Abnormal Coronary Angiography Research Articles

The relationship between NLR, LDL-C/HDL-C, NHR and coronary artery disease.

Chronic inflammation and dyslipidemia are key risk factors for atherosclerotic cardiovascular diseases. We retrospectively explored the association between the neutrophil to lymphocyte ratio (NLR), the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C), and the neutrophil to HDL-C ratio (NHR), and the severity of coronary lesions in patients with acute coronary syndrome (ACS). In June 2023, we selected 1210 patients who were diagnosed with ACS based on chest pain from January 2017 to December 2022. Of these, 1100 patients with abnormal coronary angiography were categorized into the experimental group, and 110 patients with normal coronary angiography were classified as the control group. We collected routine blood tests, lipid profiles, and coronary angiography results at admission (before coronary angiography). Patients were then stratified into a control group (Gensini score = 0) and an experimental group (Gensini score = 0) based on the Gensini score. The experimental group was further divided into a low score group (Gensini score < 69) and a high score group (Gensini score ≥ 69). 1. Statistically significant differences were observed between the control and experimental groups in terms of gender, age, body mass index (BMI), hypertension, diabetes, smoking history, and counts of neutrophils (NEU), lymphocytes (LYM), monocytes (MON), eosinophils (EOS), red cell distribution width (RDW), total cholesterol (TC), HDL-C, LDL-C, NLR, LDL-C/HDL-C, and NHR (P&lt;0.05). Furthermore, differences in BMI, hypertension, diabetes, smoking history, NEU, LYM, MON, TC, triglyceride (TG), HDL-C, LDL-C, NLR, LDL-C/HDL-C, and NHR were significant between the low and high score groups (P&lt;0.05). 2. NEU, LYM, MON, TC, HDL-C, LDL-C, NLR, LDL-C/HDL-C, and NHR showed significant correlations with the Gensini score (r>0.2, P<0.05), with NLR and LDL-C/HDL-C showing the strongest correlations (r = 0.822, P = 0.000). 3. The Receiver Operating Characteristic (ROC) curve indicated that the combination of NLR and LDL-C/HDL-C had superior sensitivity and specificity in predicting the severity of coronary lesions, with a significant difference (P&lt;0.05). The sensitivity was 87.1%, the specificity was 90.9%, and the cut-off point was 2.04. 4. A predictive model was developed based on the ratio of NLR and LDL-C/HDL-C to the Gensini score. The final model score was calculated as 6.803 + 7.029NLR + 13.079LDL-C/HDL-C (R2 = 0.708). Compared to NLR, LDL-C/HDL-C, and NHR, the combined NLR and LDL-C/HDL-C ratio is a more accurate marker for assessing the severity of coronary artery disease in ACS patients. Its convenience and effectiveness make it a promising tool for early assessment, timely risk stratification, and appropriate clinical intervention, ultimately improving clinical outcomes for ACS patients.

The clinical manifestation and outcome of COVID-19 in patients with a history of ischemic heart disease; a retrospective case-control study

IntroductionCoronary artery disease (CAD) is considered an independent risk factor for COVID-19. However, no study has specifically examined the clinical manifestations and outcomes of COVID-19 in patients with ischemic heart disease (IHD).MethodsIn a retrospective case-control study between 20 March 2020 to 20 May 2020, the medical record of 1611 patients with laboratory-confirmed SARS-CoV-2 infection was reviewed. IHD was defined as a history of an abnormal coronary angiography, coronary angioplasty, coronary artery bypass graft (CABG), or chronic stable angina. Demographic data, past medical history, drug history, symptoms, vital signs, laboratory findings, outcome, and death were investigated from medical records.Results1518 Patients (882 men (58.1%)) with a mean age of 59.3 ± 15.5 years were included in the study. Patients with IHD (n = 300) were significantly less likely to have fever (OR: 0.170, 95% CI: 0.34–0.81, P < 0.001), and chills (OR: 0.74, 95% CI: 0.45–0.91, P < 0.001). Patients with IHD were 1.57 times more likely to have hypoxia (83.3% vs. 76%, OR: 1.57, 95% CI: 1.13–2.19, P = 0.007). There was no significant difference in terms of WBC, platelets, lymphocytes, LDH, AST, ALT, and CRP between the two groups (P > 0.05). After adjusting for demographic characteristics, comorbidities and vital signs, the risk factors for mortality of these patients were older age (OR: 1.04 and 1.07) and cancer (OR: 1.03, and 1.11) in both groups. In addition, in the patients without IHD, diabetes mellitus (OR: 1.50), CKD (OR: 1.21) and chronic respiratory diseases (OR: 1.48) have increased the odds of mortality. In addition, the use of anticoagulants (OR: 2.77) and calcium channel blockers (OR: 2.00) has increased the odds of mortality in two groups.ConclusionIn comparison with non-IHD, the symptoms of SARS-CoV-2 infection such as fever, chills and diarrhea were less common among patients with a history of IHD. Also, older age, and comorbidities (including cancer, diabetes mellitus, CKD and chronic obstructive respiratory diseases) have been associated with a higher risk of mortality in patients with IHD. In addition, the use of anticoagulants and calcium channel blockers has increased the chance of death in two groups without and with IHD.

