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PubMed1994

[Recovery time from myocardial ischemia induced by exercise test: correlation with duration of ischemia during the test and with the extent of coronary disease].

BACKGROUND: Aim of this study was to evaluate the factors affecting the duration of the recovery time (RT) after a positive exercise stress test and to define its relationship with the extent of coronary artery disease (CAD). METHODS: We studied 109 consecutive patients with a positive exercise test and proven coronary disease. RESULTS: RT was neither related to the severity of CAD, nor to exercise duration, rate-pressure product at the end of the exercise and maximum ST segment depression. A significant linear relationship was found between RT and the time of ischemia during exercise (IT) (r = 0.66, p < .001). This relationship was analyzed separately in patients (pts) with advanced (Group I) and in pts with less severe CAD (Group II). The regression line of the data showed a similar slope but a higher y-axis intercept in Group I than in Group II (p < .05). The RT/IT ratio was in fact significantly higher in Group I than in Group II (3.0 +/- 1.3 vs 1.7 +/- 0.7, p < .0001). Discriminant analysis was performed to predict the presence of advanced CAD: using the RT/IT ratio instead of RT correct classification rate of the model increased from 81.4 to 86.7%, predictive accuracy from 73.7 to 85.3% and true negative rate from 85.3 to 87.4%. CONCLUSIONS: These results suggest that the normalization of the recovery time by time of ischemia during the test provides a simple and useful index for the prediction of the extent of coronary artery disease.

Coronary Angiography↗
PubMedDate not supplied

Depression is associated with cardiac symptoms, mortality risk, and hospitalization among women with suspected coronary disease: the NHLBI-sponsored WISE study.

OBJECTIVE: Depression is a robust predictor of cardiovascular risk. In this study, we examined the association between depression measured in terms of symptom severity and treatment history, cardiac symptom presentation, and clinical outcomes among a sample of women with suspected myocardial ischemia. METHODS: Seven hundred fifty women with chest pain, mean age 53.4, completed a diagnostic protocol including depression measures, coronary angiogram, ischemia testing, and coronary disease risk factor assessment. Five hundred five participants also completed the Beck Depression Inventory. We further tracked participants over a mean 2.3-year period to evaluate subsequent cardiac events, hospitalization, and mortality. RESULTS: Depression treatment history and current symptom severity were differentially associated with cardiac symptoms and outcomes. Both measures were reliably associated with coronary artery disease (CAD) risk factors and more severe cardiac symptoms. Depression symptom severity was linked to an increased mortality risk over follow-up (RR = 1.05; 95% CI, 1.01-1.09), whereas depression treatment history predicted an increased risk of hospitalization (RR = 1.3; 95% CI, 1.02-1.6), less severe CAD from angiogram, and a reduced likelihood of a positive ischemia test. CONCLUSION: Among a sample of women with suspected myocardial ischemia, depression was associated with cardiac symptoms and health outcomes over follow-up. The findings extend the range of depression effects by demonstrating relationships within a sample of women experiencing symptoms of myocardial ischemia but showing a relative absence of flow limiting coronary stenoses. Depression measurements can assist the clinician in evaluating cardiac symptom presentation and cardiovascular risk status in women.

Angina Pectoris↗
PubMed1976

[Value of long-term ECG monitoring in the diagnosis of coronary disease--comparison of 8-hour ECG monitoring and double Master exercise test with a clinical coronary index].

The use of the long term Ecg (dynamic Ecg) in the diagnosis of coronary artery disease (CAD) has been investigated in 83 patients and its sensitivity compared with the double Master two step test. The average ECG registration time was 8 hours. The presence of CAD was assumed when the clinical index according to Cohn et al. revealed a pathological value. If a horizontal or downsloping ST-segment depression of greater than or equal to 0,5 mm was chosen for the diagnosis of CAD a sensitivity of 82% resp. 64% was found for the dynamic Ecg and the double Master two step test. The specificity of the dynamic Ecg however was with 77% slightly inferior compared with the Master-test. The superiority in sensitivity of the dynamic Ecg was also present when the diagnosis of CAD was based on a ST-segment depression of greater than or equal to 1,0 mm. We believe that the dynamic Ecg can provide besides arrhythmia detection valuable information in the diagnosis of CAD and careful interpretation of the ST-segment should therefore be undertaken. The number of false positive results in the diagnosis of CAD was not influenced by the women included in the study.

