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PubMed1976

[The spontaneous course of coronary disease].

The natural history of coronary atherosclerotic heart disease was studied in a retrospective analysis of 160 patients, who underwent coronary arteriography from 1965 to 1969. All had at least one angiographically documented significant stenosis of more than 50%; the survivors were followed for at least 5 years and a maximum of 9 years. For the entire group, 5-year survival was 81%. Subdivided into single, double or triple vessel disease categories, the 5-year survival rates were 91, 85 and 63% respectively.

Angiography↗
PubMed1995

[Can we modify the pathogenesis of coronary disease? Introduction].

Recently the European Societies of Cardiology Atherosclerosis and Hypertension have published a document of Recommendations on the Prevention of Coronary Disease in Clinical Practice. The information given in the document has proven that a reduction in cholesterol reduces the risk of the onset of new coronary as well as cardiovascular mortality. It has been accepted that such reduction can induce the regression of the atheroma plaque, and the slowing of its progression. In Spain cardiovascular mortality has progressively decreased since 1975. This is true for the coronary caused mortality and the secondary to a cerebrovascular disease, the latter being that where the greatest change has been noticed, as well as in women. Probably, this trend may be explained by a better control on hypertension, as well as by a more adequate hospital net. Spain has one of the lowest rates of mortality due to coronary disease among the industrialized countries. Nevertheless, the cardiovascular mortality is still the first cause of death in Spain. Spanish cardiologist are convinced that the relationship between the levels of cholesterol and coronary risk happened in Spain, in quantitative terms, differently than in Central Europe and the USA. They consider that the "Mediterranean diet" is the protective factor.

Aged↗
PubMed1989

Exercise-induced ST segment depression in the diagnosis of multivessel coronary disease: a meta analysis.

To evaluate the variability in the reported accuracy of the exercise electrocardiogram (ECG) for predicting severe coronary disease, meta analysis was applied to 60 consecutively published reports comparing exercise-induced ST depression with coronary angiographic findings. The 60 reports included 62 distinct study groups comprising 12,030 patients who underwent both tests. Both technical and methodologic factors were analyzed. Wide variability in sensitivity and specificity was found (mean sensitivity 81% [range 40% to 100%, SD 12%]; mean specificity 66% [range 17% to 100%, SD 16%]). All three variables found to be significantly and independently related to sensitivity were methodologic (the exclusion of patients with right bundle branch block, the comparison with another exercise test thought to be superior in accuracy and the exclusion of patients taking digitalis). Exclusion of patients with right bundle branch block and comparison with a "better" exercise test were both significantly associated with sensitivity for the prediction of triple vessel or left main coronary artery disease. Adjustment of exercise-induced ECG changes for changes in heart rate was strongly associated with the specificity for critical disease (partial R2 = 0.436, p = 0.0001).

Coronary Angiography↗
PubMed1983

[Long-term antithrombotic treatment in coronary disease].

The respective roles of thrombosis and spasm in the pathogenesis of coronary disease is a subject of current discussion. Critical study of trials of long-term secondary prevention of myocardial infarction carried out between 1967 and 1982 have failed to yield any definitive conclusion as to the value of oral anticoagulants, aspirin, sulfinpyrazone or dipyridamole. However oral anticoagulants should be prescribed in the long-term, in the absence of any contra-indication, in cases of myocardial infarction complicated by ventricular ectasia, arrhythmias or cardiac failure with cardiomegaly. The use of better methods in secondary prevention trials would be desirable. Primary prevention of myocardial infarction using drugs raises difficult problems, in particular economic.

4-Hydroxycoumarins↗
PubMed1992

Identification of patients with coronary disease at high risk for loss of employment. A prospective validation study.

