Results Of Coronary Arteriography Research Articles

Study on the correlation between subgroup of blood lipid with degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease

Objective: To study the correlation between low-density lipoprotein particles (LDL-P) with other lipoprotein indexes. To explore the correlation between LDL-P and its subgroup particles(LDL1-P-LDL6-P) with the degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease(CHD) combining with the result of coronary arteriography. To explore the value of lipoprotein subgroup granules in preventing the severity of coronary artery stenosis in CHD patients. Methods: Cross-sectional study. A total of 259 patients without lipid-lowering drugs for coronary angiography in the department of cardiology of TEDA International Cardiovascular Hospital during 3 months from August 2019 to December 2019 were collected, and 52 healthy subjects were recruited during the same period. The level of high sensitivity C-reactive protein (hs-CRP) and other biochemical indexes were detected by automatic biochemical analyzer. The level of LDL-P and other biochemical indexes were detected by nuclear magnetic resonance spectroscopy(NMRS). The relation between various biomarkers levels with coronary artery stenosis degree was analyzed. Analysis of variance and nonparametric tests were used to compare the differences of indexes among each group. Pearson correlation analysis was used to determine the correlation among the measured indexes. Logistic regression was used for multi-factor analysis, ROC curve was used to evaluate the diagnostic value of related indexes. Results: LDL-P was highly correlated with low-density lipoprotein cholesterol (LDL-C),apolipoprotein B (ApoB) and total cholesterol (TC) (r= 0.927, P<0.001; r=0.921, P<0.001; r=0.844, P<0.001). LDL-P, LDL4-P, LDL5-P and LDL6-P in patients with severe coronary stenosis were higher than those in patients with mild coronary stenosis(U=4 172.000, Z=4.256, P<0.001; t=2.573, P=0.011; U=3 995.000, Z=4.621, P<0.001;t=5.223, P<0.001), LDL-P and LDL6-P were higher than those of patients with moderate coronary stenosis (U=1 159.000, Z=2.294, P=0.022; t=2.075, P=0.041). High levels of hs-CRP, LDL5-P and LDL6-P were risk factors for the degree of coronary stenosis(OR=1.095, P=0.036;OR=1.015, P=0.046;OR=1.012, P=0.039). ROC analysis showed that the AUC of LDL-P, LDL5-P and LDL6-P on coronary stenosis was 0.67, 0.68 and 0.69, respectively. Hs-CRP combined with LDL5-P and LDL6-P had the greatest effect on the degree of coronary stenosis (AUC= 0.70). Conclusions: LDL-P is highly correlated with LDL-C. The levels of LDL-P and LDL6-P were significantly higher in patients with severe stenosis than in patients with mild and moderate stenosis. hs-CRP, LDL5-P and LDL6-P can be used as new risk factors for the degree of coronary stenosis and may be further used as risk predictors. The combined detection of hs-CRP, LDL5-P and LDL6-P is helpful for the diagnosis of the severity of coronary stenosis, and may further become risk predictors.

Correlation between the Serum Platelet-Derived Growth Factor, Angiopoietin-1, and Severity of Coronary Heart Disease.

