Coronary Artery Disease in Patients with Atherosclerotic Peripheral Vascular Disease of Lower Extremities

BACKGROUND: Prevalence of the coronary artery disease(CAD) has been reported to be high in patients with the atherosclerotic peripheral vascular disease of lower extremities(PVD). However, the evaluation of the coexisting coronary artery disease(CAD) in patients with the PVD was often difficult due to limitation of the exercise capacity in these patients. This prespective study was designed to determine the prevalence, clinical characteristics of the associated CAD in patioents with PVDd, and to determine the value of the preoperative coronary angiogram as a predictor of the perioperative cardiovascular complications. METHODS: Eighty-two patients with PVD(78 male, age 62+/-7.8) were included from February 1991 to May 1993. Coronary angiogram was performed on the day of periperal angiogram in all patients and patients were divided into two group ; patients with CAD and patients without CAD. Clinical characteristics were compared, and among patients in whom revascularization surgery were undertaken, the incidences of the perioperative cardiovascular complications were compared between two groups. RESULTS: Coronary artery disease(CAD) was present in 50 patients(61%) of 82 PVD patients. In patients with CAD(N=50), only 72% of the patients were suspected for having coexisting CAD on the basis of chest pain and resting electrocardiogram. Revascularization surgery were performed in 46 patients and significantly high incidence of the perioperative acute myocardial infarction was observed in patients with coexisting CAD(4/25, 16% vs. 0/21, 0%). CONCLUSION: Considering the high prevalence of the CAD in patients with PVD and frequent occurrence of perioperative revascularization surgery in patients with PVD, we recommend that simultaneous coronary angiogram with aortography and peripheral angiogram should be considered in patients with PVD.

Predicting Factors of Multivessel Coronary Artery Disease in Dobutamine Stress Echocardiography

BACKGROUND: Dobutamine stress echocardiography(DSE) is useful detection of coronary artery disease as a noninvasive test. The purpose of this study is to find predicting factors of multivessel disease (MVD) in DSE. METHODS: Sixty-five patients suspicious of coronary artery disease excluding myocardial infarction on clinical base had undergone DSE and coronary arteriography. We divided the patient group into normal group (22 patients), single vessel disease(SVD) group(25 patients) and multivessel disease (MVD) group (18 patients) according to the findings of the findings of coronary angiogram. DSE findings and hemodynamic change during stress were analyzed and compared in these groups. We defined MVD on DSE as findings of new or aggravating regional wall motion abnormalities in 2 or more coronary artery territories, and significant stenosis on coronary angiogram as stenosis of 50% or more. RESULTS: 1) The numbers of diseased vessel evaluated by DSE showed significant correlation with those evaluated by coronary angiogram. 2) Resting, low-dose and peak-dose wall motion scores were significantly different among 3 groups, being higher in MVD group than in SVD and normal group. 3) Total administered dose of dobutamine in MVD group was significantly lower than that of normal group. 4) Heart rate at peak-dose showed significant difference among 3 groups, but product of heart rate and systolic blood pressure at peak-dose was not significantly different. 5) Frequency of ST segment change was significantly higher in multicessel disease group CONCLUSION: DSE reflects severity of coronary artery disease. and frequency of resting regional wall motion abnormally. wall motion score in low-dose and paak stress seems to be useful as a predictor of multivessel disease. Value of total administered dose of dobutamine, hemodynamic changes and ST segment changes as a MVD remains to be proved.

Predicting Factors of Multivessel Coronary Artery Disease in Dobutamine Stress Echocardiography

BACKGROUND: Dobutamine stress echocardiography(DSE) is useful detection of coronary artery disease as a noninvasive test. The purpose of this study is to find predicting factors of multivessel disease (MVD) in DSE. METHODS: Sixty-five patients suspicious of coronary artery disease excluding myocardial infarction on clinical base had undergone DSE and coronary arteriography. We divided the patient group into normal group (22 patients), single vessel disease(SVD) group(25 patients) and multivessel disease (MVD) group (18 patients) according to the findings of the findings of coronary angiogram. DSE findings and hemodynamic change during stress were analyzed and compared in these groups. We defined MVD on DSE as findings of new or aggravating regional wall motion abnormalities in 2 or more coronary artery territories, and significant stenosis on coronary angiogram as stenosis of 50% or more. RESULTS: 1) The numbers of diseased vessel evaluated by DSE showed significant correlation with those evaluated by coronary angiogram. 2) Resting, low-dose and peak-dose wall motion scores were significantly different among 3 groups, being higher in MVD group than in SVD and normal group. 3) Total administered dose of dobutamine in MVD group was significantly lower than that of normal group. 4) Heart rate at peak-dose showed significant difference among 3 groups, but product of heart rate and systolic blood pressure at peak-dose was not significantly different. 5) Frequency of ST segment change was significantly higher in multicessel disease group CONCLUSION: DSE reflects severity of coronary artery disease. and frequency of resting regional wall motion abnormally. wall motion score in low-dose and paak stress seems to be useful as a predictor of multivessel disease. Value of total administered dose of dobutamine, hemodynamic changes and ST segment changes as a MVD remains to be proved.

