Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias.

Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination of paroxysmal atrial fibrillation (AF) that occurs during radiofrequency ablation (RFA) of supraventricular tachycardias (SVT). Intravenous Ibutilide may be an alternative option in this setting. Thirty-four out of 386 patients who underwent SVT-RFA presented paroxysmal AF during the procedure and were randomized into receiving ibutilide or DC-ECV. Ibutilide infusion successfully cardioverted 16 out of 17 patients (94%) within 17.37 ± 7.87 min. DC-ECV was successful in all patients (100%) within 17.29 ± 3.04 min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94%) in the ibutilide arm and in all patients (100%) in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA.

Practice patterns of cardiologists, general practitioners, and internists for managing supraventricular tachycardias in Greece.

OBJECTIVES: Supraventricular tachycardias (SVT) often lead to emergency room and primary care visits. Not only cardiologists, but also general practitioners (GPs) and internists are involved to an increasing extent in the acute and long-term management of SVT. We aimed to explore the differences between practice patterns of cardiologists and noncardiologists with regard to SVT management in Greece. METHODS: A cross-sectional questionnaire survey was conducted among 250 cardiologists and 250 GPs/internists from various areas across Greece. RESULTS: A response rate of 61.8% was obtained. Vagal maneuvers were the initial therapeutic approach for SVT termination; however, 22% of noncardiologists would rather start with an antiarrhythmic drug. Adenosine was the most popular drug for SVT termination, but the GPs/internists would use it less often than the cardiologists (67 vs. 86%, P<0.001). The GPs/internists would keep the patient for at least 24 h or more after SVT termination, while 48% of the cardiologists would discharge the patient within the first 3 h. Noncardiologists would more often suggest a 24-h Holter recording than the cardiologists (73 vs. 55%, P<0.005). With regard to the long-term management of SVT, the GPs/internists would prescribe antiarrhythmic drugs earlier than the cardiologists, and seem to be less familiar with the indications for the electrophysiological testing and ablation. CONCLUSION: Significant differences in practice patterns exist in Greece with regard to SVT management between cardiologists and noncardiologists. The GPs/internists seem to rely more on antiarrhythmic drugs and tend to underestimate the role of ablation therapy for the long-term management of SVT.

The utility of the standard 12-lead electrocardiogram in the prediction of proximal right coronary artery occlusion in acute inferior myocardial infarction.

Prior studies have proposed several electrocardiogram criteria for identifying patients with acute inferior ST-segment elevation myocardial infarction (iSTEMI) caused by obstruction of the proximal part of the right coronary artery (RCA). We applied 11 of these criteria and three new ones to the admission electrocardiograms of 80 patients admitted with an acute iSTEMI in order to evaluate their utility. All patients received thrombolytic treatment and underwent coronary angiography during the hospitalization. Four previously described criteria (ST-segment depression in lead V1, ST-segment depression in leads V1-V3, maximum ST-segment depression in the precordial leads, and ST-segment depression in lead V3 of 1) were useful in identifying patients with obstruction of the proximal part of the RCA. Among the six criteria, ST depression in V1-V3 had the highest specificity (77.2%) and positive predictive value (56.5%), and a new criterion-the arithmetic sum of the ST-elevation in V3/ST-elevation in III < 0.5--had the highest sensitivity (80.9%) and negative predictive value (86.7%). Six criteria were helpful in identifying patients with acute iSTEMI caused by obstruction of the proximal part of the RCA. One of these has not been previously reported and has the higher specificity and negative predictive value.

Clinical significance of N-terminal-probrain natriuretic peptide in hypertrophic cardiomyopathy.

