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At least 973 records · Page 54Linked to original sources
PubMed2005

Usefulness of serum endothelin levels in predicting death and myocardial infarction but not coronary progression in postmenopausal women with coronary disease (from the Women's Angiographic Vitamin and Estrogen [WAVE] study).

We performed a cohort study of 392 postmenopausal women who had coronary disease to assess whether baseline serum endothelin-1 level predicts angiographic disease progression, nonfatal myocardial infarction, or death. Angiographic progression was defined as the annualized change in minimal lumen diameter of all qualifying lesions for each patient. Twenty-nine patients died or had a myocardial infarction during follow-up. Each picogram per milliliter increase in endothelin-1 was associated with a 1.8-fold increased risk of death or myocardial infarction. After adjustment for potential confounders, endothelin-1 remained a predictor of clinical events but was not correlated with angiographic progression.

Aged↗
PubMed1984

[Therapy of the hypertensive crisis with urapidil. Various effects on patients with or without coronary disease].

The effect of urapidil on various hemodynamic and echocardiographic parameters has been investigated in 36 patients with hypertensive emergencies (14 patients with coronary artery disease, 22 patients without coronary artery disease). During treatment with urapidil, blood pressure decreased in both groups by 35%, the heart rate decreased slightly (3-8%). The mean pulmonary artery pressure decreased by 45% (coronary patients) respectively 36% (non-coronary patients), the pulmonary capillary wedge pressure by 59% (coronary patients) resp. 48% (non-coronary patients). Cardiac output increased in both groups by about 20%. In the echocardiogram, both groups showed decreases in the diameters of left atrium and left ventricle, and an increase in the fractional shortening of the left ventricle. Patients with coronary artery disease required less urapidil than non-coronary patients.

Acute Disease↗
PubMedDate not supplied

[Plasma malondialdehyde in patients with type 2 diabetes mellitus and in patients with coronary disease].

UNLABELLED: After intracoronary platelet aggregation, malondialdehyde (MDA), a lipid peroxide product is released. MDA renders some lipoproteins more atherogenic. OBJECTIVE: The objective of this study was to determine the sanguineous concentration of MDA in patients with type 2 diabetes mellitus (DM2) and patients with coronary disease. We measured methods and material MDA in plasma of 131 consecutive normal subjects, 44 hyperlipidemic, hyperglycemic patients with type 2-diabetes mellitus (DM2), 60 normolipidemic patients with angina, and 62 normolipidemic patients with acute myocardial infarction with and without DM2. STATISTICAL ANALYSIS: The concentration of MDA was lowest in normal subjects (42.5 +/- 7.2 micrograms per deciliter), intermediate in those with DM2 (62.7 +/- 10.1 micrograms per deciliter, p < 0.002), and highest in those with myocardial infarction (101.6 +/- 31.7 micrograms per deciliter, p < 0.001). The mean MDA concentration of patients with infarction was similar to that of patients with angina (121.8 +/- 51.9 micrograms per deciliter, p < 0.07). Stepwise logistic regression analysis showed that MDA was a possible predictor of myocardial infarction. CONCLUSIONS: The increase of plasma MDA might be a biochemical marker of coronary artery disease. We suggest that MDA levels greater than 62.7 micrograms per deciliter could indicate a high risk for myocardial infarction.

Adolescent↗
PubMed2006

Obesity and cardiovascular events in patients with established coronary disease.

AIMS: To explore the association between obesity and major adverse coronary events (MACE) in patients with established coronary artery disease (CAD). METHODS AND RESULTS: The Prevention of Events with Angiotensin Converting Enzyme-Inhibition (PEACE) Trial randomized 8290 patients with stable CAD and left ventricular (LV) ejection fraction (EF) (LVEF) > or =0.40 to trandolapril or placebo and followed them for a median of 4.8 years. In PEACE patients who were non-diabetic at baseline (5693 men and 1171 women), we used proportional hazards models to conduct a post hoc analysis to examine whether obesity, defined as a body mass index (BMI) > or =30 kg/m(2), is an independent risk factor for the composite endpoint of MACE, defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, or stroke. The analysis was conducted separately for men and women. The baseline prevalence of obesity was 28.5% in men and 28.9% in women. After adjusting for significant confounders, obesity was associated with MACE in men [hazard ratio (HR) = 1.28, 95% CI 1.13-1.46, P < 0.01], but not in women (HR = 0.96, 95% CI 0.70-1.31, P = 0.77). Further categorization of BMI showed a J-shaped association between BMI and MACE in the men, and no association in the women. CONCLUSION: In the presence of established CAD, obesity is associated with risk for MACE in men, but there is no support of an association in women. This finding requires further evaluation.

Body Mass Index↗
PubMed1991

[Coronary disease in patients after heart transplantation].

