Evaluation of endothelial dysfunction with flow-mediated dilatation after transradial coronary angiography.

Objective Transradial coronary angiography (TRCA) may lead to endothelial dysfunction. Therefore, this study investigated the TRCA-related endothelial dysfunction and its relation to operator experience, the number of punctures and procedure duration. Methods and results A total of 57 patients (42 males and 17 females) who underwent TRCA were included in this single-centre study. Nine months after the procedure, all patients underwent radial artery B-mode ultrasound imaging, and flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) techniques were employed. The non-intervened right radial artery was accepted as control. The percentage change in diameter after FMD was significantly greater in the right radial artery compared to the left radial artery (right 13.6% vs left 10.1%, P = 0.041). The percentage change in diameter after NMD was similar in both right and left radial arteries (right 23.8% vs left 23.4%, P = 0.932). According to the puncture numbers, the percentage change was significantly lower in the intervened artery among patients with more than one puncture (13.3% vs 7.8%, P = 0.005). According to the operator experience, the percentage change in the intervened artery was significantly higher in patients in whom the procedure was performed by experienced operators (13.7% vs 7.6%, P = 0.002). The procedure duration also showed a negative correlation with the percentage change in the intervened artery (r = -0.349, P = 0.008). Conclusions TRCA may lead to endothelial dysfunction represented by FMD. Moreover, higher puncture numbers for sheath insertion, longer procedure durations and less experience in radial interventions may have adverse effects on the endothelial function.

Effects of Hemodialysis on Tei Index: Comparison between Flow Doppler and Tissue Doppler Imaging.

OBJECTIVE: Myocardial performance index (MPI, Tei index) has been described as a noninvasive measurement of left ventricle (LV) function. Our aim was to investigate the influence of preload on the LV MPI obtained by pulsed-wave tissue Doppler imaging (PWTDI) and determined by flow Doppler waveforms in patients with end-stage chronic renal failure (CRF). The second aim of this study was to investigate the relationship between the Tei indices obtained by both methods. METHODS: Eighty-four patients on regular hemodialysis (HD) treatment were included (mean age of 45.3 ± 14.5 years). Standard echocardiographic measurements, the Tei indices obtained by conventional flow Doppler and PWTDI methods, mitral inflow velocities, and mitral lateral annulus tissue Doppler velocities were measured immediately before and after hemodialysis. RESULTS: After HD, weight loss in patients was significantly revealed (predialysis 63.6 ± 13.3 kg; postdialysis 60.9 ± 13.0 kg; P < 0.001). Left ventricle and left atrium diameters were significantly decreased after HD. Transmitral E and A velocities decreased after HD. Although Tei index measuring by conventional flow Doppler method significantly increased, Tei index measuring by PWTDI did not change after HD. CONCLUSIONS: The conventional flow Doppler-derived LV Tei index is influenced by hemodialysis. However, PWTDI-derived LV Tei index is not influenced by hemodialysis. The loading status of a patient should be taken into account during the application of the Tei index to the evaluation of myocardial performance.

Evaluation of global function of the heart in scleroderma patients.

OBJECTIVE: Scleroderma is a connective tissue disease characterized by diffuse vascular lesions and fibrosis of the skin and major organs including lungs, kidneys, and heart. When cardiac involvement is clinically evident, it is recognized as a poor prognostic factor. The early detection of cardiac involvement in scleroderma would be desirable both for implementation of preventive measures in the early stages of the disease and for optimal treatment. METHODS: Left (LV) and right (RV) ventricular function were examined in 31 scleroderma patients and 21 healthy controls. Conventional and tissue Doppler echocardiography was used to evaluate systolic and diastolic function. Systolic indices including systolic (S) velocity, isovolumetric acceleration (IVA), ejection time (ET), and isovolumetric contraction time (IVCT) were measured. Early diastolic (E) velocity, late diastolic (A) velocity, E/A and E'/A' ratios, isovolumetric relaxation time (IVRT), and deceleration time (DT) were the diastolic measurements obtained. Myocardial performance index (Tei index) calculated by 2 different methods was used to assess global ventricular function. RESULTS: In our study; mitral S velocity, biventricular ET, E', E/A, E'/A', RV IVA, LV IVA, and tricuspid S velocity were significantly lower in scleroderma patients. Mitral DT, IVCT, and biventricular IVRT, were significantly higher in scleroderma patients (P < 0.0001). In addition, RV and LV Tei indices were significantly increased in scleroderma patients compared with the control group (P < 0.0001 and P < 0.001, respectively). CONCLUSIONS: In scleroderma patients, global function was depressed prior to the onset of clinical symptoms. Biventricular diastolic and systolic function abnormalities were also observed.

