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PubMed1996

Use of vital capacity for cardiac failure risk estimation in persons with coronary disease and left ventricular hypertrophy.

Cardiac failure is a common lethal outcome of coronary heart disease and left ventricular hypertrophy. The efficacy of forced vital capacity (FVC), measured biennially, in predicting the onset of cardiac failure was explored in 818 Framingham Study subjects with those predisposing conditions, among 324 developed cardiac failure. Among the men and women who had coronary disease or left ventricular hypertrophy, those with FVCs in the lower quartile were at substantially increased risk of developing cardiac failure. For men, comparing the lowest quartile with men whose FVCs were in the highest quartile (<2.7 L vs >5.6 L), the risk ratio was 1.8; for women with FVCs <1.7 L, the risk was 2.3 times those with FVCs of > or = 3.5L. The excess risk of cardiac failure imposed by a low FVC was similar in those with coronary disease and left ventricular hypertrophy. The simple FVC is an inexpensive and robust predictor of cardiac failure in persons predisposed by coronary disease or left ventricular hypertrophy. FVC determination should help identify candidates for cardiac failure needing echocardiographic examination for ventricular dysfunction.

Aged↗
PubMed2006

Effect of folic acid treatment on carotid intima-media thickness of patients with coronary disease.

BACKGROUND: Carotid intima-media thickness (CIMT) is a surrogate marker of cardiovascular morbility. Hyperhomocysteinemia, which is an independent cardiovascular risk factor, is associated with low folate levels. The aim of this study was to evaluate the effect of folic acid treatment on the evolution of CIMT in patients with coronary disease and homocysteinemia > or =9 micromol/l. METHODS: In 137 consecutive patients with coronary disease treated with statins and normal vitamin B12 values, a randomized treatment with open-label folic acid 2.5 mg/day (group A) or not (group B) was performed during 3 years. CIMT was evaluated by two-dimensional ultrasonography baseline and at the final of the study. RESULTS: Clinical, biochemical parameters and CIMT were similar in both groups of patients. Homocysteine levels decreased (12.4+/-3.4 vs. 10.3+/-2.4 micromol/l; p<0.001) in group A, but not in group B. CIMT did not change neither in group A (0.71+/-0.23 vs. 0.69+/-0.20 mm; p=0.34) nor in group B (0.74+/-0.23 vs. 0.72+/-0.29 mm; p=0.39). In 12 patients of group A with methylenetetrahydrofolate reductase (MTHFR) 677TT mutation a decrease of CIMT was found (0.83+/-0.35 vs. 0.72+/-0.27 mm; p=0.02), but a multiple linear regression only showed a trend to the association between CIMT changes and MTHFR 677TT (p=0.051), probably due to the small number of patients with this mutation. CONCLUSIONS: Long-time treatment with folic acid in patients with coronary disease and normal values of vitamin B12 decreases homocysteine levels. A CIMT decrease is observed in treated patients with MTHFR 677TT mutation.

Aged↗
PubMed2004

Drug-eluting stents: a mechanical and pharmacologic approach to coronary artery disease.

Coronary artery disease is the largest killer of men and women in the United States and costs the health care system billions of dollars annually. Several advances in both mechanical and pharmacologic treatment of coronary artery disease have occurred in recent decades. Mechanically, percutaneous coronary intervention is commonly used to treat coronary atherosclerosis. This approach has dramatically reduced both morbidity and mortality for patients with different levels of severity of coronary artery disease. However, percutaneous coronary intervention is limited by restenosis, which is an increase in growth of the intimal layer of the vessel wall. Despite the introduction of intracoronary stents and the addition of systemic pharmacotherapy, restenosis still affects a significant number of patients. The new technology of drug-eluting stents combines mechanical and pharmacologic approaches to prevent restenosis. Various types of these stents exist in different stages of development; several have been shown to prevent or reduce intimal growth after stent deployment. An understanding of how this combined mechanical and pharmacologic approach reduces restenosis requires consideration of complex issues in pathophysiology and pharmacology.

Angioplasty, Balloon, Coronary↗
PubMed2006

Ethnic disparities in cardiovascular risk factors and coronary disease prevalence among individuals with chronic kidney disease: findings from the Third National Health and Nutrition Examination Survey.

