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PubMed1982

Cardiovascular effects of nifedipine--a 4-week treatment in preselected patients with coronary disease.

In 24 patients with coronary ischemic disease the cardiovascular effects of 10-mg tablets of nifedipine given three times daily for 28 days was studied with noninvasive techniques before and after standard work load. Five patients did not complete the study because of drug nontolerance and lack of therapeutic effectiveness. In 19 patients nifedipine has been found to produce positive changes in left ventricle contraction parameters without influencing positively the ECG parameters. An increase in heart rate and the ratio of cardiac oxygen demand to general oxygen consumption was observed. The increase in systolic blood pressure after work load during nifedipine therapy contraindicates use of this drug in cardiac patients with arterial hypertension.

Adult↗
PubMedDate not supplied

[Living with coronary disease: between authentic living and living with daily ties].

Phenomenological study, which purpose is the meaning that the persons suffering from coronary diseases ascribe to the experiences undergone. From the interviews, significances were obtained: fear of death and of the return of the acute symptoms; perceiving the social, professional and sexual life transformations; feeling watched; resigning oneself to the new conditions; and feel sadness and no resignation. These significances permitted the comprehensive analyses, that was supported by Martin Heidegger in his book Being and time. The person suffering from coronary diseases showed themselves as inauthentic existences when fearing "something", by becoming tied to chatter and to the satisfaction they once had. Moreover, they transcend to the authentic living when they feel anguished, assuming coronary illness as a possibility of existence, although they fail and become tied to daily life traps. The study reflects about the need to privilege the existential dimension in health assistance and in the training of professionals, getting ahead the idea of the other as a guidance to be followed.

Activities of Daily Living↗
PubMed1997

Non-invasive risk stratification within 48 h of hospital admission in patients with unstable coronary disease.

AIMS: In this study we evaluated the prognostic value of three methods of early risk estimation in patients with unstable coronary disease. METHODS AND RESULTS: The methods evaluated were: clinical risk estimation at hospital admission, continuous ST analysis with computerized vectorcardiography for 24 h and serial measurements of creatinine kinase-MB for 48 h. Twenty-seven (14%) of the 195 patients died or had a non-fatal infarction within one year. Clinical risk evaluation correctly identified a subgroup of patients with low risk but did not otherwise predict outcome. Fifty-six (29%) patients had ST vector magnitude episodes on vectorcardiography, 70 (38%) had three or more episodes of ST change vector magnitude and 74 (38%) had a peak creatinine kinase-MB value of 6 microgram.l-1 or more. The even rate for patients with ST vector magnitude episodes (23%) was significantly higher than for those without (10%; P < 0.05). For patients with and without three or more episodes of ST change vector magnitude the event rate was 23% and 9% respectively (P < 0.05) and for patients with and without creatinine kinase-MB > or = 6 microgram.l-1 the event rate was 23% and 8% respectively (P < 0.01). The positive predictive value of having none, either one or both of the ST or creatinine kinase-MB markers positive was incremental. CONCLUSION: Continuous vectorcardiographic monitoring of ischaemia in combination with serial creatinine kinase-MB measurement considerably improves risk stratification in unstable coronary disease.

Adult↗
PubMed2003

B-type natriuretic peptide and ischemia in patients with stable coronary disease: data from the Heart and Soul study.

BACKGROUND: In patients with symptoms of heart failure, elevations in B-type natriuretic peptide (BNP) accurately identify ventricular dysfunction. However, BNP levels are not specific for ventricular dysfunction in patients who do not have overt symptoms of heart failure, suggesting that other cardiac processes such as myocardial ischemia may also cause elevations in BNP. METHODS AND RESULTS: To determine whether BNP elevations are associated with myocardial ischemia, we measured plasma BNP levels before performing exercise treadmill testing with stress echocardiography in outpatients with stable coronary disease. Of the 355 participants, 113 (32%) had inducible ischemia. Compared with participants in the lowest BNP quartile (0 to 16.4 pg/mL), those in the highest quartile of BNP (> or =105 pg/mL) had double the risk of inducible ischemia (adjusted relative risk, 2.0; 95% CI, 1.2 to 2.6; P=0.008). The relation between elevated BNP levels and inducible ischemia was especially evident in the 206 participants who had a history of myocardial infarction (adjusted relative risk, 2.6; 95% CI, 1.5 to 3.7, P=0.002) and was absent in those without a history of myocardial infarction (adjusted relative risk, 1.0; 95% CI, 0.3 to 2.2; P=0.9). This association between BNP levels and inducible ischemia remained strong after adjustment for measures of systolic and diastolic dysfunction. CONCLUSIONS: Elevated levels of BNP are independently associated with inducible ischemia among outpatients with stable coronary disease, particularly among those with a history of myocardial infarction. The observed association between BNP levels and ischemia may explain why tests for BNP are not specific for ventricular dysfunction among patients with coronary disease.