Echocardiographic assessment of diastolic function in non-ST elevation acute coronary syndrome patients and its association with in-hospital diagnosis

Objective: This study was conducted to evaluate the association of echocardiographic parameters used in left ventricular (LV) diastology with the early results of non-ST elevation acute coronary syndrome (NSTE-ACS) workup in the hospital. Methods: This cross-sectional study was performed on patients presenting with acute chest pain and a diagnosis of NSTE-ACS including only patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). All patients underwent transthoracic echocardiography in the emergency room (ER) within 12 hours of the last episode of chest pain. An invasive approach was not uniformly pursued in all of the patients so analysis was performed in two different settings. First, analysis was performed in the patients that underwent coronary angiography (CAG) and echocardiographic data were compared between those with normal and abnormal CAG results. Finally, echocardiographic data of the patients with normal diagnostic results (i.e., normal exercise tolerance test (ETT), myocardial perfusion imaging (MPI) or coronary angiography (CAG) results) were compared with the data of the patients with abnormal test results. Results: Eighty patients with a mean age of 54.43 ± 12.38 years were included in the study, of whom 57 (71.2%) were male. Fifty-three patients underwent CAG. In these 53 patients, there was significant difference in mitral annular velocity in early diastole (e’), ratio of mitral inflow velocity to e’ (E/e’), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-diastolic pressure (LVEDP) between patients with coronary artery involvement and those with normal coronary artery (P&lt;0.05). The area under the receiver operating characteristic (ROC) curve to predict CAG results for e’, E/ e’, LVEDD and LVEDP was more than 0.65. The sensitivity and specificity of the LV diastolic dysfunction for predicting coronary involvement was 94.4% and 35.29%, respectively. Comparison of echocardiographic data between patients with normal test results (non-invasive and invasive) and those with abnormal diagnostic tests showed a significant difference in e’, E/e’, acceleration time of E, LV end-diastolic diameter index, size of interventricular septum and left atrial volume. Conclusion: The results suggest that diastolic dysfunction data can be used as an adjunctive method to evaluate ACS patients in the ER.

Double Product as a Predictor of Coronary Artery Disease in Males with Normal Blood Pressure

Abstract Aim: This study investigates whether in males with normal blood pressure that underwent exercise stress test Double Product (DB) or Double Product Ratios to workload (DPR) are self-sufficient in predicting the presence of coronary artery disease (CAD). Method: 78 male patients with normal blood pressure went through bicycle exercise stress test (EST) and within four weeks they underwent coronary angiography. 34 of them resulted with normal coronary arteries and 44 of them were diagnosed with one or multiple vessel CAD. Pressure rate double product was calculated in rest, in the first stage of the exercise test, in the peak of exercise, and also in the second, fourth and sixth minutes of recovery of the stress test. Also, the ratios of pressure rate double product with the workload, which reflects the relative growth of double product to the workload, were calculated. The results were compared between the two groups, the one with normal coronary arteries, and those with abnormal coronary angiography. Results: DP in rest and in the first stage of the exercise are not significantly different for normotensive males with or without CAD, while the peak DB value of the exercise, as well as the econd and sixth minutes of the recovery are significantly lower for the group of patients with CAD. The starting peak workloads were significantly lower in the patients’ group with CAD (p=0.0002 and p&lt;0.0001). On the other hand, the double product to workload ratio at the first stage was significantly lower in males with normal blood pressure and CAD. Significant lower DPR are detected also in the fourth and sixth minutes of recovery. Conclusion: The values of DP in the peak exercise and at the second and sixth minutes of the recovery phase are significantly lower in normotensive males with abnormal coronary angiography compared to those with normal coronary arteries, and these findings can be used to detect the presence of CAD despite the ECG changes and they are not affected by the baseline characteristics of the patients. The ratios between DP and workload at the first stage, and in the fourth and sixth minutes of recovery are significantly lower in normotensive male patients with coronary artery disease compared to those without CAD and can be independent predictive parameters for the disease.