Left ventricular inferoapical diverticulum associated with normal coronary arteries.

Isolated congenital left ventricular (LV) diverticulum, which is characterized by the local failure of the ventricular muscle, is a rare cardiac abnormality with a reported prevalence of 0.4%. Clinically, it has been reported to follow an asymptomatic course in the majority of cases; however, it may cause heart failure, thrombus formation, arrhythmia, rupture or chest pain in some patients. Due to its asymptomatic course, it is difficult to diagnose an isolated LV diverticulum. Our patient was admitted to hospital with the complaint of typical chest pain and no any electrocardiogram ischemic changes. Transthoracic echocardiogram showed a diverticulum in the inferoapical wall. Coronary computed tomography angiography was performed, which revealed LV diverticulum at inferoapical region and normal coronary anatomy.

Marked narrowing of right heart chambers due to compression by giant hepatic hydatid cyst.

External compression of the heart may be presented as valvular heart disease. A 50-year-old woman with signs and symptoms of tricuspid stenosis was diagnosed with giant hepatic hydatid cyst. Symptoms were resolved after surgical excision. Echinococcosis should be in mind while evaluating patients with external cardiac compression.

Determining Subclinical Cardiovascular and Cardiac Diseases in Patients with Non-Alcoholic Fatty Liver Disease.

BACKGROUND: The aims of the present study were to determine the subclinical coronary atherosclerosis and myocardial dysfunction in patients with non-alcoholic fatty liver disease, who were asymptomatic for cardiac disease. METHODS: A total of 61 non-alcoholic fatty liver disease patients were enrolled in the study. The 10-year probability of cardiovascular events was evaluated according to the pooled cohort equation risk score (atherosclerotic cardiovascular disease). The coronary artery calcium score was measured. Conventional echocardiographic examination was followed by 2- and 3-dimensional speckle tracking echocardiography. RESULTS: Patients with non-alcoholic steatohepatitis had significantly higher insulin resistance (P = .018), serum alanine aminotransferase (P = .002) and aspartate aminotransferase levels (P = .021), hepatic steatosis (P = .023), and fibrosis (P = .001) than non-alcoholic fatty liver disease patients. The mean Atherosclerotic Cardiovascular Disease score was 7.5% ± 6.9% and 37% of the patients had medium and high cardiovascular disease risk. Cardiovascular disease (>1) was found in 30% of the patients. Interestingly, 56% had significant and extended atherosclerotic plaques. Among the patients with moderate-to-high atherosclerotic cardiovascular disease scores, 63% had significant atherosclerotic plaques and 21% had extensive plaque burden. The presence of non-alcoholic steatohepatitis did not significantly affect cardiovascular risk. Non-alcoholic steatohepatitis was deleterious on left ventricle diastolic functions. Mean A velocity in non-alcoholic steatohepatitis patients was significantly increased compared to non-alcoholic fatty liver disease patients (87.0 ± 17.5 cm/s vs. 72.3 ± 13.6 cm/s, P = .002). Mean E/e' ratio was 8.1 ± 2.0. Submyocardial fibrosis detected had a slightly higher occurrence in non-alcoholic steatohepatitis patients than in non-alcoholic fatty liver disease patients (P = .530). CONCLUSION: The presence of non-alcoholic steatohepatitis did not significantly increase the risk of cardiovascular disease and subclinical myocardial dysfunction in asymptomatic patients for cardiac disease compared to non-alcoholic fatty liver disease patients.

