Genetic Polymorphism of Angiotensin II Type 1 Receptors and Their Effect on the Clinical Outcome of Captopril Treatment in Arab Iraqi Patients with Acute Coronary Syndrome (Mid Euphrates)

Genetic variation in the angiotensin II type 1 receptor (AT1R) has an important effect on the outcome of acute coronary syndrome (ACS) initiated treatment with captopril. This study aims to investigate the impact of genetic polymorphism of AT1R (rs5186 and rs275651) on the ACS outcome in Iraqi patients treated with captopril. A total of 250 Iraqi individuals with ACS were included in this case—control study and they were divided into two study groups; Study group 1 included 125 participants who were prescribed captopril, 25 mg twice daily and study group 2 included 125 participants who received no captopril as part of their ACS treatment (control study). The AT1R gene (rs5186) CC genotype was found to be associated with ST-elevation myocardial infarction (STEMI) (Odd’s ratio (O.R) = 1.2, P = 0.7), while AC was associated with Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) (O.R = 1.2, P = 0.8). AC genotype is more prone to have Percutaneous coronary intervention (PCI) after ACS attack (O.R = 1.2, P = 0.6). CC genotype had a risk to get less improvement (O.R = 1.6, P = 0.5), so might require higher doses of captopril during acute coronary insult. The AT1R gene (rs275651) AA genotype was associated with UA (O.R = 1.3, P = 0.9). AA and AT genotypes were more prone to have PCI after ACS attack (O.R = 3.9 P = 0.2, O.R = 3.5, P = 0.3 respectively) and thus requiring higher doses of captopril. We conclude that the AT1R rs5186, rs275651 genetic polymorphisms might partially affect the clinical outcome of ACS patients treated with captopril and might have captopril resistance which requires higher doses.     

Troponin T and Heart Type Fatty Acid Binding Protein (h-Fabp) as Biomarkers in Patients Presenting with Chest Pain

Acute coronary syndrome (ACS) is a term for a range of clinical signs and symptoms suggestive of myocardial ischemia. It results in functional and structural changes and ultimately releasing protein from injured cardiomyocytes. These cardiac markers play a major role in diagnosis and prognosis of ACS. This study aims to assess the efficacy of heart type fatty acid binding protein (h-FABP) as a marker for ACS along with the routinely used hs-TropT. In our observational study, plasma h-FABP (cut-off 6.32 ng/ml) and routinely done hs-Trop T (cutoff 0.1 and 0.014 ng/ml) were estimated by immunometric laboratory assays in 88 patients with acute chest pain. Based on the clinical and laboratory test findings the patients were grouped into ACS (n = 41) and non-ACS (n = 47). The diagnostic sensitivity, specificity, NPV, PPV and ROC curve at 95 % CI were determined. Sensitivity of hs-TropT (0.1 ng/ml), hs-TropT (0.014 ng/ml) and h-FABP were 53, 86 and 78 % respectively and specificity for the same were 98, 73 and 70 % respectively. Sensitivity, specificity and NPV calculated for a cut-off combination of hs-TropT 0.014 ng/ml and h-FABP was 100, 51 and 100 % respectively. These results were substantiated by ROC analysis. Measurement of plasma h-FABP and hs-TropT together on admission appears to be more precise predictor of ACS rather than either hs-Trop T or h-FABP.     

Effect of a distal protection device on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention

Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.     

