BACKGROUND: CHRONIC STABLE ANGINA is a common disease afflicting millions of people worldwide. The purpose of this study was to assess whether normal electrocardiogram (ECG) in this group of patients would mean normal cardiac systolic function.METHODS: Ejection fraction was determined by cardiac angiography in 389 consecutive patients with CHRONIC STABLE ANGINA who had normal resting ECG. Data was analyzed using t-test in SPSS 10.5.RESULTS: Only 15 patients (3.9%) with CHRONIC STABLE ANGINA and normal resting ECG had impaired cardiac systolic function (low ejection fraction).CONCLUSION: Although a normal ECG by no means exclude possibility of coronary artery disease in patients with symptoms consistent with CHRONIC STABLE ANGINA, it makes the presence of left ventricular systolic function less likely and might predict a better prognosis.

Background: Coronary heart disease (CHD) is the leading cause of death worldwide. Research indicates that coronary atherosclerosis is the most frequent cause of CHD. Evidence is scarce concerning the clinical efficacy of fibrinogen or neutrophil-lymphocyte ratio (NLR) measurement in risk-stratifying patients with CHRONIC STABLE ANGINA.Objectives: To examine the independent and incremental prognostic value of fibrinogen and neutrophil-lymphocyte ratio (NLR) for angiographically-detected coronary artery disease (CAD).Patients and Methods: In this cross-sectional study, angiography was performed for 183 Iranian patients with CHRONIC STABLE ANGINA with exercise ECG-determined intermediate risk. Generalized estimated equations were used to obtain the odd ratio (OR) of CAD for a 1-unit increase in log-NLR and a 1-SD increase in plasma fibrinogen. Models were adjusted for established CAD risk factors.Integrated discriminatory improvement index (IDI) and net reclassification improvement index (NRI) were used as measures of predictive ability for CAD, combined with traditional risk factors by NLR and fibrinogen.Results: The mean age of the participants was 57.5, with 51.9% being male. Only 12% of participants had angiographically determined patent coronary arteries. The numberof participants with one, two, and three-vessel stenosis were 76, 31, 31, respectively, while 45 did not have stenosed vessels. NLR and fibrinogen levels were significantly higher in patients with stenosis in two (2.4 and 512 mg.dL-1) or three (2.6 and 517 mg.dL-1) coronary arteries, as compared to the group of patients with no significant involvement (2 and 430 mg.dL-1) (all P<0.01). Patients with a higher NLR and a higher fibrinogen levels were more likely to have higher grades of CAD. OR log-NLR=1.36 (95% CI: 1.05 - 1.94) and OR Z-Fibrinogen=1.61 (95% CI: 1.18 - 2.22). When NLR and fibrinogen were added to the traditional risk factors separately, the NRIs were 0.170 (0.023 - 0.324) and 0.380 (0.214 - 0.543), respectively. The NRI was 0.460 (0.303 - 0.620) when both NLR and fibrinogen added to traditional risk factors simultaneously.Conclusions: NLR and fibrinogen predicted CAD, independent of traditional CAD risk factors. Both measures (whether separately or together) substantially enhanced the predictive performance of traditional risk factors for identifying patients with CAD.

Background: Epicedial fat tissue is known as a risk factor in cardiovascular diseases. This study was designed to compare the epicedial fat thickness in patients with cardiovascular diseases and normal patients. It also tried to find a correlation between epicedial fat thickness and severity of coronary stenosis.Methods: This study was conducted from September 2010 to April 2011 at two university hospitals (Noor and Chamran Referral centers) associated to Isfahan University of Medical Sciences, Isfahan, Iran.A total number of 196 subjects were allocate to three groups of control (n=68), acute coronary syndrome (n=64) and CHRONIC STABLE ANGINA (n=64). After registering demographic data, all individuals underwent echocardiography in diastolic subcostal view to determine the epicedial fat thickness.Angiography was also conducted to assess the severity of coronary stenosis. The thickness of epicedial fat was compared between groups and its correlations with age, sex, hypertension, hypercholesterolemia, diabetes, waist circumference, body mass index and severity of coronary stenosis were evaluated.Findings: The mean age of participants was 59.54±11.01 years. There were statistical differences between age, sex, smoking and severity of coronary stenosis (P<0.001, P=0.03, P=0.04, and P<0.001, respectively). The mean of epicedial fat thickness in acute coronary syndrome, CHRONIC STABLE ANGINA and control groups were 5.7±2.1, 6.2±2.0 and 4.6±1.9 mm (P<0.001). There were no independent correlation between predicting factors and epicedial fat thickness (P>0.05).Conclusion: This study indicated the thickness of epicedial fat to be more in cardiovascular diseases compared with normal persons. Future studies for evaluating the sensitivity and specificity of this diagnostic method are warranted.