BACKGROUND: Work disability is common in patients with coronary artery disease and adversely affects both economic well-being and quality of life. The purpose of this study was to construct a model to predict premature departure from the work force of patients with coronary disease and to validate this model prospectively in an independent cohort of patients. METHODS AND RESULTS: We enrolled 1,252 coronary disease patients referred for diagnostic cardiac catheterization who were less than age 65, employed, and without prior coronary angioplasty or coronary bypass surgery. Medical, functional, psychological, economic, and job-related variables were measured at the time of baseline diagnostic cardiac catheterization, and all patients were followed for 1 year. Three hundred twelve patients underwent percutaneous transluminal coronary angioplasty (PTCA) within 60 days of catheterization, and 449 had coronary artery bypass graft surgery (CABG) within 60 days of catheterization. The remaining 491 patients were treated with initial medical therapy. Logistic regression was used to develop a multivariable model for predicting 1-year work status in the training sample patients (872 patients enrolled between March 1986 and February 1989). This model was then validated in the independent prospective test sample (380 patients enrolled between March 1989 and June 1990). Eight factors were independent predictors of departure from the work force: lower initial functional status (as assessed by the Duke Activity Status Index), followed by older age, black race, presence of congestive heart failure, lower education level, presence of extracardiac vascular disease, poorer psychological status, and lower job classification. Standard clinical variables provided only 20% of the total predictive information available from the model about follow-up work outcomes, whereas functional measures provided 27%, and demographic and socioeconomic measures provided 45%. In the test sample, the area under the receiver operating characteristic curve for the model predictions was 0.74, compared with 0.80 in the training sample, and model predictions agreed well with observed prevalences of return to work. After adjustment for baseline imbalances, there was no significant difference in 1-year return-to-work rates among the patients receiving initial PTCA or CABG therapy versus initial medical therapy. CONCLUSIONS: Patients with coronary disease who are at high risk for premature departure from the work force can be accurately identified from a combination of medical and nonmedical risk factors. The model developed in this study provides a tool to identify patients at high risk for premature loss from the work force. Such patients may benefit from special multidimensional intervention programs designed to preserve work status. Our data show that revascularization with either PTCA or CABG is not, by itself, sufficient to accomplish this goal.

Angioplasty, Balloon, Coronary↗
PubMed1999

Anti-oxidant therapy for the treatment of coronary artery disease.

Coronary artery disease is the most common cause of death in developed countries. It may present in many different ways, but most frequently as a myocardial infarction, sudden death, angina or heart failure. Preventive measures in relation to coronary artery disease are particularly important because of its high incidence, high mortality and because most patients die outside hospital. Since the oxidation of low density lipoprotein cholesterol (LDL-C) is a critical early step in the process of atheroma formation, taking anti-oxidants to prevent LDL-C oxidation may prove a very effective means of reducing coronary artery disease mortality. However, the role of anti-oxidants in coronary artery disease prevention needs to be evaluated as part of an overall strategy that includes pharmacological and non-pharmacological measures, which are described in this review. In addition, a more structured and scientific approach to anti-oxidant therapy needs to be adopted. This requires that evidence for oxidative stress in a particular condition is obtained, the nature and severity determined and an appropriate anti-oxidant is administered, in an effective dose, which can be shown to correct the oxidative stress. When this is achieved, meaningful clinical trials should be possible, which will determine the place of anti-oxidant therapy for the specified condition.

Journal Article↗
PubMed1993

[Ischemia--reliable results of therapy, operation and angioplasty--in coronary disease].

Randomized studies have shown that coronary bypass-surgery is effective in prolonging survival and reducing symptoms in various groups of patients with coronary artery disease, when compared with medical therapy alone. This effect is most pronounced and stable in patients who received an internal-mammary-artery graft. Therefore internal-mammary-artery grafting for lesions of the left anterior descending coronary artery is preferable whenever indicated and technically feasible. While percutaneous transluminal coronary angioplasty is effective in improving symptoms of angina pectoris, beneficial effects on survival have not yet been shown. In randomized trials of PTCA versus bypass-surgery acute results were comparable. During follow-up significantly less re-interventions and more angina-free patients were seen in the bypass-groups, indicating a more stable result after bypass surgery. In older patients with a higher mortality and rate of cerebral vascular events during surgery, a palliative PTCA of the culprit lesion may be superior to the bypass-operation. For the often used "unproven" indications for PTCA (silent ischemia, infarct-related artery in asymptomatic patients, isolated proximal LAD-stenosis, acute myocardial infarction, cardiogenic shock) larger randomized trials should be awaited to prove the effectiveness of PTCA in these settings.

