Single Coronary Artery with Anomalous Origin of the Right Coronary Artery from the Distal Portion of Left Circumflex Artery: A Very Rare Case

Congenital anomalies of coronary arteries, albeit rare, may be significant contributors to angina pectoris, hemodynamic abnormalities, and sudden cardiac death. A 47-year-old man referred to us with atypical chest pain. Electrocardiography demonstrated no significant ischemic changes, but cardiac troponin I test was positive. The patient underwent coronary angiography, which revealed a single coronary artery from the left Valsalva sinus. In addition, the left anterior descending (LAD) and the left circumflex (LCx) arteries were in normal position with significant stenosis in the mid-portion of the LAD and the distal portion of the LCx. A large branch originated from the distal portion of the LCx and tapered toward the proximal portion as the right coronary artery (RCA). This is a rare coronary anomaly that has no ischemic result. Coronary lesions were the cause of the patient’s angina pectoris. Angioplasty and stenting of the LAD and LCx was done, and medical therapy (Clopidogrel, Aspirin, Atorvastatin, and Metoprolol) was continued. The patient was asymptomatic at 8 months’ follow-up. J Teh Univ Heart Ctr 2013;8(3):161-163 This paper should be cited as: Pourbehi MR, Amini A, Farrokhi S. Single Coronary Artery with Anomalous Origin of the Right Coronary Artery from the Distal Portion of Left Circumflex Artery: A Very Rare Case. J Teh Univ Heart Ctr 2013;8(3):161-163. Keywords: Coronary angiography, Coronary vessel anomalies • Angina pectori

Renal Artery Stenosis and Its Predictors in Hypertensive Patients Undergoing Coronary Artery Angiography

Background: Renal artery stenosis (RAS) has been increasingly recognized in the recent years, especially in patients with coronary artery disease (CAD). RAS affects the patients with hypertension (HTN), but the exact prevalence is not known. Objectives: This study was performed to determine the prevalence and to identify the predictors of RAS in hypertensive patients undergoing coronary artery angiography. Patients and Methods: In a cross-sectional study from August 2008 to August 2009, 481 patients with HTN and suspected CAD underwent selective coronary and renal angiography for screening and predicting RAS. RAS was defined as a higher than 50% stenosis in the renal artery lumen. Multivariate analysis of factors associated with the presence of RAS were examined using a logistic regression model. Results: The mean ± standard deviation of age was 59.25 ± 10.81 years and 50.3% were men. According to angiographic data, 425 patients (88.4%) had CAD, while 56 (11.6%) had normal coronary arteries. RAS was seen in 94 (22%) patients with CAD. The multivariate logistic regression analysis identified only age (P < 0.001) and the number of significant coronary lesions (P < 0.001) as independent predictors of RAS. Gender, smoking, congestive heart failure, diabetes mellitus (DM), hyperlipidemia (HLP) and body mass index (BMI) were not independent predictors. Conclusions: This study suggests that in the management of patients with RAS, risk factors should most likely be considered as beneficial. In addition, the clinical and angiographic features are helpful in predicting its presence in elderly patients with CAD

Evaluating the impact of fractional flow reserve-guided percutaneous coronary intervention in intermediate coronary artery lesions on the mode of treatment and their outcomes: An Iranian experience.

BACKGROUND: Today, the fractional flow reserve (FFR) guides the physician to select suitable patients with intermediate severity coronary lesions in angiography that should be treated or not with stent. The aim of this study was to evaluate the impact of using FFR in the selection of appropriate treatment strategy in angiographic intermediate coronary lesions and their short-term outcome in a sample of Iranian population. METHODS: In a prospective cohort, 34 patients who had intermediate coronary artery lesion(s), defined as having a 40-70% diameter stenosis, as determined by visual estimation or quantitative coronary angiography were enrolled through a convenience sampling method. All patients underwent FFR measurement to decide whether percutaneous coronary intervention should be performed. The results of visual assessment, quantitative coronary angiography, and functional assessment of the severity of coronary stenosis were compared. Significant stenosis was defined as FFR < 0.80. All patients were followed for 6 months for the incidence of major advanced cardiac events. RESULTS: In this study, 34 patients (22 male and 12 female) with mean age of 57 ± 8 (range 45-70) were included. In 26.47% (9/34) of patients, FFR was 0.80 and stenting was done to the other vessels with significant coronary lesions. CONCLUSION: Measurement of FFR is a useful approach in making clinical decisions about revascularization procedures in patients with moderate coronary artery lesion severity, especially in LM and multivessel disease. This study showed that not only FFR can change treatment plan of the patients, but also it would improve clinical outcomes. KEYWORDS: Coronary Angiography; Coronary Stenosis; Fractional Flow Reserve Myocardia

Bone mineral density is not related to angiographically diagnosed coronary artery disease

Based on data, there may exist an association between low bone mineral density (BMD) and atherosclerosis. Thisstudy aimed to investigate the association between BMD and coronary artery disease (CAD). In this study the possible association of BMD with CAD in 65 men with CAD and in 49 men with normal angiography as well as in 51 women with CAD and in 51 normal women was investigated. Both spinal and femoral BMD values for men were higher than those of women (P<0.05). Neither femoral nor spinal BMD values were different in patients with or without CAD. In addition, BMD values were not associated with the severity of CAD. Body massindex (BMI) was positively correlated with BMD both in men and women, whereas age and anti-diabetic treatment were linked with lower BMD in women. In conclusion, in this study CAD was not related to low BMD. However, BMI was an independent predictor of diminished BMD

