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PubMed1985

[Behavior of HDL cholesterol and the apoproteins A1 A2 and B in the central circulation in patients with coronary disease and genetically determined hyperlipoproteinemias].

Seven lipid parameters, including apoproteins A1, A2 and B were determined in blood from different parts of the cardiovascular system in two groups of patients one with and the other without coronary heart disease. In addition, HDL cholesterol levels were compared in patients with coronary heart disease and primary monogenic combined hyperlipoproteinaemia. None of the seven parameters showed significant differences in samples from the pulmonary artery (mixed venous blood) and the hepatic vein of the control and patient groups. The expected significant concentration gradient between the two vascular regions was confirmed in the groups with and without coronary heart disease. HDL components showed a contrary behaviour: the hepatic vein and pulmonary artery exhibited significantly lower values of HDL cholesterol in patients with coronary heart disease than in the controls, but this was not true for HDL apoproteins A1 and A2. Patients with coronary heart disease and primary hyperlipoproteinaemia showed a significant concentration gradient between the two vascular regions for total and HDL cholesterol. These observations reveal the importance of genetic disturbances of lipid metabolism, particularly the implication of various lipid fractions in the pathogenesis of atherosclerosis.

Apoproteins↗
PubMed1994

[Coronary disease and noncardiac surgery. An evaluation of the surgical risk].

Coronary artery disease is one of the leading causes of death in developed countries and one of the factors contributing to high mortality associated with noncardiac surgical procedures. This is the reason why is so important to correctly assess surgical risk in patients with ischemic heart disease. These patients can be evaluated by a simple clinic examination, electrocardiogram and chest X-ray. In asymptomatic patients or in patients with angina (Class I-II), normal electrocardiogram and chest X-ray, the operative risk is low. On the other hand, patients with severe heart failure (Class IV NYHA), unstable angina or acute myocardial infarction have a high surgical risk. The exercise stress testing must be performed in some cases in order to identify preoperative factors (electrocardiographic ischemic changes, low functional capacity) that might affect the development of cardiac events after noncardiac surgery. When not possible a thallium-dipyridamole scintigraphy should be considered. We discuss preoperative indications for coronary angiography and coronary revascularization. Coronary artery bypass surgery must be thought based on clinic severity, therapeutic results, left ventricular function and patient age, among other factors.

Coronary Disease↗
PubMed2002

[Interleukin-10 and coronary disease].

Understanding of the pathophysiology of atherosclerosis has changed markedly over the past few decades. It is now widely accepted that inflammation plays a fundamental role in the genesis and development of atherosclerosis. Inflammatory mechanisms also appear to determine clinical presentation and disease outcome. Atherosclerotic lesions have high concentrations of inflammatory cells (T lymphocytes and activated macrophages) as well as an abundance of pro-inflammatory cytokines [interleukin (IL)-1, IL-6, IL-8, interferon-gamma, tumor necrosis factor-alpha, etc.] that modulate local inflammatory responses. These may also alter plaque stability and facilitate the development of acute cardiovascular events. The role of anti-inflammatory cytokines in this context remains to be studied. IL-10 is an anti-inflammatory cytokine synthesised by T-lymphocytes and macrophages and has other anti-inflammatory effects. IL-10 expression within human atherosclerotic plaques has been demonstrated and animal experiments have shown that low levels of IL-10 lead to the development of extensive and unstable atherosclerotic lesions. Currently available evidence suggests a potential protective role for IL-10 in atherosclerosis. This new perspective on coronary disease as a chronic inflammatory process may open new avenues for the management of ischemic heart disease.

Animals↗
PubMed1975

[Geometric changes of the left ventricle during the isovolumic contraction in healthy people and patients with coronary disease].

Biplane cineventriculograms of 5 normal and 12 patients with coronary artery disease were analysed in order to determine the dimensional changes of the left ventricle during the isovolumic phase of contraction. In postero-arterior projection the ventricular diameters in both groups decreased by an average of 3-6%, the wall thickness increased by 5-10%, In lateral projection there were no significant changes of geometry. The changes in regional diameters showed significantly greater maximal differences in diseased than in normal ventricles. Using ventriculographic data of enddiastole instead of aortic valve opening for determination of ejection phase parameters resulted in an overestimation of the mean velocity of circumferential fiber shortening by an average of 10-20%, of the stroke volume of 5-15% and of the ejection fraction of 5%. These results indicate that ejection phase indices can only be determined exactly from cineventriculograms when aortic valve opening and closure is considered.

