Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty

BackgroundOutcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy.ObjectivesThis comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared.MethodsOver duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n = 90), Non-smokers (n = 60)] of the study population. There was no difference in procedure in two groups.ResultsIn the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value = 0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p = 0.001) respectively. Smokers tended to have higher thrombus burden (p = 0.06) but less multi vessel disease (p = 0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p = 0.261) and 5.33% vs 2.66% (p = NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months.ConclusionThe study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.     

Prediction of cardiovascular events in pre-dialysis chronic kidney disease patients with normal SPECT myocardial perfusion imaging

PurposePatients with normal stress myocardial perfusion imaging (MPI) results generally have an excellent prognosis with <1% cardiovascular events/year. Chronic kidney disease (CKD) is an established risk factor for cardiovascular events. However, the estimated glomerular filtration rate (eGFR) varies considerably among patients with CKD. We evaluated the prognostic value of eGFR for patients with CKD who did not undergo hemodialysis and had no evidence of coronary artery disease (CAD).Methods and subjectsPatients with CKD (n = 108; 58 males; mean age: 74 years) with no CAD [no previous CAD and normal stress MPI results; summed stress score (SSS) <4] and with no history of hemodialysis were followed-up (mean duration: 24 months). CKD was defined by eGFR of <60 ml/min/1.73 m² and/or persistent proteinuria. Cardiovascular events included cardiac death, non-fatal myocardial infarction, and unstable angina.ResultsCardiovascular events were observed in 8 patients with CKD (7%). The following were determined as significant predictors of these events: age (hazard ratio = 1.14; p = 0.019), hemoglobin levels (hazard ratio = 0.69; p = 0.021), eGFR (hazard ratio = 0.94; p = 0.008), SSS (hazard ratio = 2.31; p = 0.012), and summed difference score (hazard ratio = 2.33; p = 0.014).ConclusionsPatients with CKD and with no previous CAD and normal stress MPI results (SSS < 4) may not exhibit an excellent cardiovascular prognosis. Further, a lower eGFR and stress MPI results may be the predictors of cardiovascular events. Thus, patients with a lower eGFR and/or normal stress MPI results (SSS < 4) may require continuous follow-up.     

Clinical benefits of smoking cessation in reducing all-cause and disease-specific mortality among older people in Taiwan: A 10-year nationwide retrospective cohort study

ObjectiveTo investigate the relationship between smoking cessation and disease mortality risks among elderly Taiwanese.MethodsWe identified 1677 people aged 65 or above from the 2001 National Health Interview Survey in Taiwan (2001 NHIST) and linked with the 2000–2010 National Health Insurance Research Data (2000–2010 NHIRD) and 2001–2010 Death Registry. Subjects were classified into four groups: never smokers, current smokers, former smokers quitting less than 5 years and former smokers quitting at least 5 years. Information on medical history was drawn from 2000–2001 NHIRD. Cox proportional hazards models were used to analyze the smoking status and mortality risk.ResultsOver 10 years, incidences of all-cause death per person-year was 0.048 among the never smokers, 0.058 for current smokers and 0.057 for former smokers. Current smokers had higher risk of all-cause death (HR = 1.38, 95%CI = 1.13–1.68), all-cause cancers (HR = 1.85, 95%CI = 1.28–2.69), lung cancer (HR = 3.02, 95%CI = 1.56–5.85) and cardiovascular disease (HR = 1.71, 95%CI = 1.17–2.48) as compared to never smokers. Former smokers who quit smoking for < 5 years has higher mortality risk in lung cancer (HR = 3.89, 95%CI = 1.33–11.40), respiratory diseases (HR = 2.79, 95%CI = 1.32–5.87) and chronic obstructive pulmonary disease (COPD) (HR = 3.13, 95%CI = 1.07–9.17) as compared to never smokers. Former smokers who quit smoking for over 5 years were similar to never smokers on all-cause death, lung cancer, all-cause cancers, COPD, respiratory diseases and cardiovascular diseases.ConclusionSmoking plays a prominent role in increasing the mortality risk among the Taiwanese elderly. Disease mortality risks of elderly former smokers who quit smoking over 5 years were reduced to the same level as the never smokers.     

