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PubMedDate not supplied

Stress myocardial perfusion imaging in the diagnosis and prognosis of women with suspected coronary artery disease.

Coronary artery disease is the single largest killer of women in the United States and claims the lives of more than 250,000 women each year. For several decades, there was the misperception that coronary artery disease was a "man's disease." The fact is that women are indeed vulnerable to coronary artery disease; however, they typically develop the disease 10 to 15 years later than men. Once coronary artery disease is evident, women have worse outcomes as compared with men.Therefore, early and accurate diagnosis of coronary artery disease is crucial for reducing heart disease mortality in women. Stress myocardial perfusion imaging using contemporary techniques has been shown to have significant value in the diagnosis and prognosis of coronary artery disease in women. Myocardial perfusion imaging with exercise or pharmacologic stress has been shown to add incremental value to the use of clinical variables or exercise electrocardiogram stress testing alone in the risk stratification of women with an intermediate clinical pretest likelihood of coronary artery disease. This review provides an overview of the role of stress myocardial perfusion imaging in the clinical evaluation of women with suspected coronary artery disease.

Algorithms↗
PubMed2002

Coronary collateral size, flow capacity, and growth: estimates from the angiogram in patients with obstructive coronary disease.

BACKGROUND: Stimulation of coronary collateral growth has potential clinical value, yet techniques to assess such growth in patients are limited. METHODS AND RESULTS: A cineangiographic approach to classify the dominant collaterals and to quantify their lumen caliber and flow capacity was developed and validated. For measurement of 0.4- to 1.5-mm-diameter phantoms, mean error ranged from -0.01 to +0.02 mm. To illustrate the utility of such a method, 52 collateral pathways were measured in 13 patients with 17 occluded arteries before and after 10 years of intensive lipid therapy. The mean variance, final sigma, of 9 separate measurements of each collateral was +/-0.101 mm. At pretreatment, collateral diameter averaged 0.50+/-0.11 mm (SD) (range, 0.3 to 1.4 mm) without tapering or central narrowing. Over 10 years, mean increase in diameter was +16% (P=0.028); in area, +64% (P=0.015); and in estimated flow capacity, +214% (P=0.009). Certain lipoprotein characteristics tended to predict collateral growth. Patients for whom angina disappeared during 10 years had a greater increase in flow capacity than those for whom it persisted (+331% versus 4%; P=0.05). CONCLUSIONS: Coronary collateral diameter can be estimated with a precision of 0.10 mm. Flow capacity of the network is well approximated by measurement of the 2 or 3 largest connections serving an occluded artery. Initial studies with this method show that disappearance of angina is significantly associated with growth in collateral flow capacity. Collateral growth tends to associate with lipid therapy and with certain in-treatment lipid measures.

Angina Pectoris↗
PubMed1992

Effect of measurement interval on performance of the ST integral for the identification of three-vessel coronary disease.

Measurement of the ST integral has usually incorporated ST-segment depression integrated between the J point and 80 ms after the J point (J + 80). To assess the effect of varied onset and offset of ST measurement on performance of the ST integral for the identification of three-vessel coronary disease, the exercise electrocardiograms (ECGs) of 60 patients with angiographically proven coronary disease were analyzed using J point or J + 20 onsets and J + 60 or J + 80 offsets of ST integral calculation. Simple ST-segment depression of greater than 200 microV, measured at 60 ms after the J point, identified three-vessel disease with a specificity of 68% (17 out of 25 patients) and sensitivity of 69% (22 out of 35 patients). At a matched specificity of 68% (17 out of 25 patients), there was identical sensitivity (54%, 19 out of 35 patients) of ST integrals measured either from the J point to J + 80, from the J point to J + 60, or from J + 20 to J + 60. A trend toward increased sensitivity (60%, 21 out of 35 patients) when the ST integral was measured from J + 20 to J + 80 did not reach statistical significance, and comparison of receive operating characteristics (ROC) curves demonstrated that varying the onset and offset of ST-segment measurement had no significant effect on the overall performance of ST integral criteria for the detection of three-vessel disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMed1998

Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups.