Challenging Intervention to Restenosis of Right Coronary Ostial Stent Excessively Overhanging to the Aorta: A Case Report and Brief Review of Literature.

Intervention of aorto-ostial stent restenosis is challenging due to coronary anatomical variations, possible non-selective ostial engagements, and difficulties crossing the central lumen. Aorto-ostial stent restenosis is intervened through the central lumen or protruding side struts using various techniques. These techniques are often difficult and complex such as double wire technique, balloon-assisted technique, snare technique, side-strut sequential ballooning technique, and guideline-facilitated side strut stenting technique. In this case report, we presented an intervention for right coronary artery (RCA) ostial stent restenosis using a combination of balloon-assisted double wire technique and side-strut stenting technique in an acute coronary syndrome patient.

Thrombotic Complication of COVID-19: A Case Report of Acute Saphenous Vein Graft Thrombosis in a Newly Diagnosed Patient.

A 63-year-old man with active COVID-19 infection and a history of coronary artery bypass grafting presented with acute thrombotic occlusion of saphenous venous graft which was anastomosed to the left anterior descending artery. Initial antegrade approach, complicated by a small leakage in the distal left anterior descending artery, was later converted to a retrograde approach via occluded saphenous vein graft. After successful stenting, TIMI 3 flow was achieved.

Evaluation of the Impact of Ranolazine Treatment on Liver Function Tests in Patients With Coronary Heart Disease and Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is the most common liver pathology in the developed world. Nonalcoholic fatty liver disease is associated with a higher risk of cardiovascular disease. We investigated the impact of ranolazine on liver tests in patients with NAFLD and coronary artery disease (CAD). Patients who had established CAD and NAFLD (as assessed by raised serum transaminase activity, sonographic criteria, and the absence of any other obvious liver disease) were allocated to "on ranolazine" (n = 40) or "not on ranolazine" (n = 35) groups. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured in all patients at baseline and at the end of the study. After 6 months of ranolazine treatment, both ALT and AST activities were significantly lower in patients in the "on ranolazine" group compared with "not on ranolazine" patients (change from baseline: ALT, -11.0 ± 1.7 IU/L, P < .001; AST, -5.2 ± 1.9 IU/L, P =.009). In conclusion, the present study showed that treatment with ranolazine for 6 months led to a significant reduction in the activities of both serum aminotransferases in patients with stable CAD and NAFLD.

Evaluation of acute infection-induced endothelial dysfunction and its potential mediators.

OBJECTIVES: Inflammation plays an important role in the pathophysiology of atherosclerosis. Some studies suggest a link between chronic infections, an inflammatory state, and endothelial dysfunction. However, data related to acute infections are scant. We have investigated: (i) the effect of acute infection on endothelial function; (ii) the role of potential mediators of endothelial dysfunction. METHODS: Forty patients 40 years old with acute infection (mean age 53.9 +/- 8.8 years), without coronary artery disease or its equivalents were enrolled. Endothelial function and blood levels of high sensitive C-reactive protein, interleukin-6, tumour necrosis factor-a, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), apolipoprotein-A1 (Apo-A1) and apolipoprotein-B100 (Apo-B100) were assessed in the acute infection phase and 1 month after recovery. Endothelial function was evaluated by brachial artery flow-mediated vasodilation (FMD). RESULTS: The intraclass correlation coefficients for intra- and interobserver agreement for FMD measurements were 0.98 (95% CI: 0.95-0.99) and 0.93 (95% CI: 0.83-0.97), respectively. FMD improved significantly 1 month after recovery (P < 0.001). Compared to the levels at 1 month, inflammatory markers, LDL cholesterol, LDL/HDL ratio, Apo-B100 and Apo-B100/Apo-A1 ratio were significantly higher. However, HDL and apo-A1 were significantly lower in the phase of acute infection. Change in FMD from baseline to 1 month after recovery correlated significantly only with the change in Apo-A1 (r = 0.35, P = 0.027). CONCLUSIONS: Acute infection causes transient endothelial dysfunction. It increases inflammatory markers and generates an atherogenic lipid profile. Among the parameters evaluated, only the change in Apo-A1 level was associated with acute infection-induced endothelial dysfunction.

