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At least 919 records · Page 51Linked to original sources
PubMed1992

[Coronary disease and peripheral arterial disease: contribution of echo-Doppler in the study of the arteries of the neck and lower limbs before the age of 60. Apropos of 76 cases].

Echo-duplex exploration of heart and inferior limbs arteries is performed in 76 patients less than 60 years old, with angiographically established coronary heart disease. Peripheral vascular lesions are found in 15 cases (20%), they are more frequent in patients with tritrunkular coronary disease (35%) than in those with one (16%) or two-vessel lesions (10%). Mean encephalic circulatory resistance index is higher in patients with tritrunkular lesions (p less than 0.03). Vascular echo-duplex should be performed in case of coronary disease in order to avoid catheterism complications and to purpose combined surgical procedure (coronary bypass and carotid endarterectomy).

Adult↗
PubMed1988

Pressure-flow relations in the pulmonary artery during myocardial ischaemia: implications for right ventricular function in coronary disease.

Because exercise induced pulmonary hypertension may disturb optimal coupling between the right ventricle and pulmonary artery in coronary artery disease, high fidelity pulmonary artery and right ventricular pressure and electromagnetic pulmonary artery flow velocity data were recorded at rest and during supine exercise in 10 control subjects free of detectable cardiovascular disease and in 11 patients with coronary artery disease. The pulmonary artery impedance and power spectra were calculated from Fourier analysis of pressure and flow waveforms. Total hydraulic power expended per unit of forward flow was computed as an index of right ventricular-pulmonary artery coupling. In coronary artery disease exercise produced substantial increases in pulmonary artery pressure, pulmonary artery characteristic impedance, and total power per unit flow. These changes did not occur in control subjects. Despite a significant exercise increase in right ventricular end diastolic pressure and peak right ventricular dP/dt, and independent of the presence of right coronary artery involvement, the right ventricular stroke output response during exercise was significantly blunted in the coronary artery disease patients. Pulmonary vascular resistance was unchanged by exercise in either group. Exercise induced ischaemia presents an increased pulsatile hydraulic load to the right ventricle. Increased pulmonary artery input impedance impairs the hydraulic efficiency of right ventricular-pulmonary artery coupling and may contribute to the limitation of right ventricular ejection performance in coronary artery disease.

Adult↗
PubMed1998

New concepts and paradigms in cardiovascular medicine: the noninvasive management of coronary artery disease.

Coronary atherosclerosis is a diffuse heterogeneous process that occurs throughout the length of epicardial coronary arteries. Myocardial infarction and unstable coronary syndromes are caused most commonly by plaque rupture of lipid rich, less severe coronary artery stenoses. Vigorous cholesterol lowering by low fat food and lipid active drugs, control of hypertension, and smoking abstinence stabilize plaque and markedly reduce coronary events and angina pectoris with greater improvement in survival than reported for elective invasive revascularization procedures. The term "regression" or "reversal" of coronary artery disease (CAD) as used clinically incorporates the spectrum of beneficial changes in plaque composition and pathology, modest improvement in anatomic severity, endothelial healing, increased coronary flow and flow capacity, decreased symptoms, and improved survival. Standard coronary arteriography and standard noninvasive diagnostic tests (as commonly used) are inadequate for identifying or assessing severity of diffuse CAD. Newer technology or approaches using noninvasive positron emission tomography (PET), invasive intravascular ultrasound or pressure or flow velocity guide wires provide important new insights into the presence and severity of both segmental and diffuse CAD. Revascularization procedures may be beneficial in selected, restricted circumstances, primarily for 3-vessel disease and reduced left ventricular function and for "hibernating" or "stunned" myocardium. However, the benefits of revascularization procedures on survival in patients with good left ventricular function have not been convincingly documented, with substantive evidence that adverse outcomes outweigh the potential benefits. This collective new knowledge provides the basis for a shift in the management of CAD from an invasive, procedure-oriented viewpoint currently dominant in cardiology toward a noninvasive orientation that views the problem as a graded, continuous, heterogeneously diffuse disease process for which reversal treatment is optimal. Noninvasive management of CAD based on reversal treatment is a valid, safe, effective primary step, but it requires patient and physician knowledge. CAD should be treated immediately at the time of a firm diagnosis by simultaneous, vigorous risk factor management, low fat diet and a statin class drug. For control of high-density lipoprotein and triglycerides, other lipid active drugs should be added or substituted for statins if side effects prevent their use. Low fat food and weight control by appropriate caloric carbohydrate restriction are essential for reducing the highly atherogenic postprandial lipid surge that is not affected by statins. This vigorous reversal treatment, with aggressive anti-anginal and anti-platelet management as needed, should be used in every patient with diagnosed CAD before elective revascularization procedures are considered. In the author's experience, the majority of patients will pursue an effective reversal regimen when it is presented and managed appropriately with strong support by a knowledgeable participating physician providing sustained, intense guidance and pharmacologic control. For the minority of patients not responding to vigorous medical treatment or demonstrating progression, coronary arteriography and revascularization procedures are then appropriate.

