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PubMed2001

[Comparison of clinical status and long-term outcome of patients with angina pectoris and normal coronary vessels in coronary angiography or insignificantly narrowed coronary arteries].

UNLABELLED: Among patients investigated with coronary angiography because of effort chest pains, 8-30% are found to have insignificantly narrowed coronary arteries. In this group there are patients with angiographically normal coronary arteries and patients with hemodynamically insignificant atherosclerotic plaques. The aim of this study was to compare clinical status and long-term outcome of patients with effort angina whose epicardial coronary arteries were angiographically normal (Group 1) and patients with luminal diameter stenoses of maximum 30% (Group 2). Between III'91 and IV'97 we identified 230 patients who underwent coronary angiography in the Department of Coronary Artery Disease in Cracow. At the end of the follow-up the patients were asked to complete the self-report questionnaires which evaluated the course of the disease after discharge from the Department and present symptoms. On the basis of the medical records from the hospitalization in the Department and returned questionnaires data of 142 patients (Group 1: 89 patients, 46 men and 43 women, mean age 48.10 +/- 9.2 years; Group 2: 53 patients, 36 men and 17 women, mean age 52.51 +/- 9.6 years) were analyzed. Group 2 patients were older (p = 0.007), with higher prevalence of men (p = 0.05). The mean follow-up was 3.47 +/- 1.7 years for Group 1 and 2.85 +/- 1.7 years for group 2 (p = NS). Left ventricle contractility was normal in both groups. The occurrence of atherosclerosis risk factors was more frequent in Group 2 patients and didn't change significantly over the observation period. There were no deaths or new myocardial infarctions during the observation. Unstable angina occurred in 4 (2.8%) of patients. 33 patients (23.2%) reported hospital treatment for chest pain with mean frequency 0.13 +/- 0.3 hospitalizations/year in Group 1 and 0.09 +/- 0.17 in Group 2 (p = NS). Before coronary angiography this index was significantly higher -0.57 +/- 0.8 hospitalizations/year in group 1 and 0.51 +/- 0.7 in group 2 (p < 0.001 for both groups). Anginal symptoms improved significantly over the observation period. Before coronary angiography majority of patients (60.5% Group 1 patients and 58.3% of Group 2 patients) defined their angina as severe comparing to respectively 7.1% and 2.1% of patients at the end of follow-up (p < 0.05 for both groups). Only 8 (5.6%) of patients remained entirely asymptomatic at the end of the study. During the observation 7 (4.9%) of patients returned to work while 30 (21.1%) of patients retired for medical reasons out of which 25 (17.6%) were due to heart disease. During the follow-up there were no differences between the groups in the professional activity of patients. Group 2 patients were receiving more cardiac medications (mean 2.63 +/- 0.8 vs 2.18 +/- 0.9 at the discharge from the Department; p. = 0.05 and mean 2.52 +/- 0.9 vs 2.02 +/- 1.0 at the end of follow-up; p = 0.04). Group 2 patients were more frequently taking nitrates (86.3% vs 53.7% at the discharge from the Department; p < 0.001 and 77.1% vs 60.9% at the end of the study; p = 0.05) and diuretics. CONCLUSIONS: 1. During follow-up (mean 3.4 years) there were no differences between the groups in the presence of symptoms, frequency of hospitalizations and occurrence of acute coronary events. 2. In both groups severity of anginal symptoms and frequency of hospitalizations decreased significantly. 3. The persistence of cardiac symptoms might have been caused by the presence of atherosclerosis risk factors during the follow-up.

Adult↗
PubMed1985

Localization of exercise-induced myocardial ischemia with single view and biplanar radionuclide ventriculography: validation in single vessel coronary disease.

The ability of single view and biplanar radionuclide ventriculography (RVG) to determine the location of myocardial ischemia during maximal graded supine bicycle exercise was assessed in 50 patients with chest pain, no prior myocardial infarction, and a single coronary stenosis of greater than or equal to 50% luminal diameter narrowing at coronary angiography. A biplane collimator was used so that both right anterior oblique (RAO) gated first-pass and left anterior oblique (LAO) equilibrium RVG could be performed at rest and exercise. Results were compared with those obtained using 4-view 201Tl myocardial scintigraphy in the same patients. Regional wall motion abnormalities (WMA) and 201Tl perfusion defects were detected and assigned to individual coronary vessels by agreement between at least two of three independent observers, who read all studies blinded along with those from control subjects with chest pain but no angiographically significant coronary artery disease. When scintigraphic abnormalities were detected, both biplanar RVG (36/39 = 92%) and 201Tl (25/25 = 100%) were more frequently correct in predicting the stenosed vessel than single view LAO RVG (24/32 = 75%) (P less than 0.05). At RVG only inferior WMA, in the RAO view, predicted right coronary stenosis. Only posterolateral WMA, in the LAO view, predicted left circumflex stenosis. Thus biplanar, but not single view, LAO exercise RVG is a reasonable alternative to exercise 201Tl for localizing exercise-induced ischemic abnormalities to individual coronary stenoses.

