RESUMEN
Background: Hypertrophic cardiomyopathy is genetically transmitted primary cardiac disease and an important cause of morbidity and sudden death in young people, including competitive athletes. Objectives: The study was designed to compare the CAG findings between normal subject and hypertrophic cardiomyopathy patients who required CAG. Methods: HCM was diagnosed by using diagnostic criteria (clinical, electrocardiography and echocardiography) defined by Western Working group. The study was carried out on 60 subjects of which 30 had hypertrophic cardiomyopathy, 30 age and sex control (normal subjects). Results: In comparison of control it was observed that HCM cases had significantly larger proximal left anterior descending (3.81+-0.64 vs 2.49+-0.61 P < 0.001), proximal left circumflex (3.29+-0.46 Vs 2.39+-0.60, p < 0.001) and proximal right coronary artery (3.15+-0.47 vs 2.49+-0.42, P < 0.001). Coronary artery stenosis were found in 5 cases of HCM and among them, single vessel disease was present in 3, double vessel disease in I and triple vessel disease in I cases. Conclusion: Coronary artery disease (CAD) associated with hypertrophic cadiomyopathy (HCM) is a complex clinical syndrome, difficult to diagnose clinically, that can reliably be recognized by coronary arteriography.
RESUMEN
Objective To study the value of echocardiography in the diagnosis of myocardial infarction(MI) and its complica tions.Methods The examination data in 140 cases of MI were collected from January 2012 to January 2016 and performed the analysis and comparison.Results In the ultrasound examination results in 140 cases,120 cases appeared varying degrees of segmental ventricular wall motion abnormalities,its diagnostic rate to MI was 85.71％,which of EKG was 78.57％,the MI detection rate of echocardiography and ECG combined examination was 90.71％,which was higher than that of single use of echocardiography or ECG.With the coronary angiogra-phy results as the control,the detection rate of echocardiography for the coronary arterial lesion sits was 82.86 ％.Among 140 cases of MI,22 cases of complications(15.71 ％) were de-tected out by echocardiography,including 7 cases of true ventricular aneurysm(5.00 ％),4 cases of left ventricular mural thrombosis(2.86 ％),1 case of ventricular septal perforation(0.71％) and 10 cases of ischemic mitral regurgitation(7.14％).Conclusion Echocardiography has higher accuracy in the MI diagnosis,com-bining with ECG can further improve the diagnostic rate.
RESUMEN
Objective To investigate the correlation between serum lipoprotein associated phospholipase A2 (Lp‐PLA2) level and severity of coronary artery stenosis in the patients with coronary heart disease(CHD) and its clinical significance .Methods A total of 243 cases of CHD and suspected CHD were divided into the high‐risk group(at least 1 coronary artery vessel stenosis >50% ,n=102) and low‐risk group(single coronary artery vessel stenosis≤50% ,n=141) according to the coronary angiography re‐sults .The clinical data were collected and Lp‐PLA2 level was detected by ELISA .Results The serum Lp‐PLA2 level in the high‐risk group was significantly higher than that in the low‐risk group ,and the difference was statistically significant(P<0 .01) ,the sensitivity of Lp‐PLA2 for judging the high‐risk patients with CHD was 86 .3% ,the specificity was 96 .6% ,and the overall diagno‐sis accuracy was 98 .0% .Conclusion Lp‐PLA2 can better assess the risk of CHD patients and the serum Lp‐PLA2 level can reflect the severity of coronary artery lesion .
RESUMEN
Objective To investigate the correlation between the level change of serum homocysteine (HCY) and vascular endothelial growth factor (VEGF) with the degree of the coronary artery stenosis in the patients with acute coronary syndrome (ACS) .Methods A total of 157 ACS patients were divided into the ST‐elevation myocardial infarction (STEMI) group ,non‐ST el‐evation myocardial infarction (NSTEMI) group and unstable angina pectoris(UA) group based on the symptoms ,cardiac enzymes level and electrocardiogram changes .The cases were induded into the mild ,moderate and severe stenosis lesion groups according to the coronary arteriography examination;meanwhile the enzyme‐linked immunosorbent assay (ELISA) was used to detect the change of the serum VEGF concentration .The HCY level was determined by enzymatic cycling methods with the biochemical analyzer (BXC800 ,Beckman ,USA) .The differences in the concentrations of VEGF and HCY compared among different groups .Results The VEGF level had statistical differences among the mild ,moderate and sever stenosis groups(F=39 .9 ,P=0 .00) ,and between the UA group with the NSTEMI group and STEMI group(F=123 .3 ,P=0 .00) .The HCY level had statistically significant differ‐ence between the severe stenosis group with the mild and moderate stenosis groups (F=39 .7 ,P=0 .00);the HCY level had statis‐tically significant difference among the UA group ,NSTEMI group and STEMI group(F=102 .65 ,P=0 .00) .The VEGF and HCY levels in the mild stenosis group ,different degrees of coronary stenosis groups and different clinical diagnosis groups were positively correlated with the Gensini scores(r=0 .723 ,0 .716) .Conclusion The serum VEGF and HCY levels are correlated with the degree of the coronary artery lesion and myocardial necrosis in ACS patients ,furthermore are related with the Gensini scores .
