The relationship between serum uric acid levels and angiographic severity of coronary heart disease

Background: Many studies have shown that the serum uric acid (SUA) level is associated with atherosclerosis. Aim: To determine the relationship between the SUA level and the presence and severity of coronary heart disease (CHD). Methods: A total of 705 patients who underwent coronary angiography were included in this study. All patients were assessed for the presence of cardiovascular risk factors and ongoing medications. SUA levels were measured in all patients before the procedure after 12 h of fasting. The severity of CHD was assessed by the SYNTAX score. The independent association between the SUA and the severity of CHD was statistically evaluated using IBM SPSS Statistics 21 for Windows. Results: The mean age of the study population was 60.2 +/- 11.0 years. 252 were female (35.7%) and 453 were male (64.3%). Of the patients, 59.0% had significant CHD, 34.6% had diabetes mellitus, 67.7% had hypertension, 55.3% had hyperlipidaemia, and 45.4% were current smokers. The mean SYNTAX score was 10.6 +/- 12.9. According to the SYNTAX score, 289 of the patients (41%) had normal coronary arteries and non-significant CHD (controls, SYNTAX score: 0), 236 of the patients (33.5%) had mild CHD (SYNTAX score: 1-22), 97 (13.8%) had moderate CHD (SYNTAX score: 23-32), and 83 (11.8%) had severe CHD (SYNTAX score: >= 33). The mean SUA values were 5.3 +/- 1.5 mg/dL in the control group, 5.6 +/- 1.4 mg/dL in the mild CHD group, 6.2 +/- 1.6 mg/dL in the moderate CHD group, and 6.5 +/- 1.7 mg/dL in the severe CHD group. According to Spearman's rho analysis, a positive correlation between the SUA levels and the SYNTAX score was determined to be statistically significant (p < 0.001, r = 0.239; p = 0.002, r = 0.148 in men; p = 0.001, r = 0.204 in women). Conclusions: In this study, we found a positive correlation between the SUA level and the SYNTAX score. Therefore, this routine biochemical test can be used for the evaluation of the severity of CHD besides other risk factors in clinical practice. However, larger scale randomised studies are needed to show the effects of SUA on the severity of CHD

25-Hydroxy vitamin d levels and endothelial vasodilator function in normotensive women

Introduction: Vitamin D was shown to be related to endothelial function and bloodpressure. Reactive hyperaemia index (RHI) measurement by pulse arterial tonometryis a new method to evaluate vasodilator function of endothelium. We aimedto evaluate the relationship between vitamin D levels and RHI in women.Material and methods: We enrolled 56 normotensive, nonsmoker, normolipidemicand normoglycemic women, (23 with 25-OH-vita min D levels > 20 µg/l,and 33 with values lower than 20 µg/l). The cardiologist who was blind for vitaminD results executed measurements by pulse arterial tonometry. The measurementwas performed on the lying patient with pre- and post-occlusion measurementsof RHI by digital sensors placed on each index finger, by 5 minintervals. Pulse amplitudes were recorded, pre-occlusion and post-occlusionratio was compared by the software of device. Stepwise linear regression andmultiple regression analyses were performed to evaluate predictors of endothelialfunction.Results: The low vitamin D group had a lower RHI value than the normal vitaminD group (p = 0.042). In regression analysis, positive predictors of RHI wereserum 25-OHD (ß = 0.401; 95% CI 0.010-0.042, p = 0.002), serum albumin(ß = 0.315; 95% CI 0.286-2.350, p = 0.013), and, inversely, serum calcium(ß = –0.247; 95% CI (–1.347)-(–0.010), p = 0.047).Conclusions: Serum 25-hydroxy vitamin D was significantly related to endothelialfunctions measured as RHI, even in healthy non-smoker women

Zależność między stężeniem kwasu moczowego w surowicy a nasileniem zmian angiograficznych w chorobie wieńcowej

