Biomarkers and Noncalcified Coronary Artery Plaque Progression in Older Men Treated With Testosterone.

ObjectiveRecent results from the Cardiovascular Trial of the Testosterone Trials showed that testosterone treatment of older men with low testosterone was associated with greater progression of noncalcified plaque (NCP). We evaluated the effect of anthropometric measures and cardiovascular biomarkers on plaque progression in individuals in the Testosterone Trial.MethodsThe Cardiovascular part of the trial included 170 men aged 65 years or older with low testosterone. Participants received testosterone gel or placebo gel for 12 months. The primary outcome was change in NCP volume from baseline to 12 months, as determined by coronary computed tomography angiography (CCTA). We assayed several markers of cardiovascular risk and analyzed each marker individually in a model as predictive variables and change in NCP as the dependent variable.ResultsOf 170 enrollees, 138 (73 testosterone, 65 placebo) completed the study and were available for the primary analysis. Of 10 markers evaluated, none showed a significant association with the change in NCP volume, but a significant interaction between treatment assignment and waist-hip ratio (WHR) (P = 0.0014) indicated that this variable impacted the testosterone effect on NCP volume. The statistical model indicated that for every 0.1 change in the WHR, the testosterone-induced 12-month change in NCP volume increased by 26.96 mm3 (95% confidence interval, 7.72-46.20).ConclusionAmong older men with low testosterone treated for 1 year, greater WHR was associated with greater NCP progression, as measured by CCTA. Other biomarkers and anthropometric measures did not show statistically significant association with plaque progression

Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study

Background and aimsWe aimed at investigating whether diabetes is associated with progression in coronary plaque components.MethodsWe identified 142 study subjects undergoing serial coronary computed tomography angiography. The resulting propensity score was applied 1:1 to match diabetic patients to non-diabetic patients for clinical risk factors, prior coronary stenting, coronary artery calcium (CAC) score and the serial scan interval, resulting in the 71 diabetes and 71 non-diabetes patients. Coronary plaque (total, calcified, non-calcified including fibrous, fibrous-fatty and low attenuation plaque [LAP]) volume normalized by total coronary artery length was measured using semi-automated plaque software and its change overtime between diabetic and non-diabetic patients was evaluated.ResultsThe matching was successful without significant differences between the two groups in all matched variables. The baseline volumes in each plaque also did not differ. During a mean scan interval of 3.4 ± 1.8 years, diabetic patients showed a 2-fold greater progression in normalized total plaque volume (TPV) than non-diabetes patients (52.8 mm3vs. 118.3 mm3, p = 0.005). Multivariable linear regression model revealed that diabetes was associated with normalized TPV progression (β 72.3, 95%CI 24.3-120.3). A similar trend was observed for the non-calcified components, but not calcified plaque (β 3.8, 95%CI -27.0-34.7). Higher baseline CAC score was found to be associated with total, non-calcified and calcified plaque progression. However, baseline non-calcified volume but not CAC score was associated with LAP progression.ConclusionsThe current study among matched patients indicates diabetes is associated with a greater plaque progression. Our results show the need for strict adherence of diabetic patients to the current preventive guidelines

Karyotypic studies of 100 mental retarded school children in Bushehr/Iran

Mental Retardation (MR) is a major complex medical and health problem affecting at least 3-4 percent of world total population. Genetic causes at both the chromosomal and molecular (DNA) level accounts for around 50 per cent of all MR cases. To investigate the prevalence of chromosomal abnormalities among mental retarded school age children of Bushehr, 100 mentally retarded school age pupils attending five special training schools aged 10-18 years old were studied using standard Q & G banding techniques. Karyotypes were prepared according to ISCN nomenclature at the 350 bands level. From 96 successfully karyotyped pupils, 25 chomosomal abnormalities were identified in which trisomy 21 was the most frequent abnormality (19 cases). The other observed abnormalities were inversion 9q (two cases), 46,XX+M(one case), 47,XXX/46,XX (one case), 46,XY+15/13 (one case) and one case of 47,XXY/46,XY. In conclusion, the overall frequency of chromosomal abnormalities among mental retarded children in Bushehr/Iran is similar to the majority of the West European and Middle Eastern countries and should attract similar health and medical attention & preventive approaches

Chronic stable angina patients with tortuous coronary arteries: Clinical symptoms and risk factors

&nbsp;&nbsp; BACKGROUND: Lack of information about clinical symptoms and risk factors of coronary artery tortuosity prompted us to perform this study to compare patients with and without coronary artery tortuosity. &nbsp;&nbsp; METHODS: Among patients with chronic stable angina who underwent coronary angiography, we selected 98 patients with coronary tortuosity. They were retrospectively compared with 98 chronic stable angina patients without tortuosity to determine clinical symptom, risk factors, and angiography findings via Gensini score. &nbsp;&nbsp; RESULTS: In this study, 68.4% of patients with coronary tortuosity were female (P = 0.001). The mean age in this group was 59.2 years compared to 53.9 years in patients without tortuosity (P = 0.001). More than 7 clinical symptoms despite less coronary stenosis were found in tortuous coronary group. Among cardiovascular risk factors, only diabetes was significantly more common in the non-tortuous coronary group. &nbsp;&nbsp; CONCLUSION: This study concluded that coronary tortuosity is more common in the elderly and among female gender. Diabetic patients may have less prevalence of tortuosity. Further studies may provide more data about the cause and better management of the higher number of clinical symptoms in these patients despite their less epicardial artery stenosis. &nbsp;&nbsp; &nbsp; &nbsp;&nbsp; Keywords: Coronary Tortusity, Clinical Symptoms, Risk Factors.</p

