The clinical significance of sCD40L and Lp-PLA2 in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome / 西安交通大学学报(医学版)

Objective To investigate the clinical significance of soluble CD40 ligand (sCD40L ) and lipoprotein associated phospholipase A2 (Lp-PLA2 ) in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods Of the 9 6 patients with coronary heart disease diagnosed by coronary angiography,2 8 patients had stable angina pectoris (SAP),38 patients unstable angina pectoris (UAP)and 30 patients acute non-ST-segment elevation myocardial infarction (NSTEMI).Another 30 patients with non-coronary heart disease (NC)served as controls.The sCD40L and Lp-PLA2 levels were determined by enzyme-linked immune sorbent assay (ELISA)method.The Gensini score was used to assess the severity of coronary artery and analyze the correlation with sCD40L and Lp-PLA2.The correlation of sCD40L and Lp-PLA2 with GRACE risk score was analyzed too.Results ① sCD40L was significantly higher in NSTEMI and UAP groups than in SAP and NC groups (P0 .0 5 )or SAP and NC groups (P>0 .0 5 ).Lp-PLA2 was significantly higher in NSTEMI group than in UAP,SAP and NC groups (P<0.05).Lp-PLA2 was significantly higher in UAP group than in SAP and NC groups (P<0.05).② We found that sCD40L had obvious correlation with Lp-PLA2 (r=0.284, P<0.01),Gensini score (r=0.213,P<0.05),and GRACE (r=0.224,P<0.05).Lp-PLA2 was significantly correlated with Gensini score (r=0.270,P<0.05),and GRACE (r=0.323,P<0.01).③ Multivariate logistic regression analysis showed that Lp-PLA2 was independently associated with NSTE-ACS (P<0.05).Conclusion The sCD40L and Lp-PLA2 which were significantly elevated in NSTE-ACS are correlated with the severity of coronary artery disease.The two indexes indicate the instability of atherosclerotic plaque;thus they can be used as predictors of risk assessment in coronary heart disease.

Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease

OBJECTIVE: The aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease. METHODS: The study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing <50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing ≥50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses. RESULTS: The average thickness over all three regions was 13.2 ± 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm. CONCLUSION: We showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases. .

Mitral Annular Calcification is Associated with Severe Coronary Artery Disease in Patients Under 65 Years Old.

Background: Mitral annular calcification (MAC) is degenerative, fibrous calcification of the mitral valve annulus. It is more common in people over 70 years old. It is a marker of increased cardiovascular risk which occurs in a graded fashion by MAC severity. The aim of this study was to evaluate the association of Mitral annular calcification with severity of coronary artery disease (CAD) in patients under 65 years old. Methods: A total of 140 patients with IHD were enrolled by purposive sampling. Study populations were divided into MAC group and non MAC group. MAC was detected by Trans-thoracic echocardiography as an intense echo-producing structure located at the junction of the atrio-ventricular groove and posterior mitral leaflet in parasternal long axis view. MAC is measured in millimeters from the leading anterior to the trailing posterior edge and quantified as mild to moderate (1 to 4 mm) and severe (>4 mm) considering its thickness. Assessment of angiographic severity of CAD was done in the same hospital stay by Vessel score, Friesinger score and Leaman score. Results: Patients of MAC and non MAC groups were similar in terms of age and sex. Smoking (p=0.001) and family history of IHD (p=0.03) were significantly higher in MAC group. Anterior MI was significantly higher in MAC group (p=0.03). Left main and TVD were significantly higher in MAC group (p=0.001, p=0.01) whereas normal vessels were more in non MAC group (p=0.001). Intermediate and high Friesinger score (e”5) were significantly higher in MAC group whereas low Friesinger score (<5) were more in non MAC group. There was significant (p=0.01) positive correlation between MAC and CAD severity in terms of vessel score (r=0.76) Friesinger score (r=0.75) and Leaman score(r=0.42). Multivariate logistic regression analysis showed that MAC was independent predictors of significant CAD (p=0.02, OR= 2.84). Conclusion: Echocardiographically detected mitral annual calcification (MAC) can be an independent predictor of significant coronary artery disease. There is positive correlation between severity of MAC and severity of CAD. Cheap, available and radiation free nature of the echocardiographic detection of MAC may be a marker of significant CAD.

Clinical significance of the detection of visfatin in the peripheral blood of patients with coronary atherosclerotic heart disease / 中国医师进修杂志

Objective To detect the level of visfatin in the peripheral blood ofpafients with coronary atherosclerotic heart disease (coronary heart disease),and investigate the conelation between the level of visfatin and the lesion degree of coronary heart disease.Methods Two hundred and twenty patients who were diagnosed as coronary heart disease by coronary artery angiography from January to June 2011 (coronary heart disease group) were enrolled in this study,including 74 cases with stable angina pectoris(stable angina pectoris group),60 cases with unstable angina pectoris (unstable angina pectoris group),and 86 cases with acute myocardial infarction (myocardial infarction group).And 20 healthy persons with normal coronary artery angiography were selected as control group.The biochemical parameters of triglyceride (TG),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were detected by biochemistry autoanalyzer.The level of serum visfatin was detected by ELISA analysis.The serum biochemical parameters and serum visfatin among all the groups were compared and the correlation between them was analyzed.ResuIts The level of serum visfatin of coronary heart disease group [(34.07 ±5.51) μg/L] was significantly higher than that of control group [(13.22 ±3.17) μg/L](P＜0.05).TC and LDL-C of different coronary heart disease groups had no significant differences compared with that of control group (P ＞ 0.05).TG,H DL-C and serum visfatin of stable angina pectoris group,unstable angina pectoris group and myocardial infarction group [(1.44 ±0.27) mmol/L,(1.16 ±0.12) mmol/L,(21.36 ± 3.35) μg/L; ( 1.84 ±0.32) mmol/L,(1.01 ± 0.08) mmol/L,(27.78 ±4.47) μg/L; (2.31 ±0.34)mmol/L,(0.93 ± 0.06) mmol/L,(33.14 ± 5.66) μ g/L] had statistical significance compared with those of control group [(0.93 ±0.25) mmol/L,(1.48 ± 0.24) mmol/L,(13.22 ±3.17) μg/L](P＜0.05 or ＜0.01).TG,C,ensini score and serum visfatin of unstable angina pectoris group were significantly higher than those of stable angina pectoris group and HDL-C was obviously lower than that of stable angina pectoris group (P ＜0.05).Gensini score and serum visfatin of myocardial infarction group were significantly higher than those of unstable angina pectoris group and HDL-C was obviously lower than that of unstable angina pectoris group (P ＜ 0.05).Spearman correlation analysis showed that the level of serum visfatin of coronary heart disease group was positively correlated with TG and Gensini score (P ＜0.05 or ＜0.01 ) and negatively correlatedwith HDL-C (P ＜ 0.01 ),and had no correlation with TC and LDL-C (P ＞ 0.05).Conclusions The highlevel expression of visfatin in the peripheral blood may be a risk factor of coronary heart disease.The changes of serum visfatin can reflect the lesion severity degree of coronary artery.