Effects of administration of omega-3 fatty acids with or without vitamin E supplementation on adiponectin gene expression in PBMCs and serum adiponectin and adipocyte fatty acid-binding protein levels in male patients with CAD

Objective: Adiponectin is a unique anti-atherogenic adipocytokine. Regulation of adiponectin secretion is dysfunctional in cardiovascular diseases. The current trial study assessed the effects of omega-3 fatty acids with or without vitamin E on adiponectin gene expression in peripheral blood mononuclear cells and serum adiponectin and adipocyte fatty acid-binding protein (A-FABP; also called ap2 and FABP4) levels in patients with coronary artery disease (CAD). Methods: This randomized, double-blind, placebo-controlled trial included 67 male patients with CAD. First of the four group of participants received 4 g/day omega-3 fatty acids plus 400 IU/day vitamin E (OE), second group 4 g/day omega-3 fatty acids plus vitamin E placebo (OP), or both omega-3 fatty acid and vitamin E placebos (PP) for 8 weeks. Adiponectin gene expression and serum adiponectin and FABP4 levels were evaluated. Results: The combination of omega-3 fatty acids and vitamin E in patients with CAD affected their serum adiponectin and FABP4 levels and the adiponectin/FABP4 ratio significantly. In the OP group, serum adiponectin levels did not change significantly. Consumption of omega-3 fatty acids with and without vitamin E had no significant effect on adiponectin gene expression. Conclusion: Omega-3 fatty acids with or without vitamin E improve adiponectin levels in patients, without any significant changes in adiponectin gene expression. This nutritional intervention may prevent complications in patients with CAD because of increased adiponectin levels. (Anatol J Cardiol 2015; 15: 981-9

BRUCELLA ENDOCARDITIS IN IRANIAN PATIENTS: COMBINED MEDICAL AND SURGICAL TREATMENT

Brucella endocarditis is a Tare but serious complication ofbrucellosis and is the main cause of death reuuedto thisdisease: Itis not rare in the endemic areas and aaualiy accounts for up to 8~lO% ofendocarditis infections: We report seven adult cases of brucella endocarditis in lmam-Khorneini Hospual: Contrary to previous independent reports, female patients were not rare in this study and accountedfor three out ofseven. Four patients were cared for by combined medical and surgical treatment and were recovered Three of the patients that did not receive the combined theraPl could not he saved This report confirms the necessity of prompt combined medical and surgical treatment ofbrucella endocarditis

Transcatheter Closure of Patent Ductus Arteriosus: Initial Study on Echocardiographic Estimation of Device Size

Background: Transcatheter occlusion of the patent ductus arteriosus (PDA) is a minimally invasive treatment. The appropriate device size is chosen based on the angiographic measurement of the PDA. The current study aimed to assess the relationship between the transthoracic echocardiographic (TTE) measurements of the PDA prior to the occlusion procedure and the actual size of the deployed device.Methods: We reviewed the available records of 7 patients (2 male) who underwent the procedure at our institution (mean age: 21 ± 12.7 years, range: 7 to 46 years). PDA closure was performed successfully using the Amplatzer Duct Occluder (n = 5) and its Chinese copycat, Cardi-O-Fix Occluder (n = 2).Results: The TTE measurement of the aortic end diameter of the PDA showed a good linear regression correlation with the size of the implanted duct occluder [duct occluder size = 0.543 + (0.941× TTE measured diameter), R = 0.907; p value ≤ 0.01].Conclusion: TTE can provide a good estimation of the size of the Amplatzer duct occluder

The SYNTAX score can predict major adverse cardiac events following percutaneous coronary intervention

Objectives: The SYNTAX score is a grading system that evaluates the complexity and prognosis of patients undergoing percutaneous coronary intervention (PCI). We investigated the association between the incidence of major adverse cardiac events (MACE) following PCI and the SYNTAX score in patients with three-vessel disease. Methods: We consecutively enrolled 381 patients with three-vessel disease undergoing PCI and stenting. The SYNTAX score was divided into tertiles as low (≤16), intermediate (16-22) and high (>22). The endpoint was the incidence of MACE defined as cardiac death, in-hospital mortality, nonfatal myocardial infarction (MI), or target vessel revascularization. Then, the incidence of MACE was compared among the SYNTAX score tertile groups. Results: The median follow-up was 14 months, and the rate of MACE was 12.6%. The rates of MACE were 7.5%, 9.9%, and 21.6% in patients with low, intermediate, and high SYNTAX score tertiles, respectively. Higher SYNTAX scores significantly predicted a higher risk of MACE (hazard ratio = 2.36; P = 0.02) even after adjustment for potential confounders. The main predictors of MACE were SYNTAX score, advanced age, hyperlipidemia, presentation as recent ST-elevation MI, number of total lesions, and history of renal failure. Conclusion: The SYNTAX score could predict major cardiac outcomes following PCI in patients with three-vessel disease