Coexistent coronary artery disease in Indian patients undergoing permanent pacemaker implantation (PPI) for symptomatic bradyarrhythmia

BackgroundThe cause-effect of conduction disturbance in chronic lesion of coronary arteries is complicated. This study was designed to evaluate coexistent CAD in patients with symptomatic bradyarrhythmia to find common anatomic basis for conduction disturbances and its relationship to conventional coronary risk factors. MethodsIn this prospective observational study, 929 patients who admitted for symptomatic bradyarrhythmia requiring permanent pacemaker implantation were included. All included patients underwent coronary angiography and were divided into groups based on angiographic findings. Association between conduction disturbances and these groups were analyzed. ResultsA total of 929 patients with mean age of 63.1 years were included in our study. We found age ≥50 years, male sex, presence of diabetes and hypertension as statistically significant predictors of abnormal coronary angiography. Obstructive CAD (≥50% stenosis) was found in 34.4% patients. Prevalence of single vessel disease, double vessel disease and triple vessel disease was 15.3%, 10.2% and 8.9% respectively. Severe coronary obstruction (≥90% obstruction) was found in 16.25% patients. Revascularization was advised in three fourth of cases of obstructive CAD. Approximately two third of patients didn’t have significant obstruction in coronaries supplying the conduction system. Type 4 was the commonest anatomy in obstructive CAD. SA Nodal artery was found more diseased in patients of SSS with p value of 0.01. ConclusionObstructive CAD was found in one third of patients undergoing PPI. Age ≥50 years, male sex, diabetes and hypertension were found significantly correlated with presence of CAD and may act as important markers for the judgment of further coronary evaluation.

Quadricuspid aortic valve: a case report and review of the literature

Quadricuspid aortic valve (QAV) is a rare congenital anomaly that can present as aortic insufficiency later in life. We report a case of aortic regurgitation associated with a QAV, treated by aortic valve replacement. The patient presented with breathlessness, lethargy and peripheral oedema. Echocardiography and cardiac magnetic resonance revealed abnormal aortic valve morphology and coronary angiography was normal. The presence of a quadricuspid aortic valve was confirmed intra-operatively. This was excised and replaced with a bioprosthetic valve and the patient recovered well postoperatively. Importantly, the literature indicates that specific QAV morphology and associated structural abnormalities can lead to complications. Hence, early detection and diagnosis of QAV allows effective treatment. Aortic valve surgery is the definitive treatment strategy in patients with aortic valve regurgitation secondary to QAV. However, the long-term effects and complications of treatment of this condition remain largely unknown.

Chest Pain Characteristics in Cardiac Syndrome X Compared to Coronary Artery Disease.

AIM:This study aimed to assess if clinical remarks gained by analysis of the present and past medical history of patients undergoing elective coronary angiography (ECA) due to typical chest pain can help to predict the outcome of ECA.MATERIAL AND METHODS:One hundred and fifty-four ECA candidates with a history of typical chest were seen on the same day intended for ECA in the cardiac centre of AlShaab Teaching Hospital, Khartoum, Sudan. The details of the present complaints, characteristics of chest pain, past medical and socioeconomic history were recorded from each subject guided by a questionnaire. ECA confirmed CAD in 112 of the studied patients and were considered as the test group. The remaining patients (N = 42) were diagnosed as CSX after exclusion of significant narrowing of the coronary vessels and were considered as the control group.RESULTS:Univariate analysis of pain characteristics among patients undergoing coronary angiography revealed that pain is less likely to radiate to the neck (OR = 0.44, 95% CI = 0.21 – 0.91, P = 0.027) and the back (OR = 0.48, 95% CI = 0.23 – 1.00, P = 0.049) in patients with CAD. Presence of shortness of breathing and/or dizziness significantly decrease the odds of having abnormal coronary angiography (OR = 0.30 and 0.48, 95% CI = 0.12 – 0.77 and 0.22 – 0.92, P = 0.013 and 0.030 respectively). Past history of diabetes mellitus significantly increases the odds of having abnormal coronary angiography (OR = 3.96, 95% CI = 1.68 – 9.30, P = 0.002). In contrast, past medical history of migraine decreases the odds of having positive finding in ECA (OR = 0.31, 95% CI = 0.13 – 0.72, P = 0.006).CONCLUSION:Characteristics of chest pain are comparable in CAD and CSX. However, pain is less likely to radiate to the neck and/or the back in the first group. Presence of dyspnea and dizziness during angina attacks as well as the history of migraine significantly decreases the odds of having abnormal coronary angiography.