Angioplasty, Balloon, Coronary↗
PubMed2002

Paraoxonase-1 L55M polymorphism is associated with an abnormal oral glucose tolerance test and differentiates high risk coronary disease families.

Polymorphisms of the gene for the antioxidant enzyme, paraoxonase-1 (PON1), have been identified as risk factors for coronary disease (CHD), notably in diabetic patients. The polymorphisms have also been linked with other diabetic complications. The present study analyzed glucose metabolism as a function of PON1 polymorphisms in young healthy nondiabetic men from families with premature CHD and matched controls. The L55M PON1 polymorphism was independently associated with the glucose response to an oral glucose tolerance test. LL homozygotes had significantly impaired glucose disposal (P = 0.0007) compared with (LM+MM) genotypes. It was particularly marked for subjects from high CHD risk families and differentiated them from matched controls (P = 0.049). The area under the glucose curve (P = 0.0036) and the time to peak glucose value (P = 0.026) were significantly higher in the LL carriers, whereas the insulin response was slower (P = 0.013). Insulin resistance did not differ between L55M genotypes. There was a trend for reduced pancreatic beta-cell function as measured by glucose-induced insulin secretion (LL vs. LM vs. MM, 20.26 vs. 23.74 vs. 25.60; P = 0.077). The frequency of the L55 allele decreased significantly (P = 0.028) across regions defining a north-south European axis. No significant differences for the glucose response or case-control populations were observed as a function of the PON1 Q192R polymorphism. The study demonstrates an association between PON1 gene polymorphisms and glucose metabolism. The L55M-glucose interaction differentiated offspring of high CHD risk families, suggesting that it may be of particular relevance for vascular disease and possibly other diabetic complications.

Adult↗
PubMed2004

[Successful angioplasty of the left anterior descending artery in a woman with Takayasu arteritis and associated coronary disease].

Takayasu arteritis is a rare, inflammatory disease affecting mainly young women and is more prevalent in Asia and Latin America. Its etiology is obscure. It involves the aorta and its main branches. The typical lesions are represented by obliteration and aneurysmatic dilatation of arteries and ostial stenosis. We report a case of a 51-year-old woman with Takayasu arteritis and coronary disease, complaining of angina pectoris CCS class IV. The patient underwent successful angioplasty of LAD. During 6-month follow-up she remained asymptomatic. Various therapeutic options of revascularization are reviewed.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

[Prevention and risk factors of coronary disease in the Canton of Zürich].

An intervention study is being carried out in relation to the prevention of diseases caused by atherosclerosis, especially coronary heart disease. The purpose of the study is to test in one community whether an intensive health education program, including the media (newspapers, radio and educational materials) as well as more individual instruction (lecture, group discussions, courses, exhibitions, collaboration with organizations) can modify risk factors in the population through favorable changes in the mode of life. Another community without any programs serves as a control. Questionnaires are being sent and screening examinations are being carried out in random samples of both populations before and at the end of the educational campaign in order to evaluate its effect. The plan and methods of the study are being described and the distribution of risk factors, based on the first round of examinations, is presented. A second round of examinations is due after a 12 months interval.

Adult↗
PubMed1999

Chlamydia pneumoniae infection and atherosclerotic coronary disease.

BACKGROUND: Previous works have suggested an association between Chlamydia pneumoniae infection and coronary heart disease. We evaluated the prevalence of C. pneumoniae infection in patients with acute myocardial infarction (AMI) and coronary heart disease (CHD). METHODS AND RESULTS: Ninety-eight patients with AMI, 80 patients with CHD, and 50 control subjects matched for age and sex were investigated. Immunoglobulin (Ig)M, IgG, and IgA antibodies to C pneumoniae were measured by the microimmunofluorescence test. IgM antibodies were not found; IgG positivity was found in 58.2% of the AMI group, 60.0% of the CHD group, and 38% of the control group, whereas for IgA, positivity was found in 33.7%, 43.7%, and 22% of cases in AMI, CHD, and control groups, respectively. Titers indicating reinfection were found in AMI and CHD groups in 6.1% and 10%, respectively, whereas titers indicating chronic infection were found in 14% of the AMI group and 25% of the CHD group. A significant correlation was found between chronic C pneumoniae infection and dyslipidemias in the AMI and CHD groups (P =.003; P =. 0006). CONCLUSIONS: The results suggest that chronic C pneumoniae infection may be associated with the development of atherosclerotic coronary disease. In our next step, we will test whether antichlamydial antibiotics may help to reduce the risk of atherosclerotic disease.

Acute Disease↗
PubMed1979

[Congenital absence of the circumflex artery. Association with an infarction without coronary disease].