Differences in coronary disease have been reported among ethnic minorities in the US population. Whether these persist in patients with chronic kidney disease is unknown. The prevalence of myocardial infarction (MI) and angina was compared by race and GFR in the Third National Health and Nutrition Examination Survey using the Modification of Diet in Renal Disease Study equation. Age-gender standardized estimates were computed for each GFR category (>or=90, 60 to 89, and <60 ml/min per 1.73 m2), and odds ratios were compared using weighted multivariable logistic regression for each race. The age-gender standardized prevalence of MI was 3.0, 3.1, and 4.9% in white individuals; 2.8, 3.8, and 9.9% in black individuals; and 1.9, 2.9, and 3.8% in Mexican-American individuals in each category: >or=90, 60 to 89, and <60 ml/min, respectively. Compared with the referent (Mexican-American; GFR>or=90 ml/min; odds ratio 1.00), Mexican-American individuals with GFR of 60 to 89 and <60 ml/min had more than four and nine times the odds for MI; black individuals at successively lower GFR levels had 1.6, 6.1, and 16.3 times the odds for MI, whereas white individuals had 1.9, 4.7, and 20.2 times that of the referent, respectively. After adjustment for traditional risk factors, the inverse association of GFR with MI was substantially attenuated in black and white individuals and completely abolished in Mexican-American individuals. The burden of coronary disease is lower in Mexican-American than in white or black individuals with reduced kidney function even accounting for differences in traditional risk factors.

Adult↗
PubMedDate not supplied

[New treatment strategies in coronary disease].

The mortality associated with coronary atherosclerosis has decreased by 30% to 40% in the last few decades. This reduction has followed major pharmacological and biotechnological advances and can possibly be attributed to better management of risk factors for coronary atherosclerosis and to more effective therapy of its late manifestations. Nevertheless, the coronary artery disease remains a major public health problem. It is responsible for 40% to 45% of deaths in our population and, although it becomes manifest later than previously, its incidence and prevalence may not have declined significantly. Recent studies suggest that progression of coronary atherosclerosis can be delayed, that regression can also occur, and that this can lead to a reduction in morbidity and mortality. Several types of interventions have been performed in these studies. Some of them such as a drastic modification in lifestyle, the administration of one or several hypocholesterolemic agents or partial ileal bypass have achieved these results by markedly lowering LDL or raising HDL cholesterol. Other manipulations of plasma lipoproteins are also possible, such as the administration of specific protein or enzyme inhibitors, anti-oxidants and omega-3 fatty acids. Calcium antagonists and possibly angiotensin converting-enzyme inhibitors slow the progression of early coronary lesions and prevent the appearance of new lesions. These interventions, in addition to influencing the size of the atherosclerotic plaque, can have other important effects. They can contribute to the preservation of integrity and function of endothelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

Alterations in left ventricular shape in patients with angina and single-vessel coronary disease.

BACKGROUND: Left ventricular shape alterations, apparently independent of acute ischaemia or previous myocardial infarction, have been described in patients with stable angina. Our previous observations had been made in a group of patients with multivessel coronary disease; it was therefore not possible to establish a clear-cut anatomical relationship between the location of ischaemia and the changes in left ventricular contour. The aim of this work was to extend the previous observations by analysing left ventricular shape in patients with angina and single-vessel coronary disease, in whom the potentially ischaemic region can be easily localized. METHODS: Fifty-eight patients with stable or unstable angina were retrospectively selected if they had single-vessel disease, normal regional and global function and no previous myocardial infarction: 37 had a critical stenosis (more than 75% diameter reduction) of the left anterior descending artery and 21 had a critical stenosis of the right coronary artery. Patients with left ventricular hypertrophy or any other obvious cause of myocardial dysfunction were excluded. All patients underwent haemodynamic study. Left ventricular global shape was evaluated by calculating eccentricity and circular indices; regional curvature was measured at 90 points along the angiographic contours (right anterior oblique projection) by applying a windowed Fourier analysis. Results were compared with those obtained in 16 normal subjects. RESULTS: Patients had significant diastolic alterations in left ventricular shape, which assumed a more rounded aspect than normal. Regional curvature was significantly altered at several points pertaining to the anterior, apical and inferior segments. The pattern of changes in regional curvature was about the same in the left anterior descending and right coronary artery groups, with the involvement of regions supplied by angiographically normal arteries, although the extent of alteration was greater in patients with stable, chronic angina (more than 6 months) and in patients with stenosis of the left anterior descending artery. CONCLUSIONS: Patients with angina, no previous myocardial infarction and normal systolic function had left ventricular shape abnormalities either in the potentially ischaemic or in the remote zones. The mechanism leading to these changes is still speculative.

