Coronary Artery Lesions In Patients Research Articles

Correlation of lipoprotein(a) with clinical stability and severity of coronary artery lesions in patients with coronary artery disease

To analyze the correlation of lipoprotein(a) [Lp(a)] with the clinical stability and severity of coronary artery stenosis in patients with coronary artery disease (CAD). A total of 531 patients undergoing coronary angiography in Nanfang Hospital between January, 2013 and December, 2016 were enrolled in this study. At the cutoff Lp(a) concentration of 300 mg/L, the patients were divided into high Lp(a) group (n=191) and low Lp(a) group (n=340). In each group, the patients with an established diagnosis of CAD based on coronary angiography findings were further divided into stable angina pectoris (SAP) group and acute coronary syndrome (ACS) group. The correlation between the severity of coronary artery stenosis and Lp(a) was evaluated. The patients in high and low Lp(a) groups showed no significant differences in age, gender, body mass index, smoking status, hypertension, or diabetes (P>0.05). Multivariate logistic regression analysis revealed that age, gender, and serum levels of low-density lipoprotein cholesterol (LDL-C) and Lp(a) were independent risk factors for CAD in these patients. A high Lp(a) level was associated with an increased risk of CAD (OR=2.443, 95%CI: 1.205-4.951, P=0.013). The patients with a high Lp(a) level were at a significantly higher risk of CAD than those with a low Lp(a) level irrespective of a low or high level of LDL-C (P=0.006 and 0.020). In the patients with CAD, the ACS group had a significantly higher Lp(a) level than the SAP group (P < 0.001); the proportion of the patients with high Gensini scores was significantly greater in high Lp(a) group than in low Lp(a) group (17.3% vs 5.6%, P=0.026), and a linear relationship was found between Lp(a) level and Gensini score (R=0.130, P=0.006). Serum level of Lp(a) is an independent risk factor for CAD, and an increased Lp(a) is the residual risk for CAD. In patients with CAD, a high Lp(a) level is associated with the clinical instability and severity of coronary artery stenosis.

Cardiac Catheterization in Assessment and Treatment of Kawasaki Disease in Children and Adolescents.

Cardiac catheterization has become a promising tool to assess and treat coronary artery lesions in patients with Kawasaki disease. Significant coronary artery lesions can now be treated via transcatheter route even in small children. Further development and miniaturization of this technology will help to promote widespread use to the benefit of small children suffering from coronary artery disease. The role of diagnostic and interventional coronary artery procedures in children and adolescents are discussed in this article.

Difficulties of Diagnostics of Obstructive Coronary Artery Lesions in Patients with Stable Ischemic Heart Disease and Possibilities of Single-Photon Emission Computed Tomography

to assess diagnostic capabilities of single-photon emission computed tomography (SPECT) in the detection of obstructive coronary artery (CA) lesions, depending on the meeting appropriate use criteria. We used in this retrospective analysis data from 107 patients with previously diagnosed ischemic heart disease (IHD) or in need to exclude it, who were hospitalized in inpatient departments of the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2012 to 2015. All patients underwent coronary angiography (CAG) and SPECT (the time interval between the studies did not exceed 3 months) for detection of hemodynamically significant CA stenoses. Patients were distributed into two groups according SPECT imaging appropriateness score: group 1-88 patients with score 7-9 (in whom SPECT imaging was appropriate), group 2-19 patients with score 1-6 (in whom SPECT imaging was uncertain, possibly appropriate, or inappropriate. Clinical signs and symptoms of angina pectoris were predominantly found in group 1 patients (p=0.499). Asymptomatic patients were more likely to be found in group 2 (p<0.001). Group 1 patients commonly had high pretest probability (PTP) (over 90 %, p<0.001), whereas group 2 patients commonly had low PTP (5-10 %, p<0.001). Mean PTP was 77 and 58 % in groups 1 and 2, respectively (p=0.003). According to positive SPECT imaging, significant CA lesions were more often found in group 1 compared to group 2 (31.8 and 10.5 %, respectively, p=0.060). Two- and three-vessel disease prevailed in group 1 (25 % and 14.7 %) according the analysis of prevalence and location of hemodynamically significant CA lesions, although the data did not reach statistical significance (p=0.057 and p=0.073). Stenoses >70 % were more commonly detected in group 1, compared to group 2: in anterior descending artery 52.3 vs. 5.3 % (p<0.001), circumflex artery 35.2 vs. 10.5 %; (p=0.034), right coronary artery 34.1 vs. 10.5 % (p=0.041). The sensitivity in both groups was rather low (40 % vs. 25 %), whereas specificity was 83 % in group 1 and 93 % in group 2. According to clinical examination, patients with IHD and indications for SPECT imaging more often had obstructive CA lesions (63.6 %), than patients with questionable or no indications (21.1 %). However, rate of positive findings during stress tests with SPECT imaging was low in both groups and did not differ significantly (p=0.06). Despite high specificity of SPECT imaging, its sensitivity was low in both groups.

