Glutathione, vitamin E and oxidative stress in coronary artery disease: relevance of age and gender.

BACKGROUND: Observational studies suggest that low levels of antioxidants are associated with high risk for coronary artery disease (CAD). We investigated whether the biomarkers of oxidative balance undergo the same modifications in all CAD patient groups, regardless of gender and age. MATERIALS AND METHODS: One hundred sixty-eight CAD patients and 107 healthy controls were assayed for plasma levels of reduced glutathione (GSH), alpha- and gamma-tocopherol (alpha- and gamma-T) as endogenous antioxidants. A damage score (DS), representative of oxidative stress status, was calculated. ANCOVA models were used to test the association between antioxidants, DS and CAD and its modulation by age and gender. RESULTS: The DS was higher in CAD than in controls. GSH levels, were lower in CAD patients (mean +/- SEM: 57.61 +/- 1.87 micromol 10 g(-1) haemoglobin vs. 68.55 +/- 2.23 in controls, P < 0.0006) in males and in older subjects. Levels of other antioxidants exhibited a complex pattern. Overall, no difference was found in alpha- and gamma-T contents between CAD and controls, but lower alpha-T values were observed in CAD females. A significant interaction between CAD status and gender was observed (P = 0.003). CONCLUSIONS: Our study shows that the involvement of antioxidants in CAD is related to patients' characteristics. These findings may be relevant in planning antioxidant therapies.

Use of a new diagnostic catheter for transradial internal mammary artery angiography early after minimally invasive coronary bypass.

We describe a new diagnostic catheter specifically designed for selective catheterization of the left internal mammary artery via the ipsilateral radial approach. We used this catheter to assess the patency of the distal mammary-left anterior descending coronary artery anastomosis in 30 consecutive patients early after minimally invasive direct coronary artery bypass grafting. The new catheter design allowed easy and fast engagement of the left internal mammary artery leading to optimal vessel opacification in all cases. Angiography revealed graft problems in seven (23.3%) patients, two of whom required anastomosis revision, surgical in one case and with PTCA in the other. No LIMA injury occurred as a result of selective catheterization. Patients with functionally normal anastomosis were discharged on the same day of the diagnostic procedure.

Successful dissolution of occlusive coronary thrombus with local administration of abciximab during PTCA.

Treatment of intracoronary thrombus poses difficult problems and may result in severe complications. We used a local delivery catheter (InfusaSleeve, LocalMed, Palo Alto, CA) to treat an occlusive coronary thrombus that was refractory to systemic thrombolysis and conventional angioplasty. After local administration of 10 mg of abciximab with this catheter there was successful resolution of coronary thrombus and vessel recanalization. Cathet. Cardiovasc. Intervent. 48:211-213, 1999.

Failure of Fluoroscopy and Success of Intravascular Ultrasound to Locate an Intracoronary Embolized Palmaz-Schatz Stent.

We describe a patient in whom one half (disarticulated) Palmaz-Schatz stent was lost during a failed stenting procedure of an ostial left anterior coronary artery (LAD) stenosis. The embolized stent could not be located by fluoroscopy and was found in the left main coronary artery by intravascular ultrasound. The stent could not be removed using a retrieval device and was successfully deployed in the left main coronary artery by high-pressure balloon dilatation. Subsequently, LAD stenosis was successfully treated with deployment of two additional half Palmaz-Schatz stents.

"Thinning-down phenomenon" and vasomotor adaptability of the inferior epigastric artery graft.

We report a case of diffuse thinning of an inferior epigastric artery early after its implantation as a coronary free graft. This phenomenon showed reversibility at the 20-month angiographic follow-up in response to progression of the proximal lesion in the recipient coronary artery. Graft vasodilation in response to atrial pacing and nitroglycerin infusion at late angiography confirmed the vasomotor adaptability of this arterial conduit.

Anomalous origin of the left anterior descending and circumflex coronary arteries by two separate ostia from the right sinus of Valsalva.

