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ABSTRACT: Chest pain in a young person without cardiovascular risk factors is usually attributed to noncoronary causes; however, if the history suggests ischemic pain, the potential presence of unusual cardiovascular abnormalities should not be disregarded. The present case describes a young man with solitary congenital ostial atresia of right coronary artery, who to our knowledge is only the second case in the medical literature. Manifestation of ischemic symptoms in a relatively advanced age in patients with coronary artery atresia may mislead clinicians to interpret them as signs of atherosclerotic coronary artery disease. Therefore congenital coronary artery atresia should be a part of the differential diagnosis particularly in young patients with ischemic symptoms and no cardiovascular risk factors.
Journal of Cardiology 10/2009; 54(2):335-8. · 1.28 Impact Factor
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ABSTRACT: To investigate the association of estrogen receptor-alpha PvuII and BtgI polymorphisms with angiographic presence and severity of coronary artery disease (CAD).
Our cross-sectional study included 140 patients with >or=50% coronary stenoses (CAD group) and 47 patients with normal angiograms (CAD-free group) (total n=187, age 59.6+/- 13.2 years; 66 women). PvuII and BtgI genotype and allele distributions were determined by standard method of polymerase chain reaction and restriction fragment length polymorphism. The CAD subgroups by the number of diseased vessels were also defined. Variable associations and group differences were analyzed by independent t test, one-way ANOVA, Pearson's Chi-square, Spearman's correlation tests and logistic regression analyses.
While there was no association between PvuII polymorphism and angiographic CAD (p=0.384), BtgI polymorphism was more prevalent in CAD-free group (23.4% vs. 10% (CAD group), OR=2.75, 95% CI=1.150 to 6.579, p=0.019). This difference was more pronounced in women (28.6% vs. 4.4%; OR=8.6; 95% CI=1.564 to 47.303; p=0.005) compared to men (p=0.391). Logistic regression analysis confirmed BtgI polymorphism as the most important predictor for a normal coronary angiogram among parameters such as body mass index, diabetes and age (OR 8.13, 95% CI 1.257 to 52.627, p=0.028). However, no significant association between BtgI polymorphism and the number of stenotic arteries was detected.
ESR1 PvuII polymorphism is not associated with angiographically significant CAD. ESR1 BtgI polymorphism is strongly associated with the presence of normal coronary angiograms in women, which suggests protective effect. Further confirmation of these findings is required.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 09/2009; 9(4):267-72. · 0.44 Impact Factor
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ABSTRACT: Polymorphonuclear leukocytes play a central role in all stages of the atherothrombotic inflammatory process. The atherothrombotic activity of polymorphonuclear leukocytes is exerted by mediators such as myeloperoxidase (MPO). Although the role of MPO has been studied with respect to the development of adverse cardiac events in acute coronary syndromes (ACS), the association of this molecule with effectiveness of reperfusion in patients receiving thrombolysis is not yet known. The study population consisted of a total of 158 patients with acute coronary syndromes. Final diagnosis was ST-segment elevation myocardial infarction in 86 patients, 80 of whom received thrombolysis. Blood samples were drawn at presentation of the patients and serum myeloperoxidase levels were measured. Reperfusion was defined in terms of electrocardiographic ST-segment resolution. The serum levels of MPO were found to be correlated with rates of in-hospital adverse events including death (P < 0.001), reinfarction (P < 0.001), recurrent ischemia (P < 0.001), arrhythmias (P < 0.001), clinical heart failure (P < 0.001), and cardiogenic shock (P < 0.001). There was a significant difference in serum MPO levels between subjects with three-vessel disease and two- or one-vessel disease (P < 0.001). Pre-lytic serum high-sensitivity C-reactive protein levels in patients with successful reperfusion were lower than in patients with failed reperfusion (P < 0.001). Analysis of patients with ST segment elevation myocardial infarction receiving thrombolytic therapy revealed that pre-lytic serum MPO levels in patients with successful reperfusion were significantly lower than those of patients with failed reperfusion (P < 0.001). In the present study, serum MPO levels were found to be a strong predictor of response to thrombolytic treatment in patients with ST-segment elevation myocardial infarction. Therefore the level of inflammatory activity in acute coronary syndromes seems to influence the effectiveness of fibrinolysis.
Heart and Vessels 08/2009; 24(4):247-53. · 2.05 Impact Factor
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ABSTRACT: Myocardial damage mediated by oxidative stress during acute myocardial infarction (MI) has been suggested as an obstructive factor on recovery after an MI. 8-Hydroxydeoxyguanosine (8-OHdG) is a marker for oxidative DNA damage; superoxide dismutase (SOD) and glutathione peroxidase (G-Px) are major antioxidant enzymes. We determined changes in the plasma level of 8-OHdG and activities of SOD and G-Px in patients with MI and examined the relations between those changes and other cardiac markers.
