Recurrent acute myocardial infarction with coronary artery aneurysm in a patient with Behçet's disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Behçet's disease is an inflammatory disorder of unknown origin, with mucocutaneous, ocular, articular, vascular, gastrointestinal and central nervous system manifestations. Although cardiac involvement is not an uncommon manifestation of Behçet's disease, coronary aneurysm has rarely been reported.</p> <p>Case presentation</p> <p>A 36-year-old Iranian man was admitted to our emergency department for retrosternal pain of two and a half hours duration. His detailed medical history revealed that he had no risk factors for coronary artery disease, however, Behçet's disease had been diagnosed about 10 years earlier. His electrocardiogram showed inferior myocardial infarction. He underwent coronary angiography that showed multiple giant aneurysms in his coronary arteries. Two months later, he experienced another episode of unstable angina. This was followed by two episodes of anterior myocardial infarction 2 and 5 months afterwards.</p> <p>Conclusion</p> <p>This case highlights the importance of careful diagnostic work-up in the evaluation of myocardial infarction in patients. In our patient, Behçet's disease proved to be the cause of recurrent myocardial infarction.</p

The value of serum osteoprotegerin levels in patients with angina like chest pain undergoing diagnostic coronary angiography

Background: Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily.Recent evidence supports a relationship between serum OPG level and atherosclerosis. Theaim of this study was to evaluate the possible association of OPG with the presence of coronary artery disease (CAD), its severity and prognosis in patients with chest pain and suspected coronary stenosis.Methods: In this cross-sectional analytic study, 180 candidates of elective coronary artery angiography were recruited. Serum level of OPG was measured by ELISA method in all patientsand its relation with presence and severity of CAD based on a coronary atherosclerosis score (CAS) was assessed. Patients were followed for a mean period of about 24 ± 3.2 months andthe relationship between OPG levels and future cardiac events were evaluated.Results: The mean serum level of OPG was 1637 ± 226 pg/mL in those with CAD and 1295 ± 185 pg/mL (nonparametric p = 0.001) in those without it. There was a significant directcorrelation between the level of serum OPG and CAS (rho = 0.225, p = 0.002). The optimalcut-off point for predicting a significant coronary artery obstruction was a serum level of ≥ 1412 pg/mL with a sensitivity and specificity of 60% and 57.8%, respectively. Major adversecardiac events (MACE) including cardiovascular death, admission with acute coronary syndrome,or heart failure, was significantly higher in those with higher OPG levels (22 [34.3%]vs. 15 [16%], p = 0.012).Conclusions: There was a direct and significant correlation between the serum level of OPGand CAS. MACE occurred more commonly in those with higher baseline OPG levels

The Relationship between Serum NT– Pro-BNP Levels and Prognosis in Patients with Systolic Heart Failure

Introduction: Most studies reported using N-terminal pro-brain natriuretic peptide (NT-proBNP) in diagnosis of heart failure but there is controversy about use of these tests in determining prognosis and classification of severity of heart failure. The objective of this study was to determine the value of plasma NT-proBNP levels assessment in evaluation of mortality and morbidity of patients with systolic left ventricular dysfunction. Methods: A cohort study was performed in 150 patients with heart failure since September 2009 until February 2010. The patients were followed for 6 months to assess their prognosis. Patients were divided into two good and bad prognosis groups according to severity of heart failure in New York Heart Association (NYHA) class and frequency of hospital admission and mortality due to cardiac causes. Patients with good prognosis had ≥1 admission or no mortality or NYHA class ≥2 and patients that had one of this criteria considered as bad prognosis groups. Pro-BNP levels were measured at baseline and left ventricular ejection fraction (LVEF) was estimated with echocardiography. Data was analyzed with using Chi-square, t-test, ANOVA, Kruskal-Wallis tests. Results: In patients with heart failure that enrolled in this clinical study, ten patients were lost during follow-up. The mean of NT-proBNP is significantly correlated with ejection fraction (p=0.003) and NYHA class (p<0.001). In our study among 140 patients who were follow-up for 6 months, 11(9.7%) of individuals died with mean NT-proBNP of 8994.8±8375 pg/ml, in survived patients mean NT-proBNP was 3756.8±5645.6 pg/ml that was statistically significant (P=0.02). Mean NT-proBNP in the group with good prognosis was 2723.8±4845.2 pg/ml and in the group with bad prognosis was 5420.3±6681 pg/ml, difference was statistically significant (P=0.0001). Conclusion: Our study in consistent with other studies confirms that NT-proBNP is significantly correlated with mortality and morbidity. This could be predicting adverse out come and stratification in patients with heart failure. It is recommended that more research be performed in Iran

