COVID-19 mortality: evidence from a retrospective cohort study in Iran.

Background: Coronary artery calcification (CAC) has been established as an independent risk factor for major adverse cardiovascular events. Nevertheless, the effect of CAC on in-hospital mortality and adverse clinical outcomes in patients with COVID-19 has yet to be determined. Objective: To investigate the association between CAC score and in-hospital mortality of COVID-19 patients. Method: This retrospective cohort study was conducted across tertiary hospitals of University of Medical Sciences in Babol, a northern city in Iran, and enroled 551 confirmed COVID-19 patients with definitive clinical outcomes of death or discharge between March and October 2021. Demographic and clinical data, along with chest computed tomography (CT) findings and CAC score on admission, were systematically collected. The study utilized logistic regression analysis and Kaplan-Meier plots to explore the association between CAC score and in-hospital death and adverse clinical outcomes. Results: The mean age was 60.05±12.8. A significant difference regarding CAC score, age, history of hypertension, hyperlipidemia, cardiovascular diseases, and respiratory diseases among survivors and non-survivors was observed; however, gender was not found to be different. Furthermore, in multivariate analysis, CAC score greater than or equal to 400 [odds ratio (OR): 4.2, 95% CI: 1.70-10.33, P value: 0.002], hospitalization time (OR: 1.31, 95% CI: 1.13-1.53, P value < 0.001), length of ICU stay (OR: 2.02, 95% CI: 1.47-2.77, P value < 0.001), severe or critical COVID-19 severity in time of admission (95% CI: 1.79-18.29, P value: 0.003), and history of respiratory diseases (95% CI: 2.18-40, P value: 0.003) were found to be associated with higher odds of in-hospital mortality. Log-rank test also revealed a significant difference regarding the time of admission to death between patients with CAC score greater than or equal to 400 and those with CAC score less than 400 (P value < 0.001). Conclusion: Elevated CAC score is a crucial risk factor linked to in-hospital mortality and unfavourable clinical results in confirmed COVID-19 patients. This finding emphasizes the need for careful monitoring of individuals with high CAC scores.

Evaluation of Serum Pentraxin-3 Level in Patients with Acute Myocardial Infarction Compared with Control Group.

BACKGROUND & OBJECTIVE: The aim of this study was to measure serum pentraxin 3 (PTX3) in patients with acute myocardial infarction (MI) and compare it with the control group. METHODS: In this case-control study, 60 patients with MI (±ST-segment elevation) were included in the case group , and those with symptoms suspicious for coronary artery disease (CAD) and with no abnormal findings in angiography and troponin I level less than 99th percentile of normal population were included as a control group (N=30). Serum PTX3 and troponin I were measured. RESULTS: In this study, 60 patients including 34 men and 26 women were included in the case group (mean age: 61.4±8.86 years in non-ST-segment elevation myocardial infarction [NSTEMI] subgroup and mean age: 57.9±9.49 years in ST-segment elevation myocardial infarction [STEMI] subgroup), as well as 13 men and 17 women as the control group (mean age: 55.47±10.09 years). PTX3 level was higher in MI cases (1128.4±1205 pg/mL) compared to controls (394.5±170.40 pg/mL) (P=0.001). There was no relationship between ejection fraction (EF) and PTX3 level in the MI group. The area under the ROC curve (AUC) of PTX3 in MI was presented by 0.828 (AUC=0.828) (P>0.001). We defined three different cutoffs for PTX in this study, in which the cutoff ≥400 pg/mL had the highest sensitivity (92%), and the cutoff ≥700 pg/mL had the highest specificity (97%). CONCLUSION: According to the results of this study, PTX3 as an inflammatory marker showed higher level in patients with MI, especially in STEMI cases. Therefore, combined evaluation of troponin I and PTX3 levels would be associated with more accuracy in diagnosis of MI.

Patients with Coronary Artery Disease Have Lower Levels of Antibody to Heat-Stressed Fibroblast Derived Proteins, versus Normal Subjects.