冠心病人康复训练后有氧工作能力和心肌供氧的变化

目的：探讨康复训练后冠心病人进行定量负荷运动时有氧工作能力和心肌供氧的变化，以此为康复效果的评估提供依据。方法：25名男性冠心病人参加了12周有氧多样化运动康复训练，训练前、后对他们在递增负荷运动中的生理和临床指标进行了测定。结果：1）反映冠脉血流和心肌耗氧量的指标RPP，康复训练前在跑台的V级负荷时已超过200，康复训练后增加幅度则有显著下降（P〈0．01）；2）康复训练前受试者的血乳酸浓度（BL）在Ⅳ级运动负荷之后出现了突增（达到4．6mmol／L），而康复训练后他们运动中的BL增加平缓，始终保持较低水平；3）康复训练前在V级运动负荷时受试者的ST下降达到-0．9mm水平，这已接近心肌缺血的阈值，训练后心肌供血出现了明显的改善。结论：康复训练前冠心病人运动中反映运动系统缺氧的BL突增领先于心肌缺血阈值的到达；与康复训练前相比，康复训练后冠心病人在进行相同负荷运动时显示出有氧工作能力有所增强，心肌供氧状况有所改善。     

血浆纤维蛋白原水平升高同高血压,冠心病及卒中的联系

选择46岁以上的高血压(HBP)、冠心病(CHD)、卒中及其它内科住院病人共140名进行了血浆纤维蛋白原(FG)、血压、甘油三酯(TG)和吸烟等因素的观察.结果表明高血压、冠心病和车中患者FG值升高,逐步回归分析看出吸烟,HBP和TG水平升高明显影响FG的含量,提示FG水平升高同HBP,CHD和年中存在着紧密的联系。     

运动训练对大鼠冠状动脉TGFβ和TNFα表达的影响

目的：探讨不同强度训练对大鼠冠状动脉TGFβ和TNFα表达的影响。方法：采用跑台训练方式建立大鼠有氧运动和疲劳运动模型,运用免疫组织化学SABC法研究不同运动强度对大鼠冠状动脉TGFβ和TNFα表达的影响。结果：有氧运动组与对照组比较,冠状动脉TGFβ的MOD值虽有降低但并不显著,TNFα的MOD值明显降低（P〈0．05）,疲劳运动组与对照组和有氧运动组比较,冠状动脉TGFβ和TNFα表达有显著性差异（P〈0．05）。结论：有氧训练可使TGFβ和TNFα适度表达,疲劳训练会导致大鼠冠状动脉TGFβ和TNFα过量表达。因此认为运动训练与TGFβ和TNFα表达变化关系密切。     

二尖瓣病变合并冠心病13例外科治疗体会

目的总结二尖瓣病变合并冠心病的外科治疗体会。方法对13例二尖瓣病变合并冠心病患者同期行二尖瓣置换或成型及冠脉搭桥术,回顾性分析,临床资料。结果术后1例死于严重心律失常,其余均存活。随访3—36个月,心功能恢复至Ⅰ-Ⅱ级9例,Ⅲ级3例,未出现心肌缺血症状。结论术前明确诊断,充分准备,术中加强心肌保护,提高手术水平,缩短手术时间,加强围手术期治疗是手术成功的关键。     

冠心病的运动疗法

运动疗法是冠心病康复方案的主体。介绍了冠心病运动疗法的机理、适应症、禁忌症、具体的运动形式和方法，以及体育运动对冠心病患者主要危险因素的改善作用。     

运动与血脂异常的防治(一)(未完待续)--经常性运动与血脂异常的防治

血脂异常是冠心病的首要危险因素,因此,如何通过安全有效的方式防治血脂异常,进而防治冠心病一直是学术界研究的热点.运动疗法作为防治血脂异常的安全有效的手段,正日益受到国内外专家学者的关注.综述了经常性运动与血脂异常的防治、运动训练对血脂异常的防治以及运动防治血脂异常的可能机制方面的研究进展.     

血浆纤维蛋白原含量升高与冠心病

用盐析－双缩脲法对９７例健康人和７９例冠心病患者进行了血浆纤维蛋白原含量的测定，结果表明：冠心病患者血浆纤维蛋白原含量显著高于健康人（Ｐ＜０．０１），提示纤维蛋白原含量升高是冠心病、中风、血栓形成的一种重要的危险因素．对血浆纤维蛋白原进行检测，将为冠心病的临床诊断及预防提供依据