The thinking about coronary artery disease in heart transplant patients has changed recently. This term includes not only the traditional accelerated delayed atherosclerosis of the transplant, but also proximal inflammatory vascularitis associated with severe acute rejection and distal vascularitis, which is independent of interstitial rejection. This term is also used to describe purely atheromatous lesions of the large coronary vessels which usually occur in high risk patients. The morphology, significance and prognosis of these various vascular lesions are discussed on the basis of material obtained from biopsies, transplantectomies and autopsies in the cardiovascular surgery service of the la Pitié Hospital.

Arteritis↗
PubMed1999

Heart rate adjustment of ST depression in patients with coronary disease and negative standard exercise tests.

Heart rate (HR) adjustment of ST depression (STD) has been shown to correctly classify exercise test findings in up to 85% of normal subjects and patients with "equivocal" electrocardiographic (ECG) responses (> or =100 microV upsloping STD), but the performance of these methods in patients with truly negative ECG responses (<100 microV STD) has not been examined in detail. We reviewed negative standard exercise ECGs in 54 men and women (mean age 61 years) with coronary disease, comprising 16% of consecutive treadmill tests that were performed in 337 patients with angiographic coronary artery disease or stable angina. Mean STD was only 63 +/- 21 microV (0.63 mm) in these negative tests. Despite these subthreshold values for STD, the ST/HR index was abnormal (> or =1.6 microV/bpm) in 27 of 54 patients (50%) when STD was adjusted for the change in HR during exercise. Compared with patients with normal values for HR-adjusted STD, patients with an abnormal ST/HR index were slightly older (64 vs. 58 years, P < 0.05) and demonstrated a trend toward lower exercise duration (10.0 vs. 11.8 min). An abnormal ST/HR index was associated with greater subthreshold STD (73 vs. 53 microV, P < 0.0005) and smaller HR change (35 vs. 56 bpm, P < 0.0001) with exercise. Among the 27 patients with a normal ST/HR index by simple HR adjustment, 11 (44%) had abnormal ST/HR slopes (> or =2.4 microV/bpm) by the more complex linear regression method. Therefore, HR adjustment of STD contributes to the improved sensitivity of the exercise ECG by correct classification of some patients with truly negative standard tests. The magnitude of subthreshold STD and the extent of HR change with exercise both contribute to improved test performance. The increased sensitivity afforded by HR adjustment of STD highlights the importance of the precise measurement of subthreshold STD that is afforded by computerized ECG during exercise testing.

Aged↗
PubMed2004

[Partial revascularization of the myocardium in geriatric patients with different forms of coronary artery disease].

Coronary artery disease (CAD) is one of the most frequent diseases of geriatric patients, which substantially deteriorates the quality of life and leads to lethal outcomes. Coronary angioplasty (CA) is an effective method of CAD treatment in this group of patients. CA is the method of choice for geriatric patients with contraindications for surgical revascularization. No consensus about revascularization volume in multivessel disease has been reached in the worldwide practice. Peculiarities of myocardial blood supply in elderly patients allow partial revascularization with good periprocedural and long-term results.

Aged↗
PubMed1991

Symptom-limited exercise testing causes sustained diastolic dysfunction in patients with coronary disease and low effort tolerance.

Exercise stress testing is routinely used for the noninvasive assessment of coronary artery disease and is considered a safe procedure. However, the provocation of severe ischemia might potentially cause delayed recovery of myocardial function. To investigate the possibility that maximal exercise testing could induce prolonged impairment of left ventricular function, 15 patients with angiographically proved coronary disease and 9 age-matched control subjects with atypical chest pain and normal coronary arteries were studied. Radionuclide ventriculography was performed at rest, at peak exercise, during recovery and 2 and 7 days after exercise. Ejection fraction, peak filling and peak emptying rates and left ventricular wall motion were analyzed. All control subjects had a normal exercise test at maximal work loads and improved left ventricular function on exercise. Patients developed 1 mm ST depression at 217 +/- 161 s at a work load of 70 +/- 30 W and a rate-pressure product of 18,530 +/- 4,465 mm Hg x beats/min. Although exercise was discontinued when angina or equivalent symptoms occurred, in all patients diagnostic ST depression (greater than or equal to 1 mm) developed much earlier than symptoms. Predictably, at peak exercise patients showed a decrease in ejection fraction and peak emptying and filling rates. Ejection fraction and peak emptying rate normalized within the recovery period, whereas peak filling rate remained depressed throughout recovery (p less than 0.002) and was still reduced 2 days after exercise (p less than 0.02). In conclusion, in patients with severe impairement of coronary flow reserve, maximal exercise may cause sustained impairement of diastolic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Coronary thrombosis in the absence of angiographically-evident obstructive coronary disease.