One-Year Clinical Outcomes of Ultra Long Apollo Polymer-Based Paclitaxel-Eluting Stents in Patients with Complex, Long Coronary Artery Lesions

Background: For all the wealth of research comparing the efficacy of the different types of the drug-eluting stent (DES) such as sirolimus- , paclitaxel- , and zotarolimus-eluting stents, there is still a dearth of data on the different brands of each DES type. We aimed to investigate the one-year clinical outcomes, including major adverse cardiac events (MACE), of the use of the ultra long Apollo paclitaxel-eluting stent in patients with long atherosclerotic coronary artery lesions.Methods: According to a retrospective review of the Tehran Heart Center Registry of Interventional Cardiology, a single-center nonrandomized computerized data registry in which all adult patients who undergo single or multi-vessel percutaneous coronary intervention (PCI) are enrolled without any specific exclusion criteria, the mixed use of long Apollo paclitaxel-eluting stents and other types of the DES as well as myocardial infarction within forty-eight hours prior to the procedure was excluded. In total, 122 patients were enrolled in the study, and their baseline clinical, angiographic, and procedural characteristics were obtained. In addition, the patients’ follow-up data and, most importantly, MACE during a one-year period after intervention were recorded.Results: The mean follow-up duration was 14.1 ± 3.8 months. The one-year clinical follow-up data were obtained in 95.9 % of all the patients. The incidence of MACE was 5.7% during the entire study period. There was 1 death, which occurred during the initial days after PCI. The incidence of non-fatal myocardial infarction was 2.5% (3 cases), including one patient who underwent target vessel revascularization seven months later. Also, 3 patients with single-vessel disease and in-stent restenosis underwent coronary artery bypass grafting between five to ten months later.Conclusions: Our results showed that the Apollo paclitaxel-eluting stent might be regarded as a safe and effective treatment for long coronary lesions

Short-term Outcomes and Mid-term Follow-up After Coronary Angioplasty in Patients Younger Than 40 Years of Age

Background: Stenting is currently the standard of care in percutaneous coronary intervention (PCI). Whether young patients remain at increased risk after PCI in the present stent era has not been investigated widely. We evaluated angiographic characteristics and short- and mid-term outcomes in patients younger than 40 years of age who underwent PCI. Methods: From April 2003 to March 2005, prospective data were collected in 118 consecutive patients, who were less than 40 years of age and underwent PCI at our referral center. The PCI outcomes in these patients were compared to those in 354 patients, randomly selected from 2493 patients older than 40 years of age in our database. Follow-up was scheduled at 1 month, 5 months, and 9 months through clinic visits, telephone interviews, and reviewing hospital records. Results: Patients<40 years of age were more often male (91.5% vs. 71.8%, P<0.001), current smokers (33.9% vs. 15.2 %, P<0.001), and had more family history of coronary artery disease (38.1% vs. 21.8%, P<0.001) and myocardial infarction (44.1 vs. 31.1, p=0.01), while diabetes mellitus (6.8% vs. 22.1%, P<0.001), hypertension (13.6% vs. 35.3%, P<0.001), and hyperlipidemia (34.7% vs. 44.8%, P=0.055) were less common in these patients. There were no significant differences between the two groups regarding vessel involvement, reference vessel diameter, stenosis rate (before and after procedure), and lesion characteristics, with an exception that angulated lesions were more common in the patients≤ 40 years of age (P<0.05). The young patients, who underwent PCI, presented more frequently with single-vessel disease (61% vs. 46%, P=0.01).The vessel and lesion sites of PCI and clinical success rates were similar in these age groups. Usage of stent was high and similar, and drug- eluting stent use was not significantly different between the two groups. With a high procedural success (94.9% vs. 91.8%), intra-hospital and late complications were very low and similar in both groups. Conclusion: Percutaneous coronary intervention is a safe and effective procedure for young patients, and major adverse cardiac events are similar in young and older patients

Omega-3 Fatty Acid Modifies Serum HSP 70 and hs-CRP in Patients With Cardiovascular Disease: Randomized Double‐Blind Placebo-Controlled Trial

