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PubMed1983

[Echocardiography in coronary heart disease].

Coronary heart disease can be detected via echocardiography, if myocardial ischemia or infarction are present leading to segmental abnormalities of left ventricular function. The capability to demonstrate these regional changes is limited as far as TM echocardiography is concerned, whereas 2D echocardiography is more reliable. For this purpose, cross-sectional imaging of all segments in several planes is necessary. The complex mosaic of findings obtained in this way is best documented by means of a segmental scheme of representative sections. Infarct size then can be estimated by a segmental score. Depressed wall motion and systolic wall thickening are used as criteria for ischaemia and infarction. In the chronic phase, morphological changes can be identified additionally: Thinning, expansion and increased reflectivity of the infarcted areas. In acute myocardial infarction, echocardiography is mainly used if the course is complicated, in the chronic phase, if ECG-changes are questionable, or to evaluate residual ventricular function after large infarcts. Even the TM echocardiogram reliably estimates the ventricular damage caused by the infarct in the chronic phase.

Cardiomegaly↗
PubMed2003

A twin study of C-Reactive Protein compared to other risk factors for coronary heart disease.

Coronary heart disease (CHD) tends to cluster in families, and several established risk factors for the disease are to some extent inherited. Inflammation plays a key role in the development of atherosclerosis and CHD. A low-grade inflammation may be detected by highly sensitive C-Reactive Protein (CRP) determination, which is strongly associated to CHD. In order to uncover any role of genetics in low-grade inflammation, we measured CRP in healthy monozygotic twins. The within-pair correlation coefficient of CRP was 0.40, suggesting an important genetic contribution to the control of CRP level. CRP correlated significantly to other CHD risk factors like body mass index (BMI), systolic blood pressure, diastolic blood pressure, plasma fibrinogen, serum high-density lipoprotein cholesterol, plasma homocysteine, and serum triglycerides. Of these variables, BMI was most significantly associated to CRP in a linear multiple regression analysis. We conclude that CRP level (reflecting a low-grade inflammation) exhibits a moderate, but significant degree of heritability. The association between CRP and BMI, which has a larger degree of heritability, could partly explain the heritability of serum CRP level.

Adult↗
PubMed2001

Endothelial function of the popliteal artery in patients with coronary artery disease.

Coronary artery disease (CAD) is associated more closely with atherosclerosis in the popliteal than in the brachial artery. This case-control study aimed at clarifying whether endothelial dysfunction of patients with CAD can be detected non-invasively in the popliteal artery by means of ischemia-induced flow-mediated dilation (FMD) and cold pressor reaction (CPR), and how it compares with the brachial artery. We further investigated a new mode of evaluation of the CPR. Eleven cases with CAD were compared with 16 matched healthy controls. Popliteal and brachial arterial diameter was monitored by ultrasound for 20 min following ischemia and cold pressor. For CPR, the difference between maximum and minimum diameter was defined as maximum vasomotion. In the popliteal artery, maximum vasomotion and FMD were significantly smaller in cases than in controls, the difference being more pronounced than in the brachial artery, where only maximum vasomotion was significantly smaller. After exclusion of current smokers, only the difference in maximum vasomotion of both arteries remained significant. We conclude that maximum vasomotion may be more sensitive for detection of endothelial dysfunction than FMD. Endothelial dysfunction in patients with CAD is more pronounced in the popliteal artery than in the brachial artery.

Adult↗
PubMed1999

Effects of Ava II and Hinc II polymorphisms at the LDL receptor gene on serum lipid levels of Brazilian individuals with high risk for coronary heart disease.