BACKGROUND: Exercise testing is useful in the assessment of symptomatic patients for diagnosis of significant or extensive coronary disease and to predict their future risk of cardiac events. The Duke treadmill score (DTS) is a composite index that was designed to provide survival estimates based on results from the exercise test, including ST-segment depression, chest pain, and exercise duration. However, its usefulness for providing diagnostic estimates has yet to be determined. METHODS AND RESULTS: A logistic regression model was used to predict significant (>/=75% stenosis) and severe (3-vessel or left main) coronary artery disease, and a Cox regression analysis was used to predict cardiac survival. After adjustment for baseline clinical risk, the DTS was effectively diagnostic for significant (P<0.0001) and severe (P<0.0001) coronary artery disease. For low-risk patients (score >/=+5), 60% had no coronary stenosis >/=75% and 16% had single-vessel >/=75% stenosis. By comparison, 74% of high-risk patients (score <-11) had 3-vessel or left main coronary disease. Five-year mortality was 3%, 10%, and 35% for low-, moderate-, and high-risk DTS groups (P<0.0001). CONCLUSIONS: The composite DTS provides accurate diagnostic and prognostic information for the evaluation of symptomatic patients evaluated for clinically suspected ischemic heart disease.

Adult↗
PubMedDate not supplied

Improved results of carotid endarterectomy in patients with symptomatic coronary disease: an analysis of 1,546 consecutive carotid operations.

The significant risk of fatal myocardial infarction after carotid endarterectomy in patients with coronary disease long has been recognized. In 1,546 consecutive carotid endarterectomies performed in 1,238 patients over the last 10 years, angina pectoris was present in 17% (212/1,238) of patients; a further 32% (396/1,238) of patients were asymptomatic, but had a history of myocardial infarction. The perioperative mortality (30 day) in the 1,306 consecutive endarterectomies in 1,026 patients without symptomatic coronary artery disease was 1.5% (15/1,026 patients). Of the 212 patients with symptoms, 85 carotid endarterectomies were performed in 77 patients without prior coronary bypass operation with an operative mortality of 18.2% (14/77 patients). The remaining 135 patients had 155 carotid endarterectomies but were treated by either prior coronary artery bypass (84 patients) or simultaneous carotid endarterectomy and coronary artery bypass (51 patients) with an operative mortality of 3% (4/135 patients). The greatly improved survival in those patients with symptomatic coronary disease who had a coronary artery bypass prior to or at the same time as carotid endarterectomy, and the absence of permanent neurological deficit in the 51 of these 135 patients who had simultaneous carotid endarterectomy and coronary artery bypass suggests that significantly improved survival can be achieved after carotid endarterectomy in these high risk patients by the use of simultaneous coronary artery bypass surgery.

Adult↗
PubMed1980

Alienated labor, stress, and coronary disease.

The concept of alienation is used to integrate research findings on the relationship of occupational stress to coronary disease risk. The analysis takes the objective aspects of alienated labor (lack of control over the work process, loss of the product through appropriation, and competitive and fragmented work relations) and the subjective dimensions of alienation (sense of powerlessness, dissatisfaction, and frustration) as categories within which certain occupational factors in coronary disease can be subsumed. These categories are placed within a broader social analysis and critique, and it is suggested that chronic stress and alienation may be reduced as workers gain increased control over the process and product of their labor.

Coronary Disease↗
PubMed1989

[Surgery for aortic aneurysms with coronary disease].

Between 1981 and 1988, 52 patients with dissecting aneurysms were operated and four of them (7.7%) had right coronary dissections that were repaired by Bentall's method with or without right coronary bypass grafting (CABG). Three (8.5%) of 35 patients with thoracic aneurysms had coronary disease. Among them, two had one vessel disease (1VD) and one had 2VD; two underwent temporary axillofemoral bypass grafting (AFBG) without CABG and one underwent extracorporeal circulation with CABG. Eight (5.6%) of 142 patients with abdominal aneurysms had coronary disease. They consisted of three patients with 1VD, two with 2VD and three with 3VD; their ejection fraction rates were 0.46 to 0.75. Three of them underwent temporary AFBG and one first underwent CABG but later underwent abdominal aortic graft replacement. In conclusion, patients with good coronary distal run-off and a low ejection fraction rate (under 0.5) should initially undergo CABG, but for those with poor run-off, temporary AFBG is better to prevent cardiac afterload.

