Keywords : acute coronary syndrome


Gamma Glutamyltransferase as a Biomarker for Acute Coronary Syndrome

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 43-51

ABSTRACT :
BACKGROUND:
GGT ( gamma- glutamyl transferase ) enzyme is found on the surface of various cells and plays a
role in the catabolism of glutathione which is known as one of the major anti oxidants,
OBJECTIVE:
Of this study : was to emphasize the changed GGT values as anew biochemical marker for acute
coronary syndrome
METHOD:
Type of study is a case – control study. The study population: We enrolled 50 patients with acute
coronary syndrome who had been admitted to ccu unit in Merjan Teaching hospital, measurement
of serum gamma- glutamyl transferase level using gamma- glutamyl transferase was measured by
enzymatic method using the Abbott Architect C16000 autoanalyser and compared to the serum
gamma- glutamyl transferase level of the 50 control group , the period of the study is 6 months.
Both groups will under go an exclusion criteria for all causes that may lead to a high gammaglutamyl
transferase level mainly hepatobiliary diseases , alcohol history, diabetes mellitus , and
drugs that affect the gamma- glutamyl transferase level .
RESULT:
Of the study: showed that gamma- glutamyl transferase level is elevated in all patients with
documented acute coronary syndrome after exclusion of other factors which cause elevation of
gamma- glutamyl transferase in comparism with the control .
CONCLUSION & RECOMMENDATION:
This study depicts association of gamma- glutamyl transferase with acute coronary syndrome in
population from Babylon governorate & Larger community based studies are needed to establish
the role of gamma- glutamyl transferase in development of the commonly mentioned risk factors
of acute coronary syndrome. We recommend the use of GGT as a biomarker within the 4 days
events of acute coronary syndrome .

The Use of Rate of Increase of Intraventricular Pressure During Isovolumetric Contraction (dP/dt) in Assessment of Left Ventricular Function in Acute Coronary Syndrome

Muataz Fawzi Hussein; Samar I.Essa; Huda Jameel Ibrahim

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 324-330

ABSTRACT:
BACKGROUND:
Acute coronary syndrome (ACS) is the clinical manifestation of acutely diminished coronary arterial blood supply. The rate of increase of intraventricular pressure during isovolumetric contraction (left ventricular dP/dt) represents the rate of change of pressure during ejection.
OBJECTIVE:
The aim of this study is to evaluate the usefulness of the rate of increase of intraventricular pressure during isovolumetric contraction (dP/dt) in assessment of left ventricular function in patients with acute coronary syndrome and its relation to certain clinical and echocardiographic features.
PATIENTS AND METHODS:
The study is a cross sectional study including 50 patients with an established diagnosis of acute coronary syndrome. The study was performed in Baghdad Teaching Hospital during the period between 2/2/2013 and 5/3/2014. History was taken from all patients and recoded using a specially prepared questionnaire paper. Left ventricular internal dimensions at end diastole (LVIDd) and end systole (LVIDs) were measured using M-mode echocardiography to asses left ventricular systolic function (ejection fraction). Pulse Doppler tracing of the transmitral flow velocities and tissue Doppler image (TDI) mitral annular velocities were obtained from the apical four-chamber view to assess left ventricular diastolic function. Doppler-derived dP/dt was determined from mitral regurgitation (MR) spectral flow
RESULTS:
The study included 50 patients (31 males and 19 females, mean age of 65.26 ± 5 years). Low dP/dt values were found in 42 patients (84%). Low dP/dt values were found more in the age group (51-60 yrs) (p value < 0.05). The mean age of patients with low dP/dt (<1000) was (65.62 ± 5yrs) and that of patients with normal dP/dt (≥ 1000) was (63.38 ± 5 yrs) with no significant difference (p value > 0.05). Low dP/dt value was significantly associated with smoking and positive family history and not significantly associated with male sex, hypertension, and diabetes mellitus. No significant association was found between low dP/dt value and type of presentation of acute coronary syndrome (p value > 0.05) or ejection fraction (p value > 0.05). It was significantly associated with LV diastolic dysfunction, left atrial size, left atrial pressure, and left ventricular size (p value < 0.05).
CONCLUSION:
The use of dP/dt is useful for evaluating left ventricular function in patients with acute coronary syndrome.

Troponin Positive Acute Coronary Syndrome with and without Significant Stenosis on Coronary Angiography

Mohammed Hilal AL-Ali; Hassan A. Farhan

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 2, Pages 237-243

ABSTRACT:
BACKGROUND:
Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute coronary syndrome (ACS).
OBJECTIVE:
The aim was to study the frequency and to determine the most predictive factors of Troponin positive ACS without significant Stenosis on angiography.
METHODS:
The study involved one hundred twenty four patients admitted with Troponin positive ACS who underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of coronary arteries without significant stenosis, and the secondary end-point was analysis of the most predisposing factors. In evaluating the primary end-point, the patients were divided into two groups according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who has no significant coronary artery Stenosis (< 50%) was subdivided to two groups:
a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC)
b- Normal coronary angiogram
RESULTS:
Overall, 20 patients (16%) had coronary arteries without significant lesions, from which 8 patients (6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=<0.001), hypertension (P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique.
CONCLUSION:
Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment elevation or RWMA were all associated with coronary angiography showing no significant stenosis.
KEYWORD: troponin, acute coronary syndrome, angiography.