A 31 year old man had a congenitally absent circumflex coronary artery, one of the least described of all the congenital abnormalities of the coronary arteries. Before confirmation of the diagnosis, an ectopie circumflex artery was excluded by the two angiographical signs observed by Page and by non-selective coronary arteriography. This abnormality was thought to have played a role in myocardial infarction in this young patient without coronary risk factors and with no obvious coronary artery narrowing on coronary arteriography.

Adult↗
PubMed1988

[Role of clinical manifestations, the exercise test and exertion angioscintigraphy in the diagnosis of coronary disease. A multivariate study].

Data of clinical examination, exercise electrocardiography and stress radionuclide angiography in 102 patients referred for assessment of chest pain was included in a logistic regression to optimise the diagnosis of coronary artery disease with coronary angiography as the reference investigation. None of the patients had other cardiac problems nor previous myocardial infarction. In the absence of symptoms exercise testing was continued until at least 80 p. 100 of the theoretical maximal heart rate was attained. Each patient was characterised by the value of the logistic function or probability of coronary artery disease. A threshold value corresponding to 80 p. 100 sensitivity was determined by the technique of ROC graphs. The significant variables were: a clinical variable--the type of chest pain as assessed by the clinical history; two radionuclide angiographic variables--the ejection fraction at peak effort and the corrected variation of ejection fraction between rest and stress, that is not taking into account possible decreases at the last increment of exercise. Coronary patients can be identified with an 80 p. 100 sensitivity and 77 p. 100 specificity on these criteria. This specificity is greater than that obtained by clinical examination and exercise electrocardiography alone (65 p. 100). Stress radionuclide angiography may therefore reduce the number of unnecessary coronary angiographies.

Adult↗
PubMed1993

Public health focus: physical activity and the prevention of coronary heart disease.

Coronary heart disease (CHD) is the leading cause of mortality in the United States: each year, CHD is newly diagnosed in approximately 1.5 million persons and accounts for an estimated $47 billion in direct and indirect health-care costs (1). Multiple risk factors associated with CHD include genetic susceptibility, elevated serum cholesterol, low levels of high-density lipoprotein cholesterol, cigarette smoking, uncontrolled hypertension, obesity, diabetes mellitus, and physical inactivity (2). This report summarizes information about the potential efficacy and cost-effectiveness of physical activity promotion as a strategy for preventing CHD.

Canada↗
PubMed1992

Metabolic cardiac imaging in severe coronary disease: assessment of viability with iodine-123-iodophenylpentadecanoic acid and multicrystal gamma camera, and correlation with biopsy.

Fifteen patients with coronary disease and resting left ventricular ejection fractions of less than or equal to 0.35 underwent resting metabolic cardiac imaging utilizing 1 mCi [123I]iodophenylpentadecanoic acid (IPPA) intravenously and a multicrystal gamma camera. Parametric images of regional rates of IPPA clearance and accumulation were generated. Forty-two vascular territories (22 infarcted) were evaluated by metabolic imaging as well as transmural myocardial biopsy. Despite resting akinesis or dyskinesis in 20/22 (91%) infarcted territories, 16/22 (73%) of these territories were metabolically viable. Transmural myocardial biopsies in all patients (43 sites, 42 vascular territories) during coronary bypass surgery confirmed IPPA results in 39/43 patients (91%). When compared to biopsy, scan sensitivity for viability was 33/36 (92%) with a specificity of 6/7 (86%). Eighty percent of bypassed, infarcted but IPPA viable segments demonstrated improved regional systolic wall motion postoperatively as assessed by exercise radionuclide angiography. We conclude resting IPPA imaging identifies viable myocardium, thereby providing a safe, cost-effective technique for myocardial viability assessment.

Biopsy↗
PubMed1989

Clinical experience and predicting survival in coronary disease.

To study the accuracy with which long-term prognosis can be predicted in patients with coronary artery disease, prognostic predictions obtained from a large, diverse sample of practicing cardiologists were compared with predictions from a multivariable statistical model. Test samples of 10 patients each were selected from a large series of medically treated patients with significant coronary disease. Using detailed clinical summaries, 49 cardiologists each predicted the probability of 3-year survival and infarction-free survival for 10 patients. Cox regression models, developed using patients who were not in the test samples, were also used to predict corresponding outcome probabilities for each test patient. Overall, the model estimates of prognosis were significantly better than the doctors' predictions. The rank correlation of model predictions with 3-year survival was 0.60, compared with 0.52 for the physicians. Model predictions added significant prognostic information to the doctors' predictions, whereas the converse was not true. Where predictions were made by multiple doctors, the inter-physician variability was substantial. Neither practice characteristics nor extent of clinical experience significantly affected the physicians' predictive accuracy. In coronary artery disease, statistical models developed from carefully collected data can provide prognostic predictions that are more accurate than predictions of experienced clinicians made from detailed case summaries.

Coronary Disease↗