Metabolic syndrome and its risk factors among middle aged population of Iran,a population based study

AimsTo determine the prevalence of metabolic syndrome (MS) and its risk factors in a middle-aged population in Iran.MethodsThe sample was 5190 individuals aged 40–64 years participated in the first phase of the Shahroud eye cohort study. Prevalence of MS was determined in terms of the age and sex. Other variables were evaluated by using simple and multiple logistic regression methods.ResultsThe prevalence of MS was 10.88% in men, 13.03% in women and 12.14% in total. The prevalence proportion increased with increasing age. In multivariate logistic regression model, age (odds ratio (OR) = 1.06), education (OR = 0.98) and smoking (OR = 0.50), had significant effects on MS. In this model, gender, marital status and economic status had no significant effect on MS. Higher prevalence of obesity and overweight in non-smokers (79.9%) compare to smokers (47.4%, P < 0.001), indicated that the association of smoking and MS is confounded.ConclusionsDespite the low prevalence of MS in this study, older age was associated with increased risk of developing MS and higher education was associated with decreased this risk, therefore health education, changing the lifestyle, and taking greater attention in elderly is needed in order to prevent the MS and its complications.     

Impact of smoking status on early and late outcomes after isolated coronary artery bypass graft surgery

BackgroundThere are limited data on the impact of smoking status on outcomes after isolated coronary artery bypass graft (CABG) surgery.MethodsData obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who were non-smokers, previous smokers, and current smokers. The independent impact of smoking status on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively.ResultsIsolated CABG surgery was performed in 21 534 patients; smoking status was recorded in 21 486 (99.8%). Of these, 7023 (32.6%) had no previous smoking history, 11 183 (59.1%) were previous smokers, and 3290 (15.2%) were current smokers. The 30-day mortality rate was 1.8% in non-smokers, 1.5% in previous smokers, and 1.5% in current smokers (p = NS). The incidence of peri-operative complications was generally similar in the three groups, but current smokers were at an increased risk of pneumonia (p < 0.001), and multisystem failure (p = 0.003). The mean follow-up period for this study was 37 months (range, 0–106 months). After adjusting for differences in patient variables, the incidence of late mortality was higher in previous smokers [hazard ratio (HR), 1.73; 95% confidence interval (CI), 1.47–2.05; p < 0.001] or current smokers (HR, 1.41; 95% CI, 1.26–1.59; p < 0.001) compared to non-smokers.ConclusionSmoking status is not associated with early mortality after isolated CABG. It is, however, associated with an increased risk of pulmonary complications and reduced long-term survival.     

Suspected coronary artery disease and myocardial infarction with normal coronary angiography: A heterogeneous but benign condition?

IntroductionPrevious follow-up studies of patients with symptoms and/or non-invasive tests suggestive of ischemia or an acute coronary syndrome and a normal coronary angiogram have reported a good prognosis.ObjectivesThe aim of this study was to evaluate the clinical characteristics and outcome of a cohort of patients with suspected ischemic heart disease and normal coronary arteries.MethodsA clinical follow-up was performed of 607 patients (mean age 62 ± 11 years) with symptoms or non-invasive tests suggestive of ischemia (544) or myocardial infarction (63) and normal coronary angiography. The occurrence of major cardiac events or of readmission due to chest pain was recorded during a mean follow-up of 33.6 ± 9.5 months after angiography.ResultsPatients with myocardial infarction were older (65.4 ± 11.1 vs. 61.9 ± 10.7, p=0.05), and the majority were women (68.3%). Hypertension was reported by 65.5% of patients, diabetes by 17.9%, dyslipidemia by 58.6%, smoking by 14% and family history of coronary artery disease in 11%. During follow-up no patient died from cardiovascular causes; three patients (0.5%) suffered myocardial infarction and 50 (8.3%) had recurrent chest pain leading to emergency admission. Patients with myocardial infarction had more events (20.6%) than those referred for angiography due to symptoms and/or positive non-invasive tests for ischemia (7.4%) (log-rank chi-square test: 13.6, p<0.0005).ConclusionThe incidence of risk factors was high. Our data suggest that patients with a normal angiogram had a good prognosis in spite of their baseline clinical presentation. A significant number of patients showed persistence of symptoms.     

