Role of heart fatty acid binding protein in early detection of non ST-elevation myocardial infarct and its comparison with other cardiac markers.

OBJECTIVE: To determine the role of heart fatty acid-binding protein in early detection of non-ST-elevation myocardial infarction and its comparison with two other cardiac markers. METHODS: The cross-sectional study was conducted at Abbasi Shaheed Hospital, Karachi, from June 2012 to June 2014, and comprised patients presenting at the emergency department within two hours of chest pain and who were subsequently referred to the cardiology department with a provisional diagnosis of either unstable angina or non-ST-elevation myocardial infarction. Relevant history was taken on a specific proforma and electrocardiogram as well as routine investigations were done in the emergency department. Blood samples from the subjects were tested for the diagnosis of myocardial infarction through detection of heart fatty acid-binding protein, Troponin-I and Creatine kinase-myocardial band. Sensitivity and specificity of the three markers were calculated keeping coronary angiography as the gold standard. Data was analysed using SPSS 17. RESULTS: Out of 250 patients, 153(61.2%) were males. The overall mean age was 54.45±13.92 years. Sensitivity and specificity of heart fatty acid-binding protein were 80.6% and 78.5% (p<0.05), for Troponin-I, 37.7% and 75% (p>0.05), and for Creatine Kinase-myocardial band, 29.5% and 67.8% (p>0.05). CONCLUSIONS: Heart fatty acid-binding protein was found to be a good diagnostic tool for the detection of non-ST-elevation myocardial infarction.

The Association between Hemoglobin A1c and the Severity of Coronary Artery Disease in Non-diabetic Patients with Acute Coronary Syndrome.

Introduction The relationship between the severity of coronary artery disease (CAD) with hemoglobin A1c (HbA1c) levels in diabetic patients is well-understood. However, the association between HbA1c and the severity of CAD in non-diabetics is still controversial. We wanted to find out if HbA1c of the non-diabetic adult population, presenting with an acute coronary syndrome (ACS), had any correlation with the severity of CAD. Methods We selected 119 non-diabetic adults who underwent coronary intervention for clinical reasons during the period of July 2015 to February 2017. The mean age of the patients was 54 ± 10.2 years. All patients were labeled as 'acute coronary syndrome', which included unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). We obtained blood samples of patients for laboratory investigations, including HbA1c. We used the SYNTAX score as a tool to classify the severity of CAD, and patients having a SYNTAX score of >22 were considered to be having severe CAD. Results In order to find out the association between HbA1c and CAD, a linear regression analysis of HbA1c with the SYNTAX score was performed, which showed no statistically significant correlation between the SYNTAX score and HbA1c (correlation co-efficient = 0.142; p-value = 0.124). To compare the median value of HbA1c in groups with SYNTAX scores of ≤22 and those with SYNTAX scores of >22, we analyzed the data with the Mann-Whitney U test, which showed no significant difference in HbA1c between the two groups (p-value = 0.771). We determined the independent predictors of the severity of CAD by analyzing all variables with logistic regression, considering a SYNTAX score of >22 as a dependent variable. None of the variables, including HbA1c, proved to be statistically significant in multivariate logistic regression analysis. The unadjusted and adjusted odds ratio (OR) of HbA1c with 95% confidence intervals (CI) were 1.71 (0.47-2.92), p-value = 0.735 and 0.87 (0.33-2.29), and 0.78, respectively. Conclusion In conclusion, we find that HbA1c is not an independent predictor of the severity of CAD in non-diabetic adult patients.

Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery.

OBJECTIVE: To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009. METHODOLOGY: Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. RESULTS: One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 ± 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. CONCLUSION: Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time.

Presentation of tuberculosis as isolated massive pericardial effusion in a patient with rheumatoid arthritis.

The case of a 60 year old male patient, diagnosed with rheumatoid arthritis presenting with recurrent massive pericardial effusion, and unresponsive to treatment of rheumatoid arthritis is documented. Pericardial biopsy proved Tuberculous pericarditis with positive fluid culture for Mycobacterium Tuberculosis. Anti-tuberculous treatment was started along with corticosteroids. Follow up after three months showed no evidence of pericardial effusion.

Size of radial and ulnar artery in local population.

OBJECTIVE: To evaluate radial and ulnar artery diameter in patients undergoing diagnostic coronary angiography. METHOD: This was a cross-sectional study in which we measured the inner diameter of radial and ulnar artery by using two dimensional ultrasound and Doppler examination in 251 patients visiting our hospital for diagnostic coronary angiography between February to September 2008. RESULTS: The mean diameter of right and left radial artery was 2.3 +/- 0.4 mm and 2.2 +/- 0.4 mm respectively. The mean diameter of right and left ulnar artery was 2.4 +/- 0.4 mm and 2.3 +/- 0.3 mm respectively. The factors found to positively influence the size of radial artery included male sex, diabetes mellitus and smoking. There was no relationship of the size of the radial and ulnar artery with body size parameters (height, weight, Body Surface Area (BSA) & Body Mass Index (BMI). CONCLUSION: We conclude that ulnar artery diameter is larger than the radial artery in our population. Knowing the size will guide the interventional cardiologist in using appropriate size sheaths and guide catheters. Cardiac surgeons can utilize ulnar artery for bypass grafting when it is deemed unsafe to harvest the radial artery.

Left main coronary artery dissection during percutaneous coronary intervention in patient with chronic total occlusion.

Catheter induced left main coronary artery dissection is a rare but well recognized life threatening complication of coronary angiography and angioplasty. We present a case of left main coronary artery dissection induced with a guide catheter while dealing with chronic total occlusion (CTO) and bailout stenting of left main and Left anterior descending (LAD) artery.