N-Terminal-probrain natriuretic peptide (NT-proBNP) plasma levels are elevated in patients with congestive heart failure. Published data concerning the utility of NT-proBNP in hypertrophic cardiomyopathy (HCM) are lacking. Our aim was to evaluate the clinical significance of NT-proBNP in patients with HCM. A blood sample was collected for plasma NT-proBNP measurement from 43 consecutive patients with documented HCM. NT-proBNP was measured using a chemiluminescent immunoassay kit (Roche Diagnostics) on an Elecsys 2010 analyzer. Median value of NT-proBNP was 219 pg/ml (range 8-3 045 pg/ml) in NYHA class I patients, 698 pg/ml (125-2 463 pg/ml) in NYHA class II patients, and 2 683 pg/ml (131-11 542 pg/ml) in NYHA class III and IV patients. NT-proBNP plasma levels were significantly higher across the severity of functional limitation (i.e., NYHA class classification) (P = 0.002). NT-proBNP levels were significantly higher in female than male (P = 0.034), in referral vs nonreferral patients (P = 0.004), in symptomatic vs asymptomatic patients (P = 0.020), in patients with basal subaortic gradient >or=30 mmHg (P = 0.001) and in the patients who were on cardioactive medication (P = 0.010). In univariate analysis NT-proBNP was significantly correlated with age (P < 0.001), left ventricular maximum wall thickness (P = 0.001), left atrial size (P = 0.019), and subaortic gradient >or=30 mmHg (P < 0.001). In multivariate regression analysis, age (P < 0.001), maximum wall thickness (P = 0.007), and gradient >or=30 mmHg (P = 0.027) were independently associated with NT-proBNP levels. Our data support the idea that measurement of plasma NT-proBNP levels in HCM patients is useful to assess their clinical status, especially the severity of hypertrophy and the presence of obstruction, although age must be taken into account.

Clinical significance of tissue Doppler imaging in patients with hypertrophic cardiomyopathy.

BACKGROUND: A transmitral E/septal Ea ratio > or =15 is a predictor of adverse outcome in cardiac disease, so it was hypothesized that a septal E/Ea >/=15 would predict the risk of adverse outcome, including sustained ventricular tachycardia (VT), cardiac arrest, implantable cardioverter defibrillator (ICD) discharge, or sudden death (SD) in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS: The study group comprised 96 consecutive patients with HCM (median age 53 years) who completed all noninvasive tests for risk stratification. The endpoint of the study was defined as death, cardiac arrest, documented sustained VT, or ICD-discharge. The median follow-up was 20.6 months. All patients were alive at the end of follow-up, although 8 patients had reached the endpoint during the study period. The variables that were predictive of adverse clinical outcome were family history of premature SD (p=0.03), syncope (p<0.001), maximum wall thickness > or =3 cm (p=0.02), and septal E/Ea > or =15 (p<0.001). In a stepwise multivariable model the only independent prognostic indicator was a septal E/Ea > or =15 (relative risk 0.26, 95% confidence interval 0.2-0.58, p<0.001). The cumulative event-free survival rate was 78.9% in patients with septal E/Ea > or =15, and 100% in patients with septal E/Ea <15 (p=0.0003). CONCLUSIONS: Septal E/Ea > or =15 predicts patients with HCM who are at risk of sustained VT, cardiac arrest, ICD-discharge, or SD. (Circ J 2007; 71: 897 - 903).

Early diastolic impairment of diabetic heart: the significance of right ventricle.

BACKGROUND: Left ventricular diastolic dysfunction represents the earliest preclinical manifestation of diabetic cardiomyopathy. Right ventricular function has not been studied in depth yet in diabetic patients, although the right ventricle has an important contribution to the overall cardiac function. This study was designed to assess diastolic and systolic ventricular function in both ventricles, in patients with type 1 diabetes, free from coronary artery disease and hypertension. METHODS: We studied 66 type 1 diabetic patients and 66 age- and sex-matched normal subjects by conventional and tissue Doppler echocardiography. A possible correlation was examined for age, diabetes duration and echocardiographic measurements of left ventricular and right ventricular functions with univariate analysis. RESULTS: Type 1 diabetic patients were found to have impaired diastolic function in both ventricles with either conventional or tissue Doppler echocardiography. On the contrary, systolic function in both ventricles was preserved in our diabetic population. The measured indexes showed an expected correlation with age and diabetes duration except from systolic velocity in tricuspid annulus determined by color tissue Doppler. Moreover, significant correlations were found among parameters of left and right ventricular function. CONCLUSIONS: Patients with type 1 diabetes mellitus have impaired diastolic function, and particularly relaxation, in both ventricles before the development of myocardial systolic dysfunction. These alterations in myocardial function may be attributed to ventricular interdependence as well as to the uniform effect of diabetes to cardiac function.