Adult↗
PubMed1978

The predictive value of anginal chest pain as an indicator of coronary disease during exercise testing.

To determine the significance of anginal chest pain during exercise testing, a series of 302 patients undergoing coronary arteriography with exercise testing was reviewed. Of the 302 patients, 85 had ischemic ECG changes and chest pain (Group I); 87 patients had ischemic ECG changes but no chest pain (Group II); 25 patients had chest pain but no ischemic ECG changes (Group III); 105 patients had neither chest pain nor ischemic ECG changes (Group IV). Coronary artery disease was present in 95% of Group I, 75% of Group II, 72% of Group III, and 28% of Group IV. Of those patients with coronary disease, multiple vessels were involved in 94% of Group I, 51% of Group II, 67% of Group III, and 21% of Group IV. The predictive value for presence and extent of coronary disease showed Group I greater than Groups II and III greater than Group IV (p less than 0.025). We conclude that (1) anginal chest pain during exercise testing predicts the presence and extent of coronary disease more accurately than its absence; (2) the presence of chest pain even without an ischemic ECG response during exercise testing appears to be as predictive of coronary disease as an ischemic ECG response alone; and (3) the combination of anginal chest pain during exercise testing and an ischemic ECG response is highly predictive of multivessel coronary artery disease.

Angina Pectoris↗
PubMed2004

Nitric-oxide mediated effects of transdermal capsaicin patches on the ischemic threshold in patients with stable coronary disease.

BACKGROUND: Capsaicin has been shown to exert direct vasodilating effects through increased calcitonin gene-related peptide (CGRP) release. However, no data exist on its effect following systemic administration in humans. METHODS: Twelve male patients with stable coronary disease and a persistently positive exercise were selected for study. According to a double blind, placebo-controlled, cross-over study, patients were randomized to placebo or 3 g oleic capsaicin-containing patches, on 2 different days and with a 2-day interval between treatments. Patients performed treadmill exercise testing according to the Bruce protocol. Time to 1 mm ST segment depression and to peak exercise, maximal ST segment depression, and the number of ECG leads showing diagnostic changes were also measured. Blood samples for nitric oxide (NO) and CGRP were drawn at baseline, 2, 6, and 24 hours after exercise. RESULTS: On placebo, all patients had a positive ECG during exercise test. Only 1 patient experienced angina, on both treatments. With capsaicin, 1 patient had a negative exercise, while 8 patients significantly increased time to 1 mm ST depression from 328 +/- 167 to 401 +/- 174 seconds (P = 0.01). Of the remaining patients, 1 did not show any changes and 2 showed a worse ischemic threshold when on capsaicin. CGRP levels were not significantly different between placebo and capsaicin treatment. Conversely, when on capsaicin, NO significantly increased at 6 hours. CONCLUSIONS: Transdermal capsaicin may improve ischemic threshold in patients with stable coronary disease, probably through arteriolar vasodilation. Increased capsaicin-induced NO availability could represent the principal mechanism of action.

Administration, Cutaneous↗
PubMed1988

Effects of a comprehensive rehabilitation programme in patients with three-vessel coronary disease.

The aim of the study was to assess the effects of rehabilitation in 46 consecutive three-vessel coronary disease patients who were considered to have no possibility of revascularization; there were 45 males and one female (mean age 58) sent in the third week after acute myocardial infarction (N = 31) or after unstable angina (N = 15). Left ventricular ejection fraction (EF) was normal in 50% of the patients, but 15% had an EF less than or equal to 0.30. Three patients could not begin their rehabilitation because of unstable angina (N = 2) or severe pulmonary oedema (N = 1). After a 4-week rehabilitation programme, the comparison of stress tests revealed an increase in functional capacities (maximal work-load = 103.6 +/- 27 W before rehabilitation, 126.4 +/- 31 W after rehabilitation, P less than 0.001), and an improvement of the ischaemic threshold [82 +/- 32 W before rehabilitation, 91 +/- 31 W after rehabilitation, P less than 0.05]. During long-term follow up [20.8 months], four patients died of cardiac events [8.7%]; all of them had an EF less than 0.45. Among the 42 living patients 61.9% were asymptomatic, 28.7% had exertional angina, and 9.4% had cardiac complications, and coronary surgery was performed in two cases with good results. The level of return to work was 85% with the mean delay of 1.7 months after rehabilitation. So, rehabilitation in three-vessel coronary disease patients is safe under medical control; improvements in exertional capacities are obvious and give the patients a better self confidence as assessed by the good score of return to work after rehabilitation.