Cellular stress response plays an important role in the pathophysiology of coronary artery disease (CAD). Inhibition of cellular stress may provide a novel clinical approach regarding the diagnosis and treatment of CAD. Fibroblasts constitute 60-70% of cardiac cells and have a crucial role in cardiovascular function. Hence, the aim of this study was to show a potential therapeutic application of proteins derived from heat-stressed fibroblast in CAD patients. Fibroblasts were isolated from the foreskin and cultured under heat stress conditions. Surprisingly, 1.06% of the cells exhibited a necrotic death pattern. Furthermore, heat-stressed fibroblasts produced higher level of total proteins than control cells. In SDS-PAGE analysis, a 70 kDa protein band was observed in stressed cell culture supernatants which appeared as two acidic spots with close pI in the two-dimensional electrophoresis. To evaluate the immunogenic properties of fibroblast-derived heat shock proteins (HSPs), the serum immunoglobulin-G (IgG) was measured by ELISA in 50 CAD patients and 50 normal subjects who had been diagnosed through angiography. Interestingly, the level of anti-HSP antibody was significantly higher in non-CAD individuals in comparison with the patient's group (p < 0.05). The odds ratio for CAD was 5.06 (95%CI = 2.15-11.91) in cut-off value of 30 AU/mL of anti-HSP antibody. Moreover, ROC analysis showed that anti-HSP antibodies had a specificity of 74% and a sensitivity of 64%, which is almost equal to 66% sensitivity of exercise stress test (EST) as a CAD diagnostic method. These data revealed that fibroblast-derived HSPs are suitable for the diagnosis and management of CAD through antibody production.

Epidemiologic comparison of the first and second waves of coronavirus disease in Babol, North of Iran.

BACKGROUND: A few studies compared the epidemiologic features of the first and second waves of coronavirus disease 2019 (COVID-19) outbreak. This research was carried out to compare the 1st and the 2nd waves of the epidemics in the northern Iran. METHODS: In this observational research, demographic, clinical and laboratory characteristics of the patients with COVID-19, admitted to four government hospitals affiliated to Babol University of Medical Sciences during the 1st and the 2nd waves of COVID-19 epidemics have been compared. The period from May 21, 2020 to September 21, 2020 was considered as the second wave of the epidemics while from February 19, 2020 to May 20, 2020, as the first wave of the outbreak in this region. RESULTS: Out of 6691 total hospitalized cases, 4374 (65.37%), including 1532 (49.6%) people in the first wave and 2842 (78.9%) in the second wave had RT-PCR test for disease confirmation. Among those who were examined with RT-PCR test, 2322 patients (53.1%) including 728 (31.4%) persons in the first wave and 1594 (68.6%) in the second wave were positive for SARS-CoV-2 RNA. 414 (56.9%) of the confirmed cases in the first wave and 767 (48.1%) in the second wave were males (p<0.001). Gastrointestinal symptoms were more incidental in the second wave of the disease. However, severe respiratory conditions were more common during the first wave (p<0.001). Crude mortality rate was lower in the second wave of the outbreak (p<0.001). CONCLUSION: Different epidemiologic characteristics were found in the second wave of COVID-19 outbreak in comparison with the first wave of the epidemics in northerrn Iran.

Dynamic changes in purine catabolism in patients with acute coronary syndrome that underwent percutaneous coronary intervention.

BACKGROUND: Cardiovascular diseases are global problems. They are causes of death in about 43% of people worldwide and may become the most widespread reason of death by 2020. The prognosis is directly dependent to immediate diagnosis and on time treatment. Introduction of new biochemical markers as the early diagnosis of complications after coronary revascularization is very important in this period. Herein, we assayed the changes of purine catabolites in patients with acute coronary syndrome (ACS) before and after percutaneous coronary intervention (PCI) in comparison with control group. METHODS: Thirty five ACS patients (20 males and 15 females) were included (57±17 years old) in the study. The determination of intermediates of purine catabolism as guanine, hypoxanthine (GCS), adenine, xanthine (Kc) and uric acid (MK) were assayed before and 3 days after PCI. Conditionally, 35 healthy-matched persons were included in the control group. Purine catabolites were determined in plasma through the method of Oreshnikov E.V (2008). RESULTS: In ACS patients, prior to PCI, there was a tendency to increase the concentration of guanine (P=0.001), hypoxanthine (P=0.002) adenine (P=0.0003), xanthine (P=0.000003) and uric acid (P=-0.000001) relative to the upper limits of normal ranges. And on the third day after PCI, there was the second tendency to increase the levels of guanine (P=0.000001), hypoxanthine (P=0.000001) adenine (P=0.0000001), xanthine (P=0.000001) and uric acid (P=0.0000001) relative to upper limits of normal ranges. CONCLUSION: Increment of plasma purine catabolites can be a marker of inflammation and instability of coronary artery plaques and may be used as a restenosis marker in patients with history of PCI.