Adult↗
PubMed1999

A prospective study of elective stenting in unprotected left main coronary disease.

The standard treatment of left main coronary artery (LMCA) disease has been bypass surgery (CABG). Recent reports suggested that stenting of LMCA disease might be feasible. From January 1995 to April 1998, we carried out a prospective study of elective stenting of unprotected LMCA disease to evaluate its immediate and long-term results. Of 61 consecutive patients with unprotected LMCA disease, 6 were excluded. Acute procedural success was 100% for the remaining 55 patients, without any complications such as stent thrombosis, myocardial infarction, CABG, or death. During a mean follow-up of 16.1+/-9.6 months, 11 patients (20%) had symptomatic recurrence, between 2 to 6 months after their procedure. Seven patients underwent CABG, two had repeat intervention, one continued with medical therapy, and one died before planned angiography. There was no late sudden death. Forty-four patients (80%) remained asymptomatic. We conclude that elective stenting may be a safe alternative to CABG in unprotected LMCA disease.

Aged↗
PubMed1975

[Effect of potassium-magnesium aspartate on hemodynamics and myocardial metabolism of coronary disease patient during beta receptor stimulation].

2 series of patients with angiographically proven coronary artery disease were studied under the influence of an infusion of a beta-receptor stimulating drug (heptaminole) and of kalium-magnesium-aspartate (KMA) in high (series: I: 1000 mg of heptaminole in 25 min) and low doses (series II: 200 mg of heptaminole in 25 min) of beta-receptor stimulation. The results confirm the finding that high dose beta-receptor stimulation in patients with severe coronary artery disease results in failure of the contractile mechanism of the heart with the beta-receptor angina. However, administration of KMA simultaneously with the beta-receptor stimulator seems to be able to prevent the expected decrease of lactate extraction and results in no change in lactate AVD in series I and even in an 11% increase in lactate AVD in series II. Experimental data concerning the biochemical effects of KMA suggest that its ability to provide adequate amounts of oxaloacetone and hence to improve the function of the bricarbonic acid cycle seems to be of special importance. For this action to become relevant in coronary artery disease a situation would have to be postulated, in which an additional limiting factor of oxydative metabolism would be an inadequate supply of Krebs-cycle intermediates.

Acetoacetates↗
PubMed1979

Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations.

A progression of univariate followed by multivariate analyses was applied to 46 variables selected from the clinical examination, exercise test, coronary arteriography, and quantitative angiographic assessment of left ventricular function in patients with coronary disease to determine those variables most predictive of survival. For the 733 medically treated patients, the final Cox's regression analysis showed that the left ventricular ejection fraction was most predictive of survival, followed by age, number of vessels with stenosis(es) greater than or equal to 70%, and ventricular arrhythmia on the resting electrocardiogram. For the 1870 surgically treated patients, ventricular arrhythmia on the resting electrocardiogram was most predictive of survival followed by ejection fraction, heart murmur, left main coronary artery stenosis greater than or equal to 50%, and use of diuretic agents.

Adult↗
PubMed1982

Early and late results of combined endarterectomy and coronary bypass grafting for diffuse coronary disease.

Between October 1969 and December 1979, a total of 440 patients who had diffuse coronary artery disease were treated with combined endarterectomy and coronary bypass grafting. This constitutes 42 percent of all patients operated on at the same institution during this period. Six hundred eight endarterectomies were performed, 329 on the right coronary artery, 227 on the left anterior descending coronary artery and 52 on the left circumflex coronary artery. The early mortality rate was 4.3 percent and the late mortality rate 9 percent during a mean follow-up period of 47 months. The perioperative infarction rate was 15 percent. Ninety-five percent of survivors were asymptomatic or in improved condition. Only 11 patients were lost to follow-up study. Three hundred fourteen patients (71 percent) were reinvestigated with coronary and graft arteriography 1 month to 8 years postoperatively. The early patency rate of grafts to the endarterectomized vessels was 85 percent and the late patency rate (1 year or more) was 77 percent. The runoff was good in 79 percent, fair in 14 percent and poor in 7 percent of grafts. Endarterectomy is a valuable additional procedure in the management of patients with diffuse coronary artery disease.