Troponin Positive Acute Coronary Syndrome with and without Significant Stenosis on Coronary Angiography

Mohammed Hilal AL-Ali; Hassan A. Farhan

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 237-243

ABSTRACT:
BACKGROUND:
Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute coronary syndrome (ACS).
OBJECTIVE:
The aim was to study the frequency and to determine the most predictive factors of Troponin positive ACS without significant Stenosis on angiography.
METHODS:
The study involved one hundred twenty four patients admitted with Troponin positive ACS who underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of coronary arteries without significant stenosis, and the secondary end-point was analysis of the most predisposing factors. In evaluating the primary end-point, the patients were divided into two groups according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who has no significant coronary artery Stenosis (< 50%) was subdivided to two groups:
a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC)
b- Normal coronary angiogram
RESULTS:
Overall, 20 patients (16%) had coronary arteries without significant lesions, from which 8 patients (6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=<0.001), hypertension (P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique.
CONCLUSION:
Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment elevation or RWMA were all associated with coronary angiography showing no significant stenosis.

The Value of Admission Glucose and Glycosylated Hemoglobin in Patients with acute Coronary Syndrome

Manal Khudhur Abdul Razzaq; Jawad Ibrahim Rasheed; Haider Shaheed Mohmmad

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 75-84

ABSTRACT:
BACKGROUND:
In nondiabetic patients, elevated admission glucose level is a strong predictor of short-term adverse outcome in patients with acute coronary syndrome. Admission glucose may be affected by meals, the circadian cycle, and also the stress response. Glycated hemoglobin A1c is a convenient marker of long-term glucose regulation. However, the prognostic value of diabetic control assessed by HbA1c level in patients with acute coronary syndrome (ACS) is still undefined.
OBJECTIVE:
To determine the association between (admission glucose and HbA1c) and short term outcome in patients not known to be diabetics presented with ACS.
PATIENTS AND METHODS:
This observational study included 50 consecutive patients without known diabetes mellitus admitted to the coronary care unit with ACS. Patients were sub-divided into three groups: patients with unstable angina (UA, n = 10), those with ST segment elevation myocardial Infarction (STEMI, n = 18) and those with non ST segment elevation myocardial infarction (NSTEMI, n = 22). Patients were stratified according to their HbA1c into three groups: Group 1: <6.5
(12, 24%), group 2: 6.5- 8.5 (22, 44%) and group 3: > 8.5 (16, 32%). Both glucose and HbA1c were measured on admission. The diagnosis of ‘‘undiagnosed DM’’ was made if patients presented with fasting glucose >7.0 mmol/L or random glucose >11.1 mmol/L together with an admission HbA1c >6.5% according to the latest ADA recommendations. Main outcome measure was left ventricular (LV) systolic function which was assessed by ejection fraction (EF); and the set point was 50%. Data were analyzed separately using multiple regression analysis.
RESULTS:
The mean age of patients was 60.6 ± 6.33 years and 74% were males. Of total, 42% were smokers, 68% were hypertensive, 48% had hyperlipidemia and BMI ≥ 30 in 22%. Eighteen percent of patients were diagnosed as new cases of DM. Mean admission glucose was higher in patients with EF< 50% compared to those with EF> 50% with statistically significant difference (P< 0.05). There was a linear correlation between EF% and HbA1c in all types of presentation. 95.5% of patients in group 2 and 100% of patients in group 3 showed EF<50% with statistically significant difference (P< 0.05).
CONCLUSION:
HbA1c on admission is a powerful predictor of LV systolic dysfunction as a major adverse event of acute coronary syndrome in patients not known to be diabetics. Measurement of HbA1c levels may improve risk assessment in those patients when presenting with ACS

Evaluation of the Complement (C3) in Patients with Acute Coronary Syndrome

Basil Najeeb; Ali Hiad; Ebtsam A. Saleh; mnther A Tlair Haider; EMAD J. M MT

Iraqi Postgraduate Medical Journal, 2011, Volume 10, Issue 1, Pages 40-45

ABSTRACT: BACKGROUND: To evaluate complement activation (C3) levels in all forms of acute coronary syndrome (ACS) and to find whether there is any significant changes in C3 concentration at the 1st and 4th day after admission and its relation to clinical outcome. OBJECTIVE: Comparing the degree of complement activation (C3 level) between ACS and stable pectoris.To know whether there is any significant difference between the level C3 at first and fourth day. Any correlation between CRP and C3 in patients with ACS. PATIENT AND METHODS: 129 subjects (94 male and 35 female) age range (41-72 years, mean age 57 ± 10.6) were admitted in this study over the period of Feb 2009-Jan 2010 categorized into three groups; 76 patients with acute coronary syndrome (group A), 25 patients with stable angina (group B) and 28 healthy control (group C). Full clinical, biochemical, electrocardiographic and echocardiographic studies liveredone. All patients were followed to the fourth day of admission, Blood samples from peripheral veins were collected centrifuged and Serum C3 levels were measured using immunokit based on single immunodiffusion. RESULTS: The sample of patients was (129) subjects (94 male 72.9%) and (35 female 27.1%). Troponin (I) was positive in 35.7% and negative in 64.3% of the study sample (p. value 0.0005). C-reactive protein (CRP) was significantly correlated with different groups (p. value 0.0004).the same with diabetes mellitus (p. value 0.0003) but not in hypertensive and smokers (p. value 0.486 and 0. 368 respectively).C3levels was significant in correlation to clinical status in both STEMI and NSYEMI 1st and 4th day. Correlation between C3 and C-reactive protein level was insignificant with different groups. CONCLUSION: C3 levels was significantly elevated in correlation between ACS compared to patient with stable angina and healthy control subjects. Also C3 level was significant at the fourth day of admission in patients with NSTEMI in correlation to its level at the first day. However no significance associations between C3 levels and CRP in different studied groups