Added value of aortic pulse wave velocity index for the detection of coronary heart disease by elective coronary angiography

Background: Non-invasive tests leading to elective coronary angiography (CAG) have low diagnostic yield for obstructive coronary heart disease (CHD). Aortic stiffness, an independent predictor of CHD events can be easily measured by pulse wave velocity (PWV). We aimed at retrospectively evaluating the diagnostic accuracy PWV index to detect CHD in consecutive patients with suspected CHD that underwent CAG.Method: In population of 86 healthy patients with available PWV data, a theoretical PWV was derived. In different population of 62 individuals who underwent CAG for suspected CHD, PWV index was calculated as index [(measured PWV – theoretical PWV)/theoretical PWV]. Logistic regression and comparisons between ROC curves were used to add value of CAG indication performance of PWV index.Results: Out of 62, seventeen patients presented obstructive CHD and 22 patients had non-obstructive CHD. PWV index and severity of CHD were positively correlated (p < 0.0001). After applying several models that included classical CHD predictor, the higher performance to detect abnormal CAG was obtained with the combined classifier PWV index/carotid plaque with 87% sensitivity, 93% specificity, 0.92 accuracy and 0.31 threshold. To detect obstructive CAG, individual classifier PWV index presents 94% sensitivity, 91% specificity, 0.95 accuracy and 0.46 threshold.Conclusion: PWV index is individualized approach that optimizes CHD diagnostic strategies and thus might be clinically useful for reducing the rate of unnecessary invasive CAG.

Coronary lesions in black African patients with acute coronary syndromes

Introductionles syndromes coronariens aigus (SCA) sont en progression en Afrique sub-saharienne. Les données angio-coronarographiques sont rares. L'objectif de cette étude était d'analyser les lésions coronaires observées dans les syndromes coronariens aigus (SCA) à Abidjan.Méthodesétude transversale, du 1er janvier 2010 au 31 décembre 2014. Tous les patients admis pour SCA et ayant bénéficié d'une coronarographie à l'Institut de cardiologie d'Abidjan pendant la période d'étude ont été inclus. Deux cent cinquante-six patients ont été sélectionnés. Nous avons analysé et comparé les lésions coronaires chez les patients ayant présenté un SCA avec sus décalage persistant du segment ST (SCA ST+) et ceux ayant présenté SCA sans sus décalage du segment ST (SCA ST-).Résultatsl'âge moyen des patients était de 53,2 ± 10,8 ans. Il existait une prédominance masculine avec un sex-ratio de 6,1. Le taux de coronarographies anormales était significativement plus élevé dans les SCA ST+ (95,4% et 64,2% respectivement, p < 0,001). Trois cent quatre lésions coronaires ont été observées dans les SCA ST+ contre 43 dans les SCA ST- . Les lésions sténosantes étaient majoritairement monotronculaires (45,3%) dans les SCA ST+ et bi ou tri tronculaires dans les SCA ST- (68,0%). Les lésions de type B1 étaient plus fréquentes dans les SCA ST- (62,8% versus 36,5%, p = 0,002). Les lésions les plus complexes de type C étaient plus fréquentes dans les SCA ST+ (17,8%), sans différence significative. La majorité des patients avait un score SYNTAX inférieur à 22 quel que soit le type de SCA (87,4% dans les SCA ST+ et 90,1% dans les SCA ST-).Conclusionles lésions coronaires dans les SCA sont majoritairement monotronculaires dans les SCA ST+ et plus diffuses dans les SCA ST- mais avec une proportion plus importante de coronaires angiographiquement normales. La prise en charge de ces lésions relève dans la majorité des cas de l'angioplastie coronaire.