Background: Many studies have shown that the serum uric acid (SUA) level is associated with atherosclerosis. Aim: To determine the relationship between the SUA level and the presence and severity of coronary heart disease (CHD). Methods: A total of 705 patients who underwent coronary angiography were included in this study. All patients were assessed for the presence of cardiovascular risk factors and ongoing medications. SUA levels were measured in all patients before the procedure after 12 h of fasting. The severity of CHD was assessed by the SYNTAX score. The independent association between the SUA and the severity of CHD was statistically evaluated using IBM SPSS Statistics 21 for Windows. Results: The mean age of the study population was 60.2 ± 11.0 years. 252 were female (35.7%) and 453 were male (64.3%). Of the patients, 59.0% had significant CHD, 34.6% had diabetes mellitus, 67.7% had hypertension, 55.3% had hyperlipidaemia, and 45.4% were current smokers. The mean SYNTAX score was 10.6 ± 12.9. According to the SYNTAX score, 289 of the patients (41%) had normal coronary arteries and non-significant CHD (controls, SYNTAX score: 0), 236 of the patients (33.5%) had mild CHD (SYNTAX score: 1–22), 97 (13.8%) had moderate CHD (SYNTAX score: 23–32), and 83 (11.8%) had severe CHD (SYNTAX score: ≥ 33). The mean SUA values were 5.3 ± 1.5 mg/dL in the control group, 5.6 ± 1.4 mg/dL in the mild CHD group, 6.2 ± 1.6 mg/dL in the moderate CHD group, and 6.5 ± 1.7 mg/dL in the severe CHD group. According to Spearman’s rho analysis, a positive correlation between the SUA levels and the SYNTAX score was determined to be statistically significant (p &lt; 0.001, r = 0.239; p = 0.002, r = 0.148 in men; p = 0.001, r = 0.204 in women). Conclusions: In this study, we found a positive correlation between the SUA level and the SYNTAX score. Therefore, this routine biochemical test can be used for the evaluation of the severity of CHD besides other risk factors in clinical practice. However, larger scale randomised studies are needed to show the effects of SUA on the severity of CHD.Wstęp: W wielu badaniach wykazano, że stężenie kwasu moczowego w surowicy (SUA) wiąże się z występowaniem miażdżycy. Cel: Celem niniejszej pracy było określenie zależności między stężeniem SUA a występowaniem i nasileniem choroby wieńcowej (CHD). Metody: Do badania włączono ogółem 705 chorych poddanych koronarografii. Wszystkich uczestników badania oceniono pod kątem obecności czynników ryzyka sercowo-naczyniowego i stosowanej farmakoterapii. Przed koronarografią u wszystkich chorych zmierzono stężenie SUA na czczo (po 12 godzinach nieprzyjmowania pokarmów). Nasilenie CHD określano za pomocą skali SYNTAX. Niezależny związek między stężeniem SUA a nasileniem CHD oceniano statystycznie przy użyciu oprogramowania IBM SPSS Statistics 21 do systemu Windows. Wyniki: Średnia wieku badanej grupy wynosiła 60,2 ± 11,0 lat. Wśród uczestników były 252 (35,7%) kobiety i 453 (64,3%) mężczyzn. U 59,0% osób rozpoznano istotną CHD, u 34,6% — cukrzycę, u 67,7% — nadciśnienie tętnicze, u 55,3% — hiperlipidemię, a 45,4% pacjentów paliło tytoń. Średnia punktacja w skali SYNTAX wynosiła 10,6 ± 1,9. Zgodnie z punktacją w skali SYNTAX 289 (41%) chorych miało prawidłowe tętnice wieńcowe i nieistotną CHD (grupa kontrolna, punktacja w skali SYNTAX: 0), 236 chorych (33,5%) — łagodną CHD (punktacja w skali SYNTAX: 1–22), 97 chorych (13,8%) — umiarkowaną CHD (punktacja w skali SYNTAX: 23–32), a 83 (11,8%) osób — ciężką CHD (punktacja w skali SYNTAX: ≥ 33). Średnie stężenie SUA wynosiło 5,3 ± 1,5 mg/dl w grupie kontrolnej, 5,6 ± 1,4 mg/dl w grupie z łagodną CHD, 6,2 ± 1,6 mg/dl w grupie z umiarkowaną CHD i 6,5 ± 1,7 mg/dl w grupie z ciężką CHD. Na podstawie analizy współczynnika rho Spearmana wykazano, że dodatnia korelacja między stężeniem SUA a punktacją w skali SYNTAX była statystycznie istotna (p &lt; 0,001; r = 0,239; u mężczyzn: p = 0,002; r = 0,148; u kobiet: p = 0,001, r = 0,204). Wnioski: W niniejszym badaniu stwierdzono dodatnią korelację między stężeniem SUA a punktacją w skali SYNTAX. Zatem to rutynowe badanie biochemiczne może być stosowane w praktyce klinicznej w celu oceny stopnia ciężkości CHD obok innych czynników ryzyka. Potrzebne są jednak badania z randomizacją obejmujące większą grupę chorych, aby wykazać wpływ stężenia SUA na nasilenie CHD