Coronary heart disease (CHD) has presented high prevalence in the Brazilian population. Nevertheless, studies of genetic risk factors for CHD in our country are insufficiently carried out. We have investigated the effects of Ava II (exon 13) and Hinc II (exon 12) polymorphisms at the low-density lipoprotein receptor (LDLR) gene on circulating lipids of 170 white unrelated individuals presenting a lipid profile with high risk for CHD (HRG) and 130 controls (CG) from São Paulo City, Brazil. Ava II and Hinc II polymorphic regions at the LDLR gene were amplified by PCR and analyzed by enzymatic isotyping. The frequency of the genotypes A+A+ (Ava II) and H+H+ (Hinc II) was greater in HRG group compared to that of the controls (32 vs. 16% and 32 vs. 18%, respectively). Moreover, in the HRG group, A+A+ and H+H+ genotypes were associated with high concentrations of total cholesterol and LDL-C in serum (P = 0.0001). Our results indicate that Ava II and Hinc II polymorphisms at the LDLR locus contribute to the variability of total cholesterol and LDL-C levels in HRG individuals. These data suggest that the LDLR polymorphism remains a useful genetic marker for predicting CHD risk.

Adult↗
PubMedDate not supplied

The experiences of younger women with coronary artery disease.

Coronary artery disease (CAD) continues to be a major cause of death in women, with increased incidence noted among women after menopause. Many younger women also develop CAD, and little is known about the experiences of these women. In this investigation, premenopausal women were recruited from a cardiac rehabilitation program in a large inner-city hospital. In-depth interviews were conducted with 11 younger women. Interviews were transcribed verbatim, and the computer program QSR NUD.IST was used to facilitate data analysis. Foci of analysis included risk factors, presenting signs and symptoms, and participants' experiences after their diagnosis with CAD. All participants had strong family histories of CAD. However, several believed they were safe until after menopause or were not at risk because of their gender. Although most participants experienced chest discomfort, often this was not the initial symptom. Participants discussed the effects of their illness on their lifestyle. Areas of concern included diet, exercise, careers, and relationships. Strategies for coping and adapting, as well as advice for other younger women newly diagnosed with CAD, were discussed. The diagnosis of CAD strongly and uniquely affects the lives of younger women. Understanding the unique experiences of younger women is essential to providing them with relevant healthcare as they recover from and learn to live with CAD.

Activities of Daily Living↗
PubMed2006

The gut microbiota and lipid metabolism: implications for human health and coronary heart disease.

Coronary heart disease (CHD) is the leading cause of mortality in Western societies, affecting about one third of the population before their seventieth year. Over the past decades modifiable risk factors of CHD have been identified, including smoking and diet. These factors when altered can have a significant impact on an individuals' risk of developing CHD, their overall health and quality of life. There is strong evidence suggesting that dietary intake of plant foods rich in fibre and polyphenolic compounds, effectively lowers the risk of developing CHD. However, the efficacy of these foods often appears to be greater than the sum of their recognised biologically active parts. Here we discuss the hypothesis that beneficial metabolic and vascular effects of dietary fibre and plant polyphenols are due to an up regulation of the colon-systemic metabolic axis by these compounds. Fibres and many polyphenols are converted into biologically active compounds by the colonic microbiota. This microbiota imparts great metabolic versatility and dynamism, with many of their reductive or hydrolytic activities appearing complementary to oxidative or conjugative human metabolism. Understanding these microbial activities is central to determining the role of different dietary components in preventing or beneficially impacting on the impaired lipid metabolism and vascular dysfunction that typifies CHD and type II diabetes. This approach lays the foundation for rational selection of health promoting foods, rational target driven design of functional foods, and provides an essential thus-far, overlooked, dynamic to our understanding of how foods recognised as "healthy" impact on the human metabonome.

Biomarkers↗
PubMed1986

Symptomatic coronary disease for 20 or more years: clinical aspects, angiographic findings, and therapeutic implications.

