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The dysfunction of coronary microcirculation is an important cause of coronary artery disease (CAD). The index of microcirculatory resistance (IMR) is a quantitative evaluation of coronary microcirculatory function, which provides a significant reference for the prediction, diagnosis, treatment, and prognosis of CAD. IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions, and is closely associated with coronary hemodynamic parameters such as flow rate, distal coronary pressure, and aortic pressure, which have been widely applied in computational studies of CAD. However, there is currently a lack of consensus across studies on the normal and pathological ranges of IMR. The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified, which limits the application of IMR in computational CAD studies. In this paper, we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD. Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.
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Humans , Coronary Angiography , Coronary Artery Disease , Coronary Circulation , Microcirculation , Predictive Value of Tests , Vascular ResistanceABSTRACT
【Objective】 To investigate the potential mechanism of miR-17 in vascular smooth muscle cells in coronary artery disease (CAD). 【Methods】 mRNA expression of miR-17 and insulin growth factor 1 (IGF-1) in serum and VSMCs of CAD patients were detected by RT-qPCR. Potential targets of miR-17 were detected by bioinformatics and luciferase reporter assay; CCK-8 and cloning formation assay was performed to measure the proliferation of VSMCs. 【Results】 RT-qPCR results showed that compared with those in control group, the miR-17 mRNA expression in VSMCs and serum of CAD patients were significantly upregulated (P<0.01). The results of CCK-8 and clone formation assay showed that compared with those in control group, the number of VSMCs proliferation and cloning formation in the miR-17 overexpression group were significantly increased (P<0.01); those in the miR-17 low expression group were significantly reduced (P<0.01). Bioinformatics analysis showed that the 3’-UTR of IGF-1 had an miR-17 binding site. The luciferase reporter assay showed that the luciferase activity of VSMCs co-transfected with wild-type IGF-1 plasmid and miR-17 mimic was increased (P<0.001). However, the luciferase activity of VSMCs transfected with mutant IGF-1 plasmid and miR-17 mimics remained unchanged. Compared with that in control group, the expression of IGF-1 in VSMCs was upregulated after miR-17 overexpression (P<0.01). And the number of VSMCs proliferation and clone formation in the IGF-1 overexpression group was significantly increased (P<0.05). 【Conclusion】 miR-17 promotes the proliferation of VSMCs by targeting IGF-1. This indicates that miR-17 can be used as a predictive biomarker of CAD, and IGF-1 may be a potential therapeutic target.
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The ApoB/ApoA-I ratio reflects the balance between pro- and anti-atherogenic particles, all of which contain cholesterol. The ApoB/A ratio is valid in both genders of all ages and is independent of the lipid levels and phenotypes. This study has been designed to investigate the association between the ratio of apolipoprotein B (apo B)/ apolipoprotein A1 (apo A1) and HDL-C with severity of coronary artery disease in patients with and without type 2 diabetes mellitus.METHODSThe present case control study was carried out in departments of Cardiology and Biochemistry, Vinayaka Missions Hospital, Salem. Fasting blood samples have been collected from 109 CAD patients and 71 control subjects. Serum lipids were measured enzymatically, ApoA-I and Apo B were analysed by immunoturbidimetric method. The study was approved by ethics committee and informed consent was obtained.RESULTSIn our study, Apo A-1 level was significantly low (1.187±0.20) and Apo B was found to be significantly high (1.64±0.62) in CAD with diabetes subjects, when compared to CAD without diabetes. HDL level was found to be significantly lowered in CAD patients. A significant positive association was observed between ApoA-1 and lipid parameters in CAD subjects with HDL-C at (p= 0.00).CONCLUSIONSApo B/Apo A1 ratio may be a healthier forecaster than conventional lipid markers to explore the severity of CAD. This study suggests that instead of measurement of lipid profiles alone, a better indicator apo B, A-I and B/A-I ratio measurement, which in turn highlights the cholesterol balance, can reduce the delay in the recognition of CAD.