A new scoring system to predict Kawasaki disease with coronary artery lesions.

To clarify the independent risk factors and construct a scoring system for Kawasaki disease (KD) with coronary artery lesions (CAL) at acute and subacute stages. Data of KD inpatients at acute and subacute stages were reviewed in a tertiary care center from January 2009 to December 2014. A total of 2305 acute and subacute KD cases were enrolled in this study with a CAL rate of 24.1%. The OR (95%CI) values of male, total fever duration ≥ 8days, IVIG resistance (IVIGR), albumin (ALB) ≤ 35.9g/L, eosionphils (EO) ≥ 2.2%, and monocytes (MO) ≥ 5.9% were 1.45 (1.15-1.82), 1.78 (1.43-2.22), 1.42 (1.09-1.85), 1.53 (1.23-1.91), 1.17 (0.94-1.45), and 1.37 (1.09-1.69), respectively. In patients ≤ 6months old, the OR (95%CI) values for total fever duration ≥8days, delayed diagnosis, and ALB ≤ 35.9g/L were 3.61 (2.02-6.45), 3.49 (1.49-8.16), and 2.07 (1.14-3.74), respectively. ROC curve showed that the AUC value and sensitivity and specificity of predicting KD with CAL in patients ≤ 6months old were 0.731, 64.7%, and 80.9%, respectively. The independent risk factors for acute and subacute KD combined with CAL, including being a boy, long fever duration, IVIGR, low ALB, elevated EO, and MO. Joint of parameters (total fever duration ≥ 8days, delayed diagnosis, and ALB ≤ 35.9g/L) can be used to predict the occurrence of CAL in KD patients ≤ 6months old.

High antistreptolysin O titer is associated with coronary artery lesions in patients with Kawasaki disease.

Purpose In Kawasaki disease (KD) patients, coronary artery complications, incomplete and refractory types occur more frequently in patients with streptococcal or other bacterial/viral infections. Recently, we observed a higher incidence of coronary lesions in KD patients with high anti-streptolysin O (ASO) titer. Therefore, we hypothesized that KD patients diagnosed with concurrent streptococcal infection have poor prognoses, with respect to treatment response and development of coronary artery lesions.Methods A retrospective review was performed in 723 patients with KD who were admitted to 2 major hospitals between June 2010 and September 2017.Results Among 723 patients with KD, 11 initially showed an elevated ASO titer (>320 IU/mL) or elevated follow-up ASO titer after treatment. Of these patients, 5 showed no response to the first intravenous immunoglobulin treatment, 3 had abnormalities of the coronary arteries. This is a significantly higher proportion of patients with a high ASO titer (n=3, 27.3%) than those with a normal ASO titer (n=53 [7.4%], P=0.047). A severe clinical course was seen in 81.8% of patients in the high ASO group versus 14.5% of patients in the normal ASO group.Conclusion It is not certain whether acute streptococcal infection may cause KD, but this study revealed that KD with high ASO titers showed higher rates of severe clinical course. It may be helpful to analyze concurrent streptococcal infection in patients with a severe clinical course.

