ABSTRACT
Accurately identifying coronary artery disease (CAD) is the key element in guiding the work-up of patients with suspected angina. Thickening of the arterial wall is a hallmark of atherosclerosis. Therefore, the main purpose of this study was to determine whether abdominal aortic intima-media thickness (AAIMT), which is the earliest zone of atherosclerotic manifestations, has a predictive value in CAD severity. A total of 255 consecutive patients who were referred for invasive coronary angiography due to suspected stable angina pectoris were prospectively included in the study. B-mode ultrasonography was used to determine AAIMT before coronary angiography. Coronary artery disease severity was assessed with the SYNTAX score (SS). A history of hypertension, age, dyslipidemia, and higher AAIMT (odds ratio: 2.570; 95%CI 1.831-3.608; P < .001) were independent predictors of intermediate or high SS. An AAIMT <1.3 mm had a negative predictive value of 98% for the presence of intermediate or high SS and 83% for obstructive CAD. In conclusion, AAIMT showed a significant and independent predictive value for intermediate or high SS. Therefore, AAIMT may be a noninvasive and useful tool for decision-making by cardiologists (eg, to use a more invasive approach).
Subject(s)
Angina, Stable/diagnostic imaging , Aorta, Abdominal/diagnostic imaging , Aortic Diseases/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Tunica Intima/diagnostic imaging , Tunica Media/diagnostic imaging , Ultrasonography, Doppler , Aged , Clinical Decision-Making , Coronary Angiography , Decision Support Techniques , Early Diagnosis , Female , Humans , Male , Middle Aged , Plaque, Atherosclerotic , Predictive Value of Tests , Prognosis , Prospective Studies , Risk Assessment , Risk Factors , Severity of Illness IndexABSTRACT
A 49-year-old female patient with hypertension was admitted with an intraabdominal murmur and referred for multidetector computed tomography angiography for suspected renal artery stenosis. Her medical history, clinical examination, serum biochemistry, and ultrasound examination findings showed no pathological findings of diabetes mellitus or any other disease. Axial and coronal reformatted multidetector computed tomography angiography revealed a dilated accessory polar renal vein which drained the venous circulation of the left lower pole into the inferior vena cava at midline. In conclusion, multidetector computed tomography angiography plays a progressively substantial role in the assessment of renal vascularity. Vascular surgeons and urologists should be a thorough knowledge of renal vascular variations.
ABSTRACT
BACKGROUND: Recently, the role of osteoprotegerin (OPG) in the pathogenesis of heart failure through different mechanisms has received much attention. Subclinical changes in left ventricular (LV) function can be identified using quantification of myocardial strain, and global longitudinal strain (GLS) is a superior predictor of outcomes than ejection fraction. We hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in treated diabetic hypertensive patients with preserved LV ejection fraction. METHODS: The study was composed of 86 diabetic hypertensive and 30 nondiabetic hypertensive patients. All patients underwent echocardiography and venous blood samples were taken for determination of OPG. The relation between OPG levels and LV GLS was investigated using 2-dimensional speckle tracking echocardiography. RESULTS: Diabetic hypertensive patients had higher diastolic peak early/early diastolic tissue velocity and lower systolic tissue velocity, GLS, GLS rate systolic, and GLS rate early diastolic than nondiabetic hypertensive patients (P = 0.009, P = 0.049, P < 0.001, P = 0.004, and P < 0.001, respectively). Diabetic hypertensive patients were divided into 2 groups according to median GLS value (> 18.5 and ≤ 18.5). The patients with GLS ≤ 18.5 had higher diastolic blood pressure (mm Hg; P = 0.048), OPG (pmol/L; P < 0.001), and hemoglobin A1c (%; P = 0.042) values than those with GLS > 18.5. In multivariate logistic regression analysis, OPG was found to be an independent predictor of impaired GLS (P = 0.001). Receiver operating characteristic curve analysis revealed that OPG values of > 6.45 (pmol/L) identified the patients with GLS ≤ 18.5. CONCLUSIONS: Plasma OPG values could predict subclinical LV systolic dysfunction in diabetic hypertensive patients.
Subject(s)
Diabetes Mellitus/physiopathology , Echocardiography/methods , Osteoprotegerin/blood , Stroke Volume , Ventricular Dysfunction, Left/blood , Ventricular Function, Left/physiology , Aged , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Systole , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary syndrome (ACS). We assessed the association between NAFLD and SYNTAX Score (SS) in patients with ACS. Eighty consecutive patients with ACS were enrolled. Patients were evaluated using ultrasound to detect NAFLD and hepatosteatosis stage. The prevalence of NAFLD was 81.2%; median SS was 15. The SS was significantly higher in patients with NAFLD (18 ± 8 vs. 11 ± 5, P = .001). Univariate analysis showed that the stage of NAFLD correlated with SS (r = .6, P < .001). In multivariate binary logistic analysis, increased age (odds ratio [OR], 1.05; 95% confidence interval [CI],1.00-1.10) and presence of NAFLD (OR, 13.20; 95% CI, 2.52-69.15) were independent factors associated with supramedian SS. In conclusion, among patients with ACS, those with NAFLD have more complex CAD as assessed by SS.