RESUMEN
Introducción: un considerable número de pacientes que son sometidos a coronariografía, no tienen lesiones ateroscleróticas en su árbol coronario. El subgrupo con dolor anginoso y prueba ergométrica positiva se engloba en el diagnóstico de angina microvascular. Objetivo: determinar la prevalencia de angina microvascular en pacientes sometidos a coronariografía. Métodos: investigación trasversal descriptiva, en pacientes estudiados en el Laboratorio de Hemodinámica del Centro de Investigaciones Médico Quirúrgicas, en los años 2010 y 2011, que presentaban como diagnóstico inicial, angina de esfuerzo y prueba ergométrica positiva. El universo estuvo constituido por los 1 452 pacientes sometidos a coronariografía en este período. La muestra se conformó por los 452 en los que no se demostraron lesiones de aterosclerosis coronaria. Resultados: el 31,1 % de los pacientes sometidos a coronariografía presentaron angina microvascular con mayor predominio del sexo femenino. La hipertensión arterial fue el factor de riesgo que más prevaleció en los dos años de evaluación. Conclusiones: la angina microvascular es una entidad frecuente en Cuba que se relaciona con la presencia de factores de riesgo cardiovascular.
Introduction: a considerable number of patients undergoing coronary arteriography do not present any atherosclerotic lesions in their coronary tree. The subgroup with chest pain and a positive ergometric test was included in the diagnosis of microvascular angina. Objective: determine the prevalence of microvascular angina in patients undergoing coronary arteriography. Methods: descriptive cross-sectional study of patients examined at the Hemodynamic Laboratory of the Center for Medical Surgical Research from 2010 to 2011, initially diagnosed with effort angina and with a positive ergometric test. The study universe was 1 452 patients undergoing coronary arteriography in the period. The sample consisted of the 452 patients who did not show any coronary atherosclerotic lesions. Results: 31.1 % of the patients undergoing coronary arteriography had microvascular angina, with a predominance of the female sex. Arterial hypertension was the main risk factor throughout the two years' evaluation. Conclusions: microvascular angina, a common condition in Cuba, is related to the presence of cardiovascular risk factors.
RESUMEN
ObjectiveTo evaluate the value of 24 h dynamic electrocardiogram (DCG) and treadmill exercise testing(TET) in diagnosing coronary heart disease(CHD),and analyze relevant index between coronary arteriography(CAG) and treadmill exercise testing.MethodsOne hundred and forty-nine borderline cases of coronary heart disease were enrolled.Every patient was examined by DCG,TET,and CAG,compared the diagnostic value of TET combined with DCG and TET or DCG alone,and record the increased heart rate during the first minute( △ HRl min) of TET and systolic blood pressure(SBP) recovery.The patients were divided into a CHD group and a non-CHD group according to the results of coronary angiography.ResultsThe sensitivity rate was 78.57％ and specific rate was 70.77％ by means of TET.The sensitivity rate was 61.90％ and specific rate was 66.15％ by means of DCG.The sensitivity rate was 95.23％ ,specific rate was 55.38％,positive predictive value was 73.39％ and negative predictive value was 90.00％ by parallel way of DCG and TET,its sensitivity rate (95.23％) and negative predictive value (90.00％ ) were more than those of DCG or TET alone.The sensitivity rate was 52.38％,specific rate was 95.38％,positive predictive value was 93.62％ and negative predictive value was 60.78％ by serial way of DCG and TET,its specific rate (95.38％) and positive predictive value (93.62％ ) were more than those of DCG or TET alone.The number of men in the CHD group was higher than the number of women.Ratio of systolic blood pressure recovery(rSBPR) in the CHD group was significantly higher than that in the non-CHD group ( P ＜ 0.01 ).Conclusion It can obviously enhance the sensitivity rate and specific rate if combined TET with DCG.Patients with CHD have a delayed decline in SBP during recovery which can be one of the indexes to estimate the extent of myocardial ischemia and coronary artery lesion.