Background The expression of the platelet-derived growth factor (PDGF), angiopoietin-1 (Ang-1) in patients with coronary artery disease of different studies was inconsistent. This study was to investigate the expression of the PDGF and Ang-1 in peripheral blood and coronary artery in patients with acute coronary syndrome (ACS) and the relationship between the expression of the PDGF and Ang-1 and the severity of coronary artery disease. Methods A total of 81 patients with acute coronary syndrome undergoing coronary angiography were enrolled from September 2012 to December 2013. Patients with ACS included 61 patients with acute myocardial infarction (AMI group) and 20 patients with unstable angina pectoris (UAP group). The 29 patients who were hospitalized for chest pain undergoing coronary angiography without stenosis and with TIMI level 3 blood flow were selected as the control group. During coronary arteriography (CAG) or percutaneous coronary intervention (PCI), blood in the peripheral artery and in the local coronary artery was collected from all the patients. Serum PDGF and Ang-1 levels were measured by ELISA. We calculated the Gensini score of each patient with CHD according to the result of CAG. Patients with ACS were followed up, and the major adverse cardiovascular and cerebrovascular adverse events were recorded. Results In peripheral blood, the concentration of the PDGF was significantly elevated in the ACS group than that of the control group. The level of the PDGF in the AMI group was significantly higher than that in the UAP group. In coronary artery blood, the level of the PDGF in the ACS group was significantly higher than that of the UAP group. There was no significant difference in the concentration of Ang-1 in peripheral blood between patients with coronary heart disease and the control group. The concentration of Ang-1 in the coronary artery was significantly lower than that in peripheral blood. The coronary Ang-1 concentrations in the ACS group were significantly higher than those in the UAP group. The concentrations of the PDGF and Ang-1 in peripheral and coronary artery blood were positively correlated with the severity of coronary lesions. Patients with MACCE had higher PDGF and Ang-1 levels in the coronary sinus. Conclusion The serum PDGF concentration in patients with acute coronary syndrome was significantly increased, especially in the local coronary artery. The serum Ang-1 in the coronary artery was significantly increased in patients with acute myocardial infarction and was related to the degree of coronary artery stenosis. Coronary sinus PDGF and Ang-1 levels can reflect the severity of lesions in patients with acute coronary syndrome.

Association of CXCL12/CXCR4 gene polymorphisms with genetic risk and severity of coronary stenosis in patients with coronary artery disease

To investigate the association of CXCL12 and CXCR4 polymorphisms with the genetic risk and severity of coronary stenosis in patients with coronary artery disease (CAD). Competitive allele specific PCR(KASP) was performed to identify the genotypes of rs2297630 and rs2322864 polymorphisms in 302 CAD patients and 302 age-and gender-matched healthy controls. The severity of CAD patients was assessed by the Gensini scoring system according to the results of coronary arteriography. The association of rs2297630 and rs2322864 polymorphisms with genetic risk of CAD and Gensini scores were analyzed by unconditional logistic regression and multivariate linear regression respectively. There were significant differences in the genotype and allele frequencies of both rs2297630 and rs2322864 between the CAD group and healthy control (all P<0.01). Regression analysis showed that rs2297630 polymorphism was associated with genetic risk of CAD and Gensini scores (all P<0.01). People who carried the AA genotype suffered higher risk of CAD susceptibility and more serious coronary stenosis (all P<0.01), compared with GG genotype carriers. There was also significant association between rs2322864 polymorphism and genetic risk of CAD (P<0.01); those who carried the CT genotype had higher risk of CAD (P<0.01), compared with TT genotype carriers. However, rs2322864 polymorphism was not associated with the severity of coronary stenosis (P>0.05). Gene polymorphism of CXCL12 rs2297630 is associated with the genetic risk of CAD and the severity of coronary stenosis. Moreover, the gene polymorphism of CXCR4 rs2322864 is associated with genetic risk of CAD, but not with the severity of coronary stenosis.

Soluble ST2 protein and hospitalizations due to worsening chronic heart failure during a one-year follow-up in a population with reduced ejection fraction.

Hospitalizations due to worsening chronic heart failure (CHF) are common. However, the relationship between a single measurement of soluble ST2 protein (sST2) and the necessity of hospitalization in CHF is still unclear. The aim of this study was to determine the association between a single measurement of sST2 concentration and hospitalizations due to worsening CHF during a one-year follow-up. The study involved 167 consecutive patients (mean age 63 years, 83% males) with CHF in stable NYHA classes I-III with left ventricular ejection fraction (LVEF) ≤ 45% (median 29.65%, range 13-45%). Fifty-six variables were analyzed (clinical factors, basic laboratory results on admission, standard 12-lead ECG, echocardiography and coronary arteriography results). Information about hospitalizations due to worsening CHF was obtained during telephone interviews conducted 12 months after discharge from the cardiac ward. In order to define factors associated with hospitalization, uniand multivariate regression analyses were performed. A total of 53 patients from the study group (38%) were hospitalized due to worsening CHF. They included a higher percentage of males (p = 0.042), higher concentrations of sST2 (p = 0.049), and glucose (p = 0.010). The multivariate analysis (for model χ2 = 17.235; p < 0.001) revealed that glucose and sST2 were independently associated with hospitalization due to worsening CHF during the 1-year observation (p < 0.001). In patients with stable mild to moderate CHF with reduced EF, a single measurement of sST2 protein and glucose were independent variables for hospitalization due to worsening CHF over a 1-year follow-up period. The defined prognostic model including sST2 and fasting glucose better identified patients without HF-related hospitalizations.