A8808 Correlation Study between Serum Uncoupling Protein 2 Level and the Severity of Coronary Artery Lesions in Patients with Stable Coronary Artery Disease

Objectives: To investigate the correlation between serum uncoupling protein 2 (UCP2)level and severity of coronary artery disease (including Gensini score and criminal vessel counts)in patients with stable coronary artery disease (SCAD),and analyze the predictive value of serum UCP2 and urine acid (UA) on SCAD. Methods: 330 patients in Department of Cardiology,the First Affiliated Hospital of Chengdu Medical College from June 2015 to June 2017 were included.240 patients with SCAD (SCAD group),90 patients without coronary artery disease (control group) were diagnosed. Serum UCP2 level was detected by enzyme linked immunosorbent assay (ELISA)sandwich method and analyzed statistically. Results: Baseline characteristics were similar between the two groups. Serum UCP2 and UA level of SCAD group was higher than the control group:UCP2[1.60 (0.67,4.60)μg/L]vs.[0.42 (0.28,0.59)μg/L](p < 0.01),UA[(365.74 ± 66.06)μmol/L]vs.[(268.11 ± 45.81)μmol/L](p < 0.01). Multivariate Logistic regression analysis showed that UCP2 (OR = 1.010,95%CI:1.001–1.020, P = 0.025) and UA (OR = 1.039,95%CI:1.007–1.072,P < 0.05) were independently associated with SCAD. Correlation analysis showed that serum UCP2 level was positively correlated with Gensini score (r = 0.780,P < 0.01) and criminal vessel counts (r = 0.543,P < 0.01). The receiver operating characteristic curve (ROC) showed that the optimal cutoff point of serum UCP2 level predicting SCAD was 0.64 μg/L. The sensitivity was 0.833 and the specificity was 0.944. The difference in area under the curve between serum UCP2 and UA (ΔAUC) was not statistically significant (P > 0.05). Conclusion: The higher serum UCP2 level in patients with SCAD,the more severe coronary lesions. Serum UCP2 level may be a new indicator of predicting SCAD,which was no significant difference compared with traditional oxidative stress indicator of serum UA.

Delayed intravenous immunoglobulin treatment increased the risk of coronary artery lesions in children with Kawasaki disease at different status

ABSTRACT Objective: Kawasaki disease (KD) is a systemic vasculitis with serious complications, especially the development of coronary artery lesions (CALs). The aim of this study was to identify the risk for the development of CALs with IVIG treatment of KD >10 days after illness onset in patients with different KD status, and explore potential moderators of the association between delayed treatment and CALs. Methods: We performed a retrospective review of the medical records of KD patients. All patients were divided into two groups (conventional therapy group and delayed therapy group, IVIG treatment ≤10 days vs >10 days). We compared the demographic and clinical characteristics, laboratory data, and analyzed risk factors for CALs in patients who received IVIG treatment >10 days, and determined whether different status of KD modified the effects of delayed IVIG treatment on CALs. Results: In the delayed IVIG treatment group, children were more likely to develop CALs and the proportion of incomplete KD was higher, compared with the conventional therapy group. The number of children younger than 12 months or older than 61 months was higher and children had higher BMI and were more likely to receive steroids before diagnosis in the delayed IVIG treatment group compared with the conventional therapy group. Delayed IVIG treatment was an independent risk factor for the development of CALs (adjusted OR = 2.90, 95%CI = 1.42, 5.91). Delayed therapy children with higher levels of C-reactive protein (>79 mg/L) and erythrocyte sedimentation rate (>34 mm/h) had the highest risk for developing CALs (OR = 5.68, 95%CI: 1.17, 27.59; OR = 4.11, 95%CI: 1.62, 10.46, respectively). Conclusion: Delayed IVIG treatment was an independent risk factor for the development of CALs. Children in the delayed IVIG treatment group with higher levels of CRP and ESR (CRP >79 mg/L, ESR >34 mm/h) had the greatest likelihood of developing CALs.