Adult↗
PubMed1996

[Coronary disease in France: data from the MONICA registers (1985-1991)].

The MONICA Project is an international project co-ordinated by the World Health Organisation. The objective of this study is to assess fluctuations in coronary heart disease (CHD) mortality and morbidity. From 1985 to 1991 a continuous and exhaustive registration of acute coronary events (15,775 cases among which 12,789 men and 2,986 women) was carried out in the 3 French MONICA Centres Lille, Strasbourg and Toulouse. During this period, the average rate of CHD mortality according to the death certificates was higher for men in Lille (93/100,000 inh) and Strasbourg (84/100,000 inh) than in Toulouse (57/100,000 inh). The official rates are close to those found by the MONICA Registers if documented myocardial infarctions only are taken into account. If sudden deaths are included, these rates must be multiplied by 1.6. In terms of evolution, official statistics showed an improvement with a mortality decrease of 33%. For the MONICA Registers which include sudden deaths, the decrease was only 20%. Official statistics underestimate coronary death rate and overestimate the decrease tendency. Morbidity rates between the South and the North of France are close, and when compared to Northern Europe countries, France is in an area of moderate incidence. The favourable evolution of coronary disease frequency hides in fact a contrasted evolution: improvement in myocardial infarction recurrence and worsening of incidence. The example of CHD proves that registers provide relevant information for a prevention policy.

Adult↗
PubMedDate not supplied

[Synthetic membrane coronary stent graft in coronary disease].

The use of a synthetic membrane-covered stent has been suggested to overcome some specific lesions in coronary arteries and to solve some potential complications that could arise in any procedure of coronary intervention. A synthetic membrane coronary stent graft (JOSTENT-JOMED) is constituted by a membrane of polytetrafluoroethylene (PTFE), fixed between two thin metallic stents. In this clinical review of our laboratory's experience, the Jostent graft was used in several angiographic circumstances in coronary arteries or in vein grafts. Our clinical experience consists of 17 patients that were treated with placement of PTFE stents for different indications: coronary rupture in two patients; thrombus and degenerative vein grafts in eight patients, coronary aneurysms in four patients, and thrombus in coronary arteries in three more. Our clinical results with this device suggest that its implant is feasible and safe with a clinical success of 100% without complications during in-hospital stay; during the clinical 11 +/- 3 months follow-up, only three patients exhibited major cardiac events. The indication for PTFE stent in vein grafts with degenerative and thrombus lesions has not been determined yet; however, recently, some randomized trials have shown little benefit in this circumstance. On the other side, coronary vessel rupture and coronary aneurysms are currently the most definitive indications.

Adult↗
PubMed1996

Cholesterol policy and the primary prevention of coronary disease: reflections on clinical and population strategies.

Despite billions of dollars spent on targeted and population-wide strategies aimed at reducing human consumption of saturated fat and cholesterol, aspects of the diet-heart connection remain a source of debate. At least part of the uncertainty arises from a growing appreciation that the relationship between dietary habits, serum lipids, and atherosclerosis is more complex than was previously thought. While we wait for answers from clinical and basic research, what is to be done? This review examines evidence about clinical policies and population strategies for the primary prevention of coronary disease, with specific reference to diet and dyslipidemias. It also summarizes some current policies and offers conclusions about broad directions for further policy development.

Attitude to Health↗
PubMed1994

[Rickettsiosis of the typhus fever type. Its joint appearance with a left-ventricular thrombus and single-vessel coronary disease].

A 44-year-old German fell ill in Libya, where he had been living for 10 years, with high fever, rigor and a nonitching centrifugally spreading macular rash, which had spared the head, hands and soles. In addition, a systolic cardiac murmur was heard. The Weil-Felix reaction had a titre rising within 3 days from 1:160 to 1:640, confirming the diagnosis of rickettsial disease, the total clinical picture indicating typhus. On treatment with chloramphenicol (1 g three times daily i.v.) the fever subsided within 5 days. On the ninth day treatment was changed to oral doxycyclin, 200 mg daily for 3 weeks. Echocardiography surprisingly revealed a floating thrombus, about 4 x 8 cm, attached to the hypo- and even akinetic apex of the left ventricle. In addition there was single-vessel coronary disease. Since the segmental contraction abnormality persisted after the typhus had been cured, a causal connection with the rickettsial disease is unlikely. The thrombus was removed at the time of a aortocoronary bypass operation: his course has been unremarkable since then.