IN-PATIENT OUTCOMES OF PHARMACOINVASIVE REPERFUSION STRATEGY FOR ST ELEVATION MYOCARDIAL INFARCTION

Aim. To evaluate efficacy of pharmacoinvasive strategy (PCS) of treatment in ST elevation myocardial infarction (STEMI) in Rostovskaya Region, during the nearest (in-patient) period. Material and methods. The analysis performed, of 587 STEMI patients, who were referred to Regional Vascular Center “ROKB” of Rostov-na-Donu city from hospitals of the city and neighborhoods since January 2010 till June 2015, with the aim to undergo percutaneous coronary intervention (PCI) after thrombolytic therapy (TT) as PCS reperfusion strategy. Timeline mediana from pain onset to the start of TT was 140 minutes (interquartile range: 80,5-205 min). In 36,5% cases, TT was done at prehospital stage. Timeline mediana between TT and PCI was 34 hours. The results were evaluated in the nearest (in-hospital) period by the parameters as success of TT by ST dynamics on ECG, the level of blood flow restore in infarction-related artery (IRA) by TIMI score on coronary arteriography after TT in finishing of PCI, the rate of bleedings by TIMI and combinatory parameter of major adverse cardiovasular events (death, recurrent MI, stroke, need for another revascularization of target vessel). Results. ТТ regarded as successful in 52,5% of patients. By the results of coronary arteriography, blood flow TIMI-2/3 after TT was reached in 378 from 586 (64,5%) of patients. Stenting of coronary arteries was done in 548 among 586 (93,5%) of patients; in 25 (4,3%) of patients after TT there were no hemodynamically significant stenoses, in 13 (2,2%) patients stenting of IRA was technically impossible. Application of PCS in STEMI treatment made it to achieve TIMI-2/3 blood flow in IRA in 98,5% (577 among 586) patients. Rate of major bleedings was 1,9%. Stent thrombosis and recurrent infarctions did not happen, in-hospital mortality was 3,6%, rate of major adverse cardiovascular events — 3,7%. Conclusion. PCS makes it to increase time parameters of reperfusion and to increase its efficacy comparing to thrombolysis in those hospitals where it is impossible to perform primary PCI to improve long-term results of PCS it is important to reduce the time “pain-needle”, and to perform coronary angiography in maximum short time after thrombolysis. Regardless that the PCS matches with the region specifics, it is important to optimize healthcare with the aim to perform primary PCI for the highest possible number of patients.

EPICARDIAL OBESITY AND A RANGE OF METABOLIC RISK FACTORS RELATION WITH THE PREVALENCE INDEX OF CORONARY ATHEROSCLEROSIS

Aim. To assess the relation of epicardial fat tissue thickness (EFTT) and other metabolic risk factors with the index of coronary atherosclerosis Spread (CASI) in obese patients. Material and methods. Totally 186 men included (54,4±9,1 y.o.) with coronary heart disease (CHD) and obesity. By the results of coronary arteriography we calculated Gensini Score of CASI. All patients underwent laboratory tests with the measurement of basic and additional metabolic risk factors and echocardiography with EFFT measurement. Results. By the data of regression analysis we selected 7 predictors significantly related to EFTT: CASI (β=0,390), resistine (β=0,453), glucose (β=152), adiponectine (β=-0,175), high density lipoproteides cholesterol (β=-0,138), interleukine-6 (β=0,118), and tumor necrosis factor-α (β=0,117). Measurement of the predictors values led in 52,1% to the changes of CASI value (R²=0,521). Conclusion. In obese patients the assessment of the parameters described makes possible to circle a high risk group for unsymptomatic CHD forms with the aim for on-time investigation of patients and for early preventive interventions.