Relationship between mean platelet volume-to-lymphocyte ratio and coronary artery abnormalities in Kawasaki disease.

Recently, mean platelet volume-to-lymphocyte ratio has emerged as a novel parameter of inflammation. No study has investigated the role of mean platelet volume-to-lymphocyte ratio in children with Kawasaki disease. We aimed to evaluate the relationship between mean platelet volume-to-lymphocyte ratio and coronary artery abnormalities in Kawasaki disease. Between January 2008 and January 2017, a total of 58 children with Kawasaki disease and 42 healthy subjects matched for sex and age were enrolled. Before the treatment, transthoracic echocardiography for all children was performed. Clinical and laboratory results including mean platelet volume, platelet distribution width, red blood cell distribution width, and counts of platelets, neutrophils, lymphocytes, and white blood cells, erythrocyte sedimentation rate, and C-reactive protein levels were measured. Mean platelet volume-to-lymphocyte ratio was calculated as mean platelet volume divided by lymphocyte count. Compared with healthy controls, mean platelet volume-to-lymphocyte ratio was significantly lower in the children with Kawasaki disease (p<0.01). A total of 14 patients (24.1%) had incomplete Kawasaki disease and 15 (25.8%) children with Kawasaki disease had coronary involvement. Mean platelet volume-to-lymphocyte ratio was significantly lower in patients with coronary artery abnormalities (p<0.01). According to receiver operating characteristic curve analysis performed for the prediction of coronary artery abnormalities, the best cut-off point for mean platelet volume-to-lymphocyte ratio was 2.5 (area under curve=0.593, sensitivity 53.3%, specificity 51.1%). It was first shown that the children with Kawasaki disease have lower mean platelet volume-to-lymphocyte ratio compared with control subjects. Mean platelet volume-to-lymphocyte ratio may be helpful in predicting coronary artery lesions in patients with Kawasaki disease.

Characteristics of the clinical background and coronary artery lesions in patients with type 2 diabetes mellitus without a previous history of cardiovascular disease

Characteristics of the clinical background and coronary artery lesions in patients with type 2 diabetes mellitus without a previous history of cardiovascular disease

Myocardial Perfusion Reserve Index in Children With Kawasaki Disease.

Coronary artery lesions in patients with Kawasaki disease (KD) can impair myocardial perfusion, yet evaluation of perfusion defects by cardiac magnetic resonance (MR) in children is often qualitative. In this study we aimed to use a quantitative method of myocardial perfusion using stress cardiac MR-derived myocardial perfusion reserve index (MPRI) in children with KD and compare MPRI with ventricular mechanical performance evaluated by cardiac MR strain analysis. This study was a retrospective review. Twenty-one children with a diagnosis of KD who underwent stress perfusion cardiac MR were compared with nine controls. First-pass perfusion imaging using a T1 -weighted gradient echo sequence was performed at rest and stress after administration of adenosine with 1.5T or 3T magnets. The MPRI was calculated as the ratio of maximum slope of myocardial enhancement during stress compared to rest and was evaluated with the American Heart Association 17 segment model. Demographic and clinical characteristics among KD patients and controls were compared using Student's t-test for normally distributed continuous variables, Wilcoxon-rank sum test for nonnormally distributed variables, and χ2 for categorical variables. There was a significant decrease in MPRI in Segment 7 (1.53 vs. 2.23, P = 0.0058) in KD patients compared with controls. The reduction in MPRI in Segment 12 approached statistical significance (1.58 vs. 2.31, P = 0.0636). Three patients who underwent serial studies had decreased MPRI longitudinally. No differences were seen in circumferential or radial strain. MPRI shows impaired myocardial perfusion in patients with KD. MPRI can change over time, suggestive of progressive coronary artery changes, which may precede fibrosis and mechanical decline. MPRI can assess segmental and global perfusion defects in patients with KD and should be a part of routine cardiac MR evaluation in KD. 3 Technical Efficacy Stage 3 J. Magn. Reson. Imaging 2017.