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Objective: To Study the association of cerebrovascular disease with metabolic syndrome. Methods: A Total 104 patients were included in this study & investigated for cerebrovascular disease associated with metabolic syndrome or not. A study of presence or absence of metabolic syndrome in cerebrovascular disease was done. P value was calculated by using analysis of variance test (ANOVA) & P value <0.05 was considered as statistically significant. Results: Total 104 patients were included in this study in 72 patients (69.23%) were suffering from metabolic syndrome and 32 patient (30.77%) were not suffering from metabolic syndrome. Most of the patients suffering from cerebrovascular disease associated with metabolic syndrome were of older age groups (61.11%)>61 years. Second most common group was (22.22%) 51-60 years. Other patients of cerebrovascular disease not suffering from metabolic syndrome (56.25%) in 51-60 years followed by (31.25%) in 41-50 years. Amongst the patients suffering from cerebrovascular accident and metabolic syndrome males outnumbered females, although this data is not statistically significant p=0.4. Among the Cerebrovascular accident patient group prevalence was highest therefore raised fasting blood sugar (n=58) (80.55%) and low HDL values (75.2%), whereas it was highest for Hypertension (88.89%). In the cerebrovascular accident group out of total 104 patients 72%(n=72) were suffering from metabolic syndrome and 30.77%(n=32) were not suffering from metabolic syndrome there is positive correlation between metabolic syndrome and cerebrovascular accident .Using Test for equality for proportion (zscore) this data is found to be statistically significant. Conclusion: In cerebrovascular accident group (total patients =104) 67.5%(n=108) were having 3 risk factors, 50%(n=80) were having 4 risk factors and 11.25%(n=18) were having 5 risk factors of metabolic syndrome among the cases .Among the patients suffering from cerebrovascular accident (total patients =104) the prevalence of hypertension was 88.89%(n=64),of low HDL was 75.2%(n=54),of high TGs was 80.55%(n=58),of raised waist circumference was 58.32%(n=42) and of increased fasting blood sugar was 80.55%(n=58) in the case group.
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Background: Pulmonary hypertension (PH) is an uncommon cause for chest pain in patients without significant coronary artery disease (CAD). Therefore, we studied the association between chest pain, right ventricular dimensions (RVDs), and PA size on coronary coronary tomographic angiography (CCTA). Materials and methods: It was a prospective study done from the February 1, 2015 to August 31, 2015. Total of 98 patients were identified, 67 in the chest pain and 31 in the non-chest pain group. Results: Patients with chest pain without CAD showed markedly dilated right atrial and ventricular chambers compared with standard parameters. PAD was measured as 24.81± 0.47 mm in the chest pain group and 21.91 ± 0.41 mm in the control group (P < 0.05). Odds ratio between chest pain and a significantly higher PAD was 10.11 (2.76-41.91, P < .05), 10.33 (2.15-61.41, P < .05) after adjusting for age, sex, BMI, history of HTN, HLP, CHF, COPD, OSA, and smoking. The chest pain group had an RAD1 of 47.19± 0.61 mm, RAD2 of 43.83 ± 1.79 mm, RVD1 of 37.91± 0.75 mm, RVD2 of 30.87± 0.73 mm, and RVD3 of 60.31± 1.1 mm. Based on the existing echocardiographic reference ranges, these measures fall within the upper limits of normal range. When comparing chest pain vs non-chest pain group, respectively, the mean RAD2 measured 39.98 ± 0.73 mm vs 33.78± 1.13 mm (P = .005), and the mean RVD2 measured 30.87± 0.73 mm vs 26.71± 1.73 (P = .03). Conclusion: In patients presenting with chest pain without CAD on CCTA, there is a strong association between the presence of chest pain and enlarged PAD.