Underlying risk factors and their relationship with extent of coronary vessel involvement in patients undergoing coronary angiography in North of Iran.

BACKGROUND: Coronary artery disease (CAD) is one of the most progressive and life-threatening diseases and is the first leading cause of death affecting both genders in Iran. The present study aimed to determine the extent of coronary vessel involvement and relevant relationship with several underlying risk factors. METHODS: In this cross-sectional study, 1452 patients undergoing angiography who met the inclusion criteria were recruited consecutively in Babol, Iran during 2016. Data collection was performed through a questionnaire including demographic and clinical characteristics and information on underlying diseases via an interview with the patient and looking into the patients' records. RESULTS: Of these patients, 459 (31.6%) had normal coronary arteries, 220 (15.1%) suffered from non-obstructive CAD and 773 (53.3%) had one, two or three-vessel obstructive involvement. The results of multiple logistic regression showed that the chances of having coronary artery involvement in patients with diabetes (OR=1.55, p=0.012), age> 60 years old (OR=3.52, P=0.001), male gender (OR=2.54, P=0.001), history of heart attack (OR=3.16, P=0.001), and history of hospitalization because of cardiac problem (OR=1.51, P=0.021) significantly increased. CONCLUSIONS: Diabetes, male gender, age over 60 years old, history of myocardial infarction and history of hospitalization due to cardiac problem were related to the extent of coronary vessels involvement. Therefore, it is recommended to practice preventive measures more extensively in this regard.

Can chronotropic incompetence predict life-threatening ventricular arrhythmias in patients with stable ischemic heart disease?

BACKGROUND: Chronotropic incompetence has prognostic value of all-cause and cardiovascular mortality in both patients with asymptomatic and symptomatic ischemic heart disease (IHD), regardless of traditional risk factors. The aim of this study was to investigate the relationship between chronotropic response during exercise test and the development of ventricular arrhythmias. METHODS: 153 patients with stable ischemic heart disease were screened and observed during the 24 months since October 2014 in a university hospital in Astana Kazakhstan. They underwent bedside electrocardiography, 24h heart rate Holter monitoring, echocardiography, exercise stress test (treadmill) for assessment of chronotropic index calculating at first contact. Holter- electrocardiography was repeated three times (at 3, 6, 12 months of follow-up period) to reveal life-threatening ventricular arrhythmias. RESULTS: The quantity of the ventricular extrasystoles was higher in the group with low chronotropic index. Low chronotropic index increased the risk of high grade ventricular extrasystoles more than two times (P=0.015); episodes of non-sustained VT more than three times (p<0.001); and episodes of sustained VT more than nine times (p<0.001). CONCLUSIONS: Chronotropic index less than 35.6 increases the risk for life-threatening ventricular arrhythmias in patients with stable chronicle ischemic heart disease irrespectively of severe left ventricle systolic dysfunction.

Association of ATP-Binding Cassette Transporter A1 (ABCA1)-565 C/T Gene Polymorphism with Hypoalphalipoproteinemia and Serum Lipids, IL-6 and CRP Levels.

BACKGROUND: ATP-binding cassette transporter A1 (ABCA1) is a membrane integral protein which plays a vital role in High Density Lipoprotein (HDL) metabolism and exerts a protective effect against Hypoalphalipoproteinemia (HA) by mediation of rate-limiting step in HDL biogenesis. In addition, this protein possesses anti-inflammatory effects by inhibiting the production of some inflammatory cytokines in macrophages. This study investigated the association of ABCA1-565 C/T gene polymorphism with HA and serum lipids, IL-6 and CRP levels. METHODS: A population which consisted of 101 HA and 95 normal subjects were genotyped for ABCA1-565C/T polymorphism by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). The serum concentrations of lipids, IL-6 and high sensitive-CRP (hs-CRP) were measured by the relevant methods. RESULTS: The frequency of T allele was significantly higher in the HA group than the controls (31.7 vs. 19.5%, p=0.002). Thus, carriers of the T allele (CT and TT genotypes) had a higher risk for HA (p=0.016, OR=2.04, 95% CI=1.14-3.63). T allele carriers demonstrated decreased HDL-C and increased triglyceride, IL-6 and CRP levels than those with the CC genotype. CONCLUSION: This study suggests that the-565 C/T polymorphism of ABCA1 gene is associated with an increased risk of HA, decreased HDL-C and increased TG, IL-6 and CRP.