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IntroductionPatients undergoing coronary catheterization are at high risk of developing contrast-induced nephropathy (CIN) acute kidney injury (AKI). Several approaches have been supposed to limit such an effect but with mixed results or non-practical methods. Spironolactone is supposed to be effective as a nephroprotective agent in animal studies. This study will try to measure the effect of spironolactone on the incidence of CIN-AKI in patients undergoing coronary catheterization (angiography angioplasty).MethodsThis study is a single-center, investigator-driven, double-blinded randomized controlled study in Iraq-Basra. More than 400 patients admitted for coronary angio unit in our center will be allocated in a 1:1 ratio to receive either spironolactone 200 mg single dose or placebo in addition to their usual premedication.Planned OutcomesPrimary end point will be CIN defined as more than 25% or 0.3 mg/dl elevation in serum creatinine (S.Cr.) from baseline during the first 2–3 days after the procedure. We hope to identify or answer an important question regarding CIN in such high-risk patients.Trial RegistrationClinicalTrials.gov Identifier, NCT03329443.

Anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly. There are two types of ALCAPA syndrome: the infant and the adult types, each type presents with different clinical findings and outcomes. In infantile type, infants usually suffer myocardial infarction and congestive heart failure, and about 90% of them die within the first year of life if untreated surgically. In rare instances, ALCAPA syndrome presents in adolescents and adults; it is considered as an important cause of sudden cardiac death. The ideal treatment of ALCAPA syndrome is surgical repair performed by restoration of a dualcoronary-artery system. [13] We reported a case of a 14 year old girl presented with an acute myocardial infarction and her coronary angiography revealed ALCAPA syndrome. Four months after ALCAPA diagnosis, she was successfully under went surgical reconstruction without any major complications.

Objective: To assess the relationship between the serum concentrations of vitamins C & E and the severity of coronary artery disease. Subjects and methods: In a case-control study, we evaluated 200 patients who underwent coronary angiography at AL-Basrah Cardiac Center at Al-Sader Teaching Hospital, Basra, Iraq. They were separated into two groups of case (patients with CAD) and control (non CAD). Four milliliters of blood samples were taken for measuring vitamin E and C. For statistical analyses, chi-square test, Student's t-test, one-way ANOVA, and the logistic regression were used. Results: In the present study, 94 participants with CAD in the case group and 106 participants free of CAD in the control group were included in the analysis. At baseline, there were significant differences in serum vitamin C ,vitamin E and some cardiovascular risk factors(diabetes, hypertension and smoking habits) between the two groups (P < 0.05). Moreover, when other risk factors of CVD were included in the model, serum vitamin C (Odd Ratio (OR = 0.8, 95% CI= 0.68-0.92, P = 0.0001) and serum Vitamin E (OR = 0.66, 95% CI = 0.578-0.754, P = 0.0001) were associated with CAD. There were a significant (P < 0.05) statistical changes in the vitamin C and E among the three sub groups of CAD patients being more deficient as the disease become more severe. Conclusions: Low serum vitamin C and E concentrations were associated with CAD and related to its severity.

Background: Exercise is commonly used as a physiological test to determine cardiovascular disorders not appearing at rest and to assess the functional status of the heart. It is a widely used non-invasive test for assessment of suspicious or proved cardiovascular disorders. It is mainly performed to clarify the prognosis and to assess the functional capacity, the possibility and severity of coronary artery disease (CAD), and the efficacy of treatment. Coronary angiograprhy is the standard method for diagnosis of coronary artery disease (CAD), and it determins the type of therapy according to severity of coronary involvement wether by medical therapy, percutanous coronary intervention (PCI), or coronary artery bypass grafting (CABG) surgery in patients with CAD. Aim: To estimate the sensitivity, specificity, positive and negative predictive values and accuracy of exercise treadmill test in diagnosis of coronary artery disease. Methods: Exercise treadmill test and coronary angiography were performed on 77 consecutive patients (men and women), age range between 30-70 years, they were evaluated at Basrah Cardiac Center (February-June-2012). Both examinations were performed primarily for diagnostic reasons. All clinical data and results of ECG and exercise treadmill test were collected before coronary angiography. Results: The total number of patients included in the study was 77; mean age was 56.9 ± 8.9 years. The mean age for men was 57.0 ± 8.7 years (n= 53), women had a mean age of 56.0 ± 9.5 years (n=24), 90.9% of patients had CAD risk factors. Hypertension was the frequent risk factor present in 72% of patients. Exercise test was positive in 75.3%, negative in 20.8%, pseudonormalization in 3.9%. The sensitivity and positive predictive value of the test were 88% and 79% respectively, while its specificity, negative predictive value and accuracy were 46%, 63% and 75% respectively. Conclusion: Exercise test is a relatively safe, non-invasive and valuable test in the diagnosis of CAD in patients with signs and symptoms of this disease, but still considered below the coronary angiography (which is the gold standard method) for the diagnosis of CAD. The sensitivity of the test increases as the number of diseased coronary arteries increases as in left main and three vessel diseases. ST depression in women with abnormal resting ECGs is probably of less diagnostic value than in men, false positive and false negative tests were more common in women than men.