Prevalence of systolic impairment in an unselected regional population with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HC) may transition to a phase characterized by systolic impairment resembling dilated cardiomyopathy. This study retrospectively assessed the incidence of left ventricular (LV) systolic impairment at initial clinical evaluation in 248 consecutive patients with HC (mean age 53 +/- 16 years). HC with systolic impairment was diagnosed if the LV ejection fraction was <50%, calculated by echocardiography. Twenty patients (8%) had HC with LV systolic impairment at initial evaluation. Patients with systolic impairment had a greater incidence of family histories of sudden cardiac death (SCD) than patients with preserved systolic function (25% vs 5.3%, p = 0.006) and more severe functional limitations (New York Heart Association class >or=III, p <0.001). All-cause mortality and cardiovascular mortality did not differ between the 2 groups. The incidence of SCD was 1.7% in patients with normal LV ejection fractions, and no SCD was observed in patients with systolic impairment. The latter group had more frequent major cardiac events (SCD, ventricular fibrillation, aborted cardiac arrest, and first implantable cardioverter-defibrillator discharge; p = 0.03). During follow-up, 2 patients progressed to HC with systolic impairment (annual incidence 0.85%). In conclusion, systolic impairment is not exceptional in patients with HC at initial evaluation and is associated with functional deterioration and major cardiac events.

Improved papillary muscle function attenuates functional mitral regurgitation in patients with dilated cardiomyopathy after cardiac resynchronization therapy.

BACKGROUND: Functional mitral valve regurgitation attenuation after cardiac resynchronization therapy (CRT) in patients with severe heart failure has been attributed to both the increased rate of left ventricular systolic pressure increase and to papillary muscle (PM) recoordinated contraction. We hypothesized that an increase in systolic deformation of the PMs or the adjacent myocardial wall may in part account for this effect, by preventing their outward displacement during systole. METHODS: We studied by echocardiography 22 patients with moderate/severe functional mitral valve regurgitation and a mean ejection fraction of 18 +/- 4% at baseline and after implantation of a CRT system. RESULTS: CRT induced a significant reduction of the effective regurgitant orifice area (0.18 +/- 0.11 vs 0.35 +/- 0.17 mm2, P < .001). Strain improved in both PMs and their adjacent walls, although this improvement was significant only in anterolateral PM (-16 +/- 4.7 vs -11 +/- 4.3%, P = .02) and posteromedial PM adjacent wall (-16 +/- 10 vs -8 +/- 4.6%, P = .01). CONCLUSIONS: CRT acutely reduces the severity of functional mitral valve regurgitation in patients with heart failure and this effect may be in part attributed to improved strain of PM or adjacent wall.

Survival in thalassaemia major patients.

BACKGROUND: The present study evaluated the prognostic significance of Doppler-demonstrated left ventricular (LV) restrictive filling pattern (RFP) in patients with thalassaemia major (TM), which carries an adverse cardiovascular prognosis. METHODS AND RESULTS: The study group comprised 45 asymptomatic transfusion-dependent patients with TM and normal LV systolic function. All patients were chelated with desferrioxamine. They were regularly evaluated by clinical and Doppler-echocardiographic studies throughout the 15-year follow-up period. The patients were categorized into 2 groups according to baseline data: those with LVRFP and those with LV non-RFP. The incidence of cardiac death in both groups was analyzed. The impact of chelation therapy on the ventricular filling pattern and survival was also examined. Nineteen patients (42.2%) had LVRFP and 26 (57.8%) had LV non-RFP. During follow-up 11 patients died from cardiac causes; 8 of them (72.8%) initially had LVRFP and 3 (27.2%) had LV non-RFP. LVRFP was significantly associated with mortality (p=0.018). Poor compliance with chelation therapy was significantly associated with LVRFP (p=0.007) and cardiac mortality (p=0.003). CONCLUSIONS: LVRFP is an important predictor of cardiac mortality in patients with TM. Poor compliance with chelation therapy was significantly associated with both a RFP (p=0.007) and cardiac mortality (p=0.003).

Dobutamine stress echocardiography is highly accurate for the prediction of contractile reserve in the early postoperative period, but may underestimate late recovery in contractile reserve after revascularization of the hibernating myocardium.