Factors Predicting Resistance to Intravenous Immunoglobulin Treatment and Coronary Artery Lesion in Patients with Kawasaki Disease: Analysis of the Korean Nationwide Multicenter Survey from 2012 to 2014

Background and ObjectivesApproximately 10–15% of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) and have higher risk for coronary artery lesion (CAL). The aim of this study was to identify predictive factors from laboratory findings in patients who do not respond to IVIG treatment and develop CAL from KD.MethodsWe retrospectively collected nationwide multicenter data from the Korean Society of Kawasaki Disease and included 5,151 patients with KD between 2012 and 2014 from 38 hospitals.ResultsAmong 5,151 patients with KD, 524 patients belonged to the IVIG-resistant group. The patients in the IVIG-resistant group had a significantly higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (1,573.91±3,166.46 vs. 940.62±2,326.10 pg/mL; p<0.001) and a higher percentage of polymorphonuclear neutrophils (PMNs) (70.89±15.75% vs. 62.38±32.94%; p<0.001). Multivariate logistic regression analyses revealed that significantly increased PMN, NT-proBNP, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were the predictors of IVIG resistance (p<0.05). Multivariate logistic regression analyses also showed that only CRP was associated with the risk of CAL (p<0.01), while PMN, NT-proBNP, AST, and ALT were not.ConclusionsElevated PMN, serum NT-proBNP, CRP, AST, and ALT levels are significantly associated with IVIG resistance in patients with KD. Moreover, serum CRP is significantly increased in patients with KD with CAL.

Correlation of heart rate variability and procalcitonin, high sensitivity C-reactive protein in children with Kawasaki disease in the acute stage

Objective To investigate the relationship of heart rate variability(HRV) and procalcitonin(PCT), high sensitivity C-reactive protein(hs-CRP) and erythrocyte sedimentation rate(ESR) in children with Kawasaki disease (KD) in the acute stage, and to investigate their value in diagnosis and prognosis of KD especially incomplete KD (iKD). Methods Two hundred and twenty patients with KD in Chengdu Women and Children′s Central Hospital from August 2012 to October 2015 were selected.According to the diagnostic criteria, patients with KD were divided into a typical KD group and an iKD group.According to the status of coronary artery damage, the patients with KD were divided into coronary artery lesion (CAL) group and no coronary artery lesion(NCAL) group.Another 100 healthy children were selected as healthy control group.All the children received 24 h dynamic electrocardiogram and were given tests of blood PCT, hs-CRP and ESR.The differences of HRV, PCT, hs-CRP and ESR between the CAL group and the NCAL group, between the typical KD group and iKD group were compared.The correlations of HRV and PCT, hs-CRP and ESR were analyzed. Results Of 220 KD patients, 182 cases were in the typical KD group and 38 cases in the iKD group; 64 cases in the CAL group and 156 cases in the NCAL group.The mean levels of HRV were lower in KD group than those in healthy control group(all P 0.05). The mean level of ESR had a statistically significant difference between 2 groups(P<0.05). SDNN was negatively correlated with PCT, hs-CRP and ESR (r=-0.443, -0.364, -0.427, all P<0.05). Conclusion In patients with KD in the acute stage, the decrease of HRV can be correlated with inflammatory reaction.HRV can be used as valuable predictors for coronary artery lesion in patients with KD, but its help in the early diagnosis of iKD has not found. Key words: Kawasaki disease; Heart rate variability; Procalcitonin; High sensitivity C-reactive protein; Erythrocyte sedimentation rate