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Background: Ventricular Tachycardia (VT) constitutes an important manifestation of coronary artery disease (CAD). VT can occur in the immediate acute myocardial infarction (MI) period, further complicating the management. VT also occurs after long duration of acute coronary syndrome (ACS) in the healed MI. Aim: The aim of our study was to evaluate the epidemiology, clinical presentation, hemodynamic status, treatment received and finally the outcome of CAD patients manifesting as sustained VT. Materials and methods: This prospective study was conducted at Sher I Kashmir Institute of Medical Sciences (SKIMS), a tertiary care center in Srinagar, Jammu and Kashmir, India, between August 2013 to May 2016. All the cases of definite sustained VT already admitted in the hospital or Rahul Sudan, Mehroz Ahmed, Khursheed Aslam, Irfan Yaqoob, Gunjan Gupta, Shantanu Aggarwal. Sustained ventricular tachycardia (VT) in coronary artery disease (CAD): A study from tertiary care center in north India. IAIM, 2018; 5(2): 160- 167. Page 161 presenting in the emergency department including those who developed VT during the course of acute MI were evaluated. Results: In our study, a total of 35 patients of CAD manifesting as sustained VT were observed. Majority of these patients were males. The most common presenting symptom was chest pain seen in a total of 14 patients. A total of 23 patients (66%) were hemodynamically stable at the time of VT. A decreased Left Ventricular Ejection Fraction (LVEF <50%) was seen in 18 patients (51%). Monomorphic VT was seen in a total of 28 patients (80%) and the rest of 7 patients showed polymorphic VT. Mortality was seen in 8 patients (23%). Conclusion: Polymorphic pattern of sustained VT, hemodynamic instability at the time of VT and a decreased LVEF are associated with increased mortality in patients of CAD manifesting as VT.
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Myocardial perfusion imaging using positron emission tomography (PET) has several advantages over single photon emission computed tomography (SPECT). The recent advances in SPECT technology have shown promise, but there is still a large need for PET in the clinical management of coronary artery disease (CAD). Especially, absolute quantification of myocardial blood flow (MBF) using PET is extremely important. In spite of considerable advances in the diagnosis of CAD, novel PET radiopharmaceuticals remain necessary for the diagnosis of CAD because clinical use of current cardiac radiotracers is limited by their physical characteristics, such as decay mode, emission energy, and half-life. Thus, the use of a radioisotope that has proper characteristics and a proper half-life to develop myocardial perfusion agents could overcome these limitations. In this review, the current state of cardiac PET and a general overview of novel ¹⁸F or ⁶⁸Ga-labeled radiotracers, including their radiosynthesis, in vivo characterization, and evaluation, are provided. The future perspectives are discussed in terms of their potential usefulness based on new image analysis methods and hybrid imaging.
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Coronary Artery Disease , Diagnosis , Half-Life , Myocardial Perfusion Imaging , Perfusion , Positron-Emission Tomography , Radiopharmaceuticals , Tomography, Emission-Computed, Single-PhotonABSTRACT
Background: Coronary artery disease is often asymptomatic in diabetic patients until the onset of myocardial infarction or sudden cardiac death. . Coronary artery CT angiography can detect Coronary artery disease with high specificity and sensitivity. Aims &objectives: To evaluate the prevalence of coronary artery disease by CT angiography in type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additive risk factors for coronary artery disease. Methods: This hospital based observational study was conducted from March 2013 to August 2014 at GMC Srinagar. This study was carried out among Type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additional risk factors for coronary artery disease. Total of 52 patients with Type 2 diabetes patient underwent Cardiac CT. Results: Mean age of study population was 57.08 ±9.33 years..34 were males and 18 were females. 65.39% of total patient who underwent CT Angiography had plaque in coronary arteries while 34.61% have no plaque and normal coronary vessels. 19.23% patients have significant stenosis defined by luminal narrowing more than 70%. There was statistically significant relation between those who have patient significant stenosis and nonsignificant stenosis with regards to mean age, BMI, duration of diabetes , HDL ,LDL ,total cholesterol ,TG, HbA1c and coronary calcium score. Conclusion: Asymptomatic diabetics with additional risk factors have high prevalence of atherosclerotic plaques with 19% having obstructive CAD .The timely detection of CAD can help in optimizing treatment.