Current cigarette smoking is an independent risk factor for subacute stent thrombosis in acute myocardial infarction patients

BackgroundAcute myocardial infarction (AMI) is prevalent and has serious consequences including re-infarction and death. Cigarette smoking is a coronary risk factor for AMI, although a “smoker's paradox” for AMI has been reported in Western countries. On the other hand, some researchers have reported that smoking is associated with subacute stent thrombosis (SAST) after AMI. However, the occurrence of this condition is not well documented in Japan. The aim of this study was to clarify how prior smoking status may affect prognosis, including SAST, in Japanese patients with AMI.MethodsA total of 266 consecutive patients with AMI were enrolled retrospectively in the study if they had undergone emergency coronary intervention (bare metal stent) within 24 h of symptom onset, and had a 5–10 month follow-up examination. The patients were divided into three groups based on their cigarette smoking status (non-smokers, past smokers, and current smokers).ResultsCurrent smokers were significantly younger than the other two groups, although their levels of low density lipoprotein-cholesterol and triglyceride were significantly higher. White blood cell count and hemoglobin level on admission were also significantly higher in current smokers compared with the other two groups. The incidence of SAST was significantly higher in current smokers than in the other groups, although the occurrence of heart failure after AMI was similar in the three groups. On the other hand, improvement in left ventricular ejection fraction was observed in non-smokers and past smokers, but not in current smokers. Multiple logistic analysis revealed that current smoking was an independent risk factor for SAST (odds ratio 5.4; p < 0.05). Current smokers were about five times more likely to have a SAST compared with non-smokers.ConclusionsThese findings indicate that current cigarette smoking predicts SAST after primary percutaneous coronary intervention for AMI in Japanese patients.     

Change in left ventricular systolic function in patients with ST elevation myocardial infarction: Evidence for smoker's paradox or pseudo-paradox?

BackgroundThe ‘smoker's paradox’ refers to the observation of favorable prognosis in current smokers following an acute ST elevation myocardial infarction (STEMI) in the era of fibrinolysis, however, several STEMI studies have demonstrated conflicting results in patients undergoing primary percutaneous coronary intervention (p-PCI).ObjectiveAim of the current study was to evaluate the impact of cigarette smoking on left ventricular function in STEMI patients undergoing p-PCI.MethodsOur population is represented by 74 first-time anterior STEMI patients undergoing p-PCI, 37 of whom were smokers. We assessed left ventricular function by left ventricular ejection fraction (LVEF) on the second day after admission and at 3-month follow-up. Early predictors of adverse left ventricular remodelling after STEMI treated by p-PCI were examined.ResultsBasal demographics and comorbidities were similar between groups. Although the LVEF during the early phase was higher in smokers compared to non-smokers (44.95 ± 7.93% vs. 40.32 ± 7.28%; p = 0.011); it worsened in smokers at follow-up (mean decrease in LVEF: −2.70 ± 5.95%), whereas it improved in non-smokers (mean recovery of LVEF: +2.97 ± 8.45%). In univariate analysis, diabetes mellitus, peak troponin I, current smoking, and lower TIMI flow grade after p-PCI, pain-to-door time and door-to-balloon times were predictors of adverse left ventricular remodelling. After multivariate logistic regression analysis, smoking at admission, lower TIMI flow grade after p-PCI, the pain-to-door time and door-to-balloon times remained independent predictors of deterioration in LVEF.ConclusionTrue or persistent ‘smoker's paradox’ does not appear to be relevant among STEMI patients undergoing p-PCI. The ‘smoker's paradox’ is in fact a pseudo-paradox. Further studies with larger numbers may be warranted.     

Myocardial Performance Index (MPI) is not influenced by increased Left Ventricular Mass in healthy obese men