Adult↗
PubMed1998

[Hospital results of angioplasty in multiple coronary vessel disease in 1990-1991 and 1994-1995. What conclusions should be drawn about the improvement of results with respect to the relevance of data of randomized trials comparing angioplasty and surgery].

The aim of this study was to determine whether advances in angioplasty techniques have improved results in multiple vessel coronary disease and to compare present results with those reported in randomised trials comparing angioplasty and surgery. The hospital results of two cohorts of multivessel coronary patients treated by angioplasty during two different periods were compared (group 1: 1990-1991. group 2: 1994-1995). The first period corresponded to the inclusion period of randomised trials comparing surgery and angioplasty. The patients in group 2 (n = 449) were older than those in group 1 (n = 424), had more triple vessel disease, more severe angina and more previous angioplasty attempts. Moreover, there were more cases of unfavourable lesions. Nevertheless, the clinical success rate was high in group 2 (92% vs 84%; p < 0.001) and the major complication rate (death, myocardial infarction or emergency bypass surgery) was lower (2.9% vs 6.1%; p = 0.02). The main technical difference between the two periods concerned the use of coronary stents (12% vs 8%; p < 0.001). The fact of being in group 2 was identified by multivariate analysis as an independent predictor for clinical success and a lower major complication rate. The authors conclude that, since the publication of randomised trials comparing angioplasty with coronary surgery, the hospital results of angioplasty have significantly improved. This should be taken into account in considering the clinical applications of the results of these trials.

Aged↗
PubMed2005

The SV stent study: a prospective, multicentre, angiographic evaluation of the BiodivYsio phosphorylcholine coated small vessel stent in small coronary vessels.

OBJECTIVE: To evaluate the use of the phosphorylcholine (PC) coated BiodivYsio small vessel (SV) stent in native coronary vessels of small calibre. DESIGN AND SETTING: Prospective, multi-centre, multi-national registry with 6-month clinical and core-lab angiographic follow-up. Adverse events were adjudicated by a Clinical Events Committee (CEC) and included peri-procedural analysis of cardiac enzymes. PATIENTS: Patients with signs or symptoms of ischaemia with an identified target lesion in an epicardial vessel with reference diameter 2.0-2.75 mm were enrolled. Intervention in other epicardial territories in the same patient was permitted. RESULTS: Recruitment of 150 consecutive lesions (in 143 patients) was completed in 19 centres in Europe and Israel. The stent was deployed successfully in all but one lesion. At 6 months, 1 patient (1%) had experienced sudden cardiac death, 4 further patients (3%) had a non-Q wave MI, and a further 24 patients (17%) had repeat revascularisation of a study target vessel. The mean reference vessel diameter prior to stenting was 2.2 mm (S.D. 0.4). Mean minimal luminal diameters at pre-procedure, post procedure and follow-up were 0.6 mm (S.D. 0.3), 2.0 mm (S.D. 0.4) and 1.2 mm (S.D. 0.6), respectively. The late lumen loss index was 0.55 (S.D. 0.53) with a binary restenosis rate of 32%. CONCLUSIONS: In stenting of selected lesions in small vessels, the BiodivYsio SV stent demonstrated high rates of implant success. The rates of major adverse cardiac events (MACE), angiographic restenosis and repeat revascularisation are similar to those reported in other small vessel bare metal stent studies.

Adult↗
PubMed2001

Coronary flow reserve in angiographically normal coronary arteries with one-vessel coronary artery disease without traditional risk factors.