Aged↗
PubMed2002

Factor V Leiden, hormone replacement therapy, and risk of venous thromboembolic events in women with coronary disease.

Oral contraceptive use in women with factor V Leiden is associated with increased rates of venous thromboembolic events (VTEs). However, the effects of hormone replacement therapy (HRT) in postmenopausal women with factor V Leiden are not known. A nested case-control study was conducted among women with established coronary disease enrolled in 2 randomized clinical trials of HRT, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Estrogen Replacement and Atherosclerosis (ERA) trial. The Leiden mutation was present in 8 (16.7%) of 48 cases with VTE compared with only 7 (6.3%) of 112 controls (odds ratio [OR](Leiden) 3.3, 95% CI 1.1 to 9.8; P=0.03). In women without the factor V Leiden mutation, risk associated with HRT use was significantly increased (OR(HRT) 3.7, 95% CI 1.4 to 9.4; P<0.01). On the other hand, in women with the factor V Leiden mutation, the estimated risk associated with HRT was increased nearly 6-fold, although the CIs were wide and included unity (OR(HRT) 5.7, 95% CI 0.6 to 53.9; P=0.13). The OR for women with the Leiden mutation who were also assigned to HRT compared with wild-type women assigned to placebo was 14.1 (95% CI 2.7 to 72.4, P=0.0015). In women with the factor V Leiden mutation who were treated with HRT, the estimated absolute incidence of VTE was 15.4 of 1000 per year compared with 2.0 of 1000 per year in women without the mutation who were taking a placebo (P=0.0015). On the basis of these data, in women with coronary disease, the estimated number needed to screen for factor V Leiden to avoid an HRT-associated VTE during 5 years of treatment is 376. If factor V Leiden genotyping becomes less expensive, it could be cost effective to screen for the presence of the mutation before instituting HRT in women with coronary disease.

Aged↗
PubMed2005

Relation of plasma brain natriuretic peptide levels in non-ST-elevation coronary disease and preserved systolic function to number of narrowed coronary arteries.

Elevated plasma brain natriuretic peptide (BNP) levels have been described in patients with acute myocardial infarction and left ventricular dysfunction. The aim of the present study was to evaluate circulating BNP levels in patients with coronary artery disease without ST-segment elevation acute myocardial infarction and preserved systolic function and to evaluate the BNP levels in relation to the number of involved coronary vessels. We studied 88 patients with coronary artery disease: group 1 had stable angina, group 2 had unstable angina (UA), group 3 had non-Q-wave myocardial infarction (NSTEMI), and group 0 consisted of 15 healthy subjects. All recruited subjects underwent angiographic examination and echocardiographic evaluation. No patients had heart failure, previous myocardial infarction, or electrocardiographic ST elevation. A significant increase in BNP levels was observed in the UA and NSTEMI groups compared with the stable angina group (stable angina 31.3 pg/ml, UA 147.3 pg/ml, NSTEMI, 165.8 pg/ml, p <0.01), and no differences were found between the UA and NSTEMI groups. Analysis of BNP in relation to the number of involved vessels showed significantly higher BNP levels in patients with 3- than in those with 1- or 2-vessel disease (1 to 45.2, 2 to 127.3, and 3 to 220.8 pg/ml, respectively, p <0.05 and p <0.0001, 3 vs 1- and 2-vessel disease, p = 0.01, respectively). Patients with left anterior descending stenosis had higher BNP levels than those with stenosis in other areas (150.8 vs 52.2 pg/ml, p <0.01). In conclusion, circulating BNP levels appeared elevated in patients with acute coronary syndromes with diffuse coronary involvement, even in the absence of systolic dysfunction or heart failure. BNP was also associated with multivessel disease and left anterior descending involvement.

