Thrombospondin-1 Levels in Patients with Coronary Heart Disease

Background: Thrombospondin-1 (TSP1) is associated with atherosclerosis in animals with diabetes mellitus (DM), but the precise role of TSP-1 in human atherosclerosis remains unknown. Objectives: To investigate serum thrombospondin1 level in patients with coronary artery disease with and without type 2 DM and its relationship to coronary artery scoring systems. Methods: The study comprised 180 patients recruited from those underwent coronary angiography for suspected coronary artery disease (CAD) was approved by Institutional Review Board and Institutional Ethical Committee for Human Research of menoufia university hospital. They were divided according to presence of CAD and type 2 DM into 4 groups: Group I (n = 44 patients): Non diabetic subjects without CAD, Group II (n = 40 patients): Diabetic patients without CAD, Group III (n = 49 patients): Non diabetic patients with CAD and Group IV (n = 47 patients): Diabetic patients with CAD. Serum level of TSP-1 was measured in all groups and coronary artery scoring analysis was done. Results: Serum TSP-1 levels were higher in patients with CAD and DM than in other groups (P < 0.01) while the levels of serum TSP-1 in diabetic patients without CAD and non-diabetic patients with CAD didn’t show significant difference. Plasma TSP-1 levels were higher in patients with DM than those in patients without DM (582.95 ± 55.70 ng/mL vs. 516.91 ± 64.56 ng/ml, P <0.001). Plasma levels of TSP-1 were higher in patients with CAD than those in patients without CAD (569.54 ± 68.16 ng/mL vs. 525.17 ± 61.77 ng/ml, P < 0.001). Patients with CAD and DM (group IV) had significantly higher severity score and vessel score than those with CAD only (group III) (9.13 ± 3.40, 2.49 ± 0.69 vs. 7.37 ± 3.16, 2.02 ± 0.80 ng/ml, P < 0.05). Patients with three vessel disease had the highest serum TSP-1 level (581.32 ± 61.30 ng/ml) when compared to patients with one or two vessel disease. The highest diagnostic performance of serum TSP-1 level in prediction of coronary artery disease was more pronounced in presence of DM while the least diagnostic performance of serum TSP-1 was detected in absence of DM. Univariate logistic regression analysis of different variables for prediction of CAD showed that TSP-1 level was one of the independent predictors of CAD (OR 1.016, CI 1.010 - 1.023, P < 0.001). Conclusion: Serum TSP-1 level is higher in patients with CAD with and without type 2 DM and its level is an independent predictor of CAD, but the diagnostic performance of serum TSP-1 level in prediction of CAD is more pronounced in presence of type 2 DM.

Atrial Myocardial Deformation Changes in Patients with Non-Valvular Atrial Fibrillation

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. It increases cardiovascular morbidity, especially embolic stroke and mortality. Two-dimensional speckle tracking echocardiography (2D STE) is a useful method that has been used to detect changes in atrial myocardial deformation in AF patients. Objectives: To study atrial myocardial deformation changes in patient with non-valvular AF using 2D STE. Patients and Methods: This study included 25 patients with non-valvular AF and 25 normal healthy controls. 2D STE was used for assessment of strain and strain rate of septal and free walls of both right atrium (RA) and LA and left ventricle (LV). Results: Mean LA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-7.2% ± 5.2% vs. -20.4% ± 3.9%, -8.7% ± 8.8% vs. -21.7% ± 3.4%) and (-0.9 ± 0.5 S-1 vs. -1.9 ± 0.4 S-1, –1.1 ± 0.6 S-1 vs. -2.04 ± 0.3 S-1) respectively. Mean RA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-5.9% ± 6.1% vs. -23.4% ± 4.5%, -8.9% ± 9.3% vs. -21.7% ± 3.4%) and (-0.98 ± 0.6 S-1 vs. -1.9 ± 0.3 S-1, -1.3 ± 0.9 S-1 vs. -2.1 ± 0.5 S-1) respectively. Mean LV global longitudinal strain (GLS) and strain rate were significantly reduced in the AF group compared to the control group (-8.8% ± 4.6% vs -19.6% ± 2.4%) and (-0.8 ± 0.3 S-1 vs -1.5 ± 0.4 S-1) respectively (P < 0.001 for all). Conclusion: AF is a bi-atrial disease, LA and RA myocardial deformation properties as well as LV GLS and strain rate measured by 2D STE were significantly impaired in AF patients compared to healthy controls.