Influence of percutaneous coronary intervention on homocysteine and galection-3 in serum of patients with coronary heart disease and correlation analysis

Objective To discuss the influence of percutaneous coronary intervention(PCI) on the serum concentration of homocysteine(Hcy) and galectin-3 in patients with coronary heart disease(CHD). Methods From September 2016 to October 2017, 70 patients in Ji'nan Central Hospital were selected.According to the results of coronary angiography(CAG), they were divided into observation group with drug-eluted stents(n=47, including 25 cases with type A CHD and 22 cases with type B CHD) and control group without abnormal CAG(n=23). Serial venous blood samples were obtained 1 day before PCI as well as 1 day and 7 days after PCI.Plasma concentrations of Hcy, BNP and galectin-3 were measured and compared.The postoperative patients with PCI were tracked for 1 year to observe the influence of serum Hcy and galectin-3 on the severity of CHD and the quality after PCI. Results The plasma Hcy levels of type A[(16.52±5.41)μmol/L]and type B[(19.32±6.35)μmol/L]after PCI were significantly higher than those of the type A[(11.66±3.25)μmol/L]and the type B[(15.87±5.20)μmol/L]before PCI(t=2.375, P<0.05, t=2.97, P<0.01). Meanwhile, the plasma galectin-3 levels of type A[(0.86±0.11)μg/L] and type B[(1.15±0.48)μg/L]after PCI were also higher than those of the type A[(0.32±0.53)μg/L]and the type B[(0.46±0.19)μg/L]before PCI(t=2.178, P<0.05, t=4.269, P<0.01). Furthermore, levels of the plasma Hcy and galectin-3 were positively associated with the severity of CHD. Conclusion The higher blood levels of serum Hcy, BNP and galectin-3 after PCI indicate that the balloon inflation and implantation of stent can affect the level of plasma Hcy, BNP and galectin-3.Therefore, the levels of serum Hcy and galectin-3 are helpful to diagnose CHD and evaluate the degree of CHD. Key words: Coronary artery disease; Percutaneous coronary intervention; Cysteine; Brain natriuretic peptide; Galectin-3; Coronary angiography; Serum; Degree of the lesion

Association between neutrophil to lymphocyte ratio and severity of coronary artery disease

Background: Atherosclerosis is a chronic systemic inflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) is systemic inflammatory marker that is correlated with poor cardiovascular outcome. The aim of this study was to investigate the association between neutrophil to lymphocyte ratio (NLR) and severity of coronary atherosclerosis.Methods: A total of 324 patients undergoing coronary angiography were included in the study. All the patients were included in study were divided into two groups based on the result of coronary angiography report. While 226 patients had abnormal coronary angiography (case) (78 female, mean age: 60.6±12.6 years), 98 patients had normal coronary angiography (control) (60 female, mean age: 57.2±10.9 years). NLR was calculated as the ratio of neutrophil count to lymphocyte count.Results: Although age distribution was similar between the two groups(p = 0.073), female gender was significantly higher in the normal coronary angiography group (p &lt; 0.001). Smoking history has shown a significant higher in cases compared to the normal coronary angiography (p=0.001). Patients with abnormal coronary angiography had significantly higher NLR when compared to patients with normal coronary angiography (p&lt;0.001). NLR was significantly correlated with Gensini score. In logistic regression analyses, NLR was an independent predictor of CAD. An NLR of 2.34 or higher predicted the CAD with a sensitivity of 66% and specificity of 70%.Conclusions: There is significant association between severity of coronary artery disease and neutrophils to lymphocyte ratio. This study suggests that the NLR is an independent predictor of coronary heart disease that may be useful for cardiac risk stratification in patients with coronary artery disease.

Risk stratification for silent coronary artery disease in patients with type-2 diabetes mellitus: Contribution of vascular duplex ultrasound

Coronary artery disease (CAD) is one of the main causes of death in patients with type-2 diabetes mellitus (T2DM), but is often atypical or asymptomatic. The aim of the study was to investigate the contribution of peripheral vascular ultrasound data in the risk stratification of silent CAD. From 2010 to 2012, 541 patients with T2DM without cardiovascular (CV) history attended a CV screening consultation, including clinical, ECG and carotid and peripheral Duplex ultrasonography. According to findings, they were referred to a screening test for ischemic heart disease, and, if necessary, subsequent coronary angiography. Silent CAD was defined as ≥ 2 ischemic segments on stress cardiac imaging or as abnormal coronary angiography. Patients without chest pain and without ischemia on ECG represented 79% of the population, with a prevalence of silent CAD of 4% in this group. Medial calcinosis (MC) of crural arteries ( OR = 5.6; 95% CI: 1.96–15.9, P = 0.001) and the presence of ≥ 3 other CV risk factors ( OR = 3.2; 95%CI: 1.1–9.4, P = 0.038), were significantly associated with silent CAD. By excluding patients without any of these 2 parameters (55%), the coronary screening can be focused on a subgroup of patients at high risk (7.8%) for silent CAD, with a negative predictive value of 99.5%. Vascular Duplex ultrasound can improve the risk stratification for silent CAD in T2DM patients.

