37 research outputs found
Metabolic syndrome and risk of major coronary events among the urban diabetic patients: North Indian Diabetes and Cardiovascular Disease Study-NIDCVD-2
Objective: The present study aimed at estimating the prevalence of metabolic syndrome (MetS) and prospectively, evaluating cardiovascular events among Asian Indians type 2 diabetic subjects. Methods: The sample comprised 1522 type 2 diabetic mellitus (T2DM) subjects aged 25-91. years, who participated in the North Indian Diabetes and Cardiovascular Disease Study (NIDCVD). The participants were screened for hypertension, dyslipidemia, obesity and cardiovascular events. Anthropometric, clinical and biochemical measurements were done in all subjects. The prevalence of MetS was estimated in all the subjects according to the harmonized criteria of 2009. Results: The prevalence of MetS among urban Indian diabetic subjects was 71.9% and was significantly higher in females (86%) as compared to males (57.9%). To determine the independent predictors of the MetS in diabetic sample, binary logistic regression analyses were performed using demographic and biochemical parameters. Significant differences in the indices of generalized and abdominal obesity and lipids (total cholesterol, high density lipoprotein) were observed (p <. 0.01) in male:female and MetS and non-MetS comparisons. Regression analysis for prediction of CAD showed that family history, age, body mass index (BMI), SBP, physical inactivity and hypertension independently and significantly predicted the disease outcome. Binary logistic regression analysis revealed that MetS may be an independent risk/predictor of CAD (odd ratio (OR) = 3.44, CI 1.31-9.01, p = 0.012) along with higher age groups, BMI and hypertension in Indian population. Conclusion: The study demonstrated that the high prevalence of MetS and its different components were positively associated with a higher risk of CAD in north Indian diabetic subjects. Nevertheless, MetS is a major health problem in India, comprehensive population studies are warranted for estimation of incidence and prevalence, and education should be provided on its prevention and control to reduce the diabetes-related morbidity and mortality
Role of DECT in coronary artery disease: a comparative study with ICA and SPECT
PURPOSEEarlier imaging techniques for coronary artery disease (CAD) focused primarily on either morphological or functional assessment of CAD. However, dual-energy computed tomography (DECT) can be used to assess myocardial blood supply both morphologically and functionally. We aimed to evaluate the diagnostic accuracy of DECT in detecting morphological and functional components of CAD, using invasive coronary angiography (ICA) and single photon emission computed tomography (SPECT) as reference standards.METHODSTwenty-five patients with known or suspicious CAD and scheduled for ICA were investigated by DECT and SPECT. DECT was performed during the resting state using retrospective electrocardiography (ECG) gating. CT coronary angiography and perfusion images were generated from the same raw data. All patients were evaluated for significant stenosis (≥50%) on both ICA and DECT coronary angiography, and for myocardial perfusion defects on SPECT and DECT perfusion. Comparison was done between ICA and DECT coronary angiography for detection of significant stenosis and between SPECT and DECT perfusion for detecting myocardial perfusion defects.RESULTSUsing ICA as reference standard, sensitivity, specificity, and accuracy of DECT coronary angiography in detecting ≥50% stenosis of coronary artery lumen were 81.6%, 97.8%, and 95.0%, respectively, by segment-based analysis and 92.1%, 96.1%, and 93.7%, respectively, by vessel-based analysis. Using SPECT as the reference standard, the sensitivity, specificity, and accuracy of DECT perfusion in detecting myocardial perfusion defects were 70.4%, 86.4%, and 80.6%, respectively, on per-segment analysis and 90.7%, 66.6%, and 84.7%, respectively, on per-territorial basis.CONCLUSIONDECT accurately detected coronary artery stenosis and myocardial ischemia using ICA and SPECT as reference standards. In the same scan, DECT can accurately provide integrative imaging of coronary artery morphology and myocardial perfusion
Paraoxonase 1 gene polymorphisms (Q192R and L55M) are associated with coronary artery disease susceptibility in Asian Indians
Background: Coronary artery disease (CAD) is a complex
metabolic disorder in which lifestyle and genetic factors are
known to play key roles in pathogenesis. The paraoxonase 1
(PON1) enzyme has a defensive effect against CAD progression,
as it safeguards low-density lipoproteins (LDLs) from
oxidative modifications. The most extensively studied genetic
variants in the PON1 gene are Q192R and L55M, which
have been related with LDL antioxidative activity and risk of
CAD. Objective: The present case-control study intended to
examine the Q192R and L55M polymorphisms and their association
with the risk of CAD patients in north Indians.
Methods: A total of 872 subjects (412 CAD patients and 460
controls) were recruited from north India. The PON1 gene
was amplified and genotypes were studies using PCR-RFLP.
χ2 analysis was performed to compare genotype/allele frequencies
in patients and controls. Results: The present study indicated abdominal obesity, elevated body mass index, and
dyslipidemia with increased levels of total cholesterol and
triglycerides as well as reduced high-density lipoprotein
cholesterol in CAD subjects compared to healthy controls
(p < 0.05). Logistic regression analysis of the data revealed an
association of the RR genotype of the Q192R polymorphism
with an about 2-fold elevated risk of CAD (OR = 2.23, 95%
CI = 1.47–3.37, p = 0.0001). Contrariwise, the L55M polymorphism
did not show significant association with CAD (OR =
1.81, 95% CI = 0.66–4.95, p = 0.326). Conclusions: The Q192R
polymorphism in the PON1 gene may be a susceptibility
gene associated with increased risk of CAD in an Asian Indian
population
Double loop technique for Percutaneous Transvenous Mitral Commissurotomy
AbstractPercutaneous Transvenous Mitral Commissurotomy (PTMC) is a standard treatment for critical mitral stenosis. In certain situations such as large left atrium (LA) or low trans-septal puncture, there is technical difficulty in crossing a PTMC balloon across the mitral valve, leading to high failure rate. I hereby describe a case of PTMC successfully performed by using double loop technique to cross the mitral valve
Percutaneous coronary intervention for acute myocardial infarction in a patient with dextrocardia
Situs inversus with dextrocardia is a rare congenital anomaly. There are limited published case reports of successful percutaneous coronary intervention (PCI) in these patients who have atherosclerotic coronary artery disease, especially when presenting with acute myocardial infarction. PCI is technically difficult because of mirror image dextrocardia. We hereby describe a 48-yr-old female, who had acute inferior wall myocardial infarction and underwent successful emergency primary coronary angioplasty and stenting of a proximally occluded right coronary artery. Technical details about PCI are discussed