Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease

<p>Abstract</p> <p>Background</p> <p>Cardiac syndrome X is an important therapeutic and diagnostic challenge to physician. Study of Csx patients may help to understand the pathophysiology of coronary microcirculation and to gain an insight on the management of these group patients.</p> <p>Methods</p> <p>We measured the flow mediated dilation of the brachial artery both endothelium dependent and independent vasodilatation by high resolution ultrasound in 30 cardiac syndrome X patients and matched with 30 healthy control subjects.</p> <p>Results</p> <p>Significantly decreased flow mediated dilatation was observed in patients when compared to control (9.42 ± 7.20 vs 21.11 ± 9.16 p < 0.01) but no significant difference was observed between groups in response to nitroglycerin (25.39 ± 6.82 vs 28.87 ± 8.69). Receiver operator characteristic analysis showed that value of < 11.11 had sensitivity of 80%, specificity 86.67%, positive predictive value 76.66%, negative predictive value 83.33%. In total, 46% of subjects had endothelial dysfunction and of them, CSX subjects had higher prevalence (76% vs 16% p < 0.01) than control subjects. Higher mean values of body mass index, systolic blood pressure and diastolic blood pressure was observed in subjects with FMD < 11.11 than > 11.11(p < 0.01). In logistic regression analysis, FMD was significantly associated with systolic blood pressure (Odds ratio 1.122 95% CI 1.053-1.196 p < 0.01) and body mass index (Odds 1.248 95%CI 0.995-1.56 p < 0.05).</p> <p>Conclusions</p> <p>The study suggests impairment of endothelial function in cardiac syndrome X patients. Increased Systolic blood pressure and body mass index may increase the risk of impairment of endothelial function in this group of patients.</p

“Correlation of red blood cell distribution width with the severity of coronary artery disease—A single center study”

Objective: Coronary Artery Disease (CAD) is the leading cause of morbidity and mortality all around the world. We evaluated the correlation of Red blood cell Distribution Width (RDW) with the severity of lesion on coronary angiography as assessed by Modified Gensini score (MGS) in CAD patients. Methods: A total of 576 consecutive patients admitted in Department of Cardiology over a period of one year, who underwent coronary angiography after diagnosis of CAD or presence of angina like chest pain and/or positive treadmill test were enrolled in the study (August 2014–May 2015). Patients were divided into two groups, with CAD (Group A) and without CAD (Group B). The RDW Cofficience of variance (RDW CV) and RDW standard deviatiton (RDW SD) of each patient, and their correlation with severity of CAD was assessed. Results: Of the total 576 patients enrolled, 438 were in Group A and 138 were in Group B. The mean age of presentation in Group A and Group B was (53.64 ± 10.36 vs 49.4 ± 9.73) years (p < 0.0001). The Male and Female ratio overall was 2.42:1. Patients in Group A had significantly elevated RDW CV and RDW SD levels compared with those in Group B [(14.59 ± 1.04)% vs (13.6 ± 0.68)%, p < 0.0001], [(45.78 ± 4.76) vs (40.77 ± 3.01), p < 0.0001 respectively]. A significant positive correlation between RDW CV, RDW SD and MGS was noted (r = 0.33, p < 0.0001) (r = 0.43, p < 0.0001) respectively. On multivariate logistic regression analysis, RDW was demonstrated to be an independent predictor for angiographic CAD (OR = 4.17, 95% CI 3.05–5.69, p < 0.0001). On receiver operating characteristic curve (ROC) analysis, an RDW value of 14.3% was identified as an effective cut off point in diagnosing CAD with a sensitivity of 58.9% and specificity of 84.8%. Conclusions: RDW is an independent predictor of CAD and severity of coronary stenosis, suggesting that it can be a readily available marker for prediction and severity of CAD

Successful Transcatheter Closure of Patent Ductus Arteriosus in Isolated Levocardia with Situs Inversus

Abstract Isolated levocardia with situs inversus is an extremely rare type of situs anomaly with an estimated incidence of 1 per 22,000 in the general population. This autosomal recessive situs anomaly has been described as normal levo position of the heart with dextro position of the abdominal viscera. In this case report, we describe accidental diagnosis of isolated levocardia with situs inversus in pediatric patient while evaluating for heart murmur. Systematic examination of the patient identified the presence of patent ductus arteriosus, anomalous course of inferior vena cava and bovine aortic arch. We shared our experience of successful transcatheter closure of patent ductus arteriosus. This case report is worth reporting both, for demonstrating the possibility of the percutaneous device closure of the patent ductus arteriosus in patient with this unusual situs anomaly to interventional cardiologists and because of scanty of literature