AIMS: Reduced coronary flow reserve has been reported in patients with traditional risk factors, in particular hyperlipidaemia, despite angiographically normal coronary arteries. However, it is recognized that traditional risk factors do not explain the presence of coronary atherosclerosis in a large proportion of patients. The aim of this study was to assess whether coronary flow reserve is preserved in the myocardium supplied by normal coronary arteries in patients with one-vessel coronary artery disease without traditional risk factors. METHODS AND RESULTS: Positron emission tomography using [13N]ammonia was performed at baseline and after intravenous dipyridamole administration (0.56 mg x dl(-1)over 4 min) in 30 subjects: six patients with ischaemia on effort, no myocardial infarction, and isolated left anterior descending coronary artery stenosis without traditional risk factors (coronary artery disease patients without risk factors, aged 59+/-13), five patients with ischaemia on effort, no myocardial infarction, and isolated left anterior descending coronary artery stenosis with multiple risk factors (coronary artery disease patients with risk factors, aged 69+/-7), 11 age-matched controls (aged 58+/-6), and eight healthy young volunteers (aged 34+/-4). Myocardial blood flow calculated in the myocardium supplied by normal coronary arteries in the coronary artery disease patients was compared with those of the two control groups. Coronary flow reserve was defined as the ratio of hyperaemic blood flow after dipyridamole infusion to baseline blood flow. Although coronary flow reserve in the coronary artery disease patients with risk factors was significantly lower than that in the age-matched controls (1.62+/-0.37, 2.58+/-0.71, P=0.0428), coronary flow reserve in the coronary artery disease patients without risk factors was similar to that in the age-matched controls (2.54+/-0.17 vs 2.58+/-0.71, P=ns). CONCLUSION: Coronary flow reserve is preserved in regions supplied by angiographically normal coronary arteries with one-vessel coronary artery disease without traditional risk factors.

Adult↗
PubMed1992

Percutaneous transluminal coronary angioplasty and the changing indications for coronary artery bypass grafting for single-vessel coronary artery disease.

Patients with single-vessel coronary artery disease have a good long-term prognosis with either medical or surgical therapy. Because percutaneous transluminal coronary angioplasty has become widely available for treating patients with symptomatic single-vessel coronary artery disease, those who currently undergo coronary artery bypass grafting may be a select group. In this study, we examined the effects of the increasing use of percutaneous transluminal coronary angioplasty on the indications for coronary artery bypass grafting in patients with symptomatic single-vessel coronary artery disease and reviewed the type of procedures performed in such patients at our institution between 1983 and 1988. During this period, 115 patients underwent coronary artery bypass grafting for single-vessel coronary artery disease. The indication for revascularization was angina in 111 patients (88% were in class III or IV, Canadian Cardiovascular Society classification), acute myocardial infarction in 3, and a strongly positive result of an exercise test in 1. The number of surgical revascularization procedures annually for single-vessel coronary artery disease remained consistent throughout the study period. In a comparison of the first 3 years of the study with the last 3 years, the number of patients who underwent coronary artery bypass grafting for restenosis after coronary angioplasty increased, but the number who had surgical revascularization because of failure of coronary angioplasty decreased. In addition, more patients received internal mammary grafts during the second half of the study (42 or 72%) than during the first half (24 or 42%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Coronary bypass grafting for single-vessel coronary artery disease: a 17-year review with short- and long-term follow-up.

STUDY OBJECTIVES: We reviewed our short- (30 days) and long-term (up to 17 years) experience with surgical revascularization for patients with angiographically documented isolated single-vessel coronary artery disease. DESIGN: Retrospective study of single-vessel coronary artery bypass procedures performed from January 1980 through June 1996. During this time, 100 consecutive patients underwent a single-vessel coronary artery bypass. All patients were men with a mean age of 59+/-9 years (range, 35 to 78 years) and a mean ejection fraction of 56+/-8% (range, 35 to 77%). The vessels bypassed included the left anterior descending in 66 (66%), right coronary artery in 31 (31%), and the obtuse marginal in 3 (3%). RESULTS: Short-term results reveal no deaths and six (6.0%) complications. Long-term follow-up by chart review and telephone survey was available in 87 (87%) patients at a mean of 46.9 months (range, 12 to 151 months). Cumulative freedom from angina and repeated revascularization was 93% and 98% at 1 year and 55% and 81% at 10 years, respectively (Kaplan-Meier). CONCLUSION: Single-vessel coronary artery bypass for isolated single-vessel disease can be performed with minimal morbidity and no mortality and provides excellent long-term relief of angina.

Adult↗
PubMedDate not supplied

Neovascularization of embryonic rat hearts cultured in oculo closely mimics in utero coronary vessel development.

Coronary neovascularization was studied following grafting of avascular hearts from gestation day-12 (E-12) rat embryos to the anterior eye chambers of adult rats. Volume densities (Vv) of vessels, myocytes, and the extracellular matrix (ECM) after 3-7, 14, 21, and 35 days in oculo were compared to Vv in hearts developing in utero at E-15, E-18, and E-20. The myocardium in both models exhibited similar vessel Vv and capillary developmental stages: (1) clustering of endothelial cells and red blood cells; (2) endothelial cell migration, and (3) tube formation/maturation. The Vv of myocytes increased while that of the ECM remained constant over time. Cross-species grafting utilizing species-specific antibodies determined that the majority, but not all, of the 10-day graft vasculature was of graft origin. Therefore, both de novo growth (vasculogenesis) and sprouting (angiogenesis) were occurring in oculo. Tracer molecules infused into host rats reached the outermost graft vessels only after 10 days in oculo, suggesting a functional link with the host circulation after this time. Thus, we have shown that both models exhibit similar: (1) vascular Vv; (2) shifts in Vv of nonvascular components; (3) stages of neovascularization, and (4) mechanisms of neovascularization. In conclusion, coronary neovascularization occurring in oculo closely mimics normal coronary vessel development.