Two-dimensional longitudinal strain and strain rate imaging for assessing the right ventricular function in patients with mitral stenosis.

BACKGROUND: Longitudinal two-dimensional strain (L2DS) deformation is a novel technique that evaluates global and regional right ventricular (RV) function. The aim of the study was to investigate the systolic function of RV by using this method in patients with pure mitral stenosis (MS). METHODS: Conventional echocardiography and L2DS analysis were performed in 45 MS patients and 21 healthy controls. For strain analysis apical four-chamber views were obtained and by using a software system, peak systolic strain and strain rates were calculated off-line in each segment. RESULTS: The mean global longitudinal strain (GLS) of the whole RV (-20 + or - 7 vs. -24 + or - 6%, P= 0.02) and mean GLS of the septum (-19 + or - 7 vs. -23 + or - 5%, P = 0.03) were significantly reduced in the MS patients. Compared with the control group no significant change was determined in the mean GLS of the RV free wall (RVFW). While the mean global longitudinal strain rates (GLSR) of the entire RV and RVFW were similar between the groups, a significant difference in the mean GLSR of the septum (-1.2 + or - 0.4 vs. -1.5 + or - 0.3 s(-1), P= 0.005) was determined in the patients with MS. A regional analysis demonstrated that MS patients had significantly reduced strain and strain rates in the basal and mid-segments of the septum, whereas only lower strain values in the basal RVFW. CONCLUSIONS: RV systolic function evaluated by L2DS analysis in patients with MS has shown decreased global and segmental systolic functions. (ECHOCARDIOGRAPHY 2010;27:525-533).

Assessment of Myocardial Perfusion by Angiographic Methods in Tortuous Coronary Arteries.

The relationship between coronary tortuosity (CorT) and tissue-level myocardial perfusion is not clear. We investigated tissue perfusion in myocardial territories supplied by tortuous coronary arteries. Among patients who had undergone coronary angiography, patients with reported CorT, those with ≥1 coronary artery were included in the study group (100 patients). The control group included patients with normal coronary arteries (100 patients). Thrombolysis In Myocardial Infarction frame count (TFC) and myocardial blush grade (MBG) were calculated for each coronary artery. Mean TFC was significantly higher in tortuous right coronary artery (RCA), left anterior descending (LAD) artery, and circumflex (Cx) artery compared to their non-tortuous counterparts (28.81 ± 6.463 vs 21.94 ± 3.328, P = .009; 43.28 ± 5.698 vs 36.17 ± 3.875, P = .006; 29.35 ± 4.111 vs 23.821 ± 2.639; P < .001, respectively). Mean MBG was also significantly lower in tortuous RCA, LAD, and Cx, compared to their normal counterparts (2.78 ± 0.417 vs 2.98 ± 0.155, P < .001; 2.74 ± 0.483 vs 2.97 ± 0.164, P < .001; 2.92 ± 0.277 vs 2.99 ± 0.110, P < .001, respectively). For each tortuous coronary artery, TFC was similar for every MBG category. Tortuous coronary arteries have higher TFC and lower MBG, suggesting impaired epicardial and microvascular coronary flow, when compared to normal coronary arteries.

Endothelial function in normotensive men with obstructive sleep apnea before and 6 months after CPAP treatment.