We report a case of absence of the left main coronary artery with the left anterior descending and circumflex coronary arteries arising by two separate ostia from the right sinus of Valsalva in a patient without other congenital cardiovascular malformations. The clinical and angiographic features of this exceedingly rare anomaly are described with a brief review of previously documented cases.

[Intravenous ultrasonography as a method for imaging the morphoanatomical effects of coronary angioplasty]. / L'ultrasonografia intravascolare quale metodica di indagine degli effetti morfoanatomici dell'angioplastica coronarica.

Despite the therapeutic success of percutaneous transluminal coronary angioplasty (PTCA), the mechanisms by which PTCA increase vessel luminal size remain uncertain. To better understand the transmural morphologic changes associated with PTCA of stenosed coronary arteries, we studied with a high-frequency intravascular ultrasound catheter 18 coronary artery segments in 18 patients following balloon angioplasty. High-quality cross-sectional images were obtained from 15 coronary sites without complications in all patients. Two distinctive morphologic features following balloon angioplasty were appreciated by intravascular ultrasound imaging. The first pattern, observed in 10 cases (67%), consisted of a stretched plaque without any evidence of dissection. The second pattern, found in 5 cases (33%), demonstrated a dissection of the plaque ranging from a radial tear with separation of the 2 ends of the plaque to an extensive dissection which, in 1 case, encompassed the entire circumference of the artery. Although angiography showed a good post-angioplasty result in all cases, intravascular ultrasound evidenced a large amount of residual atheroma occupying the artery cross-sectional area. In addition, this imaging modality revealed more often than angiography the presence of calcification and dissection. These data demonstrate that PTCA creates different morphologic patterns which are related to the mechanisms of lumen enlargement and that the coronary artery anatomy after dilatation is much more complex than that observed with angiography. This study confirms that intravascular ultrasound is a feasible and safe imaging modality which provides new valuable insight into the mechanisms by which angioplasty improves vessel patency.

Coronary angiographic features in 2,234 patients with clinical suspicion of coronary heart disease without modifiable risk factors.

Among 12,720 patients subjected to coronary angiography because of clinical suspicion of coronary heart disease, 2,234 (78% men and 22% women) were free from major modifiable coronary risk factors. They did not report alcohol consumption, use of antiplatelet or lipid lowering agents, oral contraceptives or sex hormones; there was no history of bilateral oophorectomy, smoking, diabetes mellitus, hypertension, or obesity; the ratio of total to high-density lipoprotein cholesterol was < or = 4.5. We examined lesions causing > or = 50% stenosis to total obliteration of the 3 great coronary arteries or of their major branches, and classified these patients as having single-, double-, or triple-vessel disease, or normal angiograms (no luminal irregularities). We related the extent of the coronary angiographic involvement to age and sex. From the fourth to the eighth decade of life: a) prevalence of normal angiography was significantly higher in women; b) percentage of cases with single-vessel disease was similar in both sexes and gradually reduced with aging; c) prevalence of double-vessel disease in women did not vary significantly, although a slight decline was seen at older ages; in men figures at the fifth and sixth decades were significantly greater than in women; d) percentages by decade of triple-vessel disease in males were 24, 34, 41, 49 and 57%, respectively; corresponding values in women were 11, 13, 15, 27 and 44% (p < 0.01 at each decade of age); with advances of age the sex gap in triple-vessel disease narrowed, but did not disappear. Thus, atherosclerosis tended with age to involve more vessels rather than more subjects in both genders, indicating that in the absence of modifiable coronary risk factors coronary vessels remained clearly susceptible to the influence of age, both in men and women. In these patients the feminine gender exerted a substantial protection that persisted for the entire span of life.

[Coronary vasomotor equivalents in the electrocardiographic behavior in induced ischemia]. / Corrispettivi vasomotori coronarici del comportamento elettrocardiografico nella ischemia indotta.