Animals↗
PubMed1981

[Pharmacological analysis of a disorder in the mechanisms of coronary vessel reactivity in an experimental model of coronary insufficiency].

In stimulation of the heart work with inadequate perfusion, the reactivity of coronary vessels is often disturbed which is revealed by the enhancement of extravascular contraction or by the absence of an adequate vasodilatation. The analysis of disturbance mechanisms in the reactivity of coronary vessels has been carried out with the aid of two groups of pharmacologic substances, one exercising a dilatating effect on the coronary vessels and the other affecting the calcium metabolism. One group included adenosine and verapamil (as antagonists of the action of calcium) as well as etmozine-blocker of the sodium channels capable of affecting the level of Ca+2 through Na-Ca metabolism; the other group included caffeine, calcium chloride, norepinephrine. The results suggest that adaptive reactions of the coronary vessels are closely connected with the calcium metabolism in smooth muscles of the vascular wall. Hence, while using vasodilators to treat coronary insufficiency, the approach to a selection of drugs with different effects on electro-mechanical conjunction in smooth muscles of vascular wall should be differentiated.

Animals↗
PubMed1982

[Catheter dilatation of coronary vessel stenosis (transluminal coronary angioplasty) Technic, risks, early and late results].

Between October 1977 and June 1982 a total of 300 transluminal angioplasty procedures were performed in Frankfurt. 75% were single vessel, 16% double vessel and 9% triple vessel disease. The approached stenosis was located in the LAD in 69%, the RCA in 20%, RCX in 4%, ACB in 4% and LM in 3%. Emergency surgery was carried out in 4.0%. One female patient died after surgery (0.3%). Two patients experienced a transmural myocardial infarction (0.7%). On average a widening of the approached stenosis from 80-40% was achieved. Success rate (less than or equal to 20% widening) rose from 59% in the first fifty patients to 76% in the last series. Good long-term results were achieved in 87% of the successful procedures.

Angioplasty, Balloon↗
PubMed1989

[Surgical treatment of tetralogy of Fallot associated with an anomalous coronary vessel].

Anomalous coronary arteries crossing the outflow tract of the right ventricle in tetralogy of Fallot have a prominent surgical importance in total correction. The unintentional section of these arteries is followed by a high mortality. In the period between 1977 and 1987, 475 patients with tetralogy of Fallot were operated on. Fourteen of these patients had anomalous coronaries crossing the right ventricle. Three of the patients were less than one year of age. Eleven patients were male. Diagnosis was performed in the operating room in 13 patients. Twelve patients had the anterior descending artery originating from the right coronary, and two presented single left coronary arteries. During the surgical procedure two patients had the anomalous coronary artery divided; in one a saphenous vein bypass graft was used and in the second and end-to-end anastomosis was performed. In the remaining 12 cases, a transverse ventriculotomy (one case), extensive dissection of the anomalous coronary artery (two cases), a palliative procedure (one case), a valved conduit between the right ventricle and the pulmonary artery (one case) and total correction through the atriopulmonary approach (seven cases) were performed. No immediate mortality was observed and there was one late death. The authors suggest that, whenever anatomical conditions permit, the atriopulmonary approach should be preferred in the repair of tetralogy of Fallot associated to anomalous coronary arteries.

Child↗
PubMed1984

[Echocardiographic study of the coronary vessels].

The coronary arteries were studied in normal subjects and in patients with coronary heart disease, using two-dimensional echocardiography. The authors succeeded in obtaining the image of the major trunk of the left and of the opening of the right coronary artery and in ascertaining various forms of coronary artery lesions. In twenty cases the findings of echocardiography and coronary angiography were compared.

Adult↗
PubMed1979

[Coronary vessel anomaly: fistula between the right coronary artery and the left ventricle clinically presenting as aortic valve insufficiency (author's transl)].

Under more than 200 cases of coronary vessel anomalies only 33 are fistulas from the right or left coronary artery into the left ventricle. The case presented here of a fistula from the right coronary artery into the left ventricle featured the clinical picture of an aortic valve insufficiency. The histologic findings support the theory that these fistulas are embryological anomalies: transient communications between the ventricular trabeculas and the coronary vessels may be lined with endothelium and become then persisting as fistulas.

Aortic Valve Insufficiency↗