Angina Pectoris↗
PubMed1975

[Carbohydrate tolerance, serum insulin and triglycerides in coronary disease].

The authors set up the task to study the changes in blood sugar, immunoreactive insulin and triglycerides in patients with manifested coronary disease during an oral glucoso-tolerance test in the course of three hours. They examined 32 patients with coronary disease and 19 control subjects, similar in age and body weight, divided into three subgroups: with normal glucose tolerance (NGT), suspiciously-pathological glucose tolerance (SPGT) and pathological glucose tolerance (PGT). They are led by age conformed criteria in the assessment of the blood sugar curves obtained. For a better idea about the insulin response volume, provoked by glucose loading, they compare the sums of the insulinemic values and "insulinogenic index", among the control subjects and the patients examined. The study of the carbohydrate tolerance of the patients examined, show that manifested or suspiciously pathological deviations in carbohydrate metabolism were found in almost 60% of them. Insulinemia during the glucose loading was found to be higher than that of the control subjects, maximal point appearing later and restoration to initial values delayed. The highest absolute insulin values and increased volume of insulin secretion were established in the patients with NGT and the lowest--in patients with PGT. The highest insulinogenic index is in NGT patients and is with about 50% higher than that of the control subjects while in patients with PGT it is quite the reverse, i. e.--glucose tolerance deteriorated parallelly with the reducing of insulin response to glucose stimulus or, in other words--normal glucose tolerance in patients maintained by the increased insulin production. The correlation of blood sugar and insulinemic curves with those of triglyceridemia reveals that with blood sugar elevation and insulinemia during glucose loading--triglyceride level rapidly elevates--i.e. a positive correlation was found among blood sugar, insulinemia and triglyceridemia where triglyceridemia correlates with hyperinsulinemia more intimately than with glycemia. Basing on the data obtained and the general theoretical conditons--the problem of pathogenetic commonness (at least in certain relations) between atherosclerosis, obesity and diabetes mellitus is discussed. A practical conclusion is drawn that the establishment of increased serum triglycerides and hyperinsulinism in pathological and even in still normal carbohydrate tolerance in one subject may play the role of an important diagnostic test, speaking of the possible development or for the presence of already manifested atherosclerosis.

Adult↗
PubMed1997

[The prognostic significance of late potentials in patients with chronic coronary disease].

OBJECTIVE: The prognostic value of late potentials (LP) in the subacute phase of myocardial infarction (MI) is well known, but its prognostic value in long-standing coronary disease (LSCD) has not yet been established. In a population with LSCD we searched for a relation between the presence of LP in signal-averaged ECG (SAECG) performed before cardiac catheterization, and the incidence of cardiac events. METHODS: Based on our department's casuistics, we selected 50 consecutive patients with coronary disease confirmed by an angiogram and LP, and a control group without LP, in SAECG. We selected 91 men and nine women with an average age of 59 +/- 8 years. None of the patients had had ischemic events or revascularization procedures, in the 3 month period before catheterization. The follow-up was made between the time of the SAECG and the last medical visit. The events recorded were: ventricular arrhythmia, cardiac death, coronary angioplasty, coronary artery by-pass graft, MI or unstable angina. RESULTS: During a follow-up period of 20.1 +/- 8 months, we found no statistically significant difference between the two groups, regarding the incidence of such events. However, there was a higher incidence of ventricular arrhythmic events in the group with LP (four patients with ventricular tachycardia against none in the control group). All patients with ventricular tachycardia had had a previous MI. CONCLUSIONS: In this study, the presence of LP in SAECG did not have the same prognostic value found in the subacute phase of MI, but a higher incidence of arrhythmic events was observed in the group with LP and a previous MI.

Adult↗
PubMed2000

Importance of lipoprotein metabolism parameters in the clinical and angiographic severity of coronary artery disease.