The correlation between early complications of percutaneous coronary intervention and high sensitive C-reactive protein

BACKGROUND: Increased incidence of cardiovascular diseases, especially coronary artery disease (CAD), during recent decades shows this disease entity to be the leading cause of death in the world. On the other hand many successes were achieved in the treatment of these diseases with new technology, which has its own side effects and threats for the patient. Among these new strategies is percutaneous coronary intervention (PCI), especially with stent implantation. Although coronary stents are effective in the treatment of dissection and prevention of restenosis, many side effects and even death have been observed, from 5-10% per year. Some studies showed that there is a relation between high sensitivity C-reactive protein (hs-CRP), as a laboratory marker for early detection of thrombosis and/or restenosis, and early complications of percutaneous coronary intervention. The aim of this study is to evaluate hs-CRP level in patients after PCI and to investigate if this can be a prognostic value for detection of early complication. METHODS: This is a descriptive, analytical study done in Shahid Chamran Hospital (Isfahan, Iran) in 2011&ndash;2012. 87 patients who had undergone PCI were studied. Their hs-CRP level was measured before and after the study. Moreover, early stent complications were detected during the first 24 hours after insertion. The data was recorded in a researcher-constructed checklist and analyzed by SPSS for Windows (version 18; SPSS Inc., Chicago, IL., USA). RESULTS: The mean &plusmn; SD of hs-CRP level in patients with and without complication were 1.36 &plusmn; 0.97 and 3.09 &plusmn; 1.8, respectively. According to Student&rsquo;s t-test, the hs-CRP level in patients with early complications was higher than patients without early complications of stent implantation; the difference was statistically significant (P &lt; 0.001). CONCLUSION: The hs-CRP serum concentrations of patients with, and without early stent complications were significantly different. According to the control diseases center (CDC) guideline, patients with a high level of hs-CRP need special care and attention. &nbsp; Keywords: High Sensitivity C-reactive Protein (hs-CRP), Percutaneous Coronary Intervention (PCI) Complication&nbsp;</p

Heart rate recovery in exercise test in diabetic patients with and without microalbuminuria

BACKGROUND: Diabetes mellitus (DM) has a lot of complications such as macrovessel and microvessel disease. Another complication of DM is cardiac autonomic neuropathy (CAN), which have effect on automatic nervous system of heart. Failure in heart rate slowing after exercise is a presentation of this abnormality.METHODS: We selected diabetic patients and divided them to case and control group based on microalbuminuria. Case group comprised of diabetic patients with microalbuminuria and control group included those without microalbuminuria. Patients in both groups exercised on treadmill using Bruce protocol and heart rate was measured in first and second minutes in the recovery period. RESULTS: We selected 35 patients with microalbuminuria (case group) and 35 without microalbuminuria (control group) among diabetic patients. No statistically significant difference was seen in sex and age between case and control groups. Heart rate recovery in the first minute of recovery in the case and control groups did not show significant difference; but in the second minute of recovery, it was significantly higher in control group (97 &plusmn; 19.4 vs. 101.9 &plusmn; 12.4 beat per minute, P = 0.04). CONCLUSION: In this study we evaluated the heart rate recovery or deceleration in diabetic patients with albuminuria and without microalbuminuria in recovery phase after exercise test. We found out that heart rate recovery at the second minute in the case and control groups has statistically significant difference but at the first minute, it did not. &nbsp; Keywords: Diabetes Mellitus, Exercise Test, Heart Rate Recovery</div

Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement.

Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03-1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05-1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present

Diagnostic accuracy of Visipaque enhanced coronary computed tomographic angiography: a prospective multicenter trial.

BackgroundAlthough several studies have shown promise for noninvasive angiography by coronary computed tomographic angiography (CCTA), few prospective multicenter trials have been conducted. This study evaluated the diagnostic accuracy of Visipaque enhanced CCTA to detect obstructive coronary stenosis compared with quantitative coronary angiography (QCA).Patients and methodsThree sites prospectively enrolled 77 patients (58.1% men, 54 years) with chest pain referred for invasive coronary angiography (ICA). Patients underwent CCTA (Lightspeed VCT/Visipaque 320) before ICA. CCTAs were graded on a 15-segment American Heart Association model by a CCTA core lab with blinded readers for the presence of obstructive stenosis (&gt;50% or &gt;70%); ICAs were independently graded for %stenosis by QCA, considered the reference standard. The efficacy of CCTA was assessed including all vessel segments for per-patient and per-vessel analyses.ResultsA total of 46 more than 50% stenoses in 27 (35%) patients, and 31 more than 70% stenoses in 20 (26%) patients, were identified by QCA. Per-patient and per-vessel efficacy of CCTA compared with QCA yielded sensitivities of 85% and specificities of 90 and 95%, respectively.ConclusionThis study shows the high accuracy of CCTA to reliably detect more than 50% and more than 70% stenoses in low-probability to intermediate-probability chest pain patients being referred for ICA. The high negative predictive values observed (92-100%) indicate that CCTA is also an effective noninvasive alternative to exclude obstructive coronary stenosis

Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement.

Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03-1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05-1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present