BackgroundNotwithstanding its clinical use as a reliable measure of left ventricular performance, little is known about whether myocardial performing index (MPI) is influenced by increased left ventricular mass (LVM) in healthy obese individuals.AimThe present study was targeted at investigating the impact of increased LVM on the LV MPI in healthy obese men.Subjects and MethodSixty-six normal male subjects were involved in this study. The subjects were divided according to their body mass index (BMI), into group I (BMI = 20–24.9, n = 37, mean age 33.405 ± 10.277 years) which served as the control group, and group II (BMI = ≥ 30, n = 29, mean age 39.208 ± 10.214 years). The MPI was determined in all subjects using the following formula proposed by Tei: MPI = IVCT + IVRT/ET. LVM was calculated according to the following Devereux formula as: LVM = 0.8[1.04(IVSd + PWTd + LVIDd)??(LVIDd)?] + 0.6.ResultsThere were no significant differences in MPI between control subjects and obese subjects with increased LVM (p > 0.05). Additionally, there was no linear correlation between MPI and LVM (R² = 0.0003, p = 0.89).ConclusionMPI is a simple and accurate tool for the quantitative assessment of left ventricular function. Because of its ease of application, cost effectiveness, and reproducibility, this tool could be regarded as a principal measurement for comprehensive hemodynamic studies. MPI values (according to the Tei index) did not vary significantly between healthy obese and morbidly obese individuals, and therefore may have limited utility for predicting cardiac diseases in at-risk obese individuals.     

Effect of cigarette smoking on insulin resistance risk

ObjectivesSmoking is one of the main risk factors for cardiovascular disease (CVD). The mechanism(s) of the effects of smoking on CVD are not clearly understood; however, a number of atherogenic characteristics, such as insulin resistance have been reported. We aim to investigate the effects of cigarette smoking on insulin resistance and to determine the correlation between this parameter with smoking status characteristics.Study designThis study was conducted on 138 non-smokers and 162 smokers aged respectively 35.6 ± 16.0 and 38.5 ± 21.9 years. All subjects are not diabetic.MethodsFasting glucose was determined by enzymatic methods and insulin by chemiluminescence method. Insulin resistance (IR) was estimated using the Homeostasis Model of Assessment equation: HOMA-IR = [fasting insulin (mU/L) × fasting glucose (mmol/L)]/22.5. IR was defined as the upper quartile of HOMA-IR. Values above 2.5 were taken as abnormal and reflect insulin resistance.ResultsCompared to non-smokers, smokers had significantly higher levels of fasting glucose, fasting insulin and HOMA-IR index. These associations remained significant after adjustment for confounding factors (age, gender, BMI and alcohol consumption). A statistically significant association was noted between the smoking status parameters, including both the number of cigarettes smoked/day and the duration of smoking, and fasting insulin levels as well for HOMA-IR index. Among smokers, we noted a positive correlation between HOMA-IR index and both plasma thiocyanates and urinary cotinine.ConclusionOur results show that smokers have a high risk to developing an insulin resistance and hyperinsulinemia, compared with a matched group of non-smokers, and may help to explain the high risk of cardiovascular diseases in smokers.     

Smoking increases the likelihood of Helicobacter pylori treatment failure

Background and aimsData regarding the impact of smoking on the success of Helicobacter pylori (H. pylori) eradication are conflicting, partially due to the fact that sociodemographic status is associated with both smoking and H. pylori treatment success. We aimed to assess the effect of smoking on H. pylori eradication rates after controlling for sociodemographic confounders.MethodsIncluded were subjects aged 15 years or older, with a first time positive C¹³-urea breath test (C¹³-UBT) between 2007 to 2014, who underwent a second C¹³-UBT after receiving clarithromycin-based triple therapy. Data regarding age, gender, socioeconomic status (SES), smoking (current smokers or “never smoked”), and drug use were extracted from the Clalit health maintenance organization database.ResultsOut of 120,914 subjects with a positive first time C¹³-UBT, 50,836 (42.0%) underwent a second C¹³-UBT test. After excluding former smokers, 48,130 remained who were eligible for analysis. The mean age was 44.3 ± 18.2 years, 69.2% were females, 87.8% were Jewish and 12.2% Arabs, 25.5% were current smokers. The overall eradication failure rates were 33.3%: 34.8% in current smokers and 32.8% in subjects who never smoked. In a multivariate analysis, eradication failure was positively associated with current smoking (Odds Ratio {OR} 1.15, 95% CI 1.10–1.20, p < 0.001), female gender (OR 1.20, 95% CI 1.14–1.25, p < 0.001) and a low socioeconomic status (OR 1.24, 95% CI 1.17–1.31, p < 0.001).ConclusionsAfter controlling for socio-demographic confounders, smoking was found to significantly increase the likelihood of unsuccessful first-line treatment for H. pylori infection.     