STUDY OBJECTIVES: To evaluate endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin (NTG)-induced dilation of the brachial artery with Doppler ultrasound in patients with obstructive sleep apnea (OSA) and impact of six months of continuous positive airway pressure (CPAP) treatment. DESIGN: A prospective, controlled, observational study. SETTING: Single-site, clinic-based. PATIENTS: Twenty-nine normotensive men with OSA (apnea-hypopnea index [AHI], mean +/- SD, 60.4 +/- 22.1-h), and 17 men without OSA (AHI 2.5 +/- 0.6-h). INTERVENTIONS: Six months of CPAP therapy in OSA patients. MEASUREMENTS AND RESULTS: FMD was lower in patients with OSA compared with in controls (7.19 +/- 1.78% vs 10.93 +/- 2.59%; P < 0.001) while NTG-induced vasodilation was similar in both groups (13.75 +/- 1.01% vs 14.25 +/- 1.83%; n.s.). An inverse relationship was found between FMD and AHI adjusted for age and body mass index (BMI) (beta = - 0.05, P < 0.001). Following 6 months of CPAP treatment in the OSA group, FMD was increased from 7.38 +/- 2.06% to 10.45 +/- 1.68; P = 0.001) in 20 patients compliant with the device whereas the corresponding values did not change in the non-user group (7.08 +/- 1.50% vs 7.26 +/- 1.01%). No significant changes were observed regarding the NTG-induced vasodilation after CPAP compared with the baseline values. CONCLUSIONS: Our results confirm the previous reports suggesting impaired endothelium-dependent FMD in OSA, and additionally document the sustained improvement in endothelial function after 6 months of CPAP treatment in complaint patients.

Facilitation of radial artery cannulation by periradial subcutaneous administration of nitroglycerin.

PURPOSE: To determine whether subcutaneous administration of nitroglycerin mixed with local anesthetic agent results in effective vasodilation of the radial artery, and whether this technique improves access time and decreases complications. MATERIALS AND METHODS: This prospective study consisted of two consecutive investigations. In the first (n = 30), only local anesthetic agent (prilocaine 2%) was injected into one arm, and local anesthetic agent plus 500 microg nitroglycerin was injected into the other arm. Radial artery diameters before and after injections were measured by ultrasonography. In the second, 33 patients received local anesthetic agent (prilocaine 2%) plus 500 microg nitroglycerin (group A) and 30 received only local anesthetic agent (group B) to determine whether the addition of nitroglycerin would improve radial artery access time, duration of angiography, perception of arterial pulse (ie, pulse score), number of punctures before successful cannulation, and complication rates. RESULTS: In the first investigation, radial artery diameter increased significantly in the nitroglycerin-treated arm (2.3 mm +/- 0.4 vs 2.9 mm +/- 0.5; P = .05). In the second, there were no significant differences between groups with respect to age, sex, duration of angiography, and number of punctures before cannulation. However, the pulse score increased and radial artery access time improved significantly after addition of nitroglycerin (79% vs 10% [P < .001] and 75 sec +/- 47 vs 132 sec +/- 100 [P = .005], respectively). Radial artery spasm and thrombosis were less frequently observed in group A, albeit to an insignificant extent (P = .39 and P = .49, respectively). CONCLUSIONS: Subcutaneous administration of nitroglycerin significantly increased radial artery diameter, which can lead to facilitation of catheterization of the radial artery for arteriography and interventions.

The relation between endothelial dependent flow mediated dilation of the brachial artery and coronary collateral development - a cross sectional study.