Aged↗
PubMed1992

[Exercise echocardiography in coronary disease].

Exercise echocardiography is a new method used in the investigation of coronary disease. It evaluates the repercussions on regional contractile function of the increase in oxygen consumption induced by physical exercise. It makes it possible to analyse in real time not only the amplitude of endocardial displacement, but also that of parietal thickening and thereby seems to be more precise than conventional ergonomic tests in the diagnosis of myocardial ischaemia. Its recent development owes much to the advent of digital technologies which make it easier and more accurate to interpret the changes observed in left ventricular regional kinetics by comparing the data at rest with those recorded at peak physical effort. When associated with an equally non-invasive ergometric test it is well accepted by the patients. Another of its advantages is its moderate cost. Echocardiographists must devote as much time as necessary to training. Training is indispensable to rapidly capture the images, particularly during efforts, and to reliably interpret the variations observed in left ventricular wall contraction. Exercise echocardiography is still under evaluation. Experience is lacking for the cardiologist to choose, only on its results, the most appropriate treatment for each individual patient, but its help will be appreciated in some difficult therapeutic decisions. Behind this phase of training for, and evaluating this technique several of its main clinical indications can already be outlined.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed2005

Depressive symptoms and 24-hour urinary norepinephrine excretion levels in patients with coronary disease: findings from the Heart and Soul Study.

OBJECTIVE: Depressive symptoms are associated with an increased risk of cardiac events in patients with heart disease. Elevated catecholamine levels may contribute to this association, but whether depressive symptoms are associated with catecholamine levels in patients with heart disease is unknown. METHOD: The authors examined the association between depressive symptoms (defined by a Patient Health Questionnaire score > or =10) and 24-hour urinary norepinephrine, epinephrine, and dopamine excretion levels in 598 subjects with coronary disease. RESULTS: A total of 106 participants (18%) had depressive symptoms. Participants with depressive symptoms had greater mean norepinephrine excretion levels than those without depressive symptoms (65 microg/day versus 59 mug/day, with adjustment for age, sex, body mass index, smoking, urinary creatinine levels, comorbid illnesses, medication use, and cardiac function). In logistic regression analyses, participants with depressive symptoms were more likely than those without depressive symptoms to have norepinephrine excretion levels in the highest quartile and above the normal range. Depressive symptoms were not associated with dopamine or epinephrine excretion levels. CONCLUSIONS: In patients with coronary disease, depressive symptoms are associated with elevated norepinephrine excretion levels. Future longitudinal studies are needed to determine whether elevations in norepinephrine contribute to adverse cardiac outcomes in patients with depressive symptoms.

Aged↗
PubMed1993

Atherosclerosis and coronary heart disease.

Coronary heart disease is the largest cause of morbidity and mortality in the UK. The disease develops by the interaction of a variety of environmental agents in people who may be genetically susceptible. Some of the environmental agents can be favourably altered by adjustments to lifestyle, particularly by stopping smoking, increasing exercise levels and controlling the diet. Coronary heart disease is manifested by a number of symptoms due to the partial or complete occlusion of the coronary arteries by a fibrous plaque. The processes of plaque formation can begin very early on in life and progress through various stages. The process may be initiated by injury to the endothelial lining but can also occur in areas without obvious injury. Diagnosis of coronary heart disease is largely by electrocardiographic measurements and a variety of imaging modalities and laboratory investigations. Treatment centres upon the medical control of the symptoms, or surgical intervention in the form of a coronary bypass operation or by coronary angioplasty.