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Background: The incidents of CAD is increasing alarmingly and evidence is emerging about the role of novel risk factors. hs-CRP is emerging as a crucial risk factor for premature atherothrombosis and cardio vascular events. Elevated hs- CRP concentrations early in Acute Coronary Syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. Aim: This study was undertaken to measure the levels of serum hs-CRP in patients with CAD as established by CAG. Materials and methods: This study included 100 patients admitted in General Medicine and Cardiology departments with a spectrum of coronary artery disease and undergoing coronary angiography. Routine blood investigation, ECG, Chest cardiograph, and 2D Echo test were performed. Results: A total 100 patients established that hs-CRP were elevated in all the patients irrespective of risk factor status. Also there was statistically significant difference between the levels of hs-CRP and angiographic extent of lesion. hs-CRP levels were also found to be higher in in patients with positive family history of CAD and elevated LDL-C, decreased HDL-C. Conclusion: measurement of hs-CRP should not be used as an alternative for but as an adjunct to major risk factors in assessing and thus better define the intensity of preventive therapies to be initiated
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This study aimed to investigate the biochemical profile of blood plasma of patients with coronary artery disease (CAD) and angiographically normal subjects (controls) to determine biomarkers for their differentiation. In this double blind study, 5 mL venous blood was drawn before angiography from CAD patients (n=60) and controls (n=13) comprising angiography normal individuals. In vitro high-resolution NMR spectroscopy of these blood plasma samples was carried out at 400 MHz, and intensity data were analysed with partial least square discriminant analysis. Categorization of subjects as controls or CAD patients and the patients further as single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) was done at the end of the study based on their angiography reports. Raised levels of lipids, alanine (Ala) and isoleucine/leucine/valine (Ile/Leu/Val) were observed in CAD patients compared with controls. Partial least square discriminant analysis showed separation between controls vs CAD patients. TVD patients showed increased levels of Ile/Leu/Val and Ala compared with controls and SVD. Alanine, Ile/Leu/Val, and LDL/VLDL appear as possible biomarkers for distinguishing between controls and patients with SVD and TVD. A metabolic adaptation of myocardium may play a role in raising the Ala level.
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Background: Coronary Artery Disease (CAD) remains the major cause of mortality and morbidity of mankind. Even though lot of advances are made in diagnosis, management and prevention of the disease. Coronary Artery Disease (CAD) is the leading cause of death in the United States, affecting over 5 million Americans. It is the most common cause of death in most western countries. Methods: This study was carried out in Intensive Coronary Care Unit (ICCU) of McGann hospital, Shimoga. The material of study consisted of 100 consecutive patients of Acute Myocardial Infarction (AMI) admitted to ICCU of McGann hospital from January 2014 to November 2014. Only patients who satisfied World Health Organization (WHO) definition for the diagnosis of AMI were selected for the study. Results: The age of patients in this study ranged from 24 years to 85 years. Mean age 52.91 ± 13.19 years. Out of 100 cases, 82 were males and 18 were female. The male to female ratio was 4.5:1. Among the 100 patients studied, 92 patients (92%) had atleast on of the risk factors mentioned above and 46 patients (46%) had more than one risk factors. 45 of the 96 patients (46.88%) percentage to the hospital within 6 hours of onset of chest pain. The pulse rate was within normal limits in 65 patients (65%). 26 patients (26%) had tachycardia at time of presentation and 9 patients (9%) had bradycardia. In 29 patients (29%) blood pressure was more than 140/90 mmHg and 15 patients (15%) had hypotension at time of presentation. In remaining 56 patients (56%) blood pressure was within normal limits. JVP was elevated in 6 patients (6%). 4 patients (4%) were in cardiogenic shock at the time of presentation and 13 patients (13%) were in left ventricular failure. Conclusion: There is need for early detection of risk factor to prevent the progression of coronary heart disease, need for creating awareness in the community regarding risk factors, symptoms and signs of acute myocardial infarction so that early referral can be done to coronary care unit to prevent morbidity and mortality in the community.
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Background and Objective : Acute coronary syndrome (ACS) is characterized by classical history of ischaemic chest pain, apprehension and sweating with definite Electro-Cardio gram (ECG) evidence or cardiac marker of ischaemia. The risk factors for Coronary Artery Disease (CAD) are modifiable and non-modifiable. CAD is a major cause of disability and the leading cause of death in women. The objective of our study was to assess the impact of various risk factors in women presented with ACS. Method: A total of 100 female patients of ACS and twenty healthy females were taken as control. The mean age of women presented with ACS was 62.62 years and all have attained menopause. Result: The prevalence of major risk factors of ACS in women are hypertension (78%), stress (74%), obesity (46%), sedentary habits (38%), genetic predisposition (36%), diabetes (32%) and tobacco use (18%),higher socio-economic status (74%). Significantly (P <0.05) high levels of total cholesterol, triglycerides along with reduced High Density Lipid (HDL). Conclusion: The prevalence of C - reactive protein (CRP) Positivity (>6 mg/L) is significant in women with (92%) as compared to healthy women (20%).
