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Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention
Khaled Mohamed Said Othman,
Hesham Samir Abdelaziz AbdelKawy Aggour,
Samir Saleh Wafa,
Mohamed El Sayed Zahran
Issue:
Volume 3, Issue 2, June 2019
Pages:
22-26
Received:
30 March 2019
Accepted:
7 May 2019
Published:
11 June 2019
Abstract: Background Primary Percutaneous coronary intervention (PPCI) is an established mainstay in treatment of patients presenting with acute ST elevation myocardial infarction (STEMI). However, successful revascularization of the culprit coronary vessel does not always mean ideal myocardial reperfusion in a portion of patients, mainly because of the no-reflow phenomenon. Myocardial no-reflow is associated with worse contractile dysfunction and higher incidence of complications and is an independent predictor of death and myocardial infarction after PPCI. Objective: To study the relationship between admissions CRP, Albumin, CRP/Albumin ratio, Monocyte, HDL, and Monocyte/HDL ratio, in patients presenting with acute STEMI and angiographic no-reflow after PPCI. Material and Methods: From October 2018 to February 2019, of the 1500 patients who presented with STEMI for PPCI to any of the Ain Shams University Hospitals’ cath labs, we enrolled 150 consecutive patients who had post revascularization angiographic no-reflow. They were allocated to group A. we allocated 150 age, gender, and baseline characteristics matched STEMI patients who had TIMI III flow post revascularization to group B. this was set as the control group. Results: The study population was divided into 2 groups: no-reflow “A” (n = 150) and reflow “B” (n = 150) groups. CRP and Monocytes were significantly higher in the no-reflow group; Albumin and HDL were significantly lower in the no-reflow group. The novel indices, CRP/Albumin ratio (CAR) and Monocytes/HDL ratio (MHR) were both significantly higher in the no-reflow group (p value = 0.000) for both. The tow indices were found to be independent predictors of no-reflow development. Conclusion: Our results suggested that CAR and MHR on admission before PPCI though cheap, and easily measurable laboratory tools, have a significant predictive value with an odds ratio of 0.182 with a p value = 0.000 and 0.321 with a p value = 0.002 respectively. They could help to risk stratify STEMI patients who might suffer from no-reflow phenomenon after PPCI.
Abstract: Background Primary Percutaneous coronary intervention (PPCI) is an established mainstay in treatment of patients presenting with acute ST elevation myocardial infarction (STEMI). However, successful revascularization of the culprit coronary vessel does not always mean ideal myocardial reperfusion in a portion of patients, mainly because of the no-r...
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Familial Apical Hypertrophic Cardiomyopathy in a Young Adult: A Rare Occasion for Making Precise Diagnostic in a Low Income Country
Sylvie Ndongo Amougou,
Helles Murielle Lema,
Mazou Ngou Temgoua,
Ngam Mary Engonwei,
Samuel Kingue
Issue:
Volume 3, Issue 2, June 2019
Pages:
27-30
Received:
14 April 2019
Accepted:
23 May 2019
Published:
11 June 2019
Abstract: Hypertrophic Cardiomyopathy is a genetic disorder with asymmetric left ventricular hypertrophy. In a low income country it is sometimes difficult to do global checkup and precise diagnosis in suspected patients. We present a case of apical hypertrophic cardiomyopathy with MYBPC3 mutation in a young Cameroonian. A 36 years old man with no cardiovascular risk factors, presents with a progressive chest pain on exertion. The physical examination was normal. The resting electrocardiography showed inverted T waves in anterior, lateral and inferior leads. Treadmill electrocardiography and Coronarograpy were normal. A transthoracic cardiac ultrasound showed hypertrophy of 168 mm in the apical segment, the systolic function and the regional wall motion of the left ventricle were normal. We concluded of hypertrophic cardiomyopathy with abnormality in the myosin binding protein C (MYBPC3) found on genetic analysis. A screening cardiac ultrasound was realized in the patient’s family and the son was found to have septal hypertrophy. Strict follow-ups were organized for the patient and his son. Familial Hypertrophic Cardiomyopathy is a rare disease in cardiology; the precise diagnosis requires complex exams which are sometimes unavailable in low income countries. This case was a special one with all necessary investigations giving the possibility to organize follow-ups for patient and related family member to prevent sudden death.
Abstract: Hypertrophic Cardiomyopathy is a genetic disorder with asymmetric left ventricular hypertrophy. In a low income country it is sometimes difficult to do global checkup and precise diagnosis in suspected patients. We present a case of apical hypertrophic cardiomyopathy with MYBPC3 mutation in a young Cameroonian. A 36 years old man with no cardiovasc...