Arteriosclerosis↗
PubMed1984

The effects of nitrous oxide on myocardial metabolism and hemodynamics during fentanyl or enflurane anesthesia in patients with coronary disease.

Twenty patients about to have coronary artery bypass grafts were studied before and after 15 min of 50% nitrous oxide added to either fentanyl (75 micrograms/kg) or enflurane (0.5%) anesthesia. Arterial and central pressures and cardiac output were measured, plus coronary sinus blood flow and arterio-coronary sinus differences in oxygen, hemoglobin, and lactate contents. Fentanyl-N2O and enflurane-N2O both decreased systemic resistance, heart rate, cardiac output, and hence arterial pressure. Stroke work decreased significantly with little or no change in wedge pressure: ventricular function was impaired. Coronary flow and myocardial O2 consumption decreased with fentanyl-N2O. Oxygen extraction increased with enflurane-N2O, as did lactate contents of coronary sinus blood. Hemodynamic depression occurred from the combined effects of nitrous oxide and fentanyl or enflurane. The beta-blocked myocardia of nonstimulated coronary patients were becoming ischemic globally on 50% oxygen, after significant hypotension. From this and other evidence, we conclude that nitrous oxide may not be benign in patients with coronary arterial disease.

Adult↗
PubMed2000

[The role of the echo-dipyridamole test in the diagnosis of coronary disease in patients with associated aortic stenosis].

BACKGROUND: Coronary vasodilator reserve is often significantly impaired in patients with aortic stenosis by several mechanisms: coronary artery disease, left ventricular hypertrophy, increase in cardiac chamber stiffness. The aim of this study was to evaluate the feasibility and the diagnostic accuracy of the dipyridamole echocardiography test in the diagnosis of coronary artery disease in patients with aortic stenosis. METHODS: Forty patients (26 males, 14 females, mean age 69 +/- 8.9 years) with aortic stenosis (mean valve area 0.7 +/- 0.3 cm2 calculated by the continuity equation) were studied by two-dimensional echocardiography during dipyridamole infusion up to 0.84 mg/kg over 10 min. Wall motion was graded for each segment as normal, hypokinetic, akinetic and dyskinetic. Dipyridamole echocardiography was considered positive for ischemia if wall motion in at least one segment worsened by at least one degree point level compared to wall motion at rest. All patients underwent coronary angiography (mean time after dipyridamole echocardiography 7 +/- 3 days). The chi 2 test and Student's t-test for paired data were used; a p value of < 0.05 was considered as statistically significant. RESULTS: Only one dipyridamole echocardiography was interrupted because of supraventricular tachycardia appearance. Nine patients showed new asynergy areas during dipyridamole echocardiography; 19 patients had ST segment downsloping of > or = 1 mm during dipyridamole infusion; 12 patients experienced angina during the test. Angiography showed a significant coronary stenosis in 10 patients. Dipyridamole echocardiography sensitivity was 80%, specificity was 96%; specificity of ST segment downsloping and angina were 63 and 76% respectively. CONCLUSIONS: Dipyridamole echocardiography in patients with aortic stenosis is safe and feasible with good sensitivity and better specificity. Our study suggests also that dipyridamole echocardiography test is able to rule out patients with aortic stenosis and coronary artery disease as opposed to those with angina without organic stenosis of the coronary vessels.

Aged↗
PubMed1993

[Influence of coronary disease on the results of carotid surgery].