RESUMEN
Objective: To observe the echocardiography characteristics of patients with coronary heart disease (CHD), and to discuss the diagnostic value of their echocardiography for CHD. Methods: From Jan. 2002 to Dec. 2006, a total of 276 patients with suspected CHD were examined by echocardiography; 190 patients also underwent coronary arteriography (CA) and 85 of them served as controls. The consistence between echocardiography results and CA results was analyzed. The abnormal echocardiography manifestations of the rest 105 patients were analyzed based on the stenoses and occlusion degrees revealed by CA. Results: The diagnostic consistent rate of routine echocardiographic examination was 90.6% compared with that of CA. The false positive and negative rates were both 4.7%. The echocardiographic features of CHD included the reduction of left ventricular diastolic function (74.4%), the left ventricle enlargement (23.2%), the left atrium enlargement (16.3%), and the reduction of left ventricular systolic function (9.3%). The echocardiographic features of coronary artery stenosis and occlusion included the reduction of left ventricular diastolic function (92.3%), the left ventricle enlargement (9.5%), the reduction of left ventricular systolic function (8.57%), and the reduction of E/A ratio. More diseased branches was associated with lower E/A ratio. The E/A ratios of patients with 1, 2, 3 and 4 diseased branches were 0.78, 0.66, 0.64 and 0.61, respectively; the difference of E/A ratios of different groups was significantly different (P<0.05). Conclusion: Routine echocardiographic examination has a high consistent rate with CA in diagnosis of CHD, and it is suitable for popularizing in grass-root hospitals. Reduction of left ventricular diastolic function is the main echocardiographic feature of CHD, and more attention should be paid on related parameters, but the influence of arrhythmia and other factors should be ruled out.
RESUMEN
Objective To investigate the diagnostic value of treadmill exercise tests (TET), Hoher electro-cardiogram in coronary artery disease(CAD) patients. Methods 144 patients who clinically diagnosed as CAD,un-derwent TET and Hoher electrocardiogram. Then the patients with the positive results were examined by coronary arte-riography(CAG). According to the results of CAG the diagnostic value of TET and Hoher electrocardiogram was per-formed with comparative analysis. Results The sensitivity, specificity and evaluated accuracy rates of TET were 93.3% ,72. 2% and 73. 8% respectively. But the sensitivity,specificity and positive evaluated accuracy rates of Hol-ter electrocardiogram to examine myocardial iachemia were 76.7%, 88.4%, 57.1%. Conclusions The combined examination of TET and Holter electrocardiogram could preliminarily estimate the stenosis site of coronary artery. For the patients with unconditional GAG, those two examinations could increase the diagnostic reliability of positive rate of myocardial isehemia, and on this basis to enhance the diagnostic level of the stenosis site of coronary artery.
RESUMEN
Objective To observe effect of artery hemostatic instrument in hemestasis by compression of puncture site after coronary arteriography. Methods 92 patients who were to undergo coronary arteriog-raphy were divided randomly into the experimental group(47 cases)and the control group(45 cases). Artery hemostatic imstruments were used in the experimental group, the control group used routine compression method for hemostasis. Subcutaneous hemorrhage, subcutaneous hematoma, hematocyanosis, vesicle, uroschesis, deep vein thrombus, false aneurysm, backache, extremity numbness, anxiety and sleep disorder were compared in the two groups. Results Incidence of hematocyanosis, vesicle, uroschesis, backache, ex-tremity numbness, anxiety and sleep disorder in the control group was lower than that in the experimental group. No significant difference was seen in hemorrhage and hematoma in the two groups. There was no deep vein thrombus in the two groups. There was one case of false aneurysm in the experimental group, but no false aneurysm happened in the control group, but there was no statistical significance. Conclusions there was reduced incidence of hematocyanosis, vesicle, uroschesis, backache, extremity numbness, anxiety and sleep disorder in hemostasis by compression with artery hemostatic instrument after coronary arteriography. This can improve patients' comfort and achieve effective hemostasis.
RESUMEN
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.