Lipoprotein(a) and Atherosclerotic Peripheral Vascular Disease of Lower Extremities

BACKGROUND: Lipoprotein(a)(Lp(a))is known as an independent risk factor of the coronary artery disease(CAD). However, it is not clear whether the level of the Lp(a) is elevated in the presence of atherosclerotic peripheral vascular disease(PVD) of lower extremities. MATERIALS AND METHODS: Considering high prevalence of the coronary artery disease in PVD, the association between the serum level of Lp(a) and the presence of PVD was investigated by comparing Lp(a) level in PVD patients with CAD(PVD+CAD group, N=15), PVD patients without CAD(PVD-CAD group, N=12), and control group who had normal coronary angiograms and no clinical evidence of PVD(Control group, N=22). In all PVD patients coronary angiograms were performed simultaneously with peripheral angiograms. Clinical characteristics, lipid profiles and the level of lipoprotein(a) were compared between two PVD group. The serum level of Lp(a) was measured with ELISA technique. RESULTS: Serum levels of lipoprotein(a) in patients with PVD as a whole(20.4+/-18.7mg/dl, mean standard deviation) were not significantly higher than those in control group(14.9+/-10.5mg/dl). In patients with PVD and CAD, the levels were significantly higher(27.0+/-20.2mg/dl) than those in patients with PVD but without CAD(12.2+/-13.3mg/dl). There was no significant difference between two groups with PVD in age, sex, association of hypertension, smoking, and other lipid profiles. CONCLUSIONS: Lipoprotein(a) level might not be related to the presence of PVD, but rather associated with CAD.

Identification of Ischemic Myocardium with Simultaneous Dobutamine Stress Echocardiography and 99mTc-MIBI SPECT in Patients with Suspected Coronary Artery Disease

BACKGROUND: To compare the diagnostic usefulness of dobutamine stress echocardiography(DSE) and 99mTc-methoxyisobutyl isonitrile SPECT (MIBI SPECT), two studies were performed simultaneously. METHOD: Fifty-six consecutive patients undergoing coronary angiogram and MIBI SPECT for clinical indications without clincal evidence of myocardial infarction were studied prospectively. During the DSE, MIBI was injected at peak stress, and post-stress images of MIBI SPECT were required on hour later. Both echocardiographic and MIBI SPECT images were visually analysed in a blind fashion. RESULTS: On the basis of coronary angiographic findings, the sensitivites of the DSE and MIBI SPECT (n=36) were 89% and 86%, respectively. The specificities of those (n=20) were 90% and 85%, respectively. Among 33 patients without resting perfusion defect on MIBI SPECT, resting regional wall motion abnormalities on DSE were found in only one patient, whereas, resting perfusion defect on MIBI SPECT were found in 9 patients among 41 patients without resting regional wall motion abnormalities on DSE. Among 17 patients who had resting perfusion defects with partial reversibility on MIBI SPECT, resting wall motion abnormalities were present in 11 patients and five of them showed improvement in the regional wall motion during low dose dobutamine infusion. CONCLUSION: Both dobutamine stress echocardiography and MIBI SPECT are useful methods in the detection of the coronary artery disease, however, MIBI SPECT seems to overestimate the regional ischemic myocardium with contractile reserve that can hardly be evaluated with MIBI SPECT.

Effect of Cardiac Rhythm on Hemodynamic Changes and Pulmonary Arterial Atrial Natriuretic Peptide Levels after Percutaneous Mitral Valvuloplasty

In order to evaluate the effect of cardiac rhythm on hemodynamic changes and pulmonary arterial atrial natriuretic peptide(ANP) levels after percutaneous mitral valvuloplasty(PMV), we measured and analyzed the correlations between hemodynamic parameters and pulmonary arterial ANP levels in 65 patients with mitral stenosis before, 20 minutes, and 24 hours after PMV. The results are as follows: 1) Normal sinus rhythm was present in 49 patients(group1), whereas the other sixteen (group 2) had chronic atrial fibrillation. 2)PMV decreased mean left atrial pressure(LAP) in both groups(p<0.001). Left atrial volume was also reduced after PMV in group 1(p<0.0001), whereas it was not decreased significantly in group 2. 3) Pulmonary arterial ANP levels at 24 hours after PMV decreased significantly in group 1(p<0.001), compared to those prior to PMV. However there was no significantl changes in group 2. 4) In group 1, there was a significant linear relationship between extents of drop in pulmonary arterial ANP levels and LAP, measured 24hours after PMV. These results suggest that ANP secretion might be influenced not only by hemodynamic changes of the left atrium, but also by possible structural changes of left atrial wall induced by chronic atrial fibrillation.

Identification of ischemic myocardium with simultaneous dobutamine stress echocardiography and 99mTc-MIBI SPECT in patients with suspected coronary artery disease / 신경정신의학

No abstract available.