Adult↗
PubMedDate not supplied

Myocardial revascularisation in elderly patients with refractory or unstable angina and advanced coronary disease.

BACKGROUND: Elderly patients with ischaemic heart disease are often treated more conservatively and for longer than younger patients, but this strategy may result in subsequent invasive intervention of more advanced and higher risk coronary disease. METHODS: We performed a retrospective analysis of 109 patients aged > or = 70 years (mean age 74 years, 66% men), who presented with angina refractory to maximal medical treatment or unstable angina over a 2-year period (1988-1990), to compare the relative risks and benefits of myocardial revascularisation [coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA)] in this higher-risk age group. RESULTS: Sixty patients underwent CABG and 49 patients PTCA. There were eight periprocedural deaths in total (six in the CABG group, and two in the PTCA group, P = 0.29). Six patients in the CABG group suffered a cerebrovascular accident (two fatal). Acute Q-wave myocardial infarction occurred in one patient in the CABG group and in two patients in the PTCA group. The length of hospital stay was longer for the CABG group (CABG group 11.4 +/- 5.4 days, range 7-30 days, PTCA group 7.4 +/- 7.6 days, range 1-39 days, P = 0.01). Outcome was assessed using the major cardiac event rate (MACE; i.e. the rate of death, myocardial infarction, repeat CABG or PTCA). The cumulative event-free survival in the CABG group in 1, 2 and 3 years was 87, 85 and 85%, respectively. In contrast, in the PTCA group it was 55, 48 and 48% (P = 0.0001). Age, sex, number of diseased vessels, degree of revascularisation and left ventricular function were not predictive of the recurrence of angina in both groups. Actuarial survival (total mortality, including perioperative mortality) was lower at 1 year in the CABG group due to the higher perioperative mortality, but similar in both groups after the second year (P = 0.62). CONCLUSIONS: Elderly patients with refractory or unstable angina who are revascularised surgically have a better long-term outcome (less frequent event rate of the composite end-point--myocardial infarction, revascularisation procedures and death) compared with those who are revascularised with PTCA. This benefit is been realised after the second year. Total mortality is similar in both groups after the second year. Therefore elderly patients who are fit for surgery should not be denied the benefits of CABG. PTCA may be regarded as a complementary and satisfactory treatment, especially for those whose life expectancy is limited to less than 2 years. The use of stents may improve outcome in the PTCA group and this needs to be evaluated.

Aged↗
PubMed1984

Polymorphism at the apoprotein-E locus in relation to risk of coronary disease.

The frequency of genotypes at the polymorphic locus which codes for Apoprotein-E, an important constituent of very low density serum lipoprotein, has been determined in a random sample of persons between the ages of 45 and 60 years, born in the Grampian Region of North East Scotland. Three alleles, EII, EIII and EIV occur with a frequency of respectively 0.08, 0.77 and 0.15. In a random sample of survivors of myocardial infarction, born in the same region, genotype EIVEIII occurs more and EIIIEII less frequently than expected. Also the mean age at first infarction is lower in men for genotype EIVEIII than for other genotypes. Commonly occurring genotypes at this locus apparently influence the risk of coronary disease. A prospective study is needed to show how the genetic effects are expressed.

Age Factors↗
PubMed1988

[The significance of systolic time intervals in the dipyridamole test for the diagnosis of coronary disease].

The investigations concerning the significance of the systolic time intervals in the dipyridamole test for the diagnosis of the coronary heart disease were carried out in 15 healthy test persons and 40 patients with coronary heart disease. Apart from the systolic time intervals calculated according to Weissler and co-workers also the behaviour of the ST segment, the R wave in lead V5 (RV5) and the sum of the amplitudes of the R waves (sigma R) were estimated concerning sensitivity, specifity and predictive value. At a sensitivity of 65% for the behaviour of the ST segment under influence of the dipyridamole test this was smaller for RV 5, sigma R, ICT and LVET/S1S2, on the other hand greater for PEPI and OS2I (p less than 0.05). The other time intervals did not differ in their sensitivity to the ST segment. The specifity and the predictive confirming value were 100% for the changes of the ST segment. In the analysis of the other parameters no differences were stated (p greater than 0.05). The predictive value, excluding a coronary heart disease, was 51.7% for the ST segment and still higher for PEPI and OS2I (p less than 0.05). By the analysis of the systolic time intervals the diagnosis value of the dipyridamole test continues to increase.