RESUMEN
Objective To study characters of TCM syndrome and pathological changes of coronary artery in patients of coronary artery disease combined with diabetes(CAD-DIA).Method By epidemiological way,patients with CAD-DIA were collected and compared with CAD without DIA,including clinical characters,characters of pathological changes of coronary artery,characters of syndrome.Result Compared with CAD without DIA group,history of hypertension and blood vessel rebuilt in CAD-DIA group had significant difference(P
RESUMEN
0.05). (3)The incidence rate of the single-branch lesions in
RESUMEN
@#Objective To assess characteristics of coronary artery lesions and risk factors of coronary heart disease (CHD) in young people with coronary arteriography.Methods 192 patients with CHD diagnosed by coronary arteriography were divided into the young group (91 cases, 25—40 years old) and senile group (101 cases, 41—84 years old). Characteristics of coronary artery lesions and risk factors of CHD of two groups were analyzed, and risk factors were especially tested with logistic regression.Results Coronary artery lesions in the young group were characterized in most patients by singles vessel lesion (64%), while by multi vessels lesion (71%) in the senile group. Multiple logistic regression analysis showed that risk factors such as male, smoking, hyperlipemia, family history and increassed C-reactive protein (CRP) were highly related with CHD(P<0.01).Conclusion Single vessel lesion is a feature of young patients with CHD, and independent and related risk factors of CHD in the young group are male, smoking, hyperlipemia, CHD family history and CRP.
RESUMEN
50 as group B.All patients were examined by CAG.Plaque morphology was assessed by IVUS in 14 of group A and 38 of group B before intervention.Plaque external elastic membrane,minimal lumen area,plaque area,plaque burden,lipid pool area,thickness of fibrous cap and rupture were measured by IVUS.Results Heavy smoking,excess drinking and positive family history were more frequent in group A than those in group B,while hypertension and diabetes mellitus were more common in group B.The percentage multi-vessel lesions and collateral circulation were higher in group B.IVUS results showed that vulnerable and ruptured lesions were found in most of two groups.The severity of plaque burden is milder in group A.However,they had a bigger lipid core and a thinner fibrous cap.Group B showed a more severe stenosis and bigger plaque area.Conclusion Plaque vulnerability and rupture are the most common cause substrate of AMI.There are different risk factors and different coronary artery characteristics in AMI with different ages,which suggests that different emphases should be taken in preventing AMI in patients with different ages.
RESUMEN
Objective To evaluate the diagnostic significance of ECG and coronary arteriography (CAG) in coronary heart disease in different age groups. Methods totally 216 cases of suspected or CAG-confirmed coronary heart disease were retrospectively analyzed. The non-elderly group included patients aged 45-59 years, and the elderly one was older than 60. Patients in each group were further divided into subgroup A and B with or without the pain in heart front area, respectively, accompanied by ST-T change in ECG. Comparative analysis of CAG and ECG changes was done between different age groups, and between subgroup A and B. The history of pain in heart front area, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), platelet count (PLT), and fibrinogen (Fg) were also analyzed for clinical diagnosis. Results In the non-elderly, positive CAG was 88.8% in subgroup A while 56.3% in group B ( P0.05). TC, LDL-C, and Fg were significantly higher in subgroup A than in subgroup B for the elderly group. But in non-elderly, TC, TG, LDL-C, and Fg in subgroup A were significantly higher than those in subgroup B(all P0.05). The history of pain in heart front area was longer in the elderly, and also in this age group, more patients showed multivessel involvement. Conclusions ST-T change of ECG accompanied by classical pain in heart front area is more valuable than single ST-T change in the diagnosis of coronary heart disease, especially among non-elderly patients. ST-T change could not be used simply as a tool to diagnose coronary heart disease. The diagnosis should be made generally considering the typical symptom of the pain in heart front area, clinical history, TC, TG, LDL-C, and Fg. CAG could increase the positive diagnostic rate of coronary heart disease and decrease the rate of misdiagnosis as well.