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Background: Arterial stiffness assessed noninvasively with aortic pulse wave velocity (PWV) has been associated with atherosclerosis in the coronary arteries and also cardiovascular mortality. The aim of this study was to evaluate the association between aortic PWV and severity of coronary artery disease (CAD) in patients with acute ST elevation myocardial infarction (STEMI). Methods: This cross sectional analytical study was conducted over 200 acute STEMI patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. Assessment of aortic PWV was performed noninvasively with the commercially available SphygmoCor system using applanation tonometry with high fidelity micromanometer on the day before angiogram. Study subjects were subdivided into two groups on the basis of PWV. In group I: aortic PWV was d” 10 m/sec and in group II: aortic PWV was> 10 m/sec. One hundred patients were included in each group. Angiographic severity of CAD was assessed by vessel score, Friesinger score and Leaman score. Results: Vessel score 0 and 1 were significantly higher in group I (p<0.05) where vessel score 2 and 3 were significantly higher in group II (p<0.05).The mean PWV in the group with normal angiographic result was 8.10±2.9 m/sec, and in patients with single vessel disease it was 11.65±3.46m/sec. In those with double and triple vessel disease the mean value of PWV was found 13.85±3.80 and 15.70±4.66 m/sec respectively. The mean value of PWV increased in proportion with the number of vessel involved by CAD and the differences were statistically significant(p=0.001).The mean value of PWV was observed 8.5±2.3 and 12.5±3.7m/sec in insignificant and significant CAD respectively using Friesinger score and the difference was statistically significant (p<0.05).There was statistically significant positive linear relation between the values of PWV and vessel score(r=.62, p=0.01), Friesinger score(r=.64, p=0.01) and Leaman score(r=.45, p=0.01). Conclusion: Aortic PWV is associated with the extent and severity of CAD. This noninvasive, cheap, radiation free method may be considered as risk stratification tool beyond other investigations.
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Objective: Type D personality, tendency trait to experience increased NA (Negative Affect) and SI (Social Inhibition) has been associated with negative psychological conditions linked to heart disease. This study aimed to examine the psychometric properties of the Malay version of Type D personality scale (DS14) among Malaysian patients with coronary artery disease (CAD). Methods: In this cross-sectional study 195 patients diagnosed with CAD were selected from National Heart Institute, Kuala Lumpur. They completed the questionnaire including demographic information and the Malay version of DS14 and Hospital Anxiety and Depression Scale (HADS). Results: The structural validity, as demonstrated by exploratory factor analysis of the DS14 was acceptable. The Cronbach's α coefficient for the NA and SI subscales were 0.876 and 0.732, respectively. With the standardized cut-off of NA ≥ 10 and SI ≥ 10, 28.2% of the patients with CAD were defined as having a Type D personality. Anxiety was significantly higher among patients with Type D personality. Conclusion: The results indicate that the Type D personality (DS14) questionnaire is a valid and reliable tool in the Malaysian population. The prevalence of Type D personality in Malaysia falls close to what has been found in Western countries, at least for CAD patients. This study indicates also that it is possible to use the DS14 among the Malaysian population in future cross-cultural studies.
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Background: Coronary Artery Disease (CAD) is the leading cause of death in most industrialised countries (about one-third of all deaths) and somewhat low incidence is observed in the developing countries. Aims & Objective: To study age wise distribution of Coronary Artery Disease risk factors. Material and Methods: The data for this study was collected from Baroda Heart Institute & Research Centre (BHIRC). The total 208 patients were considered for study of CAD. Results: The majority of our patients were from age group of 60-69 years i.e. 67 (32.21%) and only 10 patients (4.32%) were in the age group of ≥80 years. Amongst all patients, 93.27% were lacking exercise, 39.42% were hypertensive, 28.85% were obese, 27.88% diabetic, 10.58% had family history of CAD and 5.28% were smokers. Conclusion: It is essential to identify CAD risk factors amongst the Indians to tackle the problem. So this study would be of great help in this direction.