Efficacy and safety of plasma exchange for Kawasaki disease with coronary artery dilatation

BackgroundThe treatment of Kawasaki disease is controversial when intravenous immunoglobulin therapy fails, although it typically relies on combinations of prednisolone, infliximab, cyclosporine, and plasma exchange therapy. The goal of the treatment is no longer merely to reduce mortality but also to decrease the sequelae of coronary artery lesions, which are the most common and potentially life-threatening complications. Recently, plasma exchange therapy has been used to treat intravenous immunoglobulin-unresponsive Kawasaki disease with coronary artery lesions. When performed before coronary artery dilatation, the outcomes for plasma exchange are known to be excellent; however, when dilatation is already present, sequelae persist.MethodsBetween December 2006 and April 2015, we treated ten patients with Kawasaki disease complicated by coronary artery lesions that received plasma exchange because intravenous immunoglobulin therapy had proven to be ineffective. Here, we retrospectively review the efficacy and safety of plasma exchange therapy in such unresponsive cases against coronary artery lesions in patients with Kawasaki disease when plasma exchange performed after coronary artery dilatation.ResultsIn nine of the ten patients (90.0%), the body temperature was confirmed to be < 37.5 °C at an average of 2.7 ± 1.4 days after starting plasma exchange. Serum C-reactive protein levels decreased significantly from 9.9 ± 4.9 mg/dL before exchange to 1.9 ± 2.9 mg/dL after exchange (P < 0.05). One year after plasma exchange treatment, the coronary artery lesions had regressed to within normal limits in six of the ten patients. Although lesions remained in three patients, all three of these patients were asymptomatic. In addition, there were no stenosis of the coronary artery in nine of the ten patients. One patient died due to a ruptured giant coronary aneurysm 1 day after starting plasma exchange.ConclusionsIn conclusion, plasma exchange may be effective in not only regressing coronary artery lesions but also preventing sequelae in patients with Kawasaki disease when plasma exchange is performed after coronary artery dilatation.

2194Discordance between angiographic and physiologic evaluation of coronary artery lesions in patients with aortic valve stenosis

2194Discordance between angiographic and physiologic evaluation of coronary artery lesions in patients with aortic valve stenosis

Western Dietary Pattern Is Associated With Severe Coronary Artery Disease.

The independent predictive value of an unhealthy diet on the severity of coronary artery disease (CAD) requires further investigation. We assessed the impact of dietary pattern on CAD severity. In this cohort study, we included 188 symptomatic stable patients with CAD. Patients were categorized as having severe CAD or nonsevere CAD by coronary angiography. Among several demographics and clinical characteristics, all patients were tested using a semiquantitative food frequency questionnaire. Concerning baseline demographic characteristics, there was no difference between patients with severe CAD and nonsevere CAD. Principal component analysis revealed 8 distinct dietary patterns. The first component Western dietary pattern (increased intake of fat, red meat, and carbohydrates and minimal consumption of fruits and green leafy vegetables) was predictive of severe CAD (area under the curve: 0.73, 95% confidence intervals: 0.64-0.83, P < .001). In conclusion, an unhealthy Western type of diet is associated with the severity of coronary artery lesions in patients with stable CAD. These findings highlight the role of dietary patterns when estimating cardiovascular risk for the management of patients with CAD.