Adult↗
PubMed1982

Long-term results of endocardial resection for sustained ventricular tachycardia in coronary disease patients.

Sixty patients with recurrent sustained ventricular tachycardia (VT) refractory to medical therapy underwent subendocardial resection. There were 52 men and 8 women, ranging in age from 39 to 74 years, all of whom had coronary disease. Each patient had had a prior infarction 1 week to 11 years prior to surgery and 52 had left ventricular aneurysms. The mean ejection fraction was 27%. All 60 patients underwent endocardial resection with or without aneurysmectomy guided by intraoperative and/or catheter endocardial mapping. Thirty-seven endocardial resections were from the interventricular septum, 14 from the interoposterior free wall, and 16 were from the anteroapical and anterolateral free wall. There were five (8%) surgical deaths. The 55 survivors underwent programmed stimulation in the control state 28 days following the operation. VT was not inducible in 42 patients (group A) and was inducible in 13 patients (group B). The group B patients underwent drug testing and were discharged on the antiarrhythmic agent that made the VT noninducible or more difficult to induce. There have been only four recurrences in sustained VT with a follow-up of 19 +/- 11 months. There have also been nine late nonarrhythmic deaths. The actuarial survival curve predicted 62% survival at 40 months. We conclude that activation guided endocardial resection provides long-term effective therapy for drug-resistant ventricular tachycardia.

Adult↗
PubMed2006

Randomized controlled trial of an informatics-based intervention to increase statin prescription for secondary prevention of coronary disease.

OBJECTIVE: Suboptimal treatment of hyperlipidemia in patients with coronary artery disease (CAD) is well documented. We report the impact of a computer-assisted physician-directed intervention to improve secondary prevention of hyperlipidemia. DESIGN AND SETTING: Two hundred thirty-five patients under the care of 14 primary care physicians in an academically affiliated practice with an electronic health record were enrolled in this proof-of-concept physician-blinded randomized, controlled trial. Each patient with CAD or risk equivalent above National Cholesterol Education Program-recommended low-density lipoprotein (LDL) treatment goal for greater than 6 months was randomized, stratified by physician and baseline LDL. Physicians received a single e-mail per intervention patient. E-mails were visit independent, provided decision support, and facilitated "one-click" order writing. MEASUREMENTS: The primary outcomes were changes in hyperlipidemia prescriptions, time to prescription change, and changes in LDL levels. The time spent using the system was assessed among intervention patients. RESULTS: A greater proportion of intervention patients had prescription changes at 1 month (15.3% vs 2%, P=.001) and 1 year (24.6% vs 17.1%, P=.14). The median interval to first medication adjustment occurred earlier among intervention patients (0 vs 7.1 months, P=.005). Among patients with baseline LDLs >130 mg/dL, the first postintervention LDLs were substantially lower in the intervention group (119.0 vs 138.0 mg/dL, P=.04). Physician processing time was under 60 seconds per e-mail. CONCLUSION: A visit-independent disease management tool resulted in significant improvement in secondary prevention of hyperlipidemia at 1-month postintervention and showed a trend toward improvement at 1 year.

Adult↗
PubMed2006

Non-invasive anatomical and functional imaging for the detection of coronary artery disease.