Aged↗
PubMed2006

Degenerative aortic valve stenosis, but not coronary disease, is associated with shorter telomere length in the elderly.

OBJECTIVE: The mechanisms responsible for the age-related increase in the incidence of calcific aortic valve stenosis (CAS) are unclear but may include telomere-driven cellular senescence. Because telomere length varies widely among individuals of the same age, we hypothesized that patients with shorter telomeres would be prone to develop CAS late in life. METHODS AND RESULTS: Mean telomere length was measured in leukocytes from a cohort of 193 patients > or =70 years of age with and without CAS. Pilot experiments performed in 30 patients with CAS and controls pair-matched for age, sex, and presence or absence of coronary disease demonstrated significantly shorter telomeres in the CAS group both by Southern blot hybridization (5.75+/-0.55 kbp versus 6.27+/-0.7 kbp, P=0.0023) and by a quantitative polymerase chain reaction-based technique (relative telomere length 0.88+/-0.19 versus 1.0+/-0.19, P=0.01). This finding was then confirmed in the whole cohort (CAS n=64, controls n=129, relative telomere length=0.86+/-0.16 versus 0.94+/-0.12, P=0.0003). Both groups were comparable for potential confounding characteristics. Subgroup analysis according to the presence or absence of coronary disease demonstrated no association of this disorder with telomere length. CONCLUSIONS: In the elderly, calcific aortic stenosis, but not coronary disease, is associated with shorter leukocyte telomere length.

Aged↗
PubMed1987

Prediction of "critical" coronary disease: are the "Consensus Conference" guidelines adequate?

Presenting features of 100 patients with significant left main coronary stenosis (LMCS) were reviewed. All presented with angina--on minimal exertion in 45, moderate exertion in 38, and severe exertion in 6--and 11 had unstable angina. Although the resting ECG was normal in 44, exercise testing was positive in 92% of patients tested. The authors conclude that symptoms and the resting ECG alone are unhelpful in predicting "critical" coronary disease. However, application of a management plan similar to that suggested by the Consensus Conference on coronary artery surgery would have selected the vast majority of such patients for angiography.

Adult↗
PubMed1992

[Coronary disease in black Africans: epidemiology, risk factors, clinical symptomatology and coronarography, evolution].

The study of the epidemiological data (published since 1952) seems to show an increasing frequency of the coronary disease for 15 last years. But this incidence seems to reach a stable level about 6 to 7% of the cardiovascular diseases at the Abidjan Institute of Cardiology; and 3.17% in a study in 13 countries but without coronarography (except at the Abidjan Institute). The study of the risk factors show that they are the same ones than in Europa. The risk index in Black Africa was 2.1 to 2.7 risk factor patient. These numbers are lesser than the risk index noted in France (3.6 in coronary patients and 1.9 in non-coronary subjects). The signs of the disease show that myocardial infarctions were frequent (48.8%) and often were the first manifestations of the coronary disease (40%). Angina pectoris was observed in 32.2%, an ischemic cardiomyopathy in 6.6% and a ventricular aneurysm in 6.6%. A silent ischemia was observed in 5.5% among at risk diabetic patients. The in-hospital mortality after myocardial infarction was 15% and was the same in European and African patients. But the mortality in Africans was greater than in Europeans the next years. Coronarography showed that 18.8% of the patients with coronary disease had normal coronary arteries. The arteries were also normal in 19.9% of the patients examined after an infarction. These high percentages can be related to coronary arterial spasms or to recanalized thrombosis. A spontaneous spasm was observed in 6.6% of the patients (a provoked coronary arterial spasm was not studied. The coronary arterial lesion was an one artery disease in 38.8% of the coronary patients and 50% of the patients with infarction. The stenosis were frequently proximal (82.6%) and the anterior descending artery was interested in 45.6%. Ventricular aneurysms were observed in 56.6% and the ejection fraction was lower than 0.50 in 63.3%. These data permit to compare the myocardial infarction of Blacks with the myocardial infarction of the young occidental men. We can think that thrombolysis or angioplasty would be very useful but they are often impossible in the Black African conditions.

Africa↗
PubMed1999

[Primary and secondary prevention of coronary disease by statins].