Renal Artery Stenosis and Its Predictors in Hypertensive Patients Undergoing Coronary Artery Angiography

Background: Renal artery stenosis (RAS) has been increasingly recognized in the recent years, especially in patients with coronary artery disease (CAD). RAS affects the patients with hypertension (HTN), but the exact prevalence is not known. Objectives: This study was performed to determine the prevalence and to identify the predictors of RAS in hypertensive patients undergoing coronary artery angiography. Patients and Methods: In a cross-sectional study from August 2008 to August 2009, 481 patients with HTN and suspected CAD underwent selective coronary and renal angiography for screening and predicting RAS. RAS was defined as a higher than 50% stenosis in the renal artery lumen. Multivariate analysis of factors associated with the presence of RAS were examined using a logistic regression model. Results: The mean ± standard deviation of age was 59.25 ± 10.81 years and 50.3% were men. According to angiographic data, 425 patients (88.4%) had CAD, while 56 (11.6%) had normal coronary arteries. RAS was seen in 94 (22%) patients with CAD. The multivariate logistic regression analysis identified only age (P < 0.001) and the number of significant coronary lesions (P < 0.001) as independent predictors of RAS. Gender, smoking, congestive heart failure, diabetes mellitus (DM), hyperlipidemia (HLP) and body mass index (BMI) were not independent predictors. Conclusions: This study suggests that in the management of patients with RAS, risk factors should most likely be considered as beneficial. In addition, the clinical and angiographic features are helpful in predicting its presence in elderly patients with CAD

Association of Pathogen Burden and Hypertension: The Persian Gulf Healthy Heart Study

background Chronic infection with cytomegalovirus (CMV), Chlamydia pneumoniae, herpes simplex virus 1 (HSV-1), and Helicobacter pylori may contribute to essential hypertension. However, the evidence now available does not clarify whether the aggregate number of pathogens (pathogen burden) may be associated with hypertension. methods Sera from 1,754 men and women aged ≥25  years were analyzed for immunoglobulin G antibodies to C.  pneumoniae, HSV-1, H.  pylori, and CMV using enzyme-linked immunosorbent assay. The aggregate number of seropositives to the studied viral and bacterial agents was defined as pathogen burden. Hypertension was defined according to World Health Organization criteria. results A total of 459 (26.3%) of the subjects had hypertension. In the hypertensive group, 4.2% had 0 or 1 pathogens present, 20.6% had 2, 43.2% had 3, and 32.1% had 4; in the normotensive group, 7.9% had 0 or 1, 28.4% had 2, 42.7% had 3, and 21.0% had 4. Of the 4 studied pathogens, H.  pylori seropositivity showed a significant independent association with hypertension (odds ratio (OR) =1.37; 95% confidence interval (CI) =1.05–1.79; P = 0.02). In multiple logistic regression analyses, the pathogen burden did not show a significant independent association with hypertension. Coinfection with H.  pylori and C.  pneumoniae was significantly associated with hypertension compared with double seronegativity after adjustment for age, sex, chronic low-grade inflammation, and cardiovascular risk factors (OR = 1.68; 95% CI = 1.14–2.47; P = 0.008]. conclusions The pathogen burden was not associated with hypertension. However, coinfection with C. pneumoniae and H. pylori showed a significant association with essential hypertension, independent of cardiovascular risk factors and chronic low-grade inflammation. Keywords: blood pressure; Chlamydia pneumoniae; cytomegalovirus; Helicobacter pylori; herpes simplex virus; hypertension; pathogen

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system)

Purpose: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. Participants: Between March 2013 and October 2014, a total of 3000 men and women aged ≥60 years, residing in Bushehr, Iran, participated in this prospective cohort study ( participation rate=90.2%). Findings to date: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at –80°C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. Future plans: Risk factor assessments will be repeated every 5 years, and the participantswill be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboratio

Comparsion of influence of enoxaparin with unfractioned heparin on acute myocardial infarction with ST-segment elevation

Background: Most patients with acute myocardial infarction with ST-segment elevation (STEMI) are still treated with pharmacological reperfusion which is not always successful. The aim of this study was to determine whether enoxaparin was associated with superior efficacy and safety compared with unfractionated heparin (UFH) in the STEMI setting. Methods: In this clinical trial, 150 patients less than 75 years old (104 men and 46 women) with STEMI who were scheduled to undergo streptokinase (1.5 milion unit per hour) randomly assigned to receive enoxaparin (40 mg intravenous bolus then 1 mg/kg subcutaneously BID) (group 1) or weight adjusted UFH from 24 to 48 hours after streptokinase (group 2). All patients underwent predischarge coronary angiography. Results: A number of 75 patients in group 1 (mean age 58.9 ±9.4) and 75 pateints in 2 (mean age 56.3±9.0) were studied. Two groups were well matched with respect to main risk factors and also other concomitant medications. Time from onset of symptom to start fibrinolysis and myocardial regions infarction were similar in both groups (p=0.13). Left ventricular ejection fraction were 45.2 ± 5.6 % in group 1 and 40.3 ± 7.3 % in group 2 (p=0.056). Major bleeding just was in 2 cases of group 1. Minor bleeding was in 10 cases of group 1 and 5 of group 2 (p>0.05). Conclusion: Our data showed a benefit of Enoxaparin compared with UFH in patients receiving fibrinolysis for STEMI with a mild trend toward an excess of bleeding. However, further well designed studies to assess these results with following patients for a longer period of time and also comparing therapeutic effects are needed