Youth tobacco use in Latin America: What is the real extent of the problem?

IntroductionCigarette consumption among teenagers is one of the most critical health-related risk behaviors.MethodProspective study carried out in seven sites of five Latin American countries (Argentina [Cordoba, N = 958, Corrientes, N = 1013], Brazil [Curitiba, N = 650; Uruguaiana, N = 997], Cuba [Havana, N = 1004], Mexico [Veracruz, N = 991] and Paraguay [Ciudad del Este, N = 868]) with public-school adolescents (aged 12–19 years). Respondents were asked to answer the California Student Tobacco Survey.Results6550 adolescents took part in the survey (average age: 14 years). 38.5% (N = 2517) “tried smoking” and 37.5% started smoking before the age of 12. Sixty-one percent of adolescents think that cigarettes are easily accessible; 41.7% considered that smokers have more friends; 88% indicated knowledge of the harms of smoking one to five cigarettes per day; 58.9% would smoke new cigarette types with less harmful substances; 27.8% have already used e-cigarettes; 28% have smoked hookah. Fifty-seven point five percent have been, in the past seven days, in the same room with someone who was smoking a cigarette; and 30.5% indicated that there were not any no-smoking rules inside their homes. Identifiable risk factors were (logistic regression analysis): smoking cigarettes offered by friends, smoking cigarettes with less harmful substances, knowing what a hookah is, being in the same room with a smoker in the past week. Identifiable protective factors against tobacco use were: knowing the health risks caused by smoking hookah and to have their own room.ConclusionYouth tobacco use in Latin America is a major public health concern, and tobacco control measures are highly needed.     

Absence of a ‘smoker's paradox’ in field triaged ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention

PurposeThe ‘smoker's paradox’ refers to the observation of favorable prognosis in current smokers following an acute myocardial infarction (AMI). Initial positive findings were in the era of fibrinolysis, with more contemporary studies finding conflicting results. We sought to determine the presence of a ‘smoker's paradox’ in a cohort of ST Elevation Myocardial Infarction (STEMI) patients identified via field triage, treated with primary percutaneous coronary intervention (pPCI).MethodsThis was a single center retrospective cohort study identifying consecutive STEMI patients presenting for pPCI via field triage. The primary end points were all cause mortality, major adverse cardiac events (MACE), major bleeding, in-hospital cardiac arrest and length of stay (LOS).ResultsA total of 382 patients were included in the study. Current smokers were more likely to be younger (p < 0.00001), male (p < 0.001) and have fewer comorbidities, including renal impairment (p < 0.01) and a history of AMI (p < 0.05). Current smokers also had a shorter ischemic time (p < 0.05), were less likely to have collateral circulation (p < 0.05), and more likely to have signs of pulmonary edema at presentation (p < 0.05). There was no difference between smoking groups and all cause mortality (p = 0.67), MACE (p = 0.49), major bleeding (p = 0.49) or in-hospital cardiac arrest (p = 0.43). Current smokers had a shorter LOS (p < 0.05). In multivariate analysis smoking status did not correlate with primary outcomes.ConclusionThe ‘smoker's paradox’ does not appear to be relevant among STEMI patients undergoing pPCI, identified via field triage. The previously documented ‘smoker's paradox’ may have been an indication of patient characteristics and the historical treatment of STEMI with thrombolysis. Further studies with larger numbers may be warranted.     

Gastro-oesophageal reflux disease among patients attending an endoscopic clinic in Yemen

Background and study aimsGastro-oesophageal reflux disease (GORD) can have a major impact on quality of life and be associated with substantial morbidity. The aim of this study was to determine pattern and some of the risk factors of GORD among Yemenite patients.Patients and methodsPatients attending a medicine outpatient clinic and who underwent upper GI endoscopy for different indications were recruited. A total of 852 patients with and 1648 patients without endoscopic diagnosis of GORD were categorized as study and control groups, respectively.ResultsGORD was most common in the age group of 20–40 years (OR = 2.76, 95% CI). It tended to occur more frequently in males patients than females (OR = 1.19, 95% CI). Tobacco smokers and Khat chewers were more likely to have GORD than non-tobacco smokers (OR = 2.78, 95% CI and OR = 3.00, 95% CI, respectively). GORD complications were as following: 66 (8%) had stenosis, 10 (2%) had Barrett’s oesophagus and 768 (90%) had no complications.ConclusionThe most common risk factors for GORD were related to age, sex, tobacco smoking and Khat chewing habits. Stenosis and Barrett’s oesophagus were commonest complications of GORD.     