Aged↗
PubMed2003

[Homocysteine and progression of carotid atherosclerosis in patients with coronary disease].

BACKGROUND AND OBJECTIVE: Carotid intima-media thickness (IMT) is a marker of generalized atherosclerosis. Sequential evaluation of carotid IMT has permitted to know the factors involved in its progression. However, there are few studies about the influence of homocysteine in such progression. The aim of this work was to know the effect of homocysteine values on the evolution of carotid IMT in patients with coronary disease. PATIENTS AND METHOD: Carotid IMT (baseline and after 4 years of follow-up) was evaluated by a B-mode ultrasonography in 187 patients with coronary disease (166 males and 21 females; age: mean [standard deviation], 60 [7] years); 185 patients were treated with statins from the beginning of the study. RESULTS: Carotid IMT progression was confirmed in 59 patients (31.6%; 95% confidence interval [CI], 25.0-38.7%). Cardiovascular risk factors, basal biochemical parameters and methylenetetrahydrofolate reductase-C677T polymorphism were similar in patients with and without progression except for homocysteine values which were higher in the former (13.3 [5.3]; 95% CI, 12.0-14.6 vs 11.1 [3.5]; 95% CI, 10.5-11.7 (mol/l; p = 0.001). Biochemical changes at the end of the study were similar in both groups. In the multivariate analysis, IMT progression was associated with basal values of homocysteine (odds ratio [OR] 1.19; 95% CI, 1.07-1.31; p = 0.0008), female gender (OR 3.50; 95% CI, 1.17-10.50; p = 0.02), hypertension (OR 2.52; 95% CI, 1.14-5.59; p = 0.02) and basal high-density lipoprotein (HDL)-cholesterol values (OR, 0.94; 95% CI, 0.90-0.98; p = 0.009). CONCLUSIONS: The concentration of homocysteine is associated with the progression of carotid atherosclerosis in patients with coronary heart disease treated with statins.

Arteriosclerosis↗
PubMed1995

Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men.

BACKGROUND: It has been hypothesized that a diet containing n-3 fatty acids from fish reduces the risk of coronary heart disease, but few large epidemiologic studies have examined this question. METHODS: In 1986, 44,895 male health professionals, 40 to 75 years of age, who were free of known cardiovascular disease completed detailed and validated dietary questionnaires as part of the Health Professionals Follow-up Study. During six years of follow-up, we documented 1543 coronary events in this group: 264 deaths from coronary disease, 547 nonfatal myocardial infarctions, and 732 coronary-artery bypass or angioplasty procedures. RESULTS: After controlling for age and several coronary risk factors, we observed no significant associations between dietary intake of n-3 fatty acids or fish intake and the risk of coronary disease. For men in the top fifth of the group in terms of intake of n-3 fatty acids (median, 0.58 g per day), the multivariate relative risk of coronary heart disease was 1.12 (95 percent confidence interval, 0.96 to 1.31), as compared with the men in the bottom fifth (median, 0.07 g per day). For men who consumed six or more servings of fish per week, as compared with those who consumed one serving per month or less, the multivariate relative risk of coronary disease was 1.14 (95 percent confidence interval, 0.86 to 1.51). The risk of death due to coronary disease among men who ate any amount of fish, as compared with those who ate no fish, was 0.74 (95 percent confidence interval, 0.44 to 1.23), but the risk did not decrease as fish consumption increased. CONCLUSIONS: Although the possibility of residual confounding by unmeasured factors cannot be entirely excluded, these data suggest that increasing fish intake from one to two servings per week to five to six servings per week does not substantially reduce the risk of coronary heart disease among men who are initially free of cardiovascular disease.

Adult↗
PubMedDate not supplied

[Estimation of the levels of anxiety, emotional endurance and placement of control of female patients hospitalized with coronary disease].