Successful Management of Coronary Artery Rupture with Stent-Graft: A Case Report

Perforation of coronary arteries is a relatively rare yet life-threatening complication of percutaneus coronary interventions and is encountered in approximately 0.5% of these procedures. According to the type of coronary perforation, various methods of correction are employed, ranging from conservative approach to emergency cardiac surgery. Coronary stent-grafts are composed of two metal stents and a polytetrafluoroethylene layer between them. Advent of such stents enabled efficient endovascular repair of coronary artery perforation. We present a case of coronary artery perforation which had occurred during stent implantation for the treatment of a bridged segment in the distal portion of the left anterior descending artery. This perforation was successfully managed by implanting a stent-graft

Cardiac autonomic function and global left ventricular performance in autoimmune eauthyroid chronic thyroiditis: is treatment necessary at the euthyroid stage?

Objective: Autoimmune chronic thyroiditis (ACT) is characterized by lymphocyte infiltration in the thyroid gland and the presence of antithyroid antibodies in serum. Medical treatment does not affect antibody levels and treatment decision is not definite yet for the euthyroid patients. We aimed to evaluate cardiac autonomic function and global left ventricular performance in autoimmune euthyroid chronic thyroiditis and determine the need for medical treatment. Method: We studied 30 ACT patients and 25 healthy control subjects. Cardiac autonomic function is evaluated by heart rate recovery (HRR). Global left ventricular performance is evaluated by two-dimensional echocardiography and pulsed-wave tissue Doppler echocardiography. Results: There was no difference between patients and controls with respect to clinical and biochemical parameters except hemoglobin (13.67 +/- 1.25 g/dL, 14.51 +/- 1.35 g/dL, p:0.047) and low density lipoprotein (120.71 +/- 24.91 mg/dL, 100.55 +/- 14.73 mg/dL, p: 0.003). Tei index was significantly higher in ACT group (0.521 +/- 0.074, 0.434 +/- 0.034, P < 0.0001). E'/A' was found to be significantly lower (1.234 +/- 0.42, 1.750 +/- 0.291, P < 0.0001) and E/E' was found to be higher than the controls (8.482 +/- 0.449, 6.039 +/- 0.209, P < 0.0001). HRR was significantly lower than the controls (20 +/- 4 BPM, 30 +/- 8 BPM, P < 0.0001). Conclusion: Although left ventricular performance is found to be normal by conventional echocardiographic methods, it is found to be impaired when Tei index and tissue Doppler parameters are used. Cardiac autonomic function is also impaired in ACT patients. As a result of these cardiac changes, medical treatment may be considered earlier, even at the euthyroid stage. (Echocardiography 2011;28:15-21)