Clinical, angiographic, and therapeutic aspect of coronary artery disease of long duration (exceeding 20 years) is reviewed in 50 patients (study group) and compared to a control group of 100 consecutive patients with coronary artery disease of shorter duration. All were referred because of symptomatic coronary artery disease. The study group had a greater incidence of clinically evident extracardiac vascular disease (28% vs 4%) (p less than 0.01). Transmural infarction was more frequent in the study group (64% vs 45%). Triple-vessel and main left disease was observed respectively in 90% and 28% compared to 36% and 7% in the control group (p less than 0.01). Twenty-nine percent of collaterals were jeopardized in the study group compared to 13% of collaterals in controls (p less than 0.01). Abnormal left ventricular ejection fraction (p less than 0.05) was found in 50% of the study group compared to 28% of controls (p less than 0.01). Medical therapy was recommended for 36% of the study group with 11 of 18 (61%) considered inoperable, whereas in 39% of the control group medical therapy was continued, with 9 of 39 (23%) considered inoperable (p less than 0.01) Surgery or coronary angioplasty was recommended in 64% of the study and in 61% of the control group. No patient in the study group was considered a candidate for coronary angioplasty, whereas in 20% (12 of 61) of the control group coronary angioplasty was recommended. Patients with coronary artery disease for over 20 years have severe coronary artery disease, with one in four having main left disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Soluble Fas is a marker of coronary artery disease in patients with end-stage renal disease.

Coronary artery disease (CAD) is the leading cause of death in patients with end-stage renal disease (ESRD). Recent evidence suggests that the expression of Fas, a molecule implicated in the initiation of apoptosis in various cell types, is increased at sites of atherosclerotic plaques. However, the significance of plasma levels of the soluble form of Fas (sFas) and its ligand (sFas-L) as markers of atherosclerosis has yet to be defined. The present report is a cross-sectional analysis of baseline data from an ongoing prospective study designed to evaluate the role of sFas and sFas-L as markers of CAD in ESRD. We evaluated the association between plasma levels of sFas and sFas-L and evidence of CAD in a cohort of 107 chronic hemodialysis patients. Plasma levels of sFas were significantly greater (P = 0.04) among subjects with (n = 64) than without evidence of CAD (n = 43). Plasma levels of sFas-L were similar in both groups. Using multivariate analysis, sFas level was found to be independently associated with CAD (P = 0.01) after adjustment for classic risk factors for CAD (hyperlipidemia, diabetes, hypertension, and smoking), markers of inflammation (C-reactive protein [CRP], intercellular adhesion molecule 1), and other confounders. An increase of one quintile in plasma concentration of sFas was associated with an odds ratio for CAD of 1.64 (95% confidence interval, 1.11 to 2.41). Models that incorporated sFas were significantly better at identifying patients with CAD than models limited to classic risk factors for atherosclerosis, alone (P = 0.008) or in combination with CRP levels (P = 0.006). In summary, increased plasma levels of sFas are associated with CAD in stable patients with ESRD. These results suggest that sFas may represent a novel and independent marker of CAD.

Aged↗
PubMed2002

Prevalence and prognostic value of perfusion defects detected by stress technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease.

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in diabetics. Early diagnosis of CAD and identification of high-risk subgroups, followed by appropriate therapy, may therefore enhance survival. This study sought to determine the value of stress myocardial perfusion single-photon emission computed tomography (SPECT) with technetium-99m sestamibi to detect perfusion defects and predict cardiac events in asymptomatic diabetics. One hundred eighty asymptomatic diabetics without known CAD who underwent 2-day stress technetium-99m sestamibi SPECT were followed up for 36 +/- 18 months. End points were defined as hard (myocardial infarction or cardiac death) or total events (myocardial infarction, cardiac death, or late revascularization). Logistic regression analysis evaluated clinical variables, type of stress, exercise treadmill test (ETT), and SPECT as predictors of end points. Perfusion defects were found in 26% of patients (15% reversible, 6% mixed, and 5% fixed). Clinical or ETT variables were not associated with perfusion defect type or with hard events. However, male gender predicted total events (chi-square 3.3; p = 0.01). An abnormal SPECT significantly increased the risk of hard events (chi-square 5.4; p = 0.001) and total events (chi-square 7.4; p = 0.0001). Extensive defects determined the highest risk of total events (chi-square 18.8; p = 0.0001). Event rates increased according to SPECT: 2% of hard events per year and 5% of total events per year in patients with normal SPECT versus 9% per year and 38% per year, respectively, in those with abnormal SPECT. Importantly, a normal SPECT identified a relatively low-risk subgroup of patients. Thus, stress technetium-99m sestamibi SPECT was useful in evaluating asymptomatic diabetics for the presence of CAD, and effectively risk-stratified this population.

