Relative value of plasma copper, zinc, lipids and lipoproteins as markers for coronary artery disease.

Studies in experimental animals have suggested an association between dietary copper deficiency, alone or with an attendant elevated intake of zinc, and an increase in serum total cholesterol. These findings led some to theorize that a dietary imbalance of zinc and copper may be a factor in the etiology of coronary heart disease. Plasma zinc and copper levels were measured in 60 adult male patients with confirmed coronary artery disease and compared with serum levels of lipids and lipoproteins in the same patients. The results were compared to the accepted values in normal adult males. In subjects with significant coronary artery atherosclerosis (greater than or equal to 50% luminal occlusion) there was no correlation between plasma zinc or copper with serum lipids or lipoproteins. However, total cholesterol was significantly correlated with low density lipoprotein (LDL) cholesterol, triglycerides, and inversely correlated with HDL-C : T-Chol ratio. Although dietary zinc and/or copper may influence the plasma levels of these trace metals, our studies show that there was no association between plasma zinc or copper and the serum levels of lipids or lipoproteins; we believe that this indicates that these trace metals are of doubtful value as markers for coronary atherosclerosis.

Unusual nodular pulmonary lesions associated with thrombolytic therapy.

The occurrence of solitary nodular pulmonary lesions associated with thrombolytic therapy is reported in two patients. Resolution was spontaneous in each patient. Multiple thin needle aspiration biopsies in one case revealed only red blood cells. This unusual entity should be included as one of the potential complications associated with the use of thrombolytic agents.

The clinical importance of coronary arteriography after myocardial infarction.

An analysis of 80 patients who had elective coronary arteriography within 6 months after hospital dismissal for acute myocardial infarction showed that approximately two-thirds had multivessel coronary disease. The study is consistent with others reported in the recent literature in suggesting that most patients who survive myocardial infarction have multivessel disease. High early and late post-myocardial infarction mortality is comparable to that described for patients with two- and three-vessel occlusive disease. Knowledge of specific coronary anatomy and left ventricular function is critical in assessing post-myocardial infarction prognosis. This information is also important in defining optimal medical or surgical treatment. Unfortunately, the severity of the subjective clinical syndrome does not correlate well with the degree of anatomic findings or the prognosis. Properly selected surgical intervention may be one approach to modifying the high post-myocardial infarction mortality, which has not changed materially in the past several decades.

Echocardiographic diagnosis of left anterior descending coronary artery disease.

To determine the usefulness of the standard echocardiogram in the diagnosis of left anterior descending coronary artery disease proximal or distal to the first septal branch, coronary arteriograms and echocardiograms were performed in 77 patients with a chest pain syndrome. Seventy-nine percent of patients with proximal disease (15 of 19) had an abnormal septal motion measured as a posterior wall/interventricular septal (PW/IVS) excursion ratio greater than or equal to 2.5 compared with 10% of patients with distal disease (2 of 20) who had abnormal septal motion. Only 5% of patients without obstructive disease of the left anterior descending coronary artery (2 of 38) had abnormal septal motion. Proximal disease was found in 79% with abnormal septal motion in the echocardiogram (15 of 19) but in only 7% of patients with normal septal motion (4 of 58). Therefore, abnormal septal motion as measured by the PW/IVS excursion ratio in the echocardiogram is a useful index for the diagnosis of disease of the left anterior descending coronary artery when that disease is proximal to the first septal branch.

Clinical significance of coronary arterial ectasia.

In a study group of 2,457 consecutive patients undergoing cardiac catheterization, 30 patients had coronary arterial ectasia, an irregular dilatation of major vessels up to seven times the diameter of branch vessels. The frequency of hypertension, abnormal electrocardiogram and history of myocardial infarction was greater than that in a control group with obstructive coronary artery disease. Patients with ectasia did not differ from patients with obstructive disease in sex, age, prevalence of angina or presence of metabolic abnormalities. Six deaths occurred in the group with ectasia during a mean follow-up period of 24 months (annual rate of 15 percent). Extensive destruction of the musculoelastic elements was evident, resulting in marked attenuation of the vessel wall. The short-term prognosis in this group is the same as in medically treated patients with three vessel obstructive coronary artery disease.