Medical therapy for rheumatic heart disease: is it time to be proactive rather than reactive?

Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the progression of valvular heart disease is still controversial. Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease.

Management and outcomes of Middle Eastern patients admitted with acute coronary syndromes in the Gulf Registry of Acute Coronary Events (Gulf RACE).

Objectives: To identify the characteristics, management and hospital outcomes of acute coronary syndrome (ACS) patients in the Gulf region of the Middle East.

Methods And Results: Overall, 8176 consecutive patients with the final diagnosis of ACS were recruited in 6 months, from 64 hospitals in 6 countries. The mean age of patients was 56 years.

Coronary stent thrombosis in patients with chronic renal insufficiency.

Renal insufficiency (RI) is a strong predictor of unfavorable outcomes after percutaneous coronary intervention (PCI). After PCI, stent thrombosis (ST) is a considerable concern. The risk of ST in RI has not been independently evaluated before.

Pleiotropic effects of statins in atrial fibrillation patients: the evidence.

Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. The understanding of the pathophysiology of AF has changed during the last several decades, and a significant role of inflammation and of the renin-angiotensin-aldosterone system has been postulated both experimentally and clinically. There is emerging evidence of an association between inflammation and AF, and mounting evidence links increased C-reactive protein levels not only to already existing AF but also to the risk of developing future AF.

Inflammatory markers and intimal media thickness in diabetics with negative myocardial perfusion scan.

Background: We compared the type and duration of diabetes mellitus (DM), patient demography, high sensitivity C-reactive protein (hsCRP), Homocysteine and other variables with IMT, to determine if these markers were correlated in diabetes (in whom technetium myocardial perfusion scan were negative) and would it be appropriate biomarkers for arthrosclerosis detection in this group of diabetics.

Methods: Forty patients with DM, without CHD history, were screened with stress sintigraphy imaging using 2 days stress/rest Technetium 99 tetrafosmin protocol, employing the standard Bruce protocol. Echocardiography study requested for each patient, two blood samples for hsCRP, were requested for each candidate three weeks apart, Lipid profiles, plasma homocysteine, and hemoglobin A1C were also requested.

Total and high molecular weight adiponectin in patients with coronary artery disease.

Background: Serum adiponectin inversely correlates with the extent of coronary artery disease (CAD).

Objectives: To investigate the clinical significance of measuring high molecular weight (HMW) adiponectin in addition to total adiponectin from different samples (peripheral veins and ostia of coronary arteries) in patients with CAD.

Methods: We studied 134 patients; 57 with acute coronary syndrome (ACS), 44 with stable angina and 33 healthy patients.

Impact of gender in patients with acute coronary syndrome.

In this article, we review the impact of gender on the pathophysiology, management and outcomes after acute coronary syndrome (ACS). We searched the English-language literature indexed in MEDLINE, Scopus and EBSCOhost Research databases from 1988 through January 2009 using the indexing terms 'gender', 'short- and long-term outcomes' and 'acute coronary syndrome' and 'myocardial infarction'. Data comparing gender differences in outcomes after ACS showed that females have a higher mortality rate than males.

Prevalence and impact of diabetes mellitus in patients with acute myocardial infarction: a 10-year experience.

Background: Diabetes mellitus is associated with a higher incidence of acute myocardial infarction.

Objective: To study the prevalence and outcome of patients with diabetes among patients with acute myocardial infarction.

Methods: Retrospectively, patients who presented with acute myocardial infarction in a 10-year period were identified from the coronary care unit database.

Ankle-brachial index and extent of atherosclerosis in patients from the Middle East (the AGATHA-ME study): a cross-sectional multicenter study.

To assess the extent of atherothrombosis and the use of the ankle-brachial index (ABI) in populations from the Middle East, we conducted a multicenter study similar to AGATHA (a Global Atherothrombosis Assessment), AGATHA-ME, which included 1341 patients from 18 centers from 5 countries (United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman). Patients were assigned to 2 groups: the with-disease and at-risk groups. Abnormal ABI (< or =0.

Clinical presentation and outcomes of acute coronary syndromes in the gulf registry of acute coronary events (Gulf RACE).

Objective: To identify the characteristics, treatments and hospital outcomes for patients diagnosed with acute coronary syndromes (ACS) in the Gulf area.

Methods: Prospective, multinational, multicentre, observational survey of consecutive ACS patients who were admitted to 65 hospitals during May 2006.

Results: A total of 1484 ACS patients were recruited.

Endothelial dysfunction in diabetes mellitus.

Diabetes mellitus is associated with an increased risk of cardiovascular disease, even in the presence of intensive glycemic control. Substantial clinical and experimental evidence suggest that both diabetes and insulin resistance cause a combination of endothelial dysfunctions, which may diminish the anti-atherogenic role of the vascular endothelium. Both insulin resistance and endothelial dysfunction appear to precede the development of overt hyperglycemia in patients with type 2 diabetes.

Detection of myocardial dysfunction in the presence of normal ejection fraction.