Role of Coronary Angiography in Pre–Liver Transplantation Cardiac Evaluation: Experience From an Asian Transplant Institution

BackgroundLiver transplant (LT) patients with significant coronary artery disease (CAD) have poorer outcomes. Pre-LT coronary angiography (CA) is associated with significant complications in cirrhotic patients. MethodsThis study aimed to identify predictors of abnormal CA in pre-LT cardiac assessment and to develop a predictive model to reduce unnecessary CA. From January 2006 to June 2013, 122 patients underwent CA based on the current institutional protocol. ResultsForty-one (33.6%) patients had abnormal CA. Univariate analysis showed age ≥65 years (P = .001), cryptogenic cirrhosis (P = .046), cardiac comorbidities (P = .027), ischemic heart disease (IHD; P = .002), left ventricular hypertrophy (LVH; P = .004), hypertension (P = .002), diabetes mellitus (P = .017), dyslipidemia (P < .001), metabolic syndrome (P = .003), ≥2 CAD risk factors (P = .001), and high Framingham risk score (hard CAD risk, P = .018; cardiovascular disease: lipids, P = .002; body mass index, P < .001) to be significant predictors of abnormal CA. A predictive model was developed with the use of multivariable logistic regression and included diabetes, dyslipidemia, IHD, age ≥65 years, and LVH, achieving a specificity of 55.1% and sensitivity of 90.0%. This would reduce unnecessary CA by up to one-half in our study population (from 81 to 35) while maintaining a false negative rate of only 8.5%. ConclusionsDiabetes, dyslipidemia, IHD, age ≥65 years, and LVH appear to be predictors of abnormal CA in pre-LT patients. Our predictive model may help to better select patients for CA, although further validation is required.

Diagnostic Value Of Post Exercise Systolic Blood Pressure Response In Ischemic Heart Disease

Background: The normal decline in systolic blood pressure during recovery phase of treadmill exercise dose not occur in most patients with coronary artery disease, in others recovery values systolic blood pressure may even exceed the peak exercise value. Objectives: Treadmill exercise test parameters indicating the presence and extent of coronary artery disease have traditionally included such as exercise duration, blood pressure and ST-segment response to exercise. The three –minute systolic blood pressure ratio is another important indicator of presence and significance of coronary artery disease is useful and obtainable measure that can be applied in all patients who are undergoing stress testing for evaluation of suspected ischemic heart disease and this increase the sensitivity of exercise test . Type of the study: A prospective study. Methods: Between April 2011 and April 2012 ,all patients underwent treadmill exercise test , echocardiography coronary angiography in Ibn Ab-bitar Hospital Cardiac Surgery. Clinical and procedural data for patients undergoing treadmill and coronary angiography were prospectively collected and entered into database specially designed for the present study.To calculate mean systolic blood pressure ratio for each , Measurement of blood pressure in the 3rd minute of recovery time and divided by peak systolic blood pressure during exercise test ,after excluding patients . Coronary angiography was done for all patients who under went treadmill exercise test and multiple views were taken accordingly to clarify the lesion and critical lesion defined as &gt;50% stenosis in LMS and &gt;70% stenosis in LAD,LCX and RCA. Results: We studied 100 patients In the period from April 2011 to April 2012, 78(78%) male and 22 (22%) a female with a mean age 55.49±7.60 who undergone treadmill exercise testing and coronary angiography to assess the chest pain, 32 patient had normal blood pressure 68 had hypertension and 24 patients had normal coronary angiography and 76 patients had abnormal coronary angiography. SBP/3 minute recovery blood pressure ratio was significantly higher in patient with coronary artery disease than patient without coronary artery disease (mean ±SD O.92±0.09 VS 0.81 SBP/3 minute recovery blood pressure ratio was significantly related with the severity of coronary artery disease its higher in three vessels than one vessel disease 0.95±0.10 vs0. 91 ±0.01 p-value 0.0001. Conclusions: post exercise blood pressure response in patients with coronary artery diseaseis higher than patients with normal coronary artery .post exercise blood pressure is related to the severity of coronary artery disease

Diagnostic accuracy of resting left ventricular akinesia/hypokinesia in predicting abnormal coronary angiography.