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The increasing disease burden due to coronary artery disease (CAD) can be minimized by an early detection using a valid risk factor. Aim of this study was to determine the level of apolipoprotein AI(ApoAI), apolipoprotein B(ApoB) and ApoB/ApoAI ratio in CAD patients with or without type II diabetes mellitus(DM) and to analyze whether these parameters can be used as a more accurate lipid risk factor than the conventional ones. Fasting blood samples were collected from angiographically determined coronary artery disease patients with or without type II DM and control subjects. Serum total cholesterol (TC), triglycerides (TG),and high density lipoprotein (HDL-C)were measured enzymatically ,low density lipoprotein (LDL-C) was determined using Friedewald's formula ,Apo AI and Apo B were analyzed by immunoturbidimetric method. Plasma values of total cholesterol, triglycerides (TG), low density lipoprotein (LDL) cholesterol, were not significantly different in the groups with normal coronary arteries and CAD. Level of ApoB was significantly higher and the level of Apo AI was significantly lower in CAD patients when compared to normal coronary artery group. In the study, ratio of Apo B to Apo AI (Apo B/ Apo AI) was found to be markedly high in CAD patients ( p<0.001) when compared to the control . As the ratio covers both atherogenic and antiatherogenic lipid risk factor, it can be used as a better predictor than conventional risk factor.
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Introducción: En la actualidad la enfermedad coronaria obstructiva (obstrucción mayor de 50%) puede ser fácilmente evaluada por medio de la tomografía coronaria multicorte. Sin embargo, aún no se define si ésta puede reemplazar a la angiografía coronaria invasiva, en pacientes que van a cirugía cardiaca no coronaria. Objetivo: Conocer si la tomografía coronaria multicorte puede sustituir a la angiografía coronaria invasiva en la detección de enfermedad coronaria en pacientes que van a ser operados de cirugía cardiaca no coronaria; comparando entre si la sensibilidad y especificidad de ambos métodos en la detección de enfermedad coronaria. Método: Se incluyeron consecutivamente 64 pacientes con edades de 55.17 ± 12.73 años, en Clase I de las guías del Colegio Americano de Cardiología/Asociación Americana de Corazón para realizar angiografía coronaria en el preoperatorio de cirugía cardiaca no coronaria. Se excluyeron enfermos con angina de pecho, alergia al medio de contraste, creatinina sérica por arriba de 2.0 mg/dL, que tuvieran previamente cirugía cardiaca o angioplastia coronaria y arritmias supra-ventriculares. Se analizó la anatomía coronaria y se cuantificó la cantidad de calcio coronario. Resultados: La prevalencia de obstrucción coronaria mayor de 50% fue 12.5%. La tomografía coronaria multicorte mostró sensibilidad de 87.5%, especificidad de 92.8%, valor predictivo negativo de 98.1% y área bajo la curva de 0.90, para predecir obstrucción coronaria. Ningún paciente con valvulopatía reumática tuvo obstrucción coronaria mayor de 50% o score de calcio > 400 U A (RR = 0.80, IC 95% 0.69-0.94). La estenosis valvular aórtica degenerativa tuvo mayor probabilidad de obstrucción coronaria mayor de 50% (RR = 9.0: IC 95% 1.64-49.8). Con análisis multivariado usando regresión logística, el score de calcio mayor de 400 UA (Coef ß 0.342, t = 4.297, p = 0.000) y sexo masculino (Coef ß 0.174, t = 2.214, p = 0.031), fueron las variables predictoras de más peso. Este estudio muestra poblaciones diferentes en el grupo de pacientes que van a cirugía cardiaca no coronaria. Conclusiones: El género masculino, el calcio coronario mayor de 400 UA y el tipo de enfermedad cardiaca previa a la cirugía cardiaca no coronaria pueden ser variables útiles para realizar la selección de pacientes que pueden evaluarse con tomografía coronaria multicorte o con angiografía coronaria invasiva. La angiografía coronaria invasiva puede indicarse necesariamente en algunos pacientes que van a cirugía cardiaca no coronaria, pero no es absolutamente necesaria en todos los enfermos como hasta hoy se recomienda en las guías del Colegio Americano de Cardiología y la Asociación Americana de Corazón.