BACKGROUND: Endothelial dysfunction is thought to be a potential mechanism for the decreased presence of coronary collaterals. The aim of the study was to investigate the association between systemic endothelial function and the extent of coronary collaterals. METHODS: We investigated the association between endothelial function assessed via flow mediated dilation (FMD) of the brachial artery following reactive hyperemia and the extent of coronary collaterals graded from 0 to 3 according to Rentrop classification in a cohort of 171 consecutive patients who had high grade coronary stenosis or occlusion on their angiograms. RESULTS: Mean age was 61 years and 75% were males. Of the 171 patients 88 (51%) had well developed collaterals (grades of 2 or 3) whereas 83 (49%) had impaired collateral development (grades of 0 or 1). Patients with poor collaterals were significantly more likely to have diabetes (p = 0.001), but less likely to have used statins (p = 0.083). FMD measurements were not significantly different among good and poor collateral groups (11.5 +/- 5.6 vs. 10.4 +/- 6.2% respectively, p = 0.214). Nitroglycerin mediated dilation was also similar (13.4 +/- 5.9 vs. 12.8 +/- 6.5%, p = 0.521). CONCLUSION: No significant association was found between the extent of angiographically visible coronary collaterals and systemic endothelial function assessed by FMD of the brachial artery.

The association of elevated white blood cell count and C-reactive protein with endothelial dysfunction in cardiac syndrome X.

BACKGROUND: The aim of the study is to evaluate the association of inflammatory markers with endothelial function in syndrome X. METHODS: The study population consisted of 59 prospectively enrolled patients (28 women and 31 men; mean age, 50.29 +/- 6.48 years) and 51 healty control subjects (18 women and 33 men; mean age, 51.04 +/- 7.25 years). High-sensitive CRP (hs-CRP), white blood cell (WBC) count and its subtypes [neutrophil (N), lymphocyte (L) and monocyte (M)] were measured in each subject. Endothelial function was assessed with the brachial artery flow-mediated dilatation (FMD) technique. RESULTS: WBC counts and hs-CRP levels were significantly higher in patients who had syndrome X than in control subjects (7.53 +/- 1.52 x 10(9) cells/L versus 6.21 +/- 1.17 x 10(9) cells/L, P = 0.0001, and 3.11 +/- 0.63 mg/L versus 2.68 +/- 0.76 mg/L, P = 0.002, respectively). Neutrophil count and N/L ratio was significantly increased in syndrome X when compared with the control subjects (5.14 +/- 1.10 x 10(9) cells/L versus 4.11 +/- 0.76 x 10(9) cells/L, P = 0.0001 and 2.75 +/- 1.06 versus 2.37 +/- 0.65, P = 0.02, repectively). Other subtype counts were similar between the groups. FMD was impaired significantly in patients who had syndrome X in comparison with the control subjects (5.71 +/- 4.08% versus 16.02 +/- 4.13%, P = 0.0001). There was a significant correlation between hs-CRP levels and FMD measurements (r = -0.44; P = 0.0001). Furthermore, the correlation between WBC count and FMD measurements were also significant (r = -0.48; P = 0.0001). CONCLUSIONS: The present study showed that hs-CRP and WBC count were higher in patients with syndrome X than in control subjects. Furthermore, endothelial function was impaired significantly in patients with syndrome X.The increased levels of hs-CRP and WBC count may suggest that these markers may be used in clinical practice for the assessment of the inflammatory status of the endothelium in syndrome X.

Evaluation of the effect of non-ergot dopamine agonists on left ventricular systolic function with speckle tracking echocardiography.

OBJECTIVE: Parkinson's disease (PD) is a neurological disorder, and ergot dopamine agonists (DAs) are no longer usually preferred in the treatment due to the increased risk of valvular heart disease. Some recent studies have shown that commonly used non-ergot DA also increases the risk of heart failure. On the other hand, there are studies showing conflicting data about this relationship. The aim of the present study was to investigate the cardiac effects of non-ergot DAs in patients with PD using echocardiography. METHODS: Conventional echocardiography and two-dimensional (2D) speckle tracking strain echocardiography were performed to determine the possible systolic dysfunction prior to the development of apparent systolic heart failure. Ninety-one (55 male, 64±10 years) patients with PD were included in the study. Furthermore, 25 subjects with newly diagnosed PD and using no drug were enrolled as the control group. All patients were divided into groups according to their medication. Patients using levodopa were classified as Group 1 (36), levodopa+pramipexole as Group 2 (27), and levodopa+ropinirole as Group 3 (28). RESULTS: Left ventricle dysfunction with non-ergot DA use in patients with PD was not established with conventional echocardiographic evaluation. For 2D strain analysis, global longitudinal strain values were obtained as -18.5%, -18.5%, and -18.9% in the groups, respectively. Strain and strain rate values of the left ventricle were not different between the groups (p=0.816 and p=0.881, respectively). CONCLUSION: There was no significant relationship between left ventricular dysfunction and use of non-ergot DA in patients with PD. Similar results were obtained in strain analysis showing left ventricular subclinical dysfunction. Our study appears to confirm the safety of non-ergot DA in the point of heart failure risk. To our knowledge, this is the first study to evaluate the effect of this group of drugs on subclinical left ventricular systolic function.

