<p class="rtejustify" style="text-align: justify;">OBJECTIVES: To determine prevalence of coronary artery disease (CAD) among adult patients with congenital heart disease (CHD), who underwent Coronary Angiography (CA) at the UP-PGH. Secondary: to determine severity of CAD lesions among these patients.p> <p class="rtejustify" style="text-align: justify;">METHODS: This is a descriptive study of adult patients with Congenital Heart Disease who underwent selective coronary angiography from September 1998 to December 2010 at the Philippine General Hospital.p> <p class="rtejustify" style="text-align: justify;">RESULTS: 52 adult patients with CHD underwent CA, Ten (19%) had angiographic evidence of coronary atherosclerosis visually. Significant CAD was found in 11.5% (n=6), all patients being ≥ 40 years old (mean age 54 ± 7.9 years; range 47 -61); 4 (66%) are female; Five (83%) have documented traditional CVD risk factors, mostly hypertensive (33%). None with significant CAD had cyanosis, 4 patients (66%) have typical chest pain. Majority of CHD's were simple (61%), mostly atrial septal defects (36%). Four (n=4)(70%) patients with Simple CHD, 2 (30%) patients with Intermediate CHD and none of those with Complex CHD had significant CAD.p> <p class="rtejustify" style="text-align: justify;">CONCLUSION: Prevalence of CAD among ACHD patients using CA in this study is 11.5%. This study supports the notion of routine CA among patients with ACHD ≥ 35 years old with traditional CV risk factors. Need for primary prevention of CAD and modification of traditional CV risk factors among these patients is emphasized, as important with the general population.p>
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Heart Diseases-congenital ; Coronary Artery Disease-Prevalence ; Coronary Angiography

<p style="text-align: justify;">Pulmonary arterionevous malformation (PAVMs) are a rare disorder with an incidence of 2-3/1,000,000 population. Approximately 70% of cases are associated with Osler-Weber-Rendu Disease. This intrapulmonary malformation causes hypoxemia and dyspnea largely attributed to the right to left shunting.p> <p style="text-align: justify;">We present a case of 25-year-old male who was admitted for fever and headaches with chronic history of epistaxis, hemoptysis, cyanosis and clubbing. Central cyanocis and clubbing were evident with hypoxemia of 65%. Heart sounds and peripheral pulses were normal. There was no systolic bruit noted in the lung bases. Multiple telangiectasias were seen in the truncal area and abdomen. Chest x-ray revealed multi-chambered cardiomegaly with no opacifications. CBC showed erythrocytosis with hematocrits of 0.68-0.78. Transthoracic echocardiography showed intact interatrial and interventricular septum, with contrast study suggestive of intrapulmonary shunting. CT angiography revealed PAVMs in bilateral lung fields. Pulmonary angiography demonstrated diffuse PAVMS in the left lung with 3 large PAVMs with multiple feeders > 7mm and smaller PAVMs in the Right lower lobe. The diagnosis was Multiple Pulmonary Arteriovenous Malformation, Osler-Weber-Rendu Disease, Brain Abscess Left Temporoparietal area. Craniotomy with brain abscess evacuation was done. Left pneumonectomy or Right lobectomy was considered but was deemed unacceptable due to high morbidity and mortality. Endovascular coil embolization was done on the 3 large fistulas on the Left lobe. Post procedure, his arterial oxygenation improved to 96%. He has no recurrence of hemoptysis, no headaches and with less episodes of shortness of breath 2 months on follow-up. Diagnosing the complex diffuse intrapulmonary malformations requires a high index of suspicion among patients with chronic cyanosis, chronic history of bleeding, and brain abscess. Treatment of this condition and its associated complications remain a big challenge and should be highly individualized.p>
Human ; Male ; Adult ; Arteriovenous Malformations ; Embolization, Therapeutic ; Telangiectasia, Hereditary Hemorrhagic

BACKGROUND: Percutaneous coronary intervention (PCI) for left main (LMCA) coronary artery disease (CAD) was found to be non-inferior and had similar major adverse cardiovascular events (MACE) to coronary artery bypass grafting (CABG). In the local setting, the clinical profile and MACE of patients who underwent either revascularization are, however, unknown. OBJECTIVES: To determine the clinical profile and in-hospital MACE of patients who underwent revascularization (PCI or CABG) for LMCA and left main equivalent CAD. METHODS: This is a prospective descriptive study. Clinical profile and in-hospital, 30-days and 90-days post revascularization MACE were determined. RESULTS: Thirty-seven (37) adults were included. Most were males, diabetics, dyslipidemics, smokers, with previous cardiovascular events and premature CAD. Hypertension was significantly prevalent in the CABG group (PCI=62.50% vs CABG=90.48%, p=0.04). Patients who underwent CABG mostly presented with stable angina (p=0.0453). The majority of the PCI (68.75%) was done as an emergent/urgent procedure, with clear indications for PCI (i.e. STEMI). In-hospital all-cause mortality was significantly higher in the PCI group (PCI=50% vs CABG=0%, p<<0.05). CONCLUSION: Patients with LMCA and left main equivalent CAD were mostly males and had traditional CAD risk factors. In-hospital mortality was significantly higher among the PCI group; however, those who underwent PCI were unstable and unlikely to be good surgical candidates for CABG.
Coronary Artery Disease ' ; Coronary Artery Bypass ; Percutaneous Coronary Intervention ; Cardiovascular System

Trimetazidine as adjunctive therapy in cardioischemic patients has shown improvement in angina and left ventricular ejection fraction, but with conflicting evidence on hard clinical outcomes. This meta-analysis aims to compare the efficacy of trimetazidine versus placebo in reducing cardiac mortality and major adverse cardiac events (MACEs) in coronary artery disease patients after reperfusion strategies, whether percutaneous coronary intervention or thrombolysis. The primary outcomes examined were cardiac mortality and combined MACEs; secondary outcomes were repeat revascularization, heart failure after reperfusion, stent restenosis, recurrence of angina, and reinfarction. Trimetazidine in comparison to placebo was associated with lower cardiac mortality and combined MACEs, but results were not significant. Among secondary outcomes, only stent restenosis was significantly reduced (risk ratio, 0.53; 95% confidence interval, 0.34-0.83; P = 0.006). Further trials should be conducted with more standard dosing regimens, duration of therapy, and similar severities of ischemic disease.