Detection of subclinical myocardial involvement is of utmost importance in risk stratification and prognosis; the role of ejection fraction in the detection of subclinical disease may be unhelpful. Our aim was to evaluate the methodology and importance of early detection of myocardial involvement in the presence of normal ejection fraction. Most of the pertinent English and non-English articles published from 1980 to 2006 in Medline, Scopus, and EBSCO Host research databases have been reviewed.

Contrast-enhanced 64-section coronary multidetector CT angiography versus conventional coronary angiography for stent assessment.

Purpose: To prospectively evaluate the accuracy of 64-section computed tomography (CT) for diagnosis of stent restenosis, by using conventional coronary angiography as the reference standard.

Materials And Methods: The ethics committee granted permission for the study; patients gave written consent. Contrast material-enhanced coronary CT angiography was performed in 53 patients (45 men, eight women; mean age, 54 years +/- 9 [standard deviation]) suspected of having stent restenosis.

Left main coronary artery stenosis: state-of-the-art.

Patients with stenosis of the left main coronary artery present difficult challenges. The risks associated with this lesion have been known since the early days of angiography when patients were found to have increased mortality during follow-up. This information led to the general guidelines that surgical revascularization should be considered the treatment of choice in patients with significant left main coronary artery stenosis.

Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome.

Endothelial dysfunction is a well established response to cardiovascular risk factors and precedes the development of atherosclerosis. Endothelial dysfunction is involved in lesion formation by the promotion of both the early and late mechanisms of atherosclerosis including up-regulation of adhesion molecules, increased chemokine secretion and leukocyte adherence, increased cell permeability, enhanced low-density lipoprotein oxidation, platelet activation, cytokine elaboration, and vascular smooth muscle cell proliferation and migration. Endothelial dysfunction is a term that covers diminished production/availability of nitric oxide and/or an imbalance in the relative contribution of endothelium-derived relaxing and contracting factors.

Intracardiac shunting of ruptured Sinus of Valsalva aneurysm in a patient presented with acute myocardial infarction: role of 64-slice MDCT.

Rupture of Sinus of Valsalva aneurysm (SVA) may be either congenital or acquired. This report describes a case of intracardiac shunting of a ruptured SVA of atherosclerotic origin to the right atrium, presenting with acute myocardial infarction. The sinus of Valsalva aneurysm and the intracardiac shunt track into the right atrium was not defined by the two-dimensional echocardiography could be seen by 64-slice multi detector computed tomography (MDCT).

Anomalous origin of the three coronary arteries from the right aortic sinus Valsalva: role of MDCT coronary angiography.

Background: Monocuspal origin of all three coronary arteries through separate ostia from the right aortic sinus (RCS) is a rare occurrence. To date, the use of multidetector computed tomography (MDCT) for imaging of congenitally abnormal coronary arteries has been discussed only in few individual case reports.

Objective: To describe the role of MDCT coronary angiography in the evaluation of two rare cases of monocuspal origin of all three coronary from RCS.

Drug-eluting coronary stents.

The introduction and widespread use of coronary stents have been the most important advancement in the percutaneous treatment of coronary artery disease since the introduction of balloon angioplasty. Coronary artery stents reduce the rate of angiographic and clinical restenosis compared to balloon angioplasty. This angiographic restenosis was further reduced with the introduction of drug-eluting stents and hence further reduction in the frequency of major adverse cardiac events.

Epidemiology of idiopathic cardiomyopathy in Qatar during 1996-2003.

Objectives: To report the rates of cardiomyopathies in the population below 50 years of age in Qatar.

Subjects And Methods: We conducted a retrospective review of clinical data on patients with cardiomyopathy who were hospitalized in Hamad General Hospital, Doha. Data were collected from medical records during the 1996-2002 period and prospectively from the patients who were hospitalized during the year 2003.

Impact of fasting in Ramadan in patients with cardiac disease.

Objectives: To investigate whether Ramadan fasting has any effect on patients with heart disease.

Methods: We prospectively studied 465 outpatients with heart disease who were fasting during the month of Ramadan from October 24 to November 24, 2003. These studied subjects were from various medical centers in the Gulf region; State of Qatar, Kuwait, United Arab Emirates, and Bahrain.

Selected highlights from the 54th annual scientific session of the American College of Cardiology, Orlando, USA, 6-9 March 2005.

The recent scientific session of the American College of Cardiology, held in Orlando, Florida, US, was one of the largest gatherings in the field of cardiovascular medicine worldwide. This year's session provided a wealth of new information in many areas of cardiovascular medicine and the results of several clinically relevant new trials and current challenges facing cardiology were presented. Provided here are selected highlights that have important implications for clinical practice.

A teenager with angiographically normal epicardial coronary arteries and acute myocardial infarction after butane inhalation.

The most common cause of death among volatile substance abusers is sudden cardiac death. To the best of our knowledge, butane-induced myocardial infarction is a rare presentation among teenagers. We report on a 14-year-old male student who sustained cardiopulmonary arrest after sniffing seven canisters of butane.