No abstract

Background The aim of this study was to study the prognostic implications of minimal coronary artery disease (CAD) in patients with dilated cardiomyopathy (DCMP) in terms of mortality and hospitalization due to heart failure. Methods One-hundred sixty-three patients with DCMP were recruited for this study. Out of these, 61.9% (n = 101; 62.4% men) patients were without associated minimal CAD and 38% (n = 62; 66.1% men) with associated minimal CAD (stenosis < 50%), and their risk factor profile was noted. These patients were followed for 30 months, with mortality being the primary endpoint, and hospitalization secondary to cardiac decompensation in the form of heart failure was denoted as the secondary endpoint. Results In our study, independent significant predictors of CAD were age (p = 0.002), hypertension (p = 0.001), diabetes (p < 0.001), and smoking (p = 0.023). The presence of minimal CAD in DCMP patients as a predictor of mortality was not significant (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 0.62–4.62, p = 0.303); however, it was a significant predictor of hospitalization secondary to cardiac decompensation (OR: 6.78, 95% CI: 2.28–20.13, p = 0.001). Conclusions Minimal CAD was observed in 38% of DCMP patients. The risk factor profile predicting CAD in DCMP patients was the same as that of the general population. The presence of minimal CAD in DCMP patients was not associated with mortality. However, it was associated with hospitalization secondary to cardiac decompensation in the form of heart failure.

Background Heart failure is shown to be associated with elevated levels of ST2 levels in blood. The data about the relation of blood ST2 levels, in patients of significant coronary artery disease (CAD) with left ventricular (LV) dysfunction is limited. The impact of gender on ST2 levels not studied until now, so this study aimed to assess the blood ST2 levels measured for males and females patients in comparisons, of CAD with LV dysfunction and their relation to the outcomes at the end of 1-year post intervention. Material and Methods Out of the 60 patients with 1:2 ratio of females and males with CAD and LV dysfunction, baseline quantitative assessment of ST2 levels in blood was done by rapid lateral flow immunoassay method; > 35 mg/ml was considered as abnormal. Postintervention patients followed up to one year, adverse cardiovascular events noted at the end of 1 year. By using binary logistic regression, the outcomes in females compared with males for statistical significance in relation to baseline blood ST 2 levels. The p value of < 0.05 considered was significant. Results Among the 60 patients (females 33.3% and males 66.6 %) presented with CAD with LV dysfunction in the study, 40 (66.6 %) patients diagnosed of acute coronary syndrome (ACS), and 20 (33.3%) patients with chronic stable angina (CSA). In both the genders, ACS is most common presentation (55% in females and 72.5 % in males). Eighteen (90%) females and 20 (50%) males were hypertensive, 12 (60%) females and 18 (45%) males were diabetics. Twenty-seven (67.5%) males were smokers and 14 (35%) were alcoholics. Nine (45%) female and 14 (35%) male patients had elevated ST2 levels. At the end of 1 year 9 females had events including 2 mortalities, 2 heart failures, and 7 repeat revascularizations. At the same time 7 male patients had events at the end of 1 year including 4 mortalities, 5 heart failures, and 2 repeat revascularizations. The difference in the event rates between male and female patients were statistically significance (p = 0.03). Elevated ST2 levels were correlated with echocardiographic parameter end systolic volume which was statistically significant (p= 0.03). Similarly elevated ST2 levels correlated with presence of diabetes (p= 0.01) and low LV EF. Conclusion Mean Blood ST2 levels were higher in females who associated with diabetes, high echo cardio graphic end-systolic volume, and a low ejection fraction of LV in severe LV dysfunction with statistical significance. At the end of 1 year in patients with elevated baseline ST2 levels, the female patient had more events than males with statistical significance.

Progeroid syndromes (PS) involve the disorder of early aging. Although survival of progeria syndrome patients is nearly 15 years as per literature, the adult onset progeroid starts manifesting in the third decade. Here, we are presenting a rare case of progeroid at the age of 45 years with mitral regurgitation (MR). The patient has alopecia, dry skin, frontal bossing, up staring eyes with bilateral corneal opacities, prominent nose with parrot beak appearance, thin upper lip, large, low-set ears, periorbital hyperpigmentation, micrognathia, retrognathia, and hyperpigmentation over lower abdomen/both feet and hands. Facial and skeletal manifestation are the major clinical features of the PS; along with the characteristics mentioned above, the patient also had severe eccentric MR. This patient has PS with mitral valve prolapse and severe MR. Most of the features of progeria exist in this patient, which manifested at a younger age. However, the progression of the external features and survival up to 45 years favors PS instead of progeria. Therefore, genetic analysis is mandatory to confirm. We are reporting this case due to the rarity of onset of symptoms within a younger age group; however, the progression of the disease was very slow, which may be a another variant of progeria/PS.