Features of cardiopulmonary exercise test in patients with intermediate coronary stenosis / 中国康复理论与实践

ObjectiveTo review the clinical characteristics and capacity of cardiopulmonary exercise test in patients with intermediate coronary stenosis. MethodsFrom January, 2015 to January, 2020, the patients underwent coronary angiography and cardiopulmonary exercise test in Beijing Bo'ai Hospital were divided into intermediate coronary stenosis group (n = 184) and non-coronary heart disease group (n = 73). Symptoms, general information, laboratory and echocardiography information, results of cardiopulmonary exercise test were compared between two groups, and the main cardiovascular events during a year were observed. ResultsThe proportion of male (χ2 = 15.857, P < 0.001), smoking history (χ2 = 9.067, P = 0.003), hypertension history (χ2 = 15.087, P < 0.001) and hyperlipidemia history (χ2 = 13.507, P < 0.001) were more, and the level of hemoglobin A1c (Z = 2.431, P = 0.015) and high sensitivity C-reactive protein (Z = 2.108, P = 0.035) were higher in the intermediate coronary stenosis group, while less of them could reach anaerobic threshold (χ2 = 10.702, P = 0.001). The heard rate and respiratory exchange rate as anaerobic threshold decreased in the intermediate coronary stenosis group (Z > 2.156, P < 0.05). There was no significant difference in main cardiovascular events between the two groups within a year (P = 1.000). ConclusionCardiopulmonary capacity has been impaired in patients with intermediate coronary stenosis, who need to pay attention to the risk factors such as smoking, diabetes mellitus, hypertension and hyperlipidemia.

Comparison of resting and adenosine-free pressure indices with adenosine-induced hyperemic fractional flow reserve in intermediate coronary lesions

Objective Fractional flow reserve (FFR) using adenosine has been the gold standard in the functional assessment of intermediate coronary stenoses in the catheterization laboratory. We aim to study the correlation of adenosine-free indices such as whole cycle Pd/Pa [the ratio of mean distal coronary pressure (Pd) to the mean pressure observed in the aorta (Pa)], instantaneous wave-free ratio (iFR), and contrast-induced submaximal hyperemia (cFFR) with FFR. Methods This multicenter, prospective, observational study included patients with stable angina or acute coronary syndrome (>48 h since onset) with discrete intermediate coronary lesions (40–70% diameter stenosis). All patients underwent assessment of whole cycle Pd/Pa, iFR, cFFR, and FFR. We then evaluated the correlation of these indices with FFR and assessed the diagnostic efficiencies of them against FFR ≤0.80. Results Of the 103 patients from three different centers, 83 lesions were included for analysis. The correlation coefficient (r value) of whole cycle Pd/Pa, iFR, and cFFR in relation to FFR were +0.84, +0.77, and +0.70 (all p values < 0.001), respectively, and the c-statistic against FFR ≤0.80 were 0.92 (0.86–0.98), 0.89(0.81–0.97), and 0.91 (0.85–0.97) (all p values < 0.001), respectively. The best cut-off values identified by receiver–operator characteristic curve for whole cycle Pd/Pa, iFR, and cFFR were 0.94, 0.90, and 0.88, respectively, for an FFR ≤0.80. By the concept of “adenosine-free zone” (iFR = 0.86–0.93), 59% lesions in this study would not require adenosine. Conclusion All the three adenosine-free indices had good correlation with FFR. There is no difference in the diagnostic accuracies among the indices in functional evaluation of discrete intermediate coronary stenoses. However, further validation is needed before adoption of adenosine-free pressure parameters into clinical practice.