Spielberger's State--Trait Anxiety Inventory, Z. Bizoń's Questionnaire of Neurotic Symptoms as the indicator of emotional endurance and Rotter's Internal-External Control Scale were used for the analysis of a problem concerning the mechanisms of psychological functioning of female patients hospitalized with coronary disease. 35 women suffering from coronary disease were examined, a control group consisting of 35 healthy women was also assessed. The results indicate significantly higher levels of anxiety both as a state and as a trait, lower level of endurance, and more externally placed control in the patients group in comparison with the control group. Additionally, patients strongly predisposed to anxiety tended to have an external sense of control, high level of anxiety, and low level of emotional resilience.

Adult↗
PubMed1997

[A non-invasive test choice for the diagnosis of coronary disease in women].

BACKGROUND AND PURPOSE: Regarding coronary heart disease, women have often been excluded from clinical trials. Current practical recommendations are thus based on studies in men. To identify the non invasive technique of choice in detecting coronary artery disease in women, a study with different diagnostic tests has been undertaken. METHODS: Exercise stress test, dipyridamole echocardiography (0.84 mg/kg), dobutamine echocardiography (up to a total dose of 40 micrograms/kg per minute and atropine if necessary), MIBI-SPECT during dobutamine infusion and coronary angiography, were performed in 40 consecutive women with chest pain and no previous history of coronary artery disease. RESULTS: The four tests had similar sensitivity: exercise stress test (80%; CI 95%, 52-94), dipyridamole echocardiography (80%; CI 95%, 56-93), dobutamine echocardiography (80%; CI 95%, 56-93) and scintigraphy MIBI-SPECT (85%; CI 95%, 61-95). The specificity of dipyridamole echocardiography (100%; CI 95%, 83-100) and dobutamine echocardiography (90%; CI 95%, 67-98) was higher than that of exercise stress test (50%; CI 95%, 22-78) and MIBI-SPECT (65%; CI 95%, 41-84). The positive predictive values of dipyridamole and dobutamine echocardiography were 100% and 88% respectively. CONCLUSIONS: The feasibility of exercise stress test in women is inferior to that of the other techniques. The sensitivity of the four tests to diagnose coronary artery disease is similar. The specificity of dipyridamole echocardiography and dobutamine echocardiography is higher than that of exercise stress test and MIBI-SPECT. Stress echocardiography can be considered the non invasive technique of choice for diagnosing coronary artery disease in women.

Aged↗
PubMed2001

[Subclinical carotid atherosclerosis in patients with coronary disease].

BACKGROUND: B-mode ultrasonography is a simple and valid method to evaluate subclinical atherosclerosis of the major superficial arteries. The aim of this study was toknow by this technique the prevalence of carotid atherosclerosisin patients with coronary disease and related factors. PATIENTS AND METHOD: In 232patients (205 men and 27 women; age: mean [standard deviation]59 [8] years) with coronary disease, intima-media thickness (IMT),presence and number of atheroma plaques in carotid arteries wereevaluated by B-mode ultrasonography. Controls were 50 healthy subjects whose age was not different from patients. Carotid atherosclerosis was considered when IMT was higher than mean plus two standarddeviations of control values, and/or existence of atheroma plaques. RESULTS: Carotid IMT wasincreased in patients compared to controls 0.82 [0.22] vs 0.62[0.12] mm; p < 0.001) and there were more patients with plaques(67 vs 20%; p < 0.001). Carotid atherosclerosis was found in170 patients and 11 controls (73 vs 22%; p < 0.001). By multivariate analysis, carotid atherosclerosis was associated with age (oddsratio: 1.05; 95% confidence interval [CI], 1.01-1.09) and smoking(odds ratio, 2.11; 95% CI: 1.04-4.26). The presence of more thanone plaque was associated with levels of low-density-lipoprotein(LDL)-cholesterol (odds ratio, 1.01; 95% CI, 1.00-1.02). CONCLUSIONS: In the patients with coronary disease, prevalence of subclinical carotid atherosclerosisis very high (73%), and it is associated with age and smoking. The advanced stage of atherosclerosis, evaluated by the existence of more than one plaque, is correlated with LDL-cholesterol levels.

Aged↗