STEMI vs NSTEACS management trends in non-invasive hospital

ObjectivesTo compare the clinical features, management, and in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTEACS), in the Western Region of Saudi Arabia.MethodsA total of 71 patients were enrolled in a longitudinal study at a tertiary hospital without cardiac catheterization facility. These data were collected from Saudi Project for Assessment of Coronary Events registry.ResultsTwenty-three patients with STEMI were compared to 48 patients with NSTEACS. Mean age for STEMI was younger, 57.4 ± 13.7 years compared to 63.2 ± 13.9 years respectively (p = 0.19). Forty-four percent arrived at the hospital by ambulance. History of hypertension and hyperlipidemia were more frequent in NSTEACS (p = 0.05), while both groups showed no difference in diabetes mellitus, 17% vs 22% and smoking, 30% vs 17%. In-hospital medications were: Aspirin (100%) both groups, Clopidogrel (91% vs 100%) (p = 0.03). There was more aggressive use of beta-blockers (74% vs 95%) (p = 0.01) and statins (87% vs 100%) (p = 0.01) in NSTEACS.In-hospital outcomes showed one recurrent myocardial infarction and one death in NSTEACS group (2%). Other outcome in the two groups showed recurrent ischemia (13% vs 29%) (p = 0.14) and cardiogenic shock (9% vs 2%) (p = 0.17). No stroke or major bleeding was reported in both groups.ConclusionNSTEACS patients in western province of KSA present at an older age are mostly males and have higher prevalence of hypertension and hyperlipidemia compared with STEMI patients. It is therefore important to identify patients with high-risk profile and put implement measures to reduce these factors.     

Assessment of right ventricular function by myocardial performance index in diabetic patients

BackgroundAssessment of right ventricular (RV) function remains difficult because of the RV complex shape. Data regarding RV performance in patients with diabetes are incomplete The aim of this study was to assess the feasibility of pulsed wave tissue Doppler imaging and myocardial performance index (MPI) for the assessment of right ventricular function in diabetic patients without coronary artery disease.MethodsThe study included 20 diabetic patients, 20 diabetic hypertensive and 20 gender and age matched healthy subjects underwent standard echocardiography with tissue Doppler imaging (TDI) to assess RV function. Patients with myocardial ischemia, impaired left ventricular systolic function, valvular heart disease or other diseases which could alter the right ventricular performance were excluded.ResultsMyocardial performance index was significantly higher in diabetes compared to control group (0.41 ± 0.05 versus 0.27 ± 0.04, p = 0.001). Peak myocardial systolic velocity (Sa), early diastolic myocardial velocity (Ea), and late diastolic myocardial velocity (Aa) were significantly lower in patients with diabetes mellitus (DM) compared to the control group (p = 0.0001). Isovolumetric relaxation time (IVRT) was significantly higher in DM group compared to control group (p = 0.003). MPI was significantly higher in diabetic hypertensive group versus DM alone group (0.46 ± 0.050 versus 0.41 ± 0.05, p = 0.01). There was no correlation between MPI and blood glucose level and duration of diabetes.ConclusionMyocardial performance index is a useful noninvasive tool for the detection of early right ventricular systolic and diastolic dysfunction in diabetic patients, regardless of coexisting hypertension.     

The effect of achieving a systolic blood pressure of 140 mmHg. A prospective study of ambulatory measurements in type 2 diabetic patients with nephropathy