Predictive Value of Risk Factors Model for Major Adverse Cardiac Events in Patients with Intermediate Coronary Stenosis in Proximal Left Anterior Descending Artery / 医学研究杂志

Objective To investigate the risk factors of major adverse cardiac events (MACE) in patients with intermediate coronary stenosis in proximal left anterior descending artery (ICS-PLAD) and to assess the predictive value of risk factors model for MACE in patients with ICS-PLAD.Methods Totally 221 patients with ICS-PLAD (≥50％ and ＜70 ％ diameter stenosis by angiography) were retrospectively studied.The risk factors of MACE in patients with ICS-PLAD were explored by binary logistic regression analysis.The predictive value of risk factors model for MACE in patients with ICS-PLAD was evaluated by receiver operator curves (ROC).Results Compared with No MACE group,the MACE group had more patients with diabetes(DM),hypertension and number of stenotic vessels ≥ 2,had higher body mass index (BMI),low density lipoprotein cholesterol(LDL-C)and triglycerides(TG) (P all ＜ 0.05).Binary logistic regression analysis showed that the independent risk facts were TG (OR =2.447,P =0.000,95％ CI:1.608-3.725),LDL-C (OR =1.971,P =0.006,95 ％ CI:1.219-3.187) and number of stenotic vessels ≥ 2 (OR =6.596,P =0.000,95 ％ CI:2.995-14.526).The area under the ROC (AUG) of risk factor model for the prediction of MACE in patients with ICS-PLAD were 0.794 (P =0.000).Conclusion Patients with ICS-PLAD,with DM,hypertension,number of stenotic vessels ≥2,obesity,high LDL-C or high TG,had higher MACE rate.TG,LDL-C and number of stenotic vessels ≥2 were the independent risk factors of MACE in patients with ICS-PLAD.The risk factors model has some clinical value for the prediction of MACE in patients with ICS-PLAD.

Clinical outcomes of the vulnerable plaque sealing with drug-eluting stents for the treatment of intermedi-ate coronary stenosis / 实用医学杂志

Objective To evaluate the one-year clinical outcomes in patients with the vulnerable plaque sealing with drug-eluting stents for the treatment of intermediate coronary stenosis. Methods 327 patients with an-giographically intermediate lesions(diameter stenosis 50%~70%)with the vulnerable plaque which were detected by 64 slice coronary CT were prospectively enrolled. Patients were divided into medical therapy group (n = 160) and sirolimus-eluting stent group group(n=160). The incidences of one-year major adverse cardiovascular events (MACE)was evaluated(cardiac death,myocardial infarction ,revascularization). Results The MACE tended to be lower in the sirolimus-eluting stent group than medical therapy group(3.13%vs. 10%,log-rankχ2=6.62,P=0.01). The incident of cardiac death and myocardial infarction were lower in the sirolimus-eluting stent group than medical therapy group(1.25%vs. 5.63%,log-rankχ2=4.61,P=0.03). Conclusion The treatment of the siroli-mus-eluting stent can reduce MACE for the paitents with the vulnerable plaque of intermediate coronary stenosis than medical therapy only.

Clinical outcomes of the vulnerable plaque sealing with drug-eluting stents for the treatment of intermedi-ate coronary stenosis / 实用医学杂志

Objective To evaluate the one-year clinical outcomes in patients with the vulnerable plaque sealing with drug-eluting stents for the treatment of intermediate coronary stenosis. Methods 327 patients with an-giographically intermediate lesions(diameter stenosis 50%~70%)with the vulnerable plaque which were detected by 64 slice coronary CT were prospectively enrolled. Patients were divided into medical therapy group (n = 160) and sirolimus-eluting stent group group(n=160). The incidences of one-year major adverse cardiovascular events (MACE)was evaluated(cardiac death,myocardial infarction ,revascularization). Results The MACE tended to be lower in the sirolimus-eluting stent group than medical therapy group(3.13%vs. 10%,log-rankχ2=6.62,P=0.01). The incident of cardiac death and myocardial infarction were lower in the sirolimus-eluting stent group than medical therapy group(1.25%vs. 5.63%,log-rankχ2=4.61,P=0.03). Conclusion The treatment of the siroli-mus-eluting stent can reduce MACE for the paitents with the vulnerable plaque of intermediate coronary stenosis than medical therapy only.