All stages of initiation and progression of atherosclerosis are associated with inflammatory responses. Heat shock proteins (HSP-70) can play an important role in the pathogenesis of atherosclerosis. Serum High-sensitivity C-reactive protein (hs-CRP) is significantly associated with the severity of coronary arteriosclerosis. Omega 3 fatty acids contribute to the primary and secondary prevention of cardiovascular disease (CVD). The purpose of the current study was to assess the effect of omega-3 on serum HSP-70 and HsCRP in patients with atherosclerosis. The current study was a randomized, placebo-controlled, double-blind parallel-group clinical trial, involving 42 male patients with coronary artery disease (CAD). The volunteers were randomly allocated into two groups to receive 4 g omega-3 (containing 720 mg EPA plus 480 mg DHA) supplements (n=21) or placebo (n=21) per day for 8 weeks. Fasting blood samples were taken at the beginning and end of the trial to quantify serum levels of HSP-70 and hsCRP concentrations. The result of the present study revealed that no significant difference was observed between two groups before and after the intervention in terms of serum levels of Cholesterol, Triglyceride, FBS, serum Insulin and homeostasis model of assessment-insulin resistance (HOMA-IR). The difference of HSP-70 between two groups was statistically significant (P=0.04). There was no significant difference between two groups for hsCRP. The study showed that taking omega-3 fatty acids can ameliorate serum HSP-70 as inflammatory parameters. The results suggest more investigation to assess the pathway omega-3 leads to lower incidence of CVD

Success Rate, Procedural Complications and Clinical Outcomes of Coronary Interventions in Octogenarians: a Case-Control Study

Background: Clinical trials of revascularization have routinely under-enrolled elderly subjects. Thus, symptom relief and improved survival might not apply to elderly patients, in whom the risk of mortality and disability from revascularization procedures seems to be high and co-morbidity is more prevalent. The present case control study was performed to draw a comparison in terms of the procedural success, procedural and in-hospital complications, and major adverse cardiac events (MACE) in a one-year follow-up of octogenarians (age ≥ 80 years) with a selected matched younger control group in the Tehran Heart Center Angioplasty Registry.Methods: According to the Tehran Heart Center Interventional Registry of 9, 250 patients with a minimum follow-up period of one year between April 1993 and February 2010, 157 percutaneous coronary intervention (PCI) procedures were performed in 112 octogenarians. Additionally, 336 younger patients (459 PCI procedures) were selected from the database as the propensity-score matched controls.Results: There were 147 (93.6%) and 441 (96.1%) successful PCI procedures in the elderly group and control group, respectively (p value = 0.204). Procedural complications were seen in 5 (3.2%) of the elderly group and 16 (3.5%) of the control group (p value = 0.858). Totally, 7 (6.3%) in-hospital complications occurred in the elderly group and 22 (6.8%) in the control group (p value = 0.866). One-year MACE was seen in 9 (9.1%) of the elderly and 18 (5.8%) of the control group (p value = 0.26). Conclusion: Procedural success and complications, in-hospital complications, and one-year MACE were not significantly different between our two study groups. Therefore, age alone should not be used as the sole criterion when considering revascularization procedures. Furthermore, PCI should not be refused in octogenarians if indicated

Relationship between Body Mass Index and Outcome of Elective Percutaneous Coronary Intervention

Background: Studies have shown controversial effects of obesity on major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). We sought to investigate the impact of the body mass index (BMI) on the mid-term outcome following successful PCI. Methods: Between March 2006 and August 2008, 3948 patients underwent successful elective PCI in Tehran Heart Center, Tehran, Iran, and were retrospectively included in this study. Patients who underwent PCI on the same day as the occurrence of myocardial infarction were excluded. The demographic, procedural, in-hospital, and follow-up information of these patients was extracted from the PCI Data Registry of our institution. The patients were divided into three groups:  normal weight (No. 1058, BMI < 25 kg/m2 age = 58 ± 10 years); overweight (No. 1867, 25 ≤ BMI < 30 kg/m2, age = 57 ± 10 years); and obese (No. 1023, BMI ≥ 30 kg/m2, age = 56 ± 10 years). MACE included death, myocardial infarction, target vessel revascularization, and target lesion revascularization. Results: Compared with the other patients, the obese individuals were significantly younger and more frequently female, had a higher ejection fraction, and more frequently presented with hypertension, diabetes, and hyperlipidemia. There was no association between the BMI and the angiographic and procedural findings in the univariate analysis. While no difference was found in the rate of in-hospital death between the groups, the number of the obese patients undergoing emergent cardiac surgery was marginally different in the univariate analysis (p value = 0.06). At 9 months' follow-up, MACE had occurred in 92 (2.3%) patients and cardiac mortality was 9 (0.2%). After adjustments for confounders, no significant difference was observed in terms of MACE between the BMI groups. Conclusion: The BMI had no significant effect on the rate of MACE at 9 months' follow-up in our study population. Interventionists' recommendations for patients undergoing PCI should, therefore, not be significantly influenced by the BMI status