Aged↗
PubMed1995

[Use of aspirin in coronary disease].

The beneficial effect of aspirin in different situations of coronary artery disease has been clearly demonstrated, but prescription remains empirical due to the lack of phase II trials and the incompletely understood mechanism of action. Since the ISIS-2 study was published in 1988, aspirin is indicated in the acute phase of myocardial infarction as mortality can be reduced by 20% and the rate of reocclusions reduced. The beneficial effect of aspirin in unstable angina has also been demonstrated with a reduction of more than 50% in the combined incidence of mortality and myocardial infarction. Stable angina is an ideal application for low-dose aspirin with an improvement in combined incidence of myocardial infarction and sudden death of 34%. The question of dose remains open. When prescribed for primary or secondary prevention, aspirin should be given at low-doses (50-100 mg/d) in a long-term regimen. The dose should be examined differently for treatment of acute thrombotic events including infarction and unstable angina. Doses above 250 mg/d with an initial dose of 500 mg to 1 g are recommended followed by a relay with 50 to 100 mg/d. Irreversible dose-dependent inhibition of platelet cyclooxygenase by aspirin is nearly total for a single dose of 100 mg. The effect is cumulative for smaller doses and since the anucleated platelets cannot resynthesize the enzyme only new platelet can recover enzymatic activity. The duration of the effect thus is a function of normal platelet turn-over (8 days). Currently, aspirin is indicated in all coronary artery patients and should be discussed for "potential" patients i.e. as primary prevention in healthy subjects at risk of coronary artery disease although the threshold of risk requiring prescription remains to be clearly determined.

Angina Pectoris↗
PubMed1993

Quantitative angiographic follow-up studies on the development of coronary artery disease: which coronary segments should be analyzed? Experience from INTACT.

Angiographic follow-up studies on the evolution of coronary artery disease are of increasing relevance. It has still to be evaluated which coronary segments are predominantly involved in the process of atherosclerosis and, thus, should be preferably included in the analysis. Therefore, the correlation of progression and regression of coronary disease with the diameter and location (proximal, mid or distal) of coronary segments was investigated from the data of the INTACT-study, in which 25 different coronary segments were defined including anatomic variants of rather distal segments. In 348 patients with coronary artery disease, standardized coronary angiograms were repeated within 3 years and were quantitatively analyzed (CAAS). In 1063 coronary stenoses (% diameter stenosis > 20%) compared from both angiograms, progression and regression were not influenced by diameter nor location of arterial segments. In the follow-up angiograms, the number of new lesions (stenoses and occlusions) per coronary segment differed with regard to segment diameter (> 3 mm: 64/1125 (6%); 2-3 mm: 139/1967 (7%); < 2 mm: 44/1756 (2%); p < 0.001) and location of segments (proximal: 86/1285 (7%); mid: 84/1193 (7%); distal: 77/2370 (3%); p < 0.001). Out of 77 distal new lesions, only 25 (32%) were found in segments < 2 mm in diameter. Since the absolute number of new lesions was high in distal coronary segments, but low in segments with diameters < 2 mm, angiographic follow-up studies should analyze coronary segments at any location, but may neglect segments with diameters smaller than 2 mm.

Coronary Angiography↗
PubMed1994

[Antihypertensive treatment and risk of coronary disease. How significant is the antihypertensive effect for metabolic factors?].

A recent meta-analysis of hypertension treatment trials showed a marked reduction in cerebrovascular disease and a less pronounced reduction in coronary heart disease. Treatment has consisted of diuretics and betablockers, and this paper discusses the possible influence of their metabolic side effects as compared with the new vasodilating agents (angiotensin converting enzyme inhibitors, alpha receptor antagonists and calcium channel blockers). Several studies have now been started to compare the effect of these compounds with diuretics and betablockers with respect to long-term cardiovascular morbidity and mortality. Until the results of these studies are available, young patients (i.e. < 60-65 years) at high risk of coronary heart disease, especially patients with the insulin resistance syndrome or diabetes mellitus, should in our opinion be treated with ACE-inhibitors, alpha receptor blockers or calcium channel blockers.