Adult↗
PubMed1998

Design and current status of ACTION: A Coronary disease Trial Investigating Outcome with Nifedipine GITS. Gastro-Intestinal Therapeutic System.

AIMS: To present the design of ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS), an ongoing multicentre clinical outcome trial with nifedipine GITS (Gastro-Intestinal Therapeutic System) in patients with stable angina pectoris. METHODS: At least 6000 patients with optimally treated stable angina without depressed left ventricular function are randomized in equal proportions to either nifedipine GITS or matching placebo (starting dose 30 mg, maintenance dose 60 mg once daily). Patients are followed for at least four years. The primary end-point, to be analyzed by assigned treatment, includes all-cause mortality, acute myocardial infarction, emergency coronary angiography for refractory angina, overt heart failure, debilitating stroke and peripheral revascularization. For this end-point, the trial has a power of 95% to detect a relative risk reduction of 18% at the 5%, level of significance, and is large enough to exclude an excess mortality caused by nifedipine GITS of 3.1 deaths per 1000 years of treatment or greater. The pre-specified early termination rule is more conservative in the case of a beneficial effect than in the case of an adverse effect of nifedipine GITS. The first patient was randomized on 29 November, 1996. By the end of April 1998, about 5200 patients had been started on study medication. CONCLUSIONS: Results will be available in the autumn of 2003.

Angina Pectoris↗
PubMed1997

[Prospective study of the frequency and extent of donor-transmitted coronary disease after heart transplantation by intravascular ultrasound].

PROBLEM AND OBJECTIVE: Cardiac allograft vasculopathy influences long-term survival of patients after heart transplantation. Donor-transmitted coronary artery disease may contribute to the further development of cardiac allograft vasculopathy. The aim of this study was to characterize by intracoronary ultrasound the extent and frequency of transmitted coronary artery disease. PATIENTS AND METHODS: Intravascular ultrasound studies were performed at routine angiography in 33 patients (26 men, 7 women, mean age 51 [23-69] years) early after heart transplantation. Plaque morphology was analysed in 153 coronary segments of 52 epicardial coronary arteries. RESULTS: Relevant atherosclerosis (defined as maximal plaque thickness > or = 0.5 mm in at least one coronary segment) was found in 17 patients (52%), while angiography showed irregularities in only 7 patients (21%). Maximal plaque thickness in patients with relevant atherosclerosis was 1.13 +/- 0.32 mm, mean plaque index was 19.2 +/- 10.2%. Plaque formation was eccentric, and plaques were predominantly located in proximal segments. Morphologic changes affecting more than one segment were found in 52% of the patients. Comparing clinical factors, only donor age predicted the degree of atherosclerosis. CONCLUSIONS: In more than one half of the patients studied early after heart transplantation, Intravascular ultrasound revealed epicardial atherosclerotic lesions which were incompletely identified by coronary angiography. The degree of atherosclerosis was closely related to donor age. The potential influence of donor transmitted coronary artery disease on the progression of transplant coronary artery disease requires further longitudinal studies.

Adult↗
PubMed1986

Arrhythmia control and other factors related to sudden death in coronary disease patients at intermediate risk.

Thirty-three patients with coronary artery disease and frequent, complex ventricular arrhythmias (VA) were followed long-term to evaluate factors related to sudden death (SD). Patients with malignant VA (sustained ventricular tachycardia (VT), resuscitated SD, or acute myocardial infarction) were excluded. Baseline data included angiographic ejection fraction (EF), segmental wall motion, and Holter evidence of frequent (greater than 30/hr) and complex (repetitive) ventricular premature beats (VPBs). Control of VA was attempted with conventional or experimental agents and was defined as greater than or equal to 70% reduction in VPBs, greater than or equal to 90% reduction in couplets, and abolition of nonsustained VT on two consecutive Holter tapes. After 24 +/- 15 months of follow-up on the single most effective agent, 18 patients survived while 15 patients died suddenly. There was no difference between these groups with respect to age, sex, or baseline VA. Survivors had a higher EF (51% vs 34%, p less than 0.001), fewer dyskinetic segments (0.05 vs 1.0, p less than 0.01), and better VA control (83% vs 40%, p less than 0.01) than nonsurvivors. By analysis of variance, VA control was not independent of EF (F = 6.98, p less than 0.01). The 1-, 2-, and 3-year survival rates were 90%, 90%, and 82% for patients with EF greater than or equal to 40% and 22%, 11%, and 11%, for those with EF less than 40% and uncontrolled VA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