Association of endothelial dysfunction and cytotoxin-associated gene A-positive Helicobacter pylori in patients with cardiac syndrome X

Background: Existence of coronary endothelial dysfunction has been demonstrated in patients with cardiac syndrome X (CSX). In addition, Helicobacter pylorus (H. pylori) has been associated with CSX. We aimed to assess the possible association of endothelial dysfunction and cytotoxin-associated gene A-positive H. pylori (CagA+) infection in CSX patients. Methods: Fifty-six patients with CSX (23 male/33 female; age: 51.25 ± 8.86 years) who were anti-H. pylori IgG-positive [H. pylori(+)] and 24 CSX patients (7 male/17 female; age: 52.79 ± 9.88 years) who were H. pylori(â) were included. Also, anti-H. pylori IgG-positive patients were determined by the presence of IgG antibody to CagA. Levels of endothelin-1 (ET-1), E-selectin and intercellular adhesion molecule-1 (ICAM-1) were measured. Results: Endothelial dysfunction biomarkers were higher in H. pylori(+) than in H. pylori(â) patients (ET-1: 54.60 ± 25.39 vs. 42.59 ± 18.37 pg/ml, p = 0.04; E-selectin: 42.68 ± 14.26 vs. 31.72 ± 8.26 ng/ml, p = 0.001; ICAM-1: 339.68 ± 135.8 vs. 266.51 ± 125.1 ng/ml, p = 0.02). Among H. pylori(+) subjects, 28 cases were CagA(+) and 28 cases were CagA(â). There were significant differences in measured levels of E-selectin between CagA(+) and CagA(â) groups (48.00 ± 16.37 vs. 37.37 ± 9.37 ng/ml, p = 0.004). For ET-1 and ICAM-1 levels, the difference between CagA(+) and CagA(â) was insignificant (p = 0.174 and p = 0.07, respectively). Conclusion: High levels of endothelial dysfunction biomarkers are found in CSX patients with anti-CagA(+). These findings suggest the infection with CagA(+) H. pylori strain may play a role as a risk factor in development of CSX through provocation of endothelial dysfunction. Therefore, a long term follow up to investigate the outcomes of these patients is proposed. Keywords: Cardiac syndrome X, Endothelial dysfunction, Helicobacter pylori, Cytotoxin-associated gene

Patient’s Radiation Exposure in Coronary Angiography and Angioplasty: The Impact of Different Projections

Introduction: We aimed to determine angiography projections with lower Dose Area Product (DAP) rate by measuring the mean DAP and fluoroscopy times in coronary angiography (CAG) and percutaneous coronary intervention (PCI) and calculating DAP rate in different projections. Methods: DAP and fluoroscopy times were measured in all employed projections in real-time in 75 patients who underwent CAG or PCI by a single cardiologist in Madani Cardiovascular University Hospital (45 in CAG group and 30 in PCI group). DAP rate was calculated in both groups and in all projections. The projections with highest and lowest DAP rate were determined. Results: Mean DAP was 436.73±315.85 dGy×cm2 in CAG group and 643.26±359.58 dGy×cm2 in PCI group. The projection 40° LAO/0° had the highest DAP rate in CAG group (28.98 dGy×cm2/ sec) and it was highest in 20° RAO/30° CR in PCI group (29.83 dGy×cm2/sec). The latter projection was also the most employed projection in PCI group. Conclusion: The amount of radiation dose in this study is in consistent with the previous reports. Specific angiographic projections expose patients to significantly higher radiation and they should be avoided and replaced by less irradiating projections whenever possible