OBJECTIVE: We sought to investigate the accuracy of dobutamine stress echocardiography to predict the degree and timing of recovery in resting function and contractile reserve (CR) after revascularization of the hibernating myocardium. METHODS: In all, 24 patients with ischemic cardiomyopathy (ejection fraction < 40%) underwent dobutamine stress echocardiography 1 week before and 6 weeks, 3 months, and 6 months after coronary artery bypass grafting. RESULTS: Recovery rates at 6 weeks, 3 months, and 6 months postoperation were 21%, 33%, and 45% (P < .01) for resting function and 55%, 65%, and 74% (P < .01) for CR. Positive and negative predictive values for recovery of resting function and CR at 6 months postrevascularization were 66% vs 97% (P < .001) and 78% vs 48% (P < .001), respectively. Positive and negative predictive values were both high for recovery of CR at 6 weeks postrevascularization (89% and 78%). CONCLUSIONS: Dobutamine stress echocardiography can predict early recovery in CR postrevascularization with an excellent accuracy but may underestimate the degree of late recovery in CR.

QT dispersion is determined by the relative extent of normal, hibernating, and scarred myocardium in patients with chronic ischemic cardiomyopathy. A dobutamine stress echocardiography study before and after surgical revascularization.

INTRODUCTION: The aim of the present study was to evaluate a possible association between QT dispersion (QTd) and the amount of viable and scarred myocardial tissue after revascularization in patients with coronary artery disease and impaired left ventricular (LV) function. METHODS: Twenty-two patients with ischemic LV dysfunction underwent dobutamine stress echocardiography (DSE) before and 6 months after surgical revascularization. Mean corrected QT-interval value and QTd were calculated at baseline and follow-up. Segments consisting of transmural scar were determined as the segments that remained akinetic in all stages of DSE despite reperfusion. Patients were divided into 2 groups according to the number of definitive segments consisting of transmural scar (minor scar group, < or =2 scarred segments; major scar group, >2 scarred segments). RESULTS: QTd was significantly lower in the minor compared with the major scar group at baseline and follow-up (mean [SD], 61 [22] vs 98 [33] milliseconds, P = .008, and 45 [18] vs 68 [21] milliseconds, P = .01, respectively). Segments consisting of transmural scar positively correlated to QTd at baseline (r = 0.53, P = .01) and follow-up (r = 0.62, P = .002). CONCLUSIONS: QTd is positively correlated with the extent of scarred myocardial tissue assessed by DSE. Surgical revascularization results in reduction of QTd in all patients with hibernating myocardium and LV dysfunction.

Phospholamban gene mutations are not associated with hypertrophic cardiomyopathy in a Northern Greek population.

Hypertrophic cardiomyopathy (HCM) is a genetically transmitted cardiac disease characterized by unexplained myocardial hypertrophy and diverse clinical spectrum. Currently, more than 250 HCM-related mutations in 10 genes encoding contractile sarcomeric proteins have been identified. Phospholamban (PLN) is a modest modulator of intracellular Ca2+ homeostasis and may be a candidate gene responsible for cardiomyopathy. In this study 53 consecutive patients with HCM, coming from Northern Greece, were screened for mutations of PLN gene. The patients were evaluated by clinical history, physical examination, electrocardiogram and echocardiography. All PCR products were analyzed for mutation by both restriction analysis and sequencing. The systematic mutation screening did not reveal any mutation in exons 1 and 2 or in the promoter region of phospholamban gene. Additionally, no polymorphisms were detected in all patients. Therefore, PLN gene mutations were not found to be associated with HCM in a Northern Greece population.

Multiple episodes of ischemic preconditioning are not associated with loss of benefit: preliminary clinical experience.

BACKGROUND: As a clinical analogue of ischemic preconditioning (IP), preinfarction angina (PA) shares a well-documented protective effect in the setting of acute myocardial infarction (AMI) by reducing infarct size, preserving left ventricular function and improving prognosis. In the experimental setting, multiple cycles of IP may induce the loss of this protection. OBJECTIVE: To evaluate the effect of repeated cycles of PA on clinical outcomes in patients exhibiting a first AMI. METHODS: Seventy-four consecutive patients with AMI, in whom PA was the surrogate of experimental IP, were studied prospectively. All patients had poor or no collaterals. The patients were divided into three groups: group 1 (n=32) comprised patients without PA (control subjects); groups 2 (n=24) and 3 (n=18) comprised patients reporting one to four and more than four episodes of new-onset PA, respectively (preconditioned groups). Both of the preconditioned groups were compared with the control subjects with regard to creatine kinase-MB release, corrected Q-T interval (QTc) at discharge and major in-hospital complications. RESULTS: Compared with the control subjects, groups 2 and 3 exhibited reduced creatine kinase-MB release (75+/-26 IU/L and 85+/-22 IU/L versus 172+/-13 IU/L, P=0.004 and P=0.024, respectively), lower discharge QTc values (418+/-15 ms and 422+/-19 ms versus 443+/-38 ms, P=0.004 and P=0.031, respectively), and a reduced incidence of postinfarction angina (25% and 11% versus 44%, P<0.05), arrhythmias (0% and 0% versus 22%, P<0.05) and pulmonary edema (4% and 0% versus 28%, P<0.05). CONCLUSIONS: Regardless of the number of recurrences, IP seems to be a powerful intervention to reduce infarct size, limit QTc at discharge and improve the outcome in patients with AMI.

