Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome.

Aims and objectives Pregnancy associated plasma protein-A (PAPP-A), a metalloproteinase plays a pivotal role in the pathogenesis of atherosclerosis. Recent studies have reported that elevated levels of PAPP-A, signal the onset of acute coronary syndrome (ACS). We, therefore, proposed to study the analytical competence of PAPP-A in patients admitted to the emergency department with chest pain and finally diagnosed as ACS. Methods and results Pregnancy associated plasma protein-A was measured using enzyme-linked immunosorbent assay (ELISA) in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as Non-cardiac chest pain (NCCP). Elevated levels of PAPP-A were observed in patients diagnosed as ACS on comparison with the controls. Receiver operator characteristic (ROC) curve analysis showed PAPP-A to be a good discriminator between ischaemic and non-ischaemic patients. The area under the curve was found to be 0.904, 95% CI (0.874–0.929) with 90% sensitivity and 85% specificity (P< 0.0001). The cut-off value from the ROC curve was 0.55 μg/mL above which PAPP-A was considered to be positive. Conclusion Pregnancy associated plasma protein-A seems to be a promising biomarker for identification and risk stratification for patients with ACS

Electrophysiological studies with repeated episodes of ischaemia on isolated rat heart

772-776In order to know the beneficial effect of preconditioning electrocardiography recording were used as tool to assess myocardial malfunction and for this perfusion apparatus was setup. Electrophysiological changes for each heart were recorded during perfusion at 1,2,3,5, 10, 20, 30 and 60 min of global ischaemia and also during the equal period of reperfusion. Recordings demonstrate that the normal rate was about 240 beats/min with an "R" amplitude of 4mV. During the first ischaemic episode of 1 min the rate was 180 ± 15 beats/min (counted as per 'R' wave deflection), at 2 mins it was 60 ± 6 beats/min, at 3 min the rate was 40 ± 2 beats/min, at 5 mins of ischaemia it was 90 ± 6 beats/min, at 10 min 20 ± 2 beats/min, at 20 min the rate was 60 ± 4 beats/min, and at 30 mins there were nil beats/min. The recovery during all the periods of reperfusion was restored to between 120 and 180 beats/min in all episodes. Further after a 60 min of ischaemia the heart stopped to elicit any mechanical response. It is concluded that short term ischaemia can induce a resilient effect on the beating of the heart after a few episodes as seen subsequent to 1 and 2 min of ischaemia. Further, preconditioning was beneficial up to 30 min, beyond which the heart showed signs of fatigue and irreversible injury

Serum E-selectin levels in Indian children and adolescents: relation to clinical and biochemical parameters.

Background: An adverse pattern of blood lipids and atherosclerosis begin in childhood. Unfortunately, data for children and adolescents, particularly those in the Indian population, are scarce. The present study aims to evaluate the levels of serum E-selectin in Indian children and adolescents and its correlation with anthropometric and biochemical parameters. Methods: The study groups included 338 school children and adolescents. There were 96 obese children, 97 overweight children and 42 children with congenital heart disease who were compared with 103 normal controls, aged 10–17 years. Serum E-selectin and serum leptin were analyzed with enzyme–linked immunosorbent assay kits. Lipid profile and fasting glucose were analyzed using an autoanalyzer. Results: Serum E-selectin levels were significantly increased in obese (65.3 ± 8.39 ng/mL) and overweight (56.01 ± 6.96 ng/mL) subjects (P < 0.001). However, these levels were lower in children with congenital heart disease (40.99 ± 6.54 ng/mL) than in controls (43.79 ± 6.71 ng/mL). Conclusion: Serum E-selectin levels showed good positive association with body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, leptin, total cholesterol, triglycerides and low-density lipoprotein cholesterol and showed negative correlation with fasting glucose and no significant association with high-density lipoprotein cholesterol. These findings indicate that higher E-selectin levels can induce endothelial activation and play an essential role in the earliest stage of the atherosclerotic process in obese and overweight children. Regular camps at schools to counsel the identified overweight and obese children and to encourage physical exercise would help to reduce the risk of these children being prone to major cardiovascular anomalies in adulthood

Hybrid stage I palliation for hypo-plastic left heart condition without a hybrid suite: Suggestions for developing nations

Cardiac hybrid procedures are performed in modern, spacious, and highly equipped hybrid suites in developed countries. Organizing such expensive suites in countries with an emerging economy is difficult from both a financial and logistics point of view. We share our experience of safely performing a Hybrid stage I palliation procedure for Aortic atresia with ventricular septal defect on a 2-month-old infant weighing 3.35 kg using minimal resources in a conventional catheterization laboratory

Increased serum concentrations of Soluble CD40 Ligand as a prognostic marker in patients with Acute Coronary Syndrome.

CD40-CD40L interaction plays a significant role in the pathogenesis of atherosclerosis and coronary artery disease. The clinical predictive value of Soluble CD40 Ligand (sCD40L) was evaluated in patients with Acute Coronary Syndrome (ACS) and Non-Cardiac Chest Pain (NCCP). The levels of serum soluble CD 40 ligand were measured by ELISA in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as NCCP. The levels of sCD40L were significantly increased in patients with ACS when compared to controls and NCCP. Receiver Operator Characteristic (ROC) Curve analysis showed sCD40L to be a good discriminator between patients with ischemic heart disease and patients without ischemic heart disease. The area under the curve was found to be 0.940 with 95% CI (0.915 to 0.960) (P<0.0001). The cut off value from the ROC curve was 2.99 ng/ml, above which sCD40L was considered to be positive. Combined assessment of sCD40L, Troponin I and CK-MB enhanced the risk prediction and early classification of patients. sCD40L seems to be a promising biomarker for identification and risk stratification for patients with acute coronary syndrome

Heart fatty acid binding protein (H-FABP) as a diagnostic biomarker in patients with acute coronary syndrome.

Aims and objectives Diagnosis of myocardial ischaemia at an early stage in the emergency department is often difficult. A recently proposed biomarker, heart fatty acid binding protein (H-FABP) has been found to appear in the circulation superior to that of cardiac troponins in the early hours of acute coronary syndrome. We proposed to evaluate the levels of H-FABP and ascertain its utility as an early biomarker for acute coronary syndrome (ACS). Methods and results The present study was carried out in 485 subjects, of whom 297 were diagnosed as patients with ACS, 89 were diagnosed as non-cardiac chest pain (NCCP) and 99 people served as healthy controls. H-FABP levels were measured in comparison with standard markers such as troponin I and CK-MB in all subjects enrolled in the study. The levels of H-FABP were significantly raised in patients when compared to controls and NCCP (P < 0.001). Receiver Operator Characteristic Curve (ROC) analysis showed H-FABP to be a good discriminator between patients with ischaemic heart disease and patients without ischaemic heart disease. The area under the curve was found to be 0.965 with 95% CI (0.945–0.979). The cut-off value above which H-FABP can be considered positive was found to be 17.7 ng/ml. Conclusion H-FABP is a promising biomarker for the early detection of patients with acute coronary syndrome