RESUMEN
[Objective] To re-evaluate the diagnostic value of electrocardiogram (ECG) for coronary heart disease (CHD) by coronary arteriogram (CAG). [Methods] ECG and CAG in 375 cases preliminarily diagnosed as having CHD were analyzed. [Results] ECG was abnormal in 252 cases and normal in 123 cases; 278 cases were diagnosed as having CHD and 97 non-CHD by CAG. CHD was confirmed in 205 cases from 252 with abnormal ECG and in 73 cases from 123 with normal ECG. The sensitivity of ECG for CHD was 73.7% and the specificity was 51.5% , indicating that the changes of ECG having different diagnostic value for CHD (P
RESUMEN
Objective To determine the changes of high-sensitive serum C-reactive protein (hs-CRP) in patients with typical chest pain and normal coronary arteriography.Methods One hundred and twenty three patients were included. CRP was determined using a standard technique, and all patients underwent ECG exercise testing. Results Plasma level of hs-CRP was significantly increased in patients with typical chest pain,coronary arteriography negative and exercise test positive.Conclusion Inflammation may play a role in the mechanism of chest pain for patients with normal coronary angiography.
RESUMEN
BACKGROUND: Recurrent or persistent angina in patients with coronary artery spasm is relatively common, despite antianginal medication, however, its exact cause of chest pain remains elucidated. METHODS: In order to evaluate the role of persistent coronary artery spasm in such patients, 18 patients(M : F=14 : 4, age 38-71 yrs) with coronary arteriographically proven coronary arterial spasm received follow-up coronary arteiography and same provocational test using intravenous ergonovine, intracoronary acetylcholine or intracoronary ergonovine administration. RESULTS: Upon follow-up provocation test, coronary artery spasm was demonstrated only at the same site as before in 10 patients(56%), at the same site as well as another different site in 3 patients(17%), and only at different site site in 3 patients(17%). In one patient, coronary artery spasm couldn't be provoked upon follow-up provocation test. Progression of coronary artery disease were found in 5 patients(28%) ; at same site as that of spasm in 2 patients and at different site in 3 patients. CONCLUSION: In patients with angiographically proven vasospastic angina, recurrence of anginal pain seems to be attributed mostly to the recurrence of the coronary artery spasm at consistent location and partly to newly developed fixed coronary artery stenoses.
Asunto(s)
Humanos , Acetilcolina , Dolor en el Pecho , Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Vasos Coronarios , Ergonovina , Estudios de Seguimiento , Recurrencia , EspasmoRESUMEN
12 months in 31.3% (15/48). The graft lesions were found in 72.9% (35/48) of the patients, the worsened native lesions in 8.3% (4/48) and incomplete revascularization in 12.5% (6/48). Total occlusion was found in 33.3% (45/135) of the grafts and stenosis in 5.9% (8/135). LIMA total occlusion was 46.4% (13/28), stenosis was 8.6% (3/35) and competitive flow was 8.6% (3/35). Stenosis was found in 5.2% (5/97) of the SVG and total occlusion in 35.1% (34/97). Two of the five radial arteries were stenotic. Except for the chronic total occlusions, PCI treated the above problems with a high success rate. Conclusion Reoccurrence of angina is not uncommon after CABG. The causes are mainly due to the graft problem, and secondly due to worsened native lesion and incomplete revascularization. PCI can be used to treat the above problems except for the chronic total occlusions of the native vessels and graft.
RESUMEN
BACKGROUND: Conventional visual assessment of coronary arteriogram is fraught with large interobserver variance and disagreement with pathologic findings. Thus quantitative coronary angiography had been recently developed to meet the requirement of more reproducible measurement of severity of coronary artery disease. This study was designed to evaluate the interobserver variability of quantitative coronary angiography and its usefulness in clinical application. METHODS: Three independent observers analysed coronary angiogram of 31 consecutive patients by visual assessment and quantitative measurement using computer based algorithm. RESULTS: 1) There was considerable disagreement between 3 observers in the identification of significant coronary stenosis. Complete agreement was achieved in only 29/61 (47%) coronary lesion and agreement of more than 2 observers in 41/61(67%) lesion. 2) In visual assessment, the largest interobserver variance was found in acute marginal artery and distal circumflex artery, whereas the least variance was observed in proximal right coronary artery. 3) The average interobserver variance was 13.1% in visual assessment, 14.9% in geometric analysis, and 10.5% in video densitometric analysis. There was no significant difference between these values. 4) Visual assessment was noted to overestimate the severity of stenotic lesion, by 5.6% compared to geometric analysis and by 11.8% compared to video-densitometric analysis. CONCLUSION: These findings suggest that identifying significant lesion is major source of interobserve variability in both visual and quantitative analysis of coronary arteriogram. In addition, suboptimal image quality was responsible for the inability of quantitative analysis to reduce the variance. These factors seem to be major limitation of quantitative coronary arterirogam.