In effort angina the exercise test can shift the ST-segment during the active phase and/or recovery. To investigate whether coronary vasomotility has some part in these electrocardiographic patterns, in 15 patients with stable effort angina we performed a quantitative angiographic evaluation of single, significant coronary stenoses (greater than 50%) during: spontaneous rhythm, graded atrial pacing (max 160 b/min) and at 1-3-5 min of recovery, both without drugs and after Ca-blockade (nifedipine, 10 mg sl). The greatest ST changes were at peak of the pacing in 9 patients (Group 1) and at recovery in 6 (Group 2). In each patient the stenotic lumen was reduced by atrial pacing (-9%, p less than 0.03); in Group 1 the lumen recovered soon after the end of the pacing, whereas in Group 2 narrowings became greater (-17%, p less than 0.02) at about 3 min of the recovery phase. In both groups nifedipine did not prevent the enhancement of the stenosis during pacing, but avoided constriction and ST changes during recovery in Group 2. Thus, in effort angina a superimposed active vasoconstriction contributes to the increase of the ST changes during the recovery phase of the exercise.

[Angiographic course of coronary atherosclerosis in angina pectoris. Its relation to 2 years' treatment with propranolol, nifedipine and nitrates]. / Evoluzione angiografica dell'aterosclerosi coronarica nell'angina pectoris. Relazione con il trattamento per 2 anni con propranololo, nifedipina e nitrati.

Calcium antagonists and beta-blockers may retard or inhibit atherogenesis. We tested whether nifedipine or propranolol may retard or induce regression of coronary atherosclerosis in man. In selected population of 113 patients with effort angina and proven coronary artery disease, the coronary cineangiographic pattern after 2 year therapy with nifedipine (Group 1, 39 patients), propranolol (Group 2, 36 patients), or isosorbide dinitrate (control group, 38 patients) was compared to the pre-treatment pattern. After 2 years the disease evolved to a different extent in the 3 groups. The number of lesions with evidence of progression was significantly smaller after nifedipine (14), and larger after propranolol (39) as compared with controls (24). Patients with evidence of progression of old lesions, and appearance of new lesions were significantly fewer in Group 1 than in Group 2 and in control patients. Thus, nifedipine seemed more protective than either of the other drugs against coronary atherosclerosis. The coronary risk factors were within normal limits in the nifedipine treated group and remained so with treatment supporting that they were likely dissociated from influences on atherosclerosis. The evolution, at least as judged by the number of lesions with progression, appeared significantly (p less than 0.01) worse with propranolol than with isosorbide dinitrate. This may prospect that nitrate contrasted the evolution of the disease, or that propranolol made it worse, possibly through unfavourable modifications of serum lipids (28% rise of total triglyceride and 25% decrease of HDL cholesterol were already detectable at 12 months in Group 2).

Comparison of nifedipine, propranolol and isosorbide dinitrate on angiographic progression and regression of coronary arterial narrowings in angina pectoris.

Calcium antagonists and beta blockers may retard or inhibit atherogenesis. This study investigated whether nifedipine or propranolol influences coronary atherosclerosis in humans. In selected patients with effort angina and proven coronary artery disease, the cineangiographic pattern after 2-year therapy with nifedipine (group 1, 39 patients), propranolol (group 2, 36 patients) or isosorbide dinitrate (group 3, 38 patients) was compared to that before treatment. The disease evolved to a different extent in the 3 groups. Patients with evidence of progression of old narrowings and appearance of new narrowings were significantly fewer in group 1 (31% and 10%) than in group 2 (53% and 34%) and group 3 (47% and 29%). The number of stenoses with evidence of progression was significantly smaller after nifedipine (14), and larger after propranolol (39) compared with group 3 (24). Thus, nifedipine seemed more protective than the other 2 drugs against coronary atherosclerosis. The coronary risk factors were normal in the nifedipine group and remained so with treatment, suggesting that they were dissociated from influences on atherosclerosis. The evolution, as judged by the number of narrowings with progression, appeared significantly (p less than 0.01) worse with propranolol than with isosorbide dinitrate. Propranolol caused unfavorable modifications of serum lipids; there was a 28% increase in total triglycerides and a 25% decrease in high density lipoprotein cholesterol at 12 months in group 2.