In the context of the growing complexity of atherosclerosis, LDL-cholesterol has been gradually revealed to be the main aetiological agent. However, the first clinical trials were not convincing, as they failed to demonstrate a significant improvement of coronary mortality. So-called "regression" trials revealed the need to develop clinical trials in which the primary endpoint is coronary events and no longer intermediate criteria such as the course of coronary disease on coronary angiography. Lovastatin, simvastatin and pravastatin were shown to be effective in the prevention of relapses in coronary patients and in the prevention of coronary events in healthy subjects. In 1999, the prescription for coronary patients should almost always include a statin and the prescription in healthy subjects should include a statin when this subject presents a high risk of coronary events in the years to come.

Anticholesteremic Agents↗
PubMed1978

ST segment changes post-infarction: predictive value for multivessel coronary disease and left ventricular aneurysm.

To ascertain whether exercise testing might predict multivessel coronary disease and left ventricular aneurysm after a myocardial infarction, 154 patients with a single documented myocardial infarction who had both exercise testing and coronary angiography were grouped according to whether they had greater than or equal to 1 mm ST depression, greater than or equal to 1 mm ST elevation, or neither during exercise testing: 83 patients developed ST depression alone (group 1); 22 patients had ST elevation with concomitant ST depression in other leads (group 2); 19 patients had ST elevation alone (group 3); and 30 patients had no ST changes (group 4). Multivessel disease, defined as greater than or equal to 70% luminal narrowing in two or more coronary vessels, was present in 76% (63 of 83) of group 1, 91% (20 of 22) of group 2, 21% (four of 19) of group 3, and 13% (four of 30) of group 4. A left ventricular aneurysm was present in 31% (26 of 83) of group 1, 68% (15 of 22) of group 2, 79% (15 of 19) of group 3, and 40% (12 to 30) of group 1. We conclude that ST changes during exercise testing in patients after a myocardial infarction can reliably predict the extent of coronary disease and the presence of a left ventricular aneurysm; ST depression with or without ST elevation predicts multivessel disease; ST elevation alone or a negative exercise test suggests single vessel involvement; and ST elevation with or without ST depression predicts left ventricular aneurysm.

Adult↗
PubMed1993

[Myocardial scintigraphy with Tc-99m-MIBI for assessing the extent and severity of coronary disease: a comparison with thallium-201 and equilibrium angiocardioscintigraphy].

BACKGROUND: The aim of this study was to compare in the same population of patients affected by coronary artery disease (CAD), the accuracy in the assessment of CAD extent and severity achieved by myocardial scintigraphy, performed using Tc-99m-MIBI with two different imaging techniques (planar and single photon emission tomography--SPECT) and using TI-201 SPECT and by equilibrium radionuclide angiography (RNV). METHODS: We studied 20 patients (18 men and 2 women, age range 42-74) without prior myocardial infarction, but with effort angina. Seven had one-vessel and 13 multi-vessel disease; coronary artery stenosis was > or = 70% and < 80% in 18 arteries and > or = 80% in 19. After therapy withdrawal, all patients underwent (in different days, within 2 weeks): SPECT exercise TI-201 myocardial scintigraphy (early and redistribution images), planar and SPECT Tc-99m-MIBI myocardial scintigraphy (exercise and rest imaging 24 hours apart) and RNV (baseline and exercise studies). RESULTS: All methods were highly sensitive for the diagnosis of CAD: TI-201 SPECT 95%, Tc-99m-MIBI planar 95%, Tc-99m-MIBI SPECT 100%, RNV 100%. For the recognition of the involvement of more than one territory (multi-vessel disease) myocardial scintigraphy with Tc-99m-MIBI SPECT was the most sensitive (92%, p < 0.05 vs Tc-99m-MIBI planar and p < 0.01 vs RNV) and accurate (75%) method, while regional wall motion analysis with RNV showed the highest specificity (100%, p < 0.02 vs TI-201 SPECT, p < 0.05 vs Tc-99m-MIBI SPECT). For the recognition of the involved vessels Tc-99m-MIBI SPECT had the highest sensitivity (89%, p < 0.02 vs Tc-99m-MIBI planar, p < 0.002 vs RNV) and global accuracy (80%), while regional wall motion analysis with RNV had the highest specificity (96%, p < 0.02 vs Tc-99m-MIBI planar and SPECT, p < 0.001 vs TI-201 SPECT). The degree of obstruction (< 80% vs > or = 80%) significantly influenced the rate of positive RNV results (7/18 vs 14/19, p < 0.05), but not those of the different myocardial perfusion studies. CONCLUSIONS: Our data show that clear differences among the tested methods are present with respect to the assessment of disease extent and severity. SPECT myocardial scintigraphy with Tc-99m-MIBI appears more accurate than the other methods for assessing the extent of CAD. RNV wall motion analysis shows a very good specificity for the recognition of multi-vessel CAD and for the detection of high grade obstructions. This encourages the efforts for studying, whenever possible, not only myocardial perfusion, but also ventricular function and regional wall motion. To this aim the collection of first-pass radionuclide angiocardiography at the moment of Tc-99m-MIBI injection could be particularly advantageous.