<p style="text-align: justify;">INTRODUCTION: The coronary collateral circulation (CCC) is an alternative source of blood supply in coronary artery disease (CAD). The prognostic value of the presence of CCC at the time of acute coronary syndrome (ACS) is undefined with regards to hard outcomes, particularly reduction in mortality. The study's aim is to determine if the presence of CCC demonstrated by coronary angiography during an ACS is associated with a reduction in mortality. p><p style="text-align: justify;">METHODS: We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases in all languages and examined reference lists of studies. The inclusion criteria were 1) observational; 2) population included adults >19 years old with an acute coronary syndrome; 3) reported data on mortality in association with the presence or absence of CCC on angiography; and 4) should have controlled for confounders by using logistic regression analysis. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale for observational studies. The outcome of interest was reduction in all-cause mortality, assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios.p><p style="text-align: justify;">RESULTS: Pooled analysis from 11 identified trials with 8,370 subjects showed that among patients with ACS who underwent coronary angiography, the presence of CCC showed a trend towards benefit in terms of mortality, but was not statistically different from those without CCC [RR 0.65, (95% CI 0.38 to 1.12), p<0.0001, I2=74%]. In those ACS patients with CCC treated with PCI, a significant reduction in mortality was found [RR 0.43, (95% CI 0.29 to 0.64), p< 0.0001, I2=0%].p><p style="text-align: justify;">CONCLUSION: The presence of CCC during ACS showed a trend towards mortality reduction. Further, among patients treated with PCI, those with CCC had an incrementally significant reduction in mortality compared to those without CCC.p>
Coronary Artery Disease ; Collateral Circulation ; Coronary Angiography ; Acute Coronary Syndrome ; Odds Ratio ; Prognosis ; Language ; Medline ; Logistic Models ; Coronary Circulation ; Qualitative Research ; Cardiovascular System

<p style="text-align: justify;">Objective. Several studies showed that genetic factors affect responsiveness to statins among different populations. This study investigated the associations of candidate genetic variants with poor response to statins among Filipinos.p><p style="text-align: justify;">Methods. In this unmatched case-control study, dyslipidemic participants were grouped into statin responders and poor responders based on the degree of reduction in LDL-c from baseline. DNA from blood samples were genotyped and analyzed. The association of candidate variants with statin response was determined using chi-square and logistic regression analysis.p><p style="text-align: justify;">Results. We included 162 adults on statins (30 poor responders as cases, 132 good responders as controls). The following variants are nominally associated with poor response to statin among Filipinos at a per-comparison error rate of 0.05: rs173539 near CETP (OR=3.05, p=0.015), rs1800591 in MTTP (OR=3.07, p=0.021), and rs1558861 near the BUD13-ZPR1-APOA5 region (OR=5.08, p=0.004).p><p style="text-align: justify;">Conclusion. Genetic variants near CETP, MTTP and the BUD13-ZPR1-APOA5 region are associated with poor response to statins among Filipinos. Further study is recommended to test the external validity of the study in the general Filipino population.p>
Lipids ; Hydroxymethylglutaryl-CoA Reductase Inhibitors

<p style="text-align: justify;">Background. Low levels of high-density lipoprotein cholesterol (HDL-c) is a well-recognized risk factor in the development of cardiovascular diseases. Associated gene variants for low HDL-c have already been demonstrated in various populations. Such associations have yet to be established among Filipinos who reportedly have a much higher prevalence of low HDL-c levels compared to other races.p><p style="text-align: justify;">Objective. To determine the association of selected genetic variants and clinical factors with low HDL-c phenotype in Filipinos.p><p style="text-align: justify;">Methods. An age- and sex-matched case-control study was conducted among adult Filipino participants with serum HDL-c concentration less than 35 mg/dL (n=61) and those with HDL-c levels of more than 40 mg/dL (n=116). Genotyping was done using DNA obtained from blood samples. Candidate variants were correlated with the low HDL-c phenotype using chi-squared test and conditional logistic regression analysis.p><p style="text-align: justify;">Results. Twelve single nucleotide polymorphisms (SNPs) were associated with low HDL-c phenotype among Filipinos with univariate regression analysis. The variant rs1260326 of glucokinase regulator (GCKR) (CT genotype: adjusted OR=5.17; p-value=0.007; TT genotype: adjusted OR=6.28; p-value=0.027) remained associated with low HDL-c phenotype, together with hypertension and elevated body mass index, after multiple regression analysis.p><p style="text-align: justify;">Conclusion. The variant rs1260326 near GCKR is associated with low HDL-c phenotype among Filipinos. Its role in the expression of low HDL-c phenotype should be further investigated prior to the development of possible clinical applications.p>
Cardiovascular Diseases ; Dyslipidemias ; Genetics ; Polymorphism, Single Nucleotide