Blood samples were taken at the beginning of the therapy, on the third day of hospitalization, and on the day patients were discharged home. Plasma level of 8-OHdG and SOD and G-Px activities were measured by enzyme-linked immunosorbent assay and spectrophotometric kits, respectively.
8-Hydroxydeoxyguanosine level at the beginning of the therapy was found to be decreased on the third day of therapy and on the day patients were discharged home. With respect to the treatment way, 8-OHdG level was found to be slightly decreased on the third day of therapy and then remained stable in the group treated with thrombolytic agents. However, 8-OHdG level was found to be sharply decreased on the third day of therapy in the group that underwent primary percutaneous transluminal coronary angioplasty. No significant relations were determined between those measured parameters and serum levels of cardiac markers.
Although not correlated with other cardiac markers, plasma level of 8-OHdG shows a decrease after reperfusion therapy in patients with MI, and primary percutaneous transluminal coronary angioplasty seems much more effective than thrombolytic therapy for providing a low level of 8-OHdG.
Journal of Investigative Medicine 03/2009; 57(4):595-9. · 1.96 Impact Factor
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ABSTRACT: Objective: To investigate the association of estrogen receptor-α PvuII and BtgI polymorphisms with angiographic presence and severity of coronary artery disease (CAD).Methods: Our cross-sectional study included 140 patients with ≥50% coronary stenoses (CAD group) and 47 patients with normal angiograms (CAD-free group) (total n=187, age 59.6±13.2 years; 66 women). PvuII and BtgI genotype and allele distributions were determined by standard method of polymerase chain reaction and restriction fragment length polymorphism. The CAD subgroups by the number of diseased vessels were also defined. Variable associations and group differences were analyzed by independent t test, one-way ANOVA, Pearson's Chi-square (χ2), Spearman’s correlation tests and logistic regression analyses. Results: While there was no association between PvuII polymorphism and angiographic CAD (p=0.384), BtgI polymorphism was more prevalent in CAD-free group (23.4% vs. 10% (CAD group), OR=2.75, 95% CI=1.150 to 6.579, p=0.019). This difference was more pronounced in women (28.6% vs. 4.4%; OR=8.6; 95% CI=1.564 to 47.303; p=0.005) compared to men (p=0.391). Logistic regression analysis confirmed BtgI polymorphism as the most important predictor for a normal coronary angiogram among parameters such as body mass index, diabetes and age (OR 8.13, 95% CI 1.257 to 52.627, p=0.028). However, no significant association between BtgI polymorphism and the number of stenotic arteries was detected. Conclusion: ESR1 PvuII polymorphism is not associated with angiographically significant CAD. ESR1 BtgI polymorphism is strongly associated with the presence of normal coronary angiograms in women, which suggests protective effect. Further confirmation of these findings is required.
Anadolu Kardiyoloji Dergisi. 01/2009;
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ABSTRACT: We evaluated the plasma homocysteine (tHcy) and nitric oxide metabolites (nitrite plus nitrate; NOx) data of consecutive patients undergoing diagnostic coronary angiography (n=79) with respect to the presence and severity of coronary artery disease (CAD), the presence of acute coronary syndromes (ACS), and the risk status of patients. Hyperhomocysteinemia (>15 micromol/L) was detected in 11% of the controls (n=19) and 37% of CAD patients (n=60) (p=0.03). Plasma tHcy in CAD patients was not significantly different from controls, but those with 3-vessel disease had a significantly higher tHcy concentrations than did controls (p=0.049). The patients with 3-vessel disease and ACS had the highest concentrations of tHcy (16.9 +- 4.4 micromol/L), and the difference from the ACS patients with 1- and 2-vessel involvement was significant (p=0.03). In patients with 1-vessel involvement, tHcy was correlated with NOx (r=0.62, p=0.005); in patients with 2- and 3-vessel disease this correlation could not be observed. The high-risk patients (n=51) had a higher mean number of vessel involvement and tHcy (p<0.001, p<0.05, respectively) but lower NOx (p<0.05) when compared to the low-risk patients (n=28). It appears that in the early stages of atherosclerosis hyperhomocysteinemia causes an increase in NOx production, but with progression of the disease this compensatory increase disappears.
Acta medica Okayama 03/2006; 60(1):35-41. · 0.84 Impact Factor