Effects of variation of atrioventricular interval on left ventricular diastolic filling dynamics and atrial natriuretic peptide levels in patients with DDD pacing for complete heart block.

AIMS: This study was designed to evaluate the effect of variation of atrioventricular (AV) interval (AVI) on left ventricular (LV) diastolic function and ANP and c-GMP levels during DDD pacing in patients with complete AV block and normal systolic function. METHODS: The study population comprised 22 patients (mean age 65.2+/-14.3, 12 males) with complete AV block. All patients underwent complete Doppler echocardiography before implantation of a DDD-pacemaker. Twenty-four hours later, patients were paced for a period of 30 min, at three different AVIs (100 ms, 150 ms and 200 ms), at rest. During each pacing period, Doppler-derived LV diastolic indices were re-evaluated and ANP and c-GMP levels were reassessed. RESULTS: Overall comparison showed a significant progressive augmentation, from 200 ms to 100 ms AVI, in transmitral E/A wave ratio (from 0.53+/-0.13 to 0.90+/-0.25, P = 0.0005) and in LV filling time (from 0.33+/-0.05 to 0.40+/-0.06s, P = 0.0005), followed by a significant progressive reduction in ANP and c-GMP levels. An AVI of 100 ms or 150 ms was associated with improved diastolic indices and lower natriuretic peptides levels, compared with the longer AVI. CONCLUSION: Programmed AVI during DDD pacing affects LV diastolic performance and plasma ANP and c-GMP levels. The assessment of these parameters constitutes a useful modality for AVI optimization.

Left main coronary artery stenosis after aortic valve replacement.

We describe two cases with iatrogenic left main coronary artery stenosis where a symptomatology of unstable angina appeared within three months of aortic valve replacement surgery. One patient was treated with aortocoronary bypass and the other with angioplasty and stenting.

Left ventricular Doppler characteristics in first-degree relatives of patients with hypertrophic cardiomyopathy.

Left ventricular (LV) diastolic function may be affected early in patients with hypertrophic cardiomyopathy (HCM), regardless of the phenotypic expression of the disease. The aim of the present study was to detect whether LV diastolic performance, evaluated by conventional Doppler echocardiography, is impaired in first-degree relatives of patients with phenotypically expressed HCM, who had no clinical, electrocardiographic, or echocardiographic signs of the disease. Twenty-two young adults having the previously described characteristics comprised the study population and 22 sex- and age-matched healthy individuals served as controls. The 2 groups were compared according to several echocardiographic parameters and the following diastolic function indices: peak velocity of E wave, representing early filling; peak velocity of A wave, representing late filling; ratio of peak early to peak late velocity (E/A); deceleration time of E wave; and LV isovolumic relaxation time. Slower deceleration time of transmitral early filling in first-degree relatives of patients with HCM (192 +/- 31 vs 149 +/- 31 msec, p < 0.001) was the only variable that significantly differentiated the 2 groups. This study shows that in healthy persons with a family history of HCM, Doppler-derived mitral filling pattern shifted toward that observed in HCM and the slower deceleration time may serve as an early sign of disease development.

Usefulness of low-dose dobutamine stress echocardiography for the evaluation of spontaneous recovery of stunned myocardium in patients with acute right ventricular infarction.