BackgroundAlthough several reports demonstrate the efficacy of stress echocardiography in diagnosing coronary artery disease, comparable studies on the competence of the same imaging technique at rest are limited. This study aimed to evaluate whether ventricular akinesia/hypokinesia and left ventricular ejection fraction (LVEF) < 55 % at rest are useful in predicting abnormal coronary angiography.MethodsThis study prospectively enrolled 100 diagnostic coronary catheterization candidates. Any routine echocardiography that the candidates had undergone before diagnostic coronary catheterization was reviewed. Patients were subclassified according to the presence and location of ventricular akinesia/hypokinesia, LVEF, and the results of diagnostic coronary catheterization. LVEF < 55 % was considered below the normal physiological limit. Abnormal coronary angiography was defined as narrowing of half or more of the caliber of at least one major coronary artery.ResultsAbnormal coronary angiography was significantly associated with akinesia/hypokinesia (OR = 4.85, P = 0.002) and LVEF < 55 % (OR = 5.75, P = 0.001). Screening of akinesia/hypokinesia and LVEF < 55 % as diagnostic tools for abnormal coronary angiography achieved comparable sensitivities (87.2 % vs. 88.9 %), specificities (41.5 vs. 41.8), and diagnostic accuracies (41.5 vs. 41.8). Left ventricular anterior wall akinesia/hypokinesia achieved a higher diagnostic odds ratio (9.7), sensitivity (95 %), and negative predictive value (96.4 %) compared with other types of akinesia/hypokinesia.ConclusionThe overall diagnostic accuracy of akinesia/hypokinesia and LVEF < 55 % to predict abnormal coronary angiography was poor, probably owing to significant influences of macro- as well as micro-vascular ischemia on left ventricular function.

NONINVASIVE ASSESSMENT THE HEMODYNAMIC SIGNIFICANCE OF CORONARY STENOSIS USING FUSION OF CARDIAC COMPUTED TOMOGRAPHY AND 3D ECHOCARDIOGRAPHY

Abnormal coronary CT angiography (CCTA) often leads to stress testing to determine hemodynamic significance of stenosis. We hypothesized that instead this could be achieved by fusion of the coronary anatomy with 3D echocardiography (3DE) derived resting myocardial deformation. We developed fusion

Prevalence and Risk Factors of Abnormal Coronary Angiography Findings

Background: Coronary artery occlusion is the primary reason for cardiovascular disease-related death worldwide. Hence, it is essential to identify the associated primary determinants for the proper prevention of coronary artery disease (CAD) and its related mortality and morbidity. Objectives: We investigated the association between cardiovascular risk factors and occlusion of coronary arteries. Patients and Methods: Using a cross-sectional study design, the medical records of 2046 consecutive patients suspected with car- diovascular disorders and referred to the angiography center at Imam Hossein hospital in Ilam province, Iran, between January 2010 and January 2012, were reviewed by census. Based on the angiography findings, the patients were classified as normal or included into coronary artery groups. The risk factors for cardiovascular disorders were also recorded. Binary and multivariable logistic regression models were used to determine the adjusted odds ratio (OR) for each risk factor. Results: The final multivariable regression modeling showed that gender (OR = 3.44, 95% CI: 1.02 - 5.58), age (OR = 1.10, 95% CI: 1.05 - 1.15), family history of CAD (OR = 1.12, 95% CI: 1.30 - 1.94), current smoking (OR = 1.50, 95% CI: 1.02 - 1.98), systolic blood pressure (OR = 1.16, 95% CI: 1.05 - 1.28), diastolic blood pressure (OR = 1.04, 95% CI: 1.00 - 1.09), and high density lipoprotein (HDL)-cholesterol level (OR = 1.04, 95% CI: 1.00 - 1.08) significantly increased the risk for coronary artery occlusion. Conclusions: Among the various non-modifiable variables, gender, age, and family history of CAD and among the modifiable variables, smoking, hypertension, and reduced HDL-cholesterol level increased the risk for coronary artery involvement. Further cohort studies and meta-analyses are required to delineate the causative association between these risk factors and coronary artery occlusion.

