Anahit Anvari

Angiotensin-converting enzyme and angiotensin II receptor 1 polymorphism in coronary disease and malignant ventricular arrhythmias

OBJECTIVES It has been reported that patients carrying the angiotensin-converting enzyme (ACE) deletion DD genotype with the angiotensin II type 1 (AT1) C allele are at increased risk for myocardial infarction. The frequency distribution of the ACE and AT1 receptor gene polymorphism and their possible relation regarding malignant ventricular arrhythmias in patients with coronary artery disease (CAD) and left ventricular dysfunction was determined. METHODS The ACE I/D and AT1 A/C polymorphisms (using polymerase chain reaction) in 100 Caucasian patients suffering from CAD with a history of malignant ventricular arrhythmias treated with an implantable cardioverter defibrillator (ICD group) was compared to 127 age-matched Caucasian patients with CAD and no history of malignant ventricular arrhythmias (control group). All patients had reduced left ventricular ejection fraction of < 40% and were comparable regarding sex distribution, body mass index, ACE-inhibitor treatment, lipid status and duration of CAD. RESULTS The prevalence of DD/CC in the ICD group was significantly higher (19% versus 10%, p < 0.0001). The risk for malignant ventricular arrhythmias was associated with the combination of ACE D and AT1 C alleles (odds-ratio: 2.4, 95% confidence interval 1.41 to 3.94, p < 0.001). The distribution of ACE and AT1 genotypes was not different between the two group. CONCLUSIONS Patients with coronary artery disease and left ventricular dysfunction carrying ACE D and AT1 C alleles are at increased risk for development of malignant ventricular arrhythmias. Because of available pharmacological inhibitors, these results may have clinical implications for the prevention of sudden cardiac death.

PAI-I 4G/5G polymorphism and sudden cardiac death in patients with coronary artery disease

UNLABELLED The 4G/5G polymorphism of the plasminogen activator inhibitor type I (PAI-I) gene is involved in coronary artery disease (CAD), with the highest risk in 4G/4G homozygotes. The role of PAI-I polymorphism in patients suffering from CAD and history of sudden cardiac death (SCD) has not been addressed yet. We studied the frequency distribution of the PAI-I gene to test the hypothesis that the 4G/4G genotype favors myocardial ischemia and, even in the absence of acute infarction, promotes SCD in patients with CAD. METHODS The PAI-I 4G/5G genotypes and PAI-I antigen plasma levels were determined in 97 patients with CAD and a history of SCD treated with an implantable cardioverter defibrillator (ICD) (defibrillator group) comparing to 113 patients with CAD but no history of SCD (control group). RESULTS The defibrillator group consisted of significantly more 4G/4G homozygotes and higher PAI-I levels than the control group (44% vs. 24%, 173+/-41 vs. 144+/-49 ng/ml; P<.01). The carriers of 4G allele had a significantly higher risk for SCD (odds ratio (OR) 1.9) with the highest risk in the 4G/4G genotype (OR 3.6, P<.01). CONCLUSION These results suggest that the PAI-I 4G/4G genotype is associated with SCD in patients suffering from CAD.

Comparison of Three Cardioverter Defibrillator Implantation Techniques: Initial Results with Transvenous Pectoral Implantation

A total of 121 patients underwent epicardial (n = 32), transvenous abdominal (n = 30), and transvenous pectoral (n = 59) ICD implants. Perioperative complications were defined as those occurring within 30 days after surgery. Hospital costs were calculated with

Platelet Glycoprotein Ia Gene Dimorphism α2-807 in Malignant Arrhythmia in Coronary Artery Disease

750 per day as a fixed charge. Duration of surgery was the time between the first skin incision and the last skin suture. Severe perioperative complications that were life‐threatening or required surgical intervention occurred in the epicardial (6%) and transvenous (10%) abdominal groups, but not in the pectoral group. Perioperative mortality occurred only in the epicardial abdominal group, predominantly in patients with concomitant surgery (18%), and in 5% of patients without concomitant surgery. The duration of surgery was significantly shorter for transvenous pectoral implantation (58 ± 15 rain, P < 0.05) compared to transvenous abdominal implantation (115 ± 38 min). Epicardial abdominal ICD implantation had the longest procedure time (154 ± 31 min). The postimplant hospital length of stay was significantly shorter for pectoral implantation (5 ± 3 days, P < 0.05) compared to transvenous (13 ± 5) and epicardial (19 ± 5) abdominal implantation. Total hospitalization costs significantly decreased in the pectoral implantation group (

Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators

4,068 ±

Evaluating antiarrhythmic strategies: a knowledge-based system for exploring clinical data.

2,099 for the pectoral group vs

Cardiac involvement in systemic sclerosis.

14,887 ±

New cut-off values of cardiac markers for risk stratification of angina pectoris

4,415 and

LOCAL ANAESTHESIA VERSUS GENERAL ANAESTHESIA FOR CARDIOVERTER-DEFIBRILLATOR IMPLANTATION

9,975 ±

Successful radiofrequency ablation of both atrioventricular nodal reentrant and circus movement tachycardia

3,657 for the epicardial and the transvenous abdominal group, respectively, P < 0.05). These initial results demonstrate the advantage of transvenous pectoral ICD implantation in terms of perioperative complications, procedure time, hospital length of stay, and hospitalization costs.