Identification of mutations associated with coronary artery lesion susceptibility in Kawasaki disease by targeted enrichment of genomic region sequencing technique

Objective: To screen and identify the mutations in Kawasaki disease by targeted enrichment of genomic region sequencing technique and investigate susceptibility genes associated with coronary artery lesion. Method: This was a case-control study.A total of 114 patients diagnosed as Kawasaki disease treated in Shanghai Children's Hospital between December 2015 and November 2016 were studied and another 45 healthy children who were physically examined in outpatient department were enrolled as control group. Patients were divided into two groups based on the results of echocardiogram. Peripheral venous blood was obtained from patients and controls. Genomic DNA was extracted. SeqCap EZ Choice libraries were prepared by targeted enrichment of genomic region technology. Then the libraries were sequenced to identify susceptibility genes associated with coronary artery lesion in patients diagnosed as Kawasaki disease.Susceptible genes were identified by Burden test, Pearson chi-square test or Fisher's exact probability test. Result: There was statistically significant difference in TNFRSF11B(rs2073618)G>C(p.N3K)mutation and GG/GC/CC genotype between Kawasaki disease group and control group(χ(2)=15.52, P=0.00). There was statistically significant difference in TNFRSF13B(rs34562254)C>T(p.P251L)mutation(χ(2)=10.40, P=0.01)and LEFTY1(rs360057)T>G(p.D322A)mutation(χ(2)=8.505, P=0.01)between patients with coronary artery lesions and those without. Conclusion: Targeted enrichment of genomic region sequencing technology can be used to do primary screening for the susceptible genes associated with coronary artery lesions in Chinese Kawasaki patients and may provide theoretical basis for larger sample investigation of risk prediction score standard in Kawasaki disease.

Expression of Fc < gamma > Rs on monocytes among Kawasaki disease patients with coronary artery lesions

ObjectiveTo study expression of Fc gamma receptors (Fc<gamma>Rs) on monocytes in Kawasaki disease (KD) patients with coronary artery lesions (CAL). Methods160 newly diagnosed KD patients and 80 health children were enrolled in this study. All patients were scheduled to receive both aspirin and intravenous immunoglobulin (IVIG). Serial blood samples were obtained before and 3days after completing IVIG therapy. The first two-dimensional echocardiographic examination was performed for all KD patients within 10days, and was repeated at 3weeks. CAL was defined by coronary artery Z-scores≥2.5 by echocardiography. Expression of inhibitory and activating Fc<gamma>Rs on CD14+ monocytes (MCs) was assessed by flow cytometry. Cytokine expression in MC was evaluated by PCR. ResultsOf the 160KD patients enrolled in this study, 36 had coronary artery lesions (KD-CAL+ group), while 124 did not (KD-CAL− group). There was no significant difference in Fc<gamma>RI expression on MCs from KD patients and that of Ctrls. Although Fc<gamma>RIII and Fc<gamma>RIIa levels were significantly higher in KD patients compared with those in Ctrls, there were no significant differences between the KD-CAL+ and KD-CAL− groups. Fc<gamma>RIIb expression in the KD patients was lower than that of Ctrls, meanwhile expression in the KD-CAL+ group was lower than that in the KD-CAL− group. After IVIG therapy, Fc<gamma>RIIb expression increased in KD-CAL+, but did not reach the normal range. A negative correlation was observed between the levels of IL-6, TNF-α and Fc<gamma>RIIb expression. ConclusionDecreased Fc<gamma>RIIb expression on MCs may contribute to the development of coronary artery lesions in patients with KD.

Association of Circulating IGFBP1 Level with the Severity of Coronary Artery Lesions in Patients with Unstable Angina.

Aims. Local IGFBP1 level was reported to affect the development of coronary artery plaque. This study investigated the association of circulating IGFBP1 level with the severity of coronary artery lesions in patients with unstable angina. Materials and Methods. In 112 consecutive patients with clinically diagnosed unstable angina, admitted from July 2014 to July 2015, we studied the correlations of circulating IGFBP1 and the severity of coronary artery disease (CAD). Results. All patients underwent scheduled coronary angiography, and 67 cases were diagnosed with critical and 45 with noncritical CAD. Of the 67 critical CAD patients, 41 (61.19%) presented with multivessel and 26 (38.81%) with single-vessel lesions. IGFBP1 levels were higher in patients with multivessel than those with single-vessel lesions. Moreover, the IGFBP1 level was positively correlated with the GRACE score. Among clinical variables, the IGFBP1 level was correlated with HDL-C. IGFBP1 alone (cutoff 20.86 ng/ml) demonstrated a sensitivity of 0.448 and specificity of 0.933 in predicting CAD. Combination of IGFBP1 and HDL-C had a sensitivity of 0.821 and specificity of 0.800 in predicting CAD. Conclusions. Circulating IGFBP1 level positively correlated with the severity of CAD. IGFBP1, when combined with HDL-C, might be useful in screening for high risk CAD patients.