Enhanced External Counterpulsation Is an Effective Treatment for Depression in Patients With Refractory Angina Pectoris.

To examine the effect of enhanced external counterpulsation (EECP) on depression in patients with refractory angina pectoris (Canadian Cardiovascular Society class 2-4). The study was a prospective observational investigation with a 2-month control period preceding the EECP therapy (to minimize a possible effect of the regression-toward-the-mean phenomenon). The patients were examined 2 months before and just before EECP and just after, 3 months after, and 12 months after EECP. Depression was assessed using the Major Depression Inventory and the ICD-10. During EECP, 3 sets of cuffs were fastened around the lower extremities and were inflated sequentially to a pressure of 260 mm Hg in each diastole for 60 minutes 5 days a week for 7 weeks (35 sessions). The study was conducted at a regional hospital in Denmark from May 2006 to January 2011. Fifty patients with angina pectoris and an abnormal coronary angiography, with no possibility for revascularization, were included (72% men, mean age of 63 years) between May 2006 and January 2011. The prevalence of depression before EECP was 18%, just after was 2%, 3 months after was 2%, and 12 months after was 4% (P = .013). The depressive state was more severe at a lower age (P = .016). No significant predictors of effect of EECP on depression were found (P > .05), and no association was detected between decline in depressive state and chest pain (P > .05). The study indicates that EECP is an effective treatment for depression in patients with refractory angina pectoris, that depression is more severe in younger patients, and that the effect of EECP on depression is not related to the effect on chest pain. ClinicalTrials.gov identifier: NCT01112163.

Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography.

Atherosclerosis is a chronic systemic inflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are systemic inflammatory markers that are correlated with poor cardiovascular outcomes. To explore the relation of NLR and PLR with severity of coronary artery disease (CAD). The study population consisted of 180 consecutive patients who underwent elective coronary angiography (CAG). While 100 patients (22 female, mean age: 60.6 ± 12.6 years) had abnormal CAG, 80 patients (44 female, mean age: 57.2 ± 10.9 years) had normal CAG. NLR and PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. Although age distribution was similar between the two groups (p = 0.073), female gender was significantly higher in the normal CAG group (p < 0.001). Patients with abnormal CAG had significantly higher NLR and PLR when compared to patients with normal CAG (3.7 ± 2.6 vs. 2.2 ± 1.7, p < 0.001 and 125.9 ± 72.3 vs. 102.6 ± 33.8, p = 0.027, respectively). NLR and PLR were significantly correlated with SYNTAX score and GENSINI score. In logistic regression analyses, only NLR (odds ratio: 1.576, confidence interval: 1.198-2.072, p = 0.001) was an independent predictor of CAD. An NLR of 2.3 or higher predicted the CAD with a sensitivity of 66% and specificity of 70%. NLR and PLR seem to be a simple method to predict severity of CAD in patients undergoing elective CAG, and it may be part of cardiovascular examination before CAG.

Comparison of Tc-99m tetrofosmin myocardial perfusion scintigraphy and exercise F18-FDG imaging in detection of myocardial ischemia in patients with coronary artery disease

BackgroundDirect ischemia imaging with F18-FDG can potentially overcome many limitations of SPECT-MPS inherent to “cold imaging”. We compared SPECT-MPS with exercise F18-FDG PET in detection of ischemia in patients with suspected CAD. Methods45 patients with clinical suspicion of CAD without the history of myocardial infarction were prospectively included. All patients underwent Tc-99m tetrofosmin SPECT-MPS and exercise F18-FDG PET imaging within 7 days of SPECT-MPS, and both modalities were compared with coronary angiography for detecting ischemia. Results27 patients had an abnormal coronary angiography (at least one coronary artery with stenosis >50%). Exercise F18-FDG performed better than SPECT-MPS in LAD and LCX territory with comparably good performance in RCA territory. Exercise F18-FDG performed better in single-vessel disease and equally good in multi-vessel disease compared to SPECT-MPS. Performance of exercise 18F-FDG study was significantly better than SPECT-MPS (P = .0014) in the analysis of the 81 vascular territories in the 27 patients with abnormal coronary angiography. Performance of exercise F18-FDG was significantly better than SPECT-MPS in detecting ischemia in suspected CAD patients. ConclusionExercise F18-FDG imaging is a potentially useful ischemia imaging modality which offers the advantages of direct ischemia imaging in CAD patients.