Correlation Of Global Longitudinal Systolic Strain With Severity Of Coronary Artery Disease In Non-Stelevation Acute Coronary Syndrome Having Normal Ejection Fraction.

BACKGROUND: In patients of non-ST-elevation acute coronary syndrome (NSTEACS), the global longitudinal peak systolic strain (GLPS) has been used to detect the presence of coronary artery disease (CAD) before left ventricular ejection fraction (LVEF) is affected. We tried to find out the correlation between the GLPS and severity of CAD in such patients. METHODS: A descriptive correlational study was conducted from March 2018 to January 2020 at Jinnah Hospital Lahore. Two hundred and sixteen patients of NSTEACS with EF of ≥60% were included. Patients were divided according to angiographic results into those having non-significant, one-vessel, two-vessel or three-vessel disease. These four groups were compared regarding left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic dimension (LVEDD), LVEF, global longitudinal peak systolic strains in apical long axis view (GLPS-APLEX), in apical 4-chamber view (GLPS-A4C), in apical 2-chamber view (GLPS-A2C) and average of these (GLPS-AVG). All these parameters were also compared between patients having and those not having left main coronary artery (LMCA) disease. RESULTS: Out of 216 patients, males and females were 124(57.4%) and 92 (42.6%) respectively. There were 28 (13.0%), 83 (38.4%), 62 (28.7%) and 43 (19.9%) patients who had non-significant, one-vessel, two-vessel and three-vessel CAD respectively. With increase in severity of CAD, GLPS-AVG progressively decreased from nonsignificant CAD being 20.6±0.7 to three-vessel CAD being 16.1±0.7. There was a significant negative correlation between severity of CAD and all of the GLPS-APLEX, GLPS-A4C, GLPSA2C and GLPS-AVG (p<0.001 in all). GLPS-AVG was significantly low in patients having LMCA disease (16.5±0.7) than those not having LMCA disease (18.2±1.5) with p-value of <0.001. All other types of GLPSs showed the similar trend. CONCLUSIONS: Global longitudinal peak systolic strain has a significant negative correlation with severity of coronary artery disease in non-ST-elevation acute coronary syndrome having normal ejection fraction.

Systolic Strain Rate In Left Ventricular Dysfunction Caused By Rheumatic Chronic Severe Mitral Regurgitation.

BACKGROUND: In rheumatic severe mitral regurgitation, earlier detection of left ventricular dysfunction is very necessary in order to refer the patients for surgery at appropriate time. This study tried to find a correlation between conventional parameters of left ventricular dysfunction with systolic strain rate. METHODS: A descriptive correlational study conducted from September 2016 to March 2018. One hundred and ninety-two patients of severe rheumatic MR and fifty-eight healthy controls were included. Left ventricular ejection fraction (LVEF), end diastolic dimension (LVEDD) and end systolic dimension (LVESD) were measured. Healthy controls were taken as group-I and patients were divided into group-II (ejection fraction ≥60% and LVESD ≤40 mm), group-III (ejection fraction ≥60% and LVESD ≤41-50 mm), and group-IV (ejection fraction <60%). Systolic strain rate at medial wall (SSR-med), at lateral wall (SSR-lat) and average of both (SSR-avg) were also measured by tissue doppler method for each study subject. RESULTS: Out of 250 study subjects, males were 113 (45.2%) and females were 137 (54.8%). Means of the age, LVEF, LVEDD and LVESD were 30.8±9.1, 60.0±8.3, 58.5±7.8 and 37.4±9.9 respectively. Group I, II, III and IV contained 58, 69, 67 and 56 subjects respectively. Comparing these groups, mean LVEF progressively decreased from 63.9%±2.2 in group-I to 46.2±6.5 in group-IV while means of LVEDD and LVESD progressively increased from 45.9±3.5 and 23.2±2.3 in group-I to 64.3±3.6 and 49.0±2.9 in group-IV respectively. Average systolic strain rate (SSR-avg) decreased progressively from 1.57±0.06 in group-I to 0.83±0.08 in group-IV. All the strain rates, i.e., SSRmed, SSR-lat and SSR-avg showed significant negative correlation with left ventricular dysfunction, i.e., the group number (p<0.001). CONCLUSIONS: Systolic strain rate measured by tissue doppler method have significant negative correlation with left ventricular dysfunction in patients having rheumatic chronic severe mitral regurgitation.

Cytochrome 2C19 and paraoxonase-1 polymorphisms and clopidogrel resistance in ischemic heart disease patients.

