Background PTEN gene triggers cells to undergo apoptosis and promotes myocardial dysfunction. Several TNF family cytokines are elevated during acute myocardial infarction (AMI). Their role in predicting subsequent prognosis in these setting remains poorly understood. We assessed serum levels of PTEN gene activity & TNF-α in acute ST elevation myocardial infarction and determined the impact of their levels on both left ventricular function and the clinical outcome in these patients. Methods and results Seventy patients with AMI and seventy persons as control group were subjected to: ECG, echocardiography, serum TNF-α and PTEN gene assessment. Patients were classified into: Group I (n = 32): All had left ventricular systolic failure. Group II (n = 38): without left ventricular systolic failure. Group I had a statistically significant higher serum levels of both TNF-α & PTEN gene activity as compared to group II. EF% at presentation was weakly correlated with serum levels of both markers in both groups. However at follow up, EF% in group I showed a significant negative correlations with both serum levels of TNF-α and PTEN gene activity (r = 0.77 & r = 0.67, respectively). During one year follow, 5 patients died of cardiovascular causes and 6 patients had recurrent hospitalization with heart failure. These patients had statistically significant increased serum levels of TNF-α & PTEN gene activity levels as compared by other patients. Conclusions Patients with acute myocardial infarction had statistically significant increased serum levels of PTEN & TNF-α gene activity. Both markers predict worsening of left ventricular systolic functions, development of heart failure and death.

Objectives: Right ventricular dysfunction impacts the prognosis of various heart diseases. We set-out to examine which right ventricular functional parameters after STEMI and NSTEMI have prognostic value. Of 297 eligible participants, 266 (149 STEMI and 117 NSTEMI) completed follow-up. All patients underwent Grace score and 2D-echocardiography within 24 h. Outcome was defined as occurrence of Major Adverse Cardiovascular events (MACE), such as death, recurrent ischaemia, arrhythmia, reinfarction, stroke or heart failure, within 30 days. Patients were categorized into patients with MACE and patients without MACE. Results:In STEMI-patients, compared to those without MACE, patients with MACE experienced higher grace score, left ventricle (LV) end-systolic volume, LV end-systolic dimension and wall motion score index values, but lower tricuspid annular plane systolic excursion, right ventricle (RV) fractional area change, Tricuspid S' wave peak systolic velocity and LV ejection fraction. Nevertheless, in NSTEMI-patients, those with MACE exhibited higher left atrial volume index values, but lower tricuspid annular plane systolic excursion, RV fractional area change, S' wave peak systolic velocity and LVEF. Right ventricular fractional area change < 37.5%, tricuspid annular plane systolic excursion < 15.8 mm and Tricuspid S' peak systolic velocity < 9.67 cm/s are independent predictors of MACE within first 30 days after STEMI and NSTEMI.

Background Suboptimal myocardial perfusion in primary PCI is associated with increased infarct size, left ventricular (LV) dysfunction and higher mortality rates as compared as those with optimal myocardial perfusion. We identified clinical and procedural predictors of suboptimal myocardial reperfusion as judged by myocardial plush grade (MBG) in primary PCI. Methods and Results 100 patients with acute STEMI who underwent primary PCI were prospectively subjected to clinical, ECG, laboratory and angiographic evaluation. Patients were classified into: Optimal myocardial reperfusion group: (n=73) who had final MBG=3. Suboptimal myocardial reperfusion group: (n=27) who had persistent final MBG ≤ 2. Suboptimal myocardial reperfusion group had statistically significant little history of angina prior to MI 5 (18.5%) vs 44 (60.3%), little current aspirin intake 6(22%) vs 38 (52% ), increased blood sugar on admission (240 ± 101 mg/dl vs 171 ± 72 mg/dl), increased total leucocytic count on admission (12.1 ± 3.6 vs 10.2 ± 3.3) 103/mm3, longer reperfusion time (6.1 ± 2.8 vs 4.3 ± 2.1 h ), higher thrombus burden 12 (44.4 % ) vs 13 (17.8 %), higher predilatation pressure (16 ± 2.3 vs 14 ± 1.8 ATM), repeated balloon inflation during predilatation 24 (92.3 % ) vs 46 (69.7%) as compared optimal myocardial reperfusion group, (P < 0.05 for all). Conclusion Longer reperfusion time, repeated balloon inflations, high predilatation pressure> 15 ATM , high thrombus burden, neither history of angina nor aspirin intake prior to AMI, high total leucocytic count > 10103/mm3 and high blood glucose level > 160mg/dl were predictors for persistent suboptimal myocardial reperfusion in primary PCI.

BackgroundObstructive coronary artery disease (OCAD) and coronary slow flow (CSF) are frequent angiographic findings for patients that have chest pain and require frequent hospital admission. The retina provides a window for detecting changes in microvasculature relating to the development of cardiovascular diseases such as arterial hypertension or coronary heart disease.ObjectivesTo assess the coronary and ocular circulations in patients with CSF and those with obstructive coronary artery disease.MethodsA prospective study was conducted over 3.5 years, included a total of 105 subjects classified to 4 groups: Group I (OCAD): Included 30 patients with obstructive coronary artery disease, group II (CSF): Included 30 patients with coronary slow-flow, group III (Control 1): Included 30 healthy control persons and group IV (Control 2): Included 15 patients indicated for coronary angiography that proved normal. All participants were subjected to coronary angiography (except control group 1), ophthalmic artery Doppler for measuring Pulsatility index (PI) and resistivity index (RI) and Fluorescence angiography of retinal vessels.ResultsPatients with CSF showed slow flow retinal circulation (microcirculation) evidenced by prolonged fluorescein angiography (Arm-retina time [ART] & Arterio-venous Transit time [AVTT]). Ophthalmic artery Doppler measurements (RI & PI) were significantly delayed in OCAD and CSF patients. There was significant positive correlation between TIMI frame count in all subjects and ART, AVTT, PI, RI and Body Mass Index. Using ART cutoff value of >16 s predicted CSF with sensitivity and specificity of 100%, meanwhile AVTT of >2 s predicted CSF with a sensitivity 96.7% and specificity of 93.3.ConclusionBoth delayed arm-retina time and retinal arterio-venous transit times can accurately predict coronary slow-flow.

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