Atividade Física em Pacientes Coronariopatas / Physical Activity in Patients With Coronary Artery Disease

Objetivo: verificar a prevalência da atividade física em pacientes coronariopatas. Material e Métodos: Estudo transversal, de caráter descritivo, realizado em pacientes coronariopatas de um hospital do nordeste brasileiro. Investigou-se os dados sociodemográficos (idade, sexo, estado conjugal, escolaridade), estilo de vida (dieta, tabagismo, etilismo; hipercolesterolemia, diabetes, obesidade) e medidas antropométricas (peso, altura, índice de massa corporal, pressão arterial e circunferência abdominal). O nível de atividade física foi avaliado pelo Questionário Internacional de Atividade Física (IPAQ) versão longa, entre outubro a dezembro de 2014. Para verificar associação entre as variáveis foi utilizada a regressão logística univariada e multivariada e o testequi-quadrado de independência. Resultados: Dez (53,0%) dos participantes foram considerados ativos pela avaliação das atividades consideradas habituais (doméstica ou laboral). As modalidades mais frequentes foram as atividades diárias como cuidar da casa 15 (78%), atividade física como meio de transporte-bicicleta 7 (36,8%) e atividade física no trabalho 5 (26,3%). A prática de atividade como exercício físico (caminhada ou prática desportiva)não foi frequente na rotina dos coronariopatas 6 (31,6%). Foi encontrada uma associação significativa entre o estado civil e a atividade física. Conclusão: As modalidades de atividades mais frequentes foram cuidar da casa, transporte-bicicleta, exercício ou recreação e no trabalho. Houve predomínio de indivíduos ativos nas atividades consideradas habituais moderadas em casa ou no trabalho. Foi encontrada uma associação significativa do nível de atividade e o estado civil. (AU)

Objective: To determine the prevalence of physical activity in patients with coronary artery disease. Material and Methods: This was a cross-sectional, descriptive study with patients with coronary artery disease admitted to a hospital in northeastern Brazil. Socio-demographic data (age, sex, marital status, education), as well as lifestyle (diet, smoking, alcoholism; hypercholesterolemia, diabetes, obesity) and anthropometric measurements (weight, height, body mass index, blood pressure and waist circumference), were investigated. The level of physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) Long version between October and December 2014. Univariate and Multivariate Logistic Regression and Chi-square test of independence were employed to check for association between variables. Results: Ten participants (53.0%) were considered active in the evaluation of usual activities either housekeeping or labor-related. The most frequent modalitieswere: daily activities like housekeeping (n=15,78.9%); physical activity as a means of transportation­ bicycle (n=7,36.8%); and physical activity at work (n=5,26.3%). The practice of physical exercise (walking or sport) was not frequent in the routine of patients with coronary artery disease (n=6,31.6%). There was a significant association between marital status and physical activity. Conclusion: The most frequent physical activities were housekeeping; bicycling for transportation; exercise or recreation; and activities at work. There was a predominance of active individuals performingmoderate activities at home or at work and a significant association between activity level and marital status. (AU)

Plaque Rupture in Coronary Atherosclerosis Is Associated With Increased Plaque Structural Stress.

OBJECTIVES: The aim of this study was to identify the determinants of plaque structural stress (PSS) and the relationship between PSS and plaques with rupture. BACKGROUND: Plaque rupture is the most common cause of myocardial infarction, occurring particularly in higher risk lesions such as fibroatheromas. However, prospective intravascular ultrasound-virtual histology studies indicate that <10% higher risk plaques cause clinical events over 3 years, indicating that other factors also determine plaque rupture. Plaque rupture occurs when PSS exceeds its mechanical strength; however, the determinants of PSS and its association with plaques with proven rupture are not known. METHODS: We analyzed plaque structure and composition in 4,053 virtual histology intravascular ultrasound frames from 32 fibroatheromas with rupture from the intravascular ultrasound-virtual histology in Vulnerable Atherosclerosis study and 32 fibroatheromas without rupture on optical coherence tomography from a stable angina cohort. Mechanical loading in the periluminal region was estimated by calculating maximum principal PSS by finite element analysis. RESULTS: PSS increased with increasing lumen area (r = 0.46; p = 0.001), lumen eccentricity (r = 0.32; p = 0.001), and necrotic core ≥10% (r = 0.12; p = 0.001), but reduced when dense calcium was ≥10% (r = -0.12; p = 0.001). Ruptured fibroatheromas showed higher PSS (133 kPa [quartiles 1 to 3: 90 to 191 kPa] vs. 104 kPa [quartiles 1 to 3: 75 to 142 kPa]; p = 0.002) and variation in PSS (55 kPa [quartiles 1 to 3: 37 to 75 kPa] vs. 43 kPa [quartiles 1 to 3: 34 to 59 kPa]; p = 0.002) than nonruptured fibroatheromas, with rupture primarily occurring either proximal or immediately adjacent to the minimal luminal area (87.5% vs. 12.5%; p = 0.001). PSS was higher in segments proximal to the rupture site (143 kPa [quartiles 1 to 3: 101 to 200 kPa] vs. 120 kPa [quartiles 1 to 3: 78 to 180 kPa]; p = 0.001) versus distal segments, associated with increased necrotic core (19.1% [quartiles 1 to 3: 11% to 29%] vs. 14.3% [quartiles 1 to 3: 8% to 23%]; p = 0.001) but reduced fibrous/fibrofatty tissue (63.6% [quartiles 1 to 3: 46% to 78%] vs. 72.7% [quartiles 1 to 3: 54% to 86%]; p = 0.001). PSS >135 kPa was a good predictor of rupture in higher risk regions. CONCLUSIONS: PSS is determined by plaque composition, plaque architecture, and lumen geometry. PSS and PSS variability are increased in plaques with rupture, particularly at proximal segments. Incorporating PSS into plaque assessment may improve identification of rupture-prone plaques.