Effect of blood glucose control level on coronary artery lesions in patients with coronary heart disease complicated with diabetes

Objective To analyze the effect of blood glucose control level on coronary artery lesions in patients with coronary heart disease complicated with diabetes. Methods One hundred patients with coronary heart disease complicated with type 2 diabetes mellitus treated at our hospital from March, 2013 to February, 2015 were selected as study objects and were divided into an observation group and a control group according to different blood glucose control levels (plasma glycosylated hemoglobin < 6.5% and fasting blood glucose ≤ 7.0 mmol/L indicate ideal blood glucose control), 50 cases for each group. The degree of coronary artery stenosis, the number of affected vessels, and the number of cases with diffuse lesions were compared between these two groups. The Gensini scores of coronary artery disease in the two groups were analyzed. The levels of von Willebrand factor (vWF) were compared between these two groups by enzyme linked immunosorbent assay (ELISA). Results There were no statistical differences in the degrees of coronary artery stenosis between the observation group (non-severe 46.00%, severe 34.00%) and the control group (non-severe 36.00%, severe 44.00%) (P>0.05). The numbers of affected vessels (single 4.00%, double vessels 60.00%, three vessels 36.00%) and diffuse lesions (16.00%) in the observation group were significantly lower than those in the control group (single 2.00%, double vessels 24.00%, three vessels 74.00%, diffuse lesions 42.00%) (P<0.05); HbA1c [(2.17±1.20)%], Gensini score [(49.27±1.14)] and vWF [(65.23±1.24)%] in the observation group were significantly lower than those in control group (P<0.05). Conclusion Diabetes aggravates the degree of coronary artery lesions. Therefore, coronary artery lesions can be reduced by controlling blood glucose levels and reducing vWF. Key words: Blood glucose; Control; Coronary heart disease; Diabetes; Coronary artery lesions; Effect; Analysis

Preoperative evaluation of coronary artery fistula using dual-source computed tomography

ObjectivesTo evaluate the efficacy of dual-source computed tomography (DSCT) in assessing the morphological features, quantitative features, and associated coronary artery lesions among patients with coronary artery fistula (CAF) before surgery. MethodsWe enrolled 34 patients with CAF that were morphologically and quantitatively analyzed by DSCT and compared the analyses with surgical results (reference standard). The associated coronary artery lesions were also assessed. ResultsBy DSCT, we identified 15 patients (44.1%) with left-sided CAF, 9 (26.5%) with right-sided CAF, and 10 (29.4%) with bilateral CAF; the left anterior descending coronary artery (50.0%) was most frequently involved. Drainage was most commonly in the main pulmonary artery (41.2%), and those with right-sided CAF had larger feeding coronary arteries and drainage sites than those with left-sided or bilateral CAF (p<0.05). All the morphological features presented by DSCT were confirmed at surgery. In the quantitative analysis of CAF, DSCT was as accurate as surgery (r=0.95–0.98, p<0.001), and it was able to evaluate associated lesions accurately, including arteriosclerotic plaques, coronary artery aneurysms, and myocardial bridges. The evaluation could be completed in a single scan, without requiring an increased radiation dose (mean ED=2.27±1.92mSv). ConclusionsDSCT is an alternative noninvasive imaging method that enables accurate assessment of morphological features, quantitative features, and associated coronary artery lesions in patients with CAF. It can be used to provide comprehensive information for determining surgical strategies.