Adult↗
PubMed1995

[Heart-related chest pain without manifest coronary disease].

Chest pain is a common reason for consulting a physician. Although the underlying cause of the chest pain varies, the most frequent cause is coronary disease. In many cases the diagnosis emerges from the case history, the clinical picture or non-invasive examination procedures. In cases of severe symptoms or unclear diagnosis, coronary angiography is performed which often shows the coronary arteries to be patent. In a large proportion of these patients the chest pain is of non-cardiac origin. In addition to coronary disease, other heart-related conditions may give rise to chest pain.

Chest Pain↗
PubMed2002

Health status predicts long-term outcome in outpatients with coronary disease.

BACKGROUND: Although patient-reported health status measures have been used as end points in clinical trials, they are rarely used in other settings. Demonstrating that they independently predict mortality and hospitalizations among outpatients with coronary disease could emphasize their clinical value. METHODS AND RESULTS: This study evaluated the prognostic utility of the Seattle Angina Questionnaire (SAQ), a disease-specific health status measure for patients with coronary artery disease. Patients were enrolled in a prospective cohort study from 6 Veterans Affairs General Internal Medicine Clinics. All patients reporting coronary artery disease who completed a SAQ and had 1 year of follow-up were analyzed (n=5558). SAQ predictor variables were the physical limitation, angina stability, angina frequency, and quality-of-life scores. The primary outcome was 1-year all-cause mortality, and a secondary outcome was hospitalization for acute coronary syndrome (ACS). Lower SAQ scores were associated with increased risks of mortality and ACS admissions. Prognostic models controlling for demographic and clinical characteristics demonstrated significant independent mortality risk with lower SAQ physical limitation scores; odds ratios for mild, moderate, and severe limitation were 1.5, 2.0, and 4.0 versus minimal limitation (P<0.001). Odds ratios for mild, moderate, and severe angina frequency were 0.8, 1.2, and 1.6 (P=0.078). The odds ratios for ACS admission among those with mild, moderate, and severe angina frequency were 1.4, 2.0, and 2.2, respectively (P=0.016). CONCLUSIONS: SAQ scores are independently associated with 1-year mortality and ACS among outpatients with coronary disease and may serve a valuable role in the risk stratification of such patients.

Aged↗
PubMedDate not supplied

Safety of therapeutic beta-blockade in patients with coexisting bronchospastic airway disease and coronary artery disease.

Atherosclerotic coronary artery disease and bronchospastic airway disease frequently coexist in older patients. There are substantial data suggesting reduced mortality with the use of beta-adrenergic blocking drugs in patients with symptomatic coronary artery disease, especially patients who have postmyocardial infarction and/or severe coronary artery disease associated with left ventricular dysfunction. Conversely, the use of beta-adrenergic blocking drugs (even selective beta(1)-adrenergic blocking drugs) has the potential of exacerbating bronchospasm. This prospective registry evaluates the safety of use of selective beta(1)-adrenergic blocking drugs in patients with symptomatic coronary artery disease and bronchospastic airway disease. A total of 835 consecutive patients with symptomatic coronary artery disease were prospectively evaluated for coexisting coronary and bronchospastic airway disease. Of these, 30 patients (mean age: 61 +/- 14 years) met the qualifying inclusion criteria. All these study patients except 1 (29/30 [96%]) reached therapeutic beta-blockade (resting heart rate <70 beats per minute). The 1 patient who discontinued use of beta-adrenergic blocking drugs as a result of lifestyle-limiting bronchospasm had no serious adverse outcome. No hospitalizations were required because of worsening bronchospasm. Ten percent of patients reported increased requirement of inhaled beta(2)-agonist use. The patients were followed for 15 +/- 9 months. One patient died of stroke at 22 weeks of follow-up. In conclusion, use of selective beta(1)-adrenergic blocking drugs at a therapeutic dose is safe (as long as careful clinical follow-up is available) and should be considered in all patients with coexisting symptomatic coronary artery disease and bronchospastic airway disease.

Adrenergic beta-Antagonists↗