Age Factors↗
PubMed2004

[Relations between psyche and soma in coronary disease].

The authors of the paper have presented the relations between psyche and soma on the example of coronary disease ranging from the elements of Plato's philosophy to the results of the latest studies. Various aspects of the interdependences between psychiatric status and somatic ailments have been discussed, biological factors as well as psychological ones. The necessity of the interdisciplinary, holistic approach to the patient has been emphasized that is a great challenge both to the psychiatrist and other specialists.

Anxiety↗
PubMed2005

Drug-eluting stents versus bilateral internal thoracic grafting for multivessel coronary disease.

BACKGROUND: Reduction of restenosis and reinterventions was recently reported with percutaneous interventions (PCI), including drug-eluting stents (Cypher; Cordis, Miami Lakes, FL). This study compares results of multivessel Cypher stenting with those of bilateral internal thoracic artery (BITA) grafting. METHODS: From January 2002 to June 2004, 768 consecutive patients underwent multivessel myocardial revascularization; 138 by PCI including Cyphers and 630 by BITA. After matching for age, sex, ejection fraction, extent of coronary disease, and congestive heart failure, two groups (113 patients each) were used to compare the two revascularization modalities. RESULTS: Both groups were similar; however, left main and intraaortic balloon were more prevalent in the BITA group. The number of coronary vessels treated per patient was higher in the BITA group (2.87 vs 2.22, p < 0.001). Follow-up ranged between 6 and 34 months. Thirty-day mortality was 0.9% in the BITA and zero in the PCI group (p = 0.32). There were no late deaths in the BITA and three (2.7%) in the Cypher group (p = 0.08). Angina returned in 28.3% of the Cypher and 12.4% of the BITA group, p = 0.003. A Cox proportional hazard model revealed assignment to the Cypher group to be the only predictor of angina recurrence (odds ratio 2.78, 95% confidence interval 1.46-2.56). There were 16 (14.2%) reinterventions in the Cypher group compared with six (5.3%) in the BITA group. One-year reintervention-free survival (Kaplan-Meier) of the BITA was 96% compared with 86.6% in the Cypher group (p = 0.005, log-rank test). CONCLUSIONS: Despite improved results of PCI with Cyphers, midterm clinical outcome of multivessel patients treated with BITA is still better.

Aged↗
PubMed1975

[Evaluation of the left ventricular function in patients with coronary disease by means of atrial pacing].

In 18 patients with coronary artery disease and in 12 control subjects, left ventricular function was studied by means of rapid artial pacing. The results were compared with the cardiac dynamics, as determined by left ventricular dysfunction although the angiograms portrayed normal contractility at rest. It has to be assumed, that abnormal myocardial function was only evident during the pacing stress. On the other hand, if the angiogram showed local hypokinesis, the hemodynamic effect of this slightly abnormal contraction could be determined by atrial pacing. Moreover, rapid atrial pacing often produced myocardial ischemia and anginal pain in patients with coronary heart disease. In these cases the transient "anginal" depression of left ventricular function could be separated from the chronic hypoxic "preanginal" dysfunction. This may be of vale in terms of surgical revascularisation.

Adult↗
PubMed1995

[PTCA or bypass surgery in multi-vessel coronary disease? Viewpoint of the surgeon].