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Intraprocedural Stent Thrombosis: Case Series of a Rare Complication Managed Successfully
Nikesh Jain,
Nilesh Tawade,
Nihar Mehta,
Ajit Desai,
Ashwin Mehta
Issue:
Volume 3, Issue 2, June 2019
Pages:
31-36
Received:
1 May 2019
Accepted:
10 June 2019
Published:
26 June 2019
Abstract: Intra-procedural stent thrombosis (IPST) is defined as the development of occlusive or non-occlusive new thrombus in or adjacent to a recently implanted stent before the PCI procedure is completed. The frequency of occurrence currently ranges between 0.5 – 1.7% of all PCI procedures and it seems to be considerably reduced with newer drug eluting stents and improved techniques. The occurrence of IPST is relatively rare, even in ACS patients, and is related strongly to clinical presentation and procedural factors (e.g., anticoagulation regimen, lesion type, presence of thrombus at baseline, stent under expansion and edge dissection etc.) than to baseline demographic characteristics. Imaging modalities like IVUS or OCT can prevent as well as identify the underlying cause for IPST. IPST not only decreases success rate of PCI but is also associated with higher rates of slow flow or no reflow, distal embolization and side branch closure. It is also associated with higher mortality, myocardial infarction, ischemia driven revascularisation and stent thrombosis on follow up. IPST can be managed immediately in cath lab and involves use of GP2b3a inhibitors, optimising stent apposition by repeat balloon dilatation, use of imaging to identify the cause and accordingly corrective measures to be taken. Rarely emergency CABG may be required if underlying cause cannot be corrected. Prevention is the key. IPST can be prevented by using newer anti-platelets, use of GP2b3a inhibitors especially in presence of ACS or high thrombus load, preparing the lesion well before stenting, use of atherectomy devices when needed, appropriate stent size selection and use of imaging modalities in complex lesions to optimise stent selection and apposition. We describe three cases of the intra procedural stent thrombosis under different clinical scenarios and its management.
Abstract: Intra-procedural stent thrombosis (IPST) is defined as the development of occlusive or non-occlusive new thrombus in or adjacent to a recently implanted stent before the PCI procedure is completed. The frequency of occurrence currently ranges between 0.5 – 1.7% of all PCI procedures and it seems to be considerably reduced with newer drug eluting st...
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Thermostabilization of Hyaluronidase by Chondroitin Ligands in Molecular Docking
Alexander Vasilievich Maksimenko,
Robert Shavlovich Beabealashvili
Issue:
Volume 3, Issue 2, June 2019
Pages:
37-44
Received:
28 May 2019
Accepted:
15 July 2019
Published:
30 July 2019
Abstract: Speedup of present high-molecular drug derivatives developments is based on the computational methods harmonic application. Such glycosidase as hyaluronidase has been functionated among multifarious glycosaminoglycan microenvironment in blood circulation of organism. It is important for elucidation of action mechanism of biosystem components (on vascular wall) and productive obtaining of hyaluronidase derivatives of cardiological destination the using of computer aided calculations for investigation of protein-glycosaminoglycan interactions. The aim of our study became the molecular docking fulfillment for 3D model of bovine testicular hyaluronidase with short-chain dimer and trimer chondroitin ligands. We used the molecular docking of hyaluronidase with chondroitin ligands for theoretical determination of biocatalyst conformational stability. At temperatures higher than 300 K free/native hyaluronidase (without ligands) displayed conformational transitions leading to its inactivation. Predominant manifestation of these transitions was an irreversible attraction developing between the protein area proximate to Glu-105, on the one hand, and to Arg-59 and Arg-96, on the other. Lowering of temperature did not restore the initial 3D structure of hyaluronidase. Binding of chondroitin ligands at ch 6, ch 3 and ch 1 sites stabilized the enzyme, increasing its denaturation temperature by 10°C. The highest degree of stabilization was achieved after chondroitin binding to ch 6. This effect was higher than that for chondroitin sulfate trimers concerning the enzyme inhibition by heparin tetramer, which requires binding of 4-5 chondroitin sulfate ligands to the enzyme surface. Molecular docking of 3D model of bovine testicular hyaluronidase with chondroitin dimers and trimers has revealed eight sites for their binding to the enzyme surface. At biological concentrations of these ligands the most important binding sites for them are ch 6, ch 3 and ch 1. Binding at these sites induces a reversible deformation of the protein 3D structure. Interactions between 3D model of bovine hyaluronidase with chondroitin ligands are based predominantly on electrostatic forces. Chondroitin ligands stabilized 3D structure of hyaluronidase after binding predominantly at chondroitin 6 as well as chondroitin 3 and chondroitin 1 positions and their effect was higher than chondroitin sulfate upon enzyme inhibition by heparin tetramer. Stabilizing effects of chondroitin and chondroitin sulfate ligands are fundamental for further direct theoretical comparative investigation of impact produced by these ligands.
Abstract: Speedup of present high-molecular drug derivatives developments is based on the computational methods harmonic application. Such glycosidase as hyaluronidase has been functionated among multifarious glycosaminoglycan microenvironment in blood circulation of organism. It is important for elucidation of action mechanism of biosystem components (on va...
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