Aim: Polymorphisms in cytochrome P450 (CYP) 2C19 and paraoxonase-1 (PON-1) genes are thought to be involved in clopidogrel high on treatment reactivity in ischemic heart disease (IHD) patients. Methods: A total of 240 patients with IHD were screened for CYP2C19 loss-of-function alleles (LOF; *2, *3) and PON-1 Q192R. Patients were classified as responders and nonresponders to clopidogrel based upon platelet aggregation studies. Genotyping of the CYP2C19 and PON-1 allele was carried out by PCR-RFLP. Results: Results showed that 14.3% of the patients were nonresponders, whereas 85.7% were responders to the clopidogrel therapy. CYP2C19*3 allele showed significant association with clopidogrel high on treatment reactivity in IHD patients. Conclusion: Result of our study demonstrate that IHD patients with CYP2C19*3 allele can face the problem of clopidogrel high on treatment reactivity in Punjabi Pakistani population.

Lipid profiles of non-diabetic healthy and ischaemic heart disease patients.

OBJECTIVE: To find any difference in the fasting lipid profile in patients with history of ischaemic heart disease (IHD) and established atherosclerotic plaques on angiography and in subjects with no known history of IHD. STUDY DESIGN: Observational, cross-sectional study. PLACE AND DURATION OF STUDY: Immunology Department of University of Health Sciences, Lahore, from January 2007 to January 2009. METHODOLOGY: In this study, 200 male subjects, between 40 and 60 years of age were recruited. Serum cholesterol and triglycerides were determined by enzymatic CHOD-PAP and GPO-PAP calorimetric method, HDL-C by accelerator selective detergent method and LDL-C by direct homogeneous enzymatic method. Serum ox-LDL contents were determined by using quantitative sandwich enzyme immuno-assay kits. RESULTS: The total serum cholesterol, triglyceride and LDL-C levels were within the normal range in control and patient groups whereas HDL-C levels were significantly higher in the control group compared to the patient group (p = 0.001). A significant difference (p = 0.001) for HDL-C levels was observed between smokers and non-smokers. Serum ox-LDL levels were higher in patient group as compared to the control group but the difference was not statistically significant. CONCLUSION: The significantly lower HDL levels in patient group with normal cholesterol, LDL and triglyceride levels may suggest low HDL-C has a greater role in IHD. Raising plasma HDL-cholesterol through weight loss, healthy diet, increased physical activity and by proper pharmacotherapy is, therefore, a legitimate therapeutic target for the optimal prevention of CHD in native population.

Association of interleukin-4 and IgE levels with LDL oxidation in atherosclerosis.

BACKGROUND: Atherosclerosis is an inflammatory and multifactorial disease, with a high prevalence rate in Pakistan. OBJECTIVE: To find a relation between serum IL-4 and IgE levels with oxidized LDL in atherosclerosis. METHODS: In this observational, cross sectional study 99 male patients, between forty and sixty years of age, with a history of ischemic heart disease (IHD) and established atherosclerotic plaques on angiography were recruited. The study was completed within three years (Jan 2007 to Jan 2009). One hundred and one age and gender matched healthy subjects with no known history of IHD were also recruited. All the study participants were non-diabetics. Serum IL-4, IgE and oxidized LDL (ox-LDL) levels were measured by quantitative ELISA technique. RESULTS: Serum IL-4 levels were generally undetectable or very low, but were higher in the patient group compared to the control subjects. Similarly, oxidized LDL and serum IgE levels were also increased in the patient group compared to the control, but the differences were not statistically significant. CONCLUSION: Our study could not detect any relationship between IL-4 and IgE levels with LDL oxidation in atherosclerosis.

Relationship of white blood cell counts, haemoglobin and ESR with IHD.

OBJECTIVES: To find any association of white blood cells, haemoglobin and ESR with ischemic heart disease in high risk native population. METHODOLOGY: The study included 93 male patients with Ischemic heart disease, between 40 and 60 years of age; 96 age and gender matched subjects. All study participants were non-diabetics. Complete blood cells count, haemoglobin and ESR levels were compared between the patient and control groups. RESULTS: Total leukocyte counts along with neutrophils were significantly higher in the test group compared to the control population (p < 0.001) and lymphocytes were significantly lower (p < 0.001) in the patient group as compared to the control group. Haemoglobin levels were significantly lower (p < 0.001) and ESR was higher (p = 0.030) in the patient group as compared to the control group. CONCLUSION: Although, our findings of the study variables extend previous reports, the prevalence and prognostic importance of theses variables in IHD should be assessed in future experimental studies. These parameters could be important in public health because they are routinely measured by clinicians and may be helpful to predict the risk of future and secondary ischemic events in a high risk population.