Recently several randomized studies have been devoted to a comparative analysis of angioplasty (PTCA) versus bypass surgery (CABG) in patients with multivessel coronary disease. Even though only a very limited number of the screened patients could be randomly assigned to undergo PTCA or CABG (less than 10% of the subjects originally evaluated), some valid conclusions may be drawn. With regard to perioperative mortality, no significant difference between the two treatment groups was evident; considering the incidence of peri-interventional myocardial infarction, a trend towards a slightly higher risk could be detected for the surgical patients (EAST and GABI trials). The most striking differences between the two procedures have been completeness of revascularization and incidence of restenosis. Thus, in the EAST and ERACI trials complete revascularization was achieved only in 75% and 51% respectively of the PTCA patients as compared with 99% and 88% respectively for the CABG patients. Beyond all doubt, the greatest drawback of PTCA is the occurrence of restenosis; in multivessel angioplasty several arterial segments are by definition exposed to development of narrowing at the site of PTCA, resulting in a higher risk of restenosis per patient. In a major angiographic study 50% of patients showed significant restenosis in at least one PTCA segment, and in 14% multiple restenosis were found. The occurrence of restenosis is a substantial reason for the high incidence of further interventions following multivessel angioplasty; thus, in the EAST trial only 46% of the PTCA patients did not require a subsequent revascularization procedure (versus 87% in the surgical group). Economic aspects do not counterbalance the limited efficacy of multivessel angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed2001

Pre-operative intra-aortic balloon counterpulsation in stable patients with left main coronary disease.

OBJECTIVE: To determine whether prophylactic, pre-operative, intra-aortic balloon counterpulsation (IABC) improves clinical outcome in stable patients with severe left main coronary artery disease. METHODS: A post-hoc analysis of 457 prospectively tracked, non-randomized patients undergoing coronary artery bypass graft surgery (CABG) for left main stenoses 50% and multivessel coronary disease, but without any hemodynamic compromise or ongoing angina, was conducted. Patients with heart failure, shock, ongoing ischemia or previous CABG were excluded. In 287 patients, pre-operative IABC was not used (Group 1), while IABC was initiated in 170 patients for "prophylaxis" (Group 2). RESULTS: Groups 1 and 2 were similar in age (67 +/- 10 years versus 67 +/- 11 years, respectively), sex (72% male versus 71% male, respectively), and body mass index (28 +/- 5.5 versus 27 +/- 5.1, respectively). However, more Group 1 patients had peripheral vascular disease (PVD) (25% versus 11%), but more Group 2 patients had diabetes (37% versus 29%), and a lower left ventricular ejection fraction. The unadjusted 30-day mortality was significantly higher in Group 1 [16 (5.6%) versus 2 (1.2%); p = 0.02]. Cardiopulmonary bypass time and post-operative length of stay did not differ between the two groups. After adjusting for PVD in the multivariate analysis, the p-value for the no IABP versus IABP comparison in the presence of PVD was 0.10, even though 0/18 patients with PVD and IABC died. CONCLUSION: While unadjusted mortality appears lower with prophylactic IABC, confounding variables such as PVD mandate a larger, randomized clinical trial in order to establish the role of IABC in stable patients with left main disease.

Age Factors↗
PubMed1987

Left ventricular wall motion at rest in patients with organic coronary artery disease vs coronary spasm.

Left ventricular ejection fractions and regional ejection changes obtained from left ventriculograms at rest were analyzed in 15 normal subjects, in 17 patients with isolated, organic left anterior descending coronary artery disease, and in 11 patients with isolated left anterior descending coronary artery spasm. Patients with coronary artery spasm did not have significant organic lesions at the site of spasm. All patients with organic coronary artery disease and coronary artery spasm had a history of angina pectoris without myocardial infarction. No significant differences in ejection fraction were observed among the three groups. The regional ejection change of the anterolateral and apical wall supplied by the left anterior descending coronary artery was significantly decreased in patients with organic coronary artery disease compared with those in normal subjects (anterolateral 39.5 +/- 10.3% vs 48.4 +/- 7.7%, p less than 0.05; apical 48.4 +/- 8.8% vs 55.6 +/- 7.8%, p less than 0.05). However, the anterolateral and apical wall motion was not impaired in patients with coronary artery spasm. Thus, patients with organic coronary artery disease had impairment of left ventricular wall motion, while those with coronary artery spasm did not, although both groups of patients had symptoms of angina. These results suggest that patients with organic coronary artery disease may have had coronary blood flow disturbances through stenosed vessels and chronic active ischemia that produced left ventricular impairment.

Coronary Disease↗