The Association between Serum Lipoprotein (a) and Other Cardiac Risk Factors with the Severity of Coronary Artery Disease

Several meta-analyses have provided support for an association between lipoprotein (a) [Lp (a)] and coronary disease, but the correlation of Lp (a) and other coronary risk factors with severity of coronary artery disease (CAD) are ambiguous. In this case control study, plasma Lp (a) concentration, lipid profile, diabetes, hypertension, smoking were evaluated in 108 patients with and without CAD (Case: 55 and Control: 53) who were admitted at heart center in Shahid Beheshti hospital of Zanjan in 2009. Also patients were classified into two risk groups according to their major risk factors; low risk (with two or few risk factors) and high risk (with three and more risk factors). The collected data was analyzed with using chi square, independent sample t-test, fisher's exact test, Mann-Whitney test, Kruskal Wallis test and Pearson's correlation coefficient. The mean concentration of Lp (a) in the case and control groups were 60±11 mg/dL and 32±3 mg/dL, respectively (P=0.054). 41.8% of the case group and 22.6% of the control group have abnormal level of Lp (a) (≥30 mg/dL) (P=0.03). Mean lipoprotein (a) was also higher in three vessels disease compared control group (46±41 vs. 31±23) and maximum level of lipoprotein (a) in control group was 92 mg/dL and in three vessels disease was 520 mg/dL. Between other cardiac risk factors, diabetes was more frequent in case than control groups (29.1% vs 5.7%) and had a significant relationship with severity of coronary disease (P=0.001). The main findings of this study were that mean Lp(a) levels were higher in the three vessels group compared to control and diabetes had significant relationship with the severity of coronary disease

Homocysteine Level According to Some Cardiac Risk Factors and Extent of Coronary Disease

Hyperhomocysteinemia is accompanied by many cardiovascular risk factors. However it’s relation with other cardiac risk factors and with extent of coronary artery disease (CAD) is still a controversial issue. This study was designed to investigate the relationship between total plasma homocysteine (tHcy) levels and other cardiovascular risk factors and the severity of CAD. Fasting plasma tHcy levels were measured in 60 patients with angiographically documented CAD and compared to 56 control subjects matched for age, sex, and smoking habits. Also patients were classified into two groups of low risk (with two or few risk factor) and high risk (with three and more risk factor) according to their major risk factors. Mean of tHcy levels were significantly higher in high risk patients compared to low risk patients (p=0.013). Also hyperhomocysteinemia rate was higher in the high risk patients compared to low risk patients, OR=5 (CI 95%=1.6-16).There was relationship between coronary risk factors and severe coronary artery disease (three vessels disease) but this relationship was statistically significant only in smokers (P=0.012) and diabetic patients (P=0.035) . Plasma tHcy level was an independent risk factor for high risk patients

The Relationship between Coronary Artery Movement Type and Stenosis Severity with Acute Myocardial Infarction

Introduction: The severity of coronary artery stenosis which leads to myocardial infarction (MI) has been a matter of controversy. Historical data are in favor of mild luminal stenosis (<50% diameter stenosis) while recent studies suggest hemodynamically-significant coronary stenosis as the main substrate for subsequent MI. Also, mechanical stress resulted from coronary artery movement (CAM) may be responsible for plaques rupture. In this study, we evaluated the severity of plaques leading to MI and common CAM patterns in the involved coronary segments. Methods: In a cross-sectional descriptive-analytical study, on patients with acute ST-segment myocardial infarction (STEMI) undergoing coronary angiography, the relationship between coronary artery movement type and stenosis severity with acute MI was evaluated. Lesions with stenosis diameter greater than 50 percent were defined as moderate and those equal or higher than 70% were defined as severe stenosis. Three different patterns of coronary artery motion including compression, bending and displacement types were evaluated in segments with culprit lesion. Results: One hundred and sixty two patients were enrolled. Ninety patients (55.6%) were male and 72 (44.4%) were female. Mean age of the patients was 60.56±13.43 years. In terms of Infarct related lesions (IRLs), 86% of the cases had at least moderate stenosis and in 67%, severe stenosis was present. More than 50% stenosis was found in all patients with anterior STEMI involving LAD. Among three types of coronary motion patterns, compression pattern was significantly higher in LAD (P<0.001), RCA (P<0.001), Diagonal artery (P<0.001) and OM branch (P=0.044), but not in proper LCX (P=0.307). Conclusion: Most of the lesions leading to myocardial infarction have a diameter stenosis of at least 50% and mainly are located in the coronary segments with compression movement pattern