Coronary artery disease (CAD) is still an important cause of morbidity and mortality in the Western world. The gold standard for assessing significant coronary artery stenosis is invasive coronary angiography. Several disadvantages of the technique in combination with the fact that a substantial number of patients referred for conventional angiography appear free from significant stenosis have led to the pursuit of non-invasive imaging modalities for the diagnosis of CAD. The traditional modalities for this purpose are gated single-photon emission computed tomography, position emission tomography, (contrast) stress echocardiography and cardiac magnetic resonance (CMR), and these techniques can be characterized as functional imaging techniques as they detect ischaemia. Although the presence of a flow-limiting stenosis can be adequately ruled out with these techniques, atherosclerosis cannot be visualized with functional techniques. For this purpose, non-invasive coronary angiography techniques (computed tomography and CMR) are currently under development. The purpose of this review is to provide the reader an overview of the currently used imaging modalities to detect CAD.

Coronary Artery Disease↗
PubMed2003

[Correlation of lower extremity Doppler index with flow-mediated vasodilation and the extent of coronary disease].

AIMS: The aim of this study was to examine relationship between resting ankle-brachial pressure index and flow mediated vasodilation, and that of the extent of coronary artery disease. PATIENTS AND METHODS: Authors examined 77 subjects. All had peripheral arterial disease (with ankle-brachial pressure index less than 0.8), and angina pectoris (coronary artery disease verified by coronary angiography). Mean age was 64.6 years (range 41-82 years). Flow mediated (endothelial dependent) vasodilatation was measured for all participiant. RESULTS: Authors stated, that ankle-brachial pressure index significantly correlates with flow mediated vasodilatation and the same connection can be supposed between Doppler index and coronary artery disease's extension.

Adult↗
PubMed1990

[Comparative study of the mid-term electrocardiographic and clinical tolerability of bepridil versus diltiazem in patients with coronary disease].

A randomized, double-blind, multicentric study has been carried out to compare the electrocardiographic tolerance and the clinical benefit of bepridil (B) (300 to 500 mg/day) and of diltiazem (D) (180 to 300 mg/day). 227 patients with stable coronary disease, aged 70 years or less (mean = 59.4 +/- 7.2 years) have received treatment (116 B vs 111 D) during 16 weeks. The standard ECGs at each visit (D 0-inclusion-, D 14, D 28, D 70, D 112) show that, in group D, 9 first degree auriculo-ventricular blocks (ABV), occur during the study while no ABV occur in group B. A significant prolongation of the QTc (+5%) is observed as from D 14 in group B patients compared to those in group D. This difference persists during all the study. The study of Holters of 24 hours, carried out on D 0, D 70 and D 112, shows the good tolerance of B in this type of population. The number of patients presenting attacks of angina, the frequency of these attacks and the amount of TNT consumed are not different for the two groups under treatment, whatever the period studied. The frequency of extracardiac and cardiovascular undesirable effects is not different for the two groups. The number of patients who left the trial is not different for the two groups. The biological tolerance remained within normal limits in both groups. The analysis of the individual data has never shown any pro-arrhythmic effect, attributable to B or D, in the patients with no initial arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2003

Cost-benefit analysis of electron beam CT as a life insurance coronary disease risk assessment tool.

Electron beam CT (EBCT) or ultrafast CT is a diagnostic imaging technique that can identify calcium deposits within coronary arteries. Intra-coronary calcium is associated with coronary artery atherosclerosis. EBCT imaging has been advocated as a "better" way to screen for coronary artery disease. By producing a measure of the amount of calcium present, it may provide a non-invasive risk assessment tool that can predict the risk of future coronary events and death. Medical literature concerning identification and assessment of coronary risk using EBCT in the clinical setting is reviewed. The primary purpose is to illustrate one approach to a simple "back of the envelope" cost-benefit analysis (protective value) comparing EBCT with exercise electrocardiography as a life insurance coronary disease risk assessment tool. The performance and results of this analysis are contingent on a number of critical assumptions that are outlined in the text. The analysis limitations, and the future research required to refine the results are reviewed. With optimum levels of EBCT test performance, favorable thresholds of test costs, and long-term mortality data useful for assessment of value preservation, EBCT might prove to be a valuable risk assessment tool from a cost-benefit perspective under certain circumstances. Answers to key clinical research questions from prospective studies in asymptomatic cohorts are essential for refinement of a cost-benefit estimate.

Coronary Disease↗