Coronary artery disease that is clinically and angiographically significant is associated to important biochemical parameters with direct interference in lipoprotein and apoprotein metabolism. The purpose of our study was to evaluate the importance of several lipoprotein metabolic parameters in the clinical and angiographic severity of chronic coronary artery disease. In a population with the diagnosis of ischemic coronary artery disease, we assessed the degree of angiographic (single- versus multivessel disease) and clinical (C.C.S. I-IV classification) severities. In each patient, we determined the value of total cholesterol, triglycerides, HDL and LDL cholesterol, HDL 2 and 3, apoprotein AI and B, lipoprotein (a), anti-phospholipid antibodies and C reactive protein. Our results showed that some parameters were significant in the comparison between a normal group and the global coronary artery disease population, such as the value of total cholesterol, HDL cholesterol, HDL 2, apoprotein AI and B lipoprotein (a) and anti-phospholipid antibodies. In the distinction of coronary artery disease subgroups, in relation to C.C.S. < or = 2 and > or = 3 classes, some factors could be discriminated, such as HDL cholesterol, HDL 2, total cholesterol/HDL, lipoprotein (a), anti-phospholipid antibodies and C reactive protein. In the distinction between classes C.C.S. < or = 2 and AMI, the levels of triglycerides, HDL cholesterol, HDL 2, total cholesterol/HDL, lipoprotein (a) and anti-phospholipid antibodies were significant. In the division between single vessel versus multivessel coronary artery disease we found significant values of HDL cholesterol, HDL 2, total cholesterol/HDL, apoprotein AI, lipoprotein (a), anti-phospholipid antibodies and C reactive protein. In conclusion, our present study endorses the clinical role of lipids and plasma lipoproteins in the determination of several cardiovascular risk factors, but introduction of new parameters such as lipoprotein (a) and the anti-phospholipid antibodies can be very useful for a better and global understanding of the pathophysiological processes and distinction of higher risk subgroups for extension and degree of severity of ischemic coronary artery disease.

Aged↗
PubMed1994

[Detection of coronary calcifications and coronary disease].

OBJECTIVES: The diagnosis of clinically silent coronary artery disease would be a major step in preventing episodes of acute cardiac ischaemia. We screened asymptomatic patients with hypercholesterolaemia with electron computed tomography (ultrafast CT) to determine the effectiveness of this method in detecting calcium deposits in coronary arteries. METHODS: During a 3-year period, 1000 male subjects with hypercholesterolaemia were selected among the general population consulting for systematic work-shop check-ups. Electron computed tomography was performed in all selected subjects to detect coronary atheroma and those with major pathological results then underwent coronarography. RESULTS: Calcium deposits in the coronary arteries were observed in 66% of the subjects with hypercholesterolaemia. Twenty cases with particularly pathological results were selected for coronarography which revealed that coronary narrowing was greater than 50% in 10 of them. CONCLUSION: Electron computed tomography (formerly called ultrafast CT) is an effective method for detecting calcium deposits in coronary arteries and as such is a useful tool in predicting silent coronary artery disease.

Adult↗
PubMed2006

Outcome of emergency conventional coronary surgery for acute coronary syndrome due to left main coronary disease.

BACKGROUND: Outcomes of emergency coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) due to left main coronary (LMT) disease remain unclear. This study aimed to assess prognoses for patients undergoing emergency CABG for ACS due to LMT disease. METHODS: One hundred and four patients undergoing emergency CABG for ACS due to LMT disease were retrospectively reviewed. All patients had intra-aortic balloon pumping (IABP) support and underwent surgery within 48 hours after onset. We determined predictors for operative mortality and calculated cardiac event free, actuarial survival, and cumulative graft patency rates. RESULTS: We found that 9 patients (8.7%) developed pre-operative cardiogenic shock and 7 of them required percutaneous cardiopulmonary support (PCPS). Operative mortality affected 9 patients (8.7%). Cardiac event free rate and actuarial survival rate at 10 years were 80.7 and 75.4%, respectively. Logistic regression analysis showed that pre-operative cardiogenic shock was the only predictor for operative mortality (p = 0.0146, odds 5.96). Cumulative graft patency rates for internal thoracic artery and saphenous vein (SVG) at 5 years were 92.6 and 72.4%, respectively. One year-graft patency rate for the radial artery (RA) was 100%. CONCLUSION: It is still very hard to treat patients with cardiogenic shock. We suggest that immediate percutaneous coronary intervention (PCI) with mechanical supports is required prior to CABG for survival of patients with left main shock syndrome.

Adult↗