Background and purpose: Prevalence of risk factors for health is growing rapidly in developing countries due to urbanization. In fact much of the global burden of some conditions such as ischemic heart disease is currently in low-and middle-income countries. Therefore, an integrated and effective clinical guide is highly needed for management of patients with STABLE ANGINA. Materials and methods: Databases and web-related documents were searched in order to extract clinical guidelines on STABLE ANGINA. After assessing the quality of guidelines, three were selected based on the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Then, a national guideline was compiled along with evidence and recommendations by the panel of experts. Results: Findings were presented in the form of clinical recommendations. For example, acupuncture should not be used in improving or reducing the symptoms of cardiovascular disorders in patients with STABLE ischemic heart disease. Conclusion: Considering 92 recommendations in this guideline and its adaptation in the Iranian population, this clinical guidline and its recommendations can be effective in standardizing services, screening, referral, diagnosis, treatment, and follow-up of patients with STABLE ANGINA.

BACKGROUND: Differentiation of STABLE ANGINA from unSTABLE ANGINA is important because they need different approaches. Few studies have been conducted to assess the diagnostic value of high sensitive C-reactive protein (hs-CRP) in differentiating these two diseases. This study aimed to evaluate the diagnostic value of hs-CRP levels for differentiating STABLE ANGINA from unSTABLE ANGINA. METHODS: After signing the consent form, patients with unSTABLE ANGINA who referred to Tohid Hospital emergency in Sanandaj, Iran, and patients with STABLE ANGINA who referred to the special clinic of the hospital were evaluated. Disease was confirmed by a cardiologist. Morning serum hs-CRP was tested using MONOBIND laboratory kit (USA). Data were analyzed by SPSS using Student’ s independent t-test, Mann-Whitney U, chi-square, Fisher exact test, and receiver operating characteristic curve. RESULTS: hs-CRP levels in patients with STABLE ANGINA and unSTABLE ANGINA were 1. 6 (± 1. 18) and 2. 35 (± 1. 30) mg/l, respectively (P = 0. 025). The hs-CRP level ≥ 2. 31 mg/l was the best cut-off point for differentiating STABLE from unSTABLE ANGINA. At this cut-off point, the sensitivity and specificity were 56% and 73%, respectively. Area under the curve was calculated to be 0. 679 (95% confidence interval: 0. 54-0. 81) (P = 0. 017). CONCLUSION: hs-CRP level is helpful for differentiating patients with STABLE ANGINA from those with unSTABLE ANGINA. It is recommended to consider the hs-CRP level of 2. 31 mg/l as the best cut-off point.

BACKGROUND AND OBJECTIVE: Atherosclerosis and its complications are a major cause of ischemic heart diseases. Platelets play an important role in initiation of atherosclerosis and coronary thrombus formation. Large platelets are shown to be hemostatically more active. Evaluation of platelet volume parameters could be useful and significant in prediction and differentiation of coronary events. METHODS: In this study, 100 patients with chest pain were divided into three groups according to clinical manifestation and standard diagnostic criteria. Twenty-five patients were with unSTABLE ANGINA, twenty-five patients with CHRONIC STABLE ANGINA and fifty patients with non-cardiac chest pain as normal population. Platelet indices and count were assayed within 1 to 3 hours, after sampling from venous blood and collection in K3 EDTA, by a Sysmex KX21 analyzer. Data were provided for each group and surveyed by ANOVA & Tukey tests with Pearson correlation and P- value less than 0.05.FINDINGS: Patients with unSTABLE ANGINA had a significant higher MPV (mean platelet volume) (l0.7±0.23fl), PDW (platelet distribution width) and PLCR (platelet- lerge cell ratio) than those in CHRONIC STABLE ANGINA and normal group (p<0.05). MPV in CHRONIC STABLE ANGINA patients (10.1 ± 0.2 fl) was higher than normal population (9.5± 0.1 fl), but platelet count and other indices were not statistically significant difference. There were no sex or age differences in MPV amounts in population group.CONCLUSION: Platelet volume indices are increased in unSTABLE ANGINA probably because of platelet activation and a compensatory volume enhancement. Platelets count reduction in this condition results from platelets consumption. These changes in platelet count and volume could differentiate unSTABLE ANGINA patients from CHRONIC STABLE patients and normal individuals.