Naproxen treatment prevents periprocedural inflammatory response but not myocardial injury after percutaneous coronary intervention.

BACKGROUND AND AIM: Recent studies have documented that elevation of C-reactive protein (CRP) levels after percutaneous coronary intervention (PCI) have been predictive of adverse outcome. This study was performed to test the hypothesis that preprocedural use of naproxen sodium is associated with a reduction in the extent of inflammatory response and myocardial injury after PCI. METHODS: Ninety-seven patients who were scheduled for elective PCI were randomized either for naproxen sodium (500 mg bid) (n:39, 75% male, 59+/-10 years) or control (n:58, 76% male, 60+/-10 years). All patients were troponin negative before the procedure. Blood samples for CRP, Troponin I and CK-MB were collected at baseline and after the procedure. RESULTS: The characteristics were similar between the two groups. After coronary stenting, the rise in CRP levels was significantly higher in controls than those treated with naproxen (DeltaCRP=6.4 mg/L in the controls and 0.43 mg/L in the naproxen group, p<0.0001). The incidence of any troponin I elevation or CK-MB elevation above upper limit of normal was not statistically different between groups. During follow up (12+/-2 months), major cardiac adverse events (death, myocardial infarction, and revascularization of target lesion) was similar between groups. CONCLUSION: Our data show that naproxen pretreatment leads to significant suppression in PCI related CRP elevation. However this improvement in CRP levels was not associated with any significant reduction in post-PCI myonecrosis.

The association between androgen levels and premature coronary artery disease in men.

OBJECTIVE: The relationship between androgens and the risk of development of coronary artery disease has not been clarified well. This study was planned to determine the relationship between serum androgen levels and premature development of coronary artery disease in men. METHODS: Sixty-nine men below 45 years of age with documented coronary artery disease (mean age 41.0+/-4.7) constituted the study group. Control group consisted of 56 men with similar age and normal coronary angiograms (mean age 41.3+/-3.8). Total and free testosterone, estradiol, and fasting plasma total, low-density lipoprotein, and high-density lipoprotein cholesterol, and triglyceride levels were measured, and compared between the two groups. RESULTS: Mean age, body mass index, and the frequency of hypertension were similar between the two groups; however, diabetes mellitus, smoking, hyperlipidemia, and family history of coronary artery disease were more frequent in the coronary artery disease group. Total and free testosterone levels of the patients with coronary artery disease were significantly lower than those of controls, whereas estradiol levels did not differ. Multivariate logistic regression analysis revealed that free testosterone levels (P=0.014; odds ratio=0.90; 95% confidence interval=0.87-0.99), hyperlipidemia (P<0.001; odds ratio=8.2; 95% confidence interval=3.17-21.0), and smoking (P=0.026; odds ratio=3.12; 95% confidence interval=1.15-8.48) were independent predictors of premature coronary artery disease. Moreover, using receiver operating characteristic analysis, patients with free testosterone levels below the cut-off value of 17.3 pg/ml had an adjusted 3.3-fold risk of developing premature coronary artery disease compared to those with free testosterone levels above the cut-off level (odds ratio=3.3; 95% confidence interval=1.57-6.87). CONCLUSION: A low level of free testosterone may be related to the development of premature coronary artery disease.