The object of this retrospective (case-control) study of 513 carotid artery operations in 471 patients was to evaluate whether the presence of coronary artery disease at the time the decision to operate was taken, influence the prognosis of patients operated upon for stenosis of a carotid artery. Three groups were constituted and compared; no coronary artery disease (NC), stable coronary artery disease (CS) and unstable coronary artery disease (CI). Operative mortality was 1% (NC), 5% (CS) and 9% (CI) respectively (p < 0.001). The rate of neurologic deficits was 1.3% (NC), 2.4% (CS) and 3.1% (CI), and the 5 year actuarial survival rate 83% (NC), 78% (CS) and 63% (CI) (p = 0.040 by the Log-Rank test). Premature deaths were due to cardiac and neurologic causes. In the patients with coronary disease, local and regional anesthesia was followed by 0% mortality whereas the rate was 3% (CS) and 13% (CI) (p < 0.001) after general anesthesia. The cause of delayed death was determined accurately in 50% of cases; it was cardiac in 25% (NC) and 70% in patients with coronary disease. Results of the present study confirm that the presence of coronary disease has an adverse effect on the immediate and long term prognosis for patients undergoing coronary artery surgery, and demonstrate that the operative risk can be significantly reduced by the use of local and regional anesthesia. Long term close cardiology surveillance is justified, particularly if signs of coronary disease are noted perioperatively.

Aged↗
PubMedDate not supplied

Perceived vulnerability to serious heart disease and persistent pain in patients with minimal or no coronary disease.

A hypochondriacal personality has been shown to be a major determinant of continued pain in patients with chest pain, both in the presence and absence of significant (less than 75%) coronary stenosis. We investigated preoccupation with cardiac illness among 106 patients (63 women, 43 men) within a few days after coronary angiography, carried out for evaluation of chest pain, showed no significant stenosis. Thirteen questions were used in a structured interview to assess patients' beliefs, behaviors, and expectations pertaining to their cardiac health. Information about persistence of pain was obtained 1 year later by telephone interview. A composite variable, called Self-Label of Coronary Vulnerability, was determined by factor analysis; it accounted for 65% of the variance in the responses. In a multivariable regression analysis, a high score on Self-Label showed the strongest association (p less than 0.005) with continued, unimproved chest pain 1 year later even after adjusting for other variables. As a result, perhaps of a self-labeling process a set of beliefs about vulnerability to serious heart disease helps explain persistence of pain, despite the absence of significant coronary disease.

Coronary Disease↗
PubMed2001

[The role of magnetic resonance imaging in the diagnosis of coronary disease].

As the number of diagnostic coronary angiographies without subsequent revascularization procedures is continuously rising, the need for non-invasive diagnostic procedures with a high diagnostic accuracy is well appreciated. Because of the technical advances in magnetic resonance imaging (MRI) over the last few years, major improvements have been made in the functional assessment of wall motion, myocardial perfusion and coronary flow measurements, as well as the visualization of the anatomy of the coronary arteries by MRI. Besides these classical parameters of ischemia and anatomical pathology, for the first time MRI might offer the possibility to not only non-invasively assess the lumen of the coronary arteries, but also to visualize the vessel wall. Thus, early manifestations of coronary artery disease may be detectable for the identification of patients with preclinical disease as candidates for aggressive risk modification. In this review the current status as well as future perspectives of MRI are discussed.

Angioplasty, Balloon, Coronary↗
PubMed2001

Dietary Counseling for High Blood Cholesterol in Families at Risk of Coronary Disease.

A positive family history of coronary heart disease alone confers an increased risk, which may be affected by untreated hypercholesterolemia. Dietary counseling is a first-line treatment approach. To determine whether nurse counseling can provide additional benefits over usual physician efforts to lower dietary fat in high-risk persons, 117 apparently healthy adult siblings of persons with premature coronary heart disease were counseled by a registered nurse using adapted national guidelines. Reductions in total fat, saturated fat, and cholesterol were significantly greater in the nurse group compared to those in the usual care group. Total fat intake decreased by 14 g in the nurse group, compared with an increase of 5 g in the usual care group (p=0.0001). Assignment to the nurse group was also a significant predictor of a greater reduction in the percentage of total fat calories (p=0.008). The authors conclude that a registered nurse may serve as a complement to usual care in efforts to lower dietary fat and cholesterol in high-risk families. (c)2001 CHF, Inc.

Journal Article↗