Right ventricular (RV) infarction (RVI) is usually associated with severe RV global dysfunction representing predominantly stunned myocardium that may respond favorably to reperfusion. We assessed the efficacy of low-dose dobutamine stress echocardiography (DSE), performed early in the course of a reperfused RVI, to predict the recovery of RV systolic and diastolic function in 3 months, documenting the recovery of stunned myocardium. In all, 27 patients with acute, successfully thrombolyzed RVI comprised the study population. All patients underwent standard echocardiography at baseline and 3 months later for evaluation of RV systolic and diastolic function. At day 5 DSE was performed for evaluation of RV contractile reserve. Of the total number of segments analyzed, 69% were detected as stunned. At baseline, RV systolic and diastolic indices were seriously impaired showing significant improvement at follow-up. RV wall-motion score index during DSE was positively correlated with the same index at follow-up. DSE is a safe and precise modality to predict recovery of stunned myocardium in the setting of RVI.

Evidence of left ventricular dysfunction in asymptomatic elderly patients with non-insulin-dependent diabetes mellitus.

Diabetic cardiomyopathy is a distinct entity in diabetic patients with congestive heart failure, who have no angiographic evidence of significant coronary artery stenosis. The aim of this study was to evaluate left ventricular (LV) function in 24 elderly patients (mean age 67 +/- 2 years) with type 2 diabetes, who were asymptomatic and had no history of hypertension, or coronary or valvular heart disease. LV systolic indices (ejection fraction [EF] and fractional shortening [FS]), diastolic indices (E wave, A wave, E/A ratio, isovolumic relaxation time [IVRT] and deceleration time [DT]) and the myocardial performance index (MPI) were evaluated with echocardiography. Compared to controls (24 age- and gender-matched normal subjects), the E wave was reduced (0.60 +/- 0.10 m/sec vs 0.72 +/- 0.08 m/sec, p < 0.05), the A wave was increased (0.77 +/- 0.07 m/sec vs 0.68 +/- 0.06 m/sec, p < 0.05), the E/A ratio was decreased (0.78 +/- 0.20 vs 1.06 +/- 0.18, p < 0.001) and both IVRT and DT were prolonged (0.115 +/- 0.01 sec vs 0.09 +/- 0.01 sec, p < 0.001 and 0.240 +/- 0.04 sec vs 0.180 +/- 0.03 sec, p < 0.001, respectively). The MPI was significantly increased (0.640 +/- 0.170 vs 0.368 +/- 0.098, p < 0.001). LV diastolic function and the MPI are markedly impaired in asymptomatic elderly patients with type 2 diabetes.

Echocardiographic evaluation of spontaneous recovery of right ventricular systolic and diastolic function in patients with acute right ventricular infarction associated with posterior wall left ventricular infarction.

We evaluated right ventricular (RV) systolic and diastolic function in 30 patients with acute RV myocardial infarction on echocardiography. Systolic and diastolic function were impaired early in the setting of RV myocardial infarction, but improved significantly at 3 months.

Association between plasma homocysteine levels and coronary artery disease: a population-based study in northern Greece.

OBJECTIVE: Elevated plasma total homocysteine (tHcy) levels constitute a risk factor for coronary artery disease (CAD). We prospectively examined the association of fasting tHcy levels in patients in Northern Greece who had established CAD. PATIENTS AND METHODS: Plasma fasting tHcy levels were measured in 42 patients with angiographically documented CAD and compared to 42 age-, sex-, BMI- and smoking habit-matched control subjects. We also determined the plasma vitamin B(12), folic acid and lipoprotein levels in all patients and controls. Conventional risk factors for CAD were also estimated. RESULTS: In a univariate analysis, tHcy (micromol/l) levels were higher in patients compared to controls almost reaching statistical significance (13 (7-41) vs 11.3 (4-39); p= 0.07). Multivariate analysis of conventional risk factors showed that tHcy levels were not an independent risk factor for CAD. However, tHcy levels were significantly higher in patients with a previous history of myocardial infarction compared to patients without such a history and to controls (15 (8.8-29) vs 11.7 (7-41); p = 0.007 and 15 (8.8-29) vs 11.3 (4-39); p = 0.002, respectively). Hyperhomocysteinaemia (> 15 micromol/l) was detected in 35.7% of patients and 11.9% of controls (p < 0.05). CONCLUSIONS: In Northern Greece, plasma tHcy levels may not be an independent risk factor for CAD in patients with angiographically documented CAD. However, patients with CAD have a trend towards higher tHcy levels. Additionally, plasma tHcy levels may be associated with the development of myocardial infarction.