A 31-year-old man with an acute myocardial infarction underwent intracoronary thrombolysis with streptokinase. Post-thrombolytic angiography revealed no underlying obstructive coronary disease. This particular syndrome of a documented thrombus in a normal vessel causing infarction has not previously been described. Such a sequence may explain the occurrence of myocardial infarction in some patients with normal coronary arteries. The mechanism by which thrombus occurs in an angiographically-normal coronary artery is at present undefined.

Adult↗
PubMed1998

Rapid-staged strategy for concomitant critical carotid and left main coronary disease with left ventricular dysfunction: IABP use.

BACKGROUND: Few reports address the high-risk patient population with concomitant critical carotid and left main coronary disease with left ventricular dysfunction. To decrease the risks involved with the simultaneous and traditional staged surgical approaches, we developed a rapid staging strategy using an intraaortic balloon pump. METHODS: Between 1992 and 1996, 20 patients presented with a high-risk "triad" defined by greater than 70% stenosis of the left main coronary artery, ejection fraction less than 0.30, and greater than 90% stenosis of the internal carotid artery. An intraaortic balloon pump was placed immediately before carotid endarterectomy under angiographic guidance. Less than 24 hours later (mean, 18 hours) coronary artery bypass grafting was performed, and the intraaortic balloon pump was removed the day of coronary artery bypass grafting in all cases (total IABP duration, <36 hours). RESULTS: Eighteen patients (18/20) were extubated on the day of coronary artery bypass grafting (mean, 12 hours). Sixteen patients (16/20) were transferred from the intensive care unit within 48 hours, with total hospital stay ranging from 6 to 12 days (mean, 8 days). There were no 30-day postoperative deaths, myocardial infarctions, or neurologic, vascular, bleeding, or other major complications. At a mean 29.4-month follow-up, there were two noncardiac deaths and no neurologic events. Six-month, 1-year, and 2-year follow-up ultrasounds showed all operative carotid arteries remained patent. CONCLUSIONS: A rapid staged procedure with angiographically guided placement of the intraaortic balloon pump was safe and effective in this very high risk patient population. It may be an option to decrease the risks involved with simultaneous operations and increase the efficiency and safety of "traditional" staged carotid and coronary artery bypass grafting procedures.

Aged↗
PubMed2000

Hormone replacement therapy should be administered as secondary prevention of coronary artery disease.

* Coronary artery disease in women is associated temporally with the occurrence of menopause and loss of estrogen. * Consistently, epidemiologic evidence indicates a beneficial effect of HRT on the development of CAD (primary prevention). * Observational data in women with known CAD indicate improved angioplasty and mortality outcomes in women taking HRT. * The HERS was fraught with methodologic flaws that drastically hampered the ability of HRT to show benefit as secondary prevention for cardiovascular disease. Despite this, mortality benefit was suggested with long-term therapy.

Aged↗
PubMed1989

Review of invasive treatments of coronary artery disease.

Coronary artery disease is a difficult clinical entity to manage, and all forms of current therapy are palliative in nature. Results from the large randomized studies have clearly demonstrated the superiority of surgical versus medical therapy in subsets of patients previously described herein. As patients with severely compromised ventricles are demonstrated to fare better with bypass procedures, the number of patients that should be operated upon continues to grow. With refinements in operative and perioperative care and increased use of the internal mammary artery as the bypass conduit, it is inevitable that more subgroups will be determined to be best managed by surgical revascularization. For the present time, medical treatment is preferred for the vast majority of patients who were shown by randomized trials not to benefit significantly from surgical intervention. However, caution must be used in excluding patients based on trial results that used surgical techniques and conduits that are ten years old. The role of angioplasty in the invasive treatment of ischemic cardiac disease is still in evolution. Although not yet proved by vigorous trials, it is a procedure that most likely will continue to be used in many clinical applications. The high rate of restenosis after angioplasty, which is a formidable problem, may be a factor that will limit the application of angioplasty to patients with acute myocardial infarction or to those who do not desire surgical intervention. The answers to these and other complex problems of patient management must await well-designed prospective trials comparing angioplastic with surgical revascularization. Clinical use of some of the experimental procedures mentioned is certain; the efficacy and role of these procedures in the treatment of ischemic cardiac disease must also be defined with future studies.

Angioplasty, Balloon↗
PubMed1986

Combined carotid and coronary disease--a conservative strategy.

The optimal approach to patients undergoing coronary bypass surgery for coronary artery disease with coexisting carotid disease is controversial. To determine the best approach to these patients, we screened carotid arteries in patients undergoing coronary artery bypass preoperatively with noninvasive ultrasonic duplex scanning. No correlation was noted between stroke and asymptomatic carotid disease in patients undergoing coronary revascularization. Prospective application of this finding in 2251 patients has yielded a very low incidence of perioperative stroke. We concluded that asymptomatic carotid arterial disease is not a significant risk to patients undergoing cardiopulmonary bypass and should be managed conservatively.

Carotid Artery Diseases↗