Multidetector CT of the coronary imaging:assessment of image quality and accuracy in detecting stenoses / 中华放射学杂志

Objective To evaluate the image quality of 64-multi detector computed tomography (MDCT)and the clinical accuracy in detecting coronary artery lesions.Methods One hundred and five patients were studied by MDCT.The results were compared with invasive coronary angiography(ICA). Patients were excluded for atrial fibrillation,but not for high heart rate,coronary calcification,or obesity. MDCT was analyzed with regard to image quality and presence of coronary artery lesions.Results The data evaluation of the image quality was based on a total of 1365 segments(13 coronary segments for each patient),of which 1144 segments were considered to have diagnostic image quality,but 221 segments (16.2%)could not be sufficiently evaluated because of severe calcifications(153 segments)and motion artifacts(68 segments).The median calcium score[Agatston score equivalent(ASE)]was 154(range 0—1983).87 of the 105 patients had an ASE of less than 1,000[median 105(range 0—994)],and 18 patients had an ASE greater than 1000[median 1477(range 1115—1983)].For detecting lesions with 50% or greater narrowing(without any exclusion criteria),the overall sensitivity,specificity,positive predictive value,and negative predictive value were 85.7%,97.9%,93.0%,and 95.5%,respectively. When limiting the number of patients to those with a calcium score of less than 1000 ASE,the threshold- corrected sensitivity for lesions with 50% or greater narrowing was 96.0%;specificity,98.9%;positive predictive value,95.3%;and negative predictive value,99.0%.Conclusion Our results indicate high quantitative and qualitative diagnostic accuracy of 64-slice MSCT in comparison to QCA in a broad spectrum of patients.

Initial experiences about 16-detector row CT coronary angiography / 中华放射学杂志

70 bpm during scan),the proportion of segments that could not be assessed because of motion artifact were 0.1%(1/759),1.1%(7/649),2.5% (10/407),42.6%(103/242),and 75.5%(108/143),respectively.With conventional selective coronary angiography as the golden standard,the sensitivity,specificity,positive and negative prediction values to detect≥50% stenotic lesions in the assessable segments were 79.2%,96.0%,83.8%,and 94.6%,respectively.There was a significant correlation between the number of segments per patient not assessable because of motion artifact and heart rate during the scan(r=0.655,P=0.000).Conclusion MSCT is capable of achieving high accuracy for detection of coronary artery stenosis,and is a reliable technique to diagnose coronary artery disease.

Therapeutic efficacy of puerarin in coronary heart disease patients with myocardial ischemia / 第二军医大学学报

Toassesstheeffectofpuerarinintreatingischemiacardiacdisease ,sixtycoronaryheartdisease(CHD) patientswith myocardialischemiawererandomlydividedinto 2 groups.Pueraringroup (30cases)wastreatedwithpuerarinpluswesternmedicine andcontrolgroup (30cases)withwesternmedicinealone .Thechangesofthetotalischemiaburden (TIB) ,ventricularpremature beat (VPB) ,heartrateandsystolicpressurelevelswereobservedbeforeandaftertreatmeat.Aftertreatmentwithpuerarinthe scoresofTIBlevelsweresignificantlydecreased (P 0 .0 5 ) .Thescoresofventricularprematurebeatlevelsweresignificantlydecreased (P