Introduction: Significant Coronary Artery Disease (CAD>50%) it can easily detected with Multislice Computed Tomography (MSCT), nevertheless if MSCT may replace Invasive Coronary Angiography (ICA) in the preoperative assessment of the patient undergoing to non-coronary cardiac surgery is not well defined. The objective of this study was to know if the MSCT can replace ICA in the preoperative valuation of patients who go to cardiac surgery Method: 64 consecutive patients in Class I recommendation of American College of Cardiology / American Heart Association (ACC/AHA) guidelines for preoperative ICA were evaluated. Patients with angina, contrast medium allergy, serum creatinine up to 2.0 mg/dL, previous coronary cardiac surgery or coronary angioplasty and supraventricular arrhythmias were excluded. Both, Coronary artery calcium (CAC) and coronary angiography were evaluated. Results: The prevalence of significant (>50%) CAD was 12.5%. The Sensitivity of MSCT to detect significant CAD was 87.5%, its Specificity of 92.8%, Predictive Negative Value was 98.1% and Area Under the Curve (ROC analysis) = 0.90. Anyone with Rheumatic Valvular Disease had significant CAD or CAC>400 UA (RR = 0.80, IC95% 0.69-0.94). Degenerative Aortic Valve Stenosis had a major probability of significant CAD (RR of 9.0; IC 95% 1.64-49.80). Logistic Regression Analysis showed than CAC>400 UA (Coef ß 0,351, t = 4.402 p = 0.000) and male gender (Coef ß 0,179, t = 2.445, p = 0.017), were the best predicting variables of CAD. This study shows different populations in patients undergoing to non-coronary cardiac surgery. Conclusions: Gender, CAC> 400 UA and type of cardiac disease previously surgery may be useful for triage to MSCT or ICA in the preoperative assessment. This study shows that ICA may be necessarily indicated in some patients in assessment of non-coronary cardiac surgery but not absolutely indicated in all patients that Guidelines of ACC/AHA have recommended.
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Female , Humans , Male , Middle Aged , Cardiac Surgical Procedures , Coronary Artery Disease , Multidetector Computed Tomography , Preoperative Care , Coronary Angiography/methods , Predictive Value of TestsABSTRACT
Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is a rare manifestation of coronary artery disease (CAD) and defined by a total absence of antegrade blood flow to the left anterior descending (LAD) and circumflex (Cx) system. Patients are at high risk of myocardial ischaemia as a sizeable area of myocardium is at risk and thus require urgent intervention. Surgery is the treatment of choice especially with CTO lesions as percutaneous coronary intervention has limited success with a high restenosis rate. We report a rare case of a young Chinese male who presented acutely with a myocardial infarction and discuss the aetiology and peri-operative technical considerations for successful surgery with this condition.
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A case-control study was conducted to study the Lipid profile of high risk children (age 2-10 years). There was a significant elevation of total cholesterol (P<0.001) and LDL (P<0.001). Early dietary and lifestyle modifications can prevent this cascade.
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Objective To explore the relationship between the extent of coronary artery lesions and plasma brain natriurefic peptide(BNP)levels in the patients with coronary artery disease(CAD)except for congestive heart failure(CHF).Method Seventy CAD patients without CHF evidenced by dinical manifestation and coronary arte- riography(CAG)from Cardiology Depamnent of the First Affiliated Hospital of Zhejiang University School of Medicine,China,were enrolled in the study.These patients were diagnozed under coronary arteriography(CAG) during March to May of 2007.They were divided into 3 groups:stable angina goup(24 patients),unstable angina group(25 patients),myocardial infarction group(21 patients).Twenty patients without coronary history and with normal CAG served as controls.Plasma BNP concentrations were measured with ELASA before CAG.The coronary lesion vessels and scores were estimated after CAG.The relationship between BNP levels and the coronary lesion vessels,as well as scores in CAD was analyzed.The data were expressed as(x±s)and was analyzed by using 2 independent samples test and spearman correlation with SPSS 13.0.A P value less than 0.01 indicated statistical significance.Results The plasma BNP concentrations in the patients,especially in the patients with myocardial infarction,were significantly higher than those in the controls.Spearman analysis showed that there was a positive correlation between the BNP levels and coronary lesion vessels(r1=0.309,P=0.01),also between BNP and coronary lesion score(r2=0.279,P=0.01).Conclusions In the patients without congestive heart failure,the more serious the coronary artery lesions,the higher the plasma BNP concentrations were.The degree of myocardial ischemia caused by coronary artery lesions was correlated with the plasma BNP level.Plasma BNP concentration could be valuable for the extent of coronary artery lesions in the patients of coronary artery disease.