ObjectivesWhat is the prognostic significance of achieving a systolic blood pressure of < 140 mmHg?SettingDiabetic renal policlinic, university hospital of Lund, Sweden.Subjects118 type 2 diabetic patients with micro-macroalbuminuria were followed for four years (range 1–8 years).Method and main outcome measuresThe prognostic significance of office, day- and nighttime measurements of blood pressure (BP) for development of cardiovascular complications was studied.ResultsForty-two percent (n = 49) developed one or more of the following cardiovascular endpoints: 23% (n = 27) death, 9% (n = 10) stroke, 9% (n = 11) myocardial infarction, 9% (n = 11) heart failure, 31% (n = 36) uremia and 17% (n = 20) need for dialysis. Reaching the goal for day- and nighttime systolic BP (SBP) at baseline of < 140 mmHg was associated with lower risk for developing uremia. Reaching the goal for nighttime SBP was associated with a decreased risk for developing myocardial infarction and need for dialysis treatment. None of these associations was found for office SBP.Patients not achieving the goal for nighttime systolic blood pressure of < 140 mmHg had a 12.9 times higher risk of developing myocardial infarction and 3.9 times increased risk of uremia and 2.7 times increased risk for death than patients achieving the goal.ConclusionNighttime blood pressure had better prognostic significance for developing cardiovascular and renal complications than office and daytime blood pressure.     

Risk factors and angiographic profile of coronary slow flow (CSF) phenomenon in North Indian population: An observational study

Background“Coronary slow flow’’ (CSF) is delayed vessel opacification in the absence of epicardial stenosis. Studies in different ethnic groups have found variable risk factors associated with CSF.Aimof present study was to analyze the risk factors and angiographic profile of CSF in North Indian population, not studied till date.Methods40 patients with CSF and 40 controls were studied. CSF was determined quantitatively by thrombolysis in myocardial infarction (TIMI) frame count method. Various clinical risk factors (age, sex, body mass Index (BMI), diabetes, hypertension, dyslipidemia, smoking), hematological and biochemical parameters (hematocrit, platelet count, uric acid, homocysteine, fibrinogen, high sensitivity C reactive protein (hsCRP), glycosylated hemoglobin (HbA1c) were assessed.ResultsOf the 40 patients with CSF, 37 (92.5%) were males. While 20 patients (50%) presented with chronic stable angina, rest 20 (50%) presented with acute coronary syndrome. [15 (37.5%) with unstable angina and 5 (12.5%) with non ST elevation myocardial infarction (NSTEMI)]. Patients with CSF had significantly higher BMI (27.27 ± 2.82 vs. 24.12 ± 2.35, p < 0.001), fibrinogen levels (398.48 ± 120.96 vs. 331.55 ± 162.6, p = 0.04) and smoking (24(60.0%) vs 14(35.0%), p = 0.02). On multivariable regression analysis, only BMI was found to have an independent association with CSF (odds ratio 1.613, 95% confidence interval 1.265–2.057, p < 0.001).ConclusionThis is the first study to analyze clinical presentation, angiographic profile and risk factors associated with CSF in North Indian population. In this study, we found only BMI to have an independent association with CSF.     

Acute effects of cigarette smoking in habitual smokers,a focus on endothelial function

BackgroundThe chronic effect of cigarette (cig.) smoking is well established. The acute effect of smoking abolishes the concept, argued by heavy smokers, to decrease the number of smoked cigarettes instead of quitting.AimTo detect the acute effects of cigarette smoking and the duration of these effects.Patients and methodsThirty four smokers (age 21–35 years) were studied at 3 occasions; 9 h after the last cig. smoking, 5 min after one cig. smoking and 30 min after 3 cig. smoking within 30 min. They were subjected to measurement of both ventricular functions using standard and tissue Doppler imaging (TDI), aortic distensibility, stiffness and endothelial function assessment by endothelium-dependent flow-mediated dilatation (FMD) and maximum vasodilatation.ResultsAfter one cigarette smoking, we found a statistically significant effect on blood pressure, Heart Rate, FMD percent, Dilation Ratio, aortic distensibility (P = 0.007), and aortic stiffness index (ASI) (P = 0.01). Furthermore the LV diastolic function was significantly impaired after smoking. Despite disappearance of acute effect of 3 cig. smoking within 30 min on blood pressure, Heart Rate and aortic distensibility, a significant difference was still found as regards FMD percent and dilation ratio denoting the extension of the endothelial dysfunction for more than 30 min after the last cigarette.ConclusionMany acute changes occur following one cigarette smoking even in habitual smokers. Persistence of endothelial dysfunction parameters after smoking indicates the failure of circulation adaptation in response to such offense that might contribute to the precipitation of acute events in vulnerable patients.