Association between rs1049673 polymorphism in CD36 and premature coronary heart disease.

Risk factors for premature coronary heart disease in China can be multiple; we investigated Chinese Han patients with premature coronary heart disease and a possible association with CD36 polymorphism at rs1049673, rs7755, and rs321159 sites. Outpatients were recruited according to chest X-ray coronary arteriography results; they were divided into two groups: early coronary artery lesions (premature coronary heart disease group, test group) and a control group. Coronary arteriography and laboratory blood examinations were conducted to analyze risk factors for coronary heart disease and CD36 polymorphisms. Seventy nine test and 56 control group patients were recruited. Compared with the control, the test groups had a significantly higher proportion of male patients, smoking, diabetes and metabolic syndromes, significantly higher levels of TG, LDL-C, ox-LDL, WBC, UA, FBG, and significantly lower levels of HDL-C. For rs1049673, rs7755, and rs321159 sites, patients with premature coronary heart disease have family genetic predisposition at high LDL-C level with GA, AA, and TT genotypes. Unconditional logistic regression analysis showed that gender, diabetes, high TG, LDL-C level and C carriers of rs1049673 significantly affected risk for premature coronary heart disease.

Coronary heart disease diagnosis bases on the change of different parts in treadmill exercise test ECG

Summarize the value of the change of different parts in treadmill exercise test (TET) ECG to coronary heart disease (CHD) diagnosis. Four hundred and forty-five cases have been included in this investigation, which stayed in our hospital from January of 2006 to March of 2011 and underwent TET and coronary arteriography (CAG). The change of different parts in TET ECG in these patients had been retrospective summarized to determine its diagnosis value to CHD. (1) In the 445 cases of TET testers, 200 cases showed positive in TET with 150 cases of positive CAG, and 50 cases of negative CAG; 245 cases showed negative in TET with 206 cases of negative CAG, and 39 cases of positive CAG. The diagnosis sensitivity of CHD was 79.36% (150/189), the specificity was 80.47% (206/256), positive prediction value was 75.00% (150/200), negative prediction value was 84.08% (206/245), and false-positive rate was 25.00% (50/200) with prediction accuracy of 80.00% (356/445). (2) In the 200 cases with positive TET: 51 cases were in the limb lead group; 73 cases were in the chest lead group; and 76 cases were in the limb lead + chest lead group. There were 150 cases showing positive in CAG: 22 cases were in the limb lead group; 58 cases were in the chest lead group; and 70 cases were in the limb lead + chest lead group. The positive diagnosis rate of ST change in the chest lead was obviously higher than that of simple limb lead group (P < 0.05). (3) People with healthy coronary artery will have decreased amplitude of R wave while patients with coronary stenosis have elevated amplitude of R wave. (4) As for the T wave, the positive CAG had no statistical significance between normal T wave group and TET positive group (P > 0.05); CAG results had statistical significance between normal T wave group and TET negative group (P < 0.05). (5) Positive CAG results had no statistical significance between U-wave inversion group and TET positive group (P > 0.05); positive CAG results has statistical significance when TET negative group compared with U-wave inversion group or TET positive group (P < 0.05). TET is a relatively idea invasive diagnosis method for coronary disease, which can be utilized to evaluate the stage of CHD when integrating with the change of TET ECG.

Quantitative Assessment of Left Ventricular Systolic Function in Patients with Coronary Heart Disease by Velocity Vector Imaging

To assess the left ventricular (LV) longitudinal systolic function and asynchrony in patients with coronary atherosclerotic heart disease (CAD) by syngo velocity vector imaging (VVI). Twenty-eight control subjects and 79 patients with CAD were examined, including 28 patients with myocardial infarction, 26 patients with coronary lumen stenosis <50%, and 25 patients with myocardial ischemia. According to the results of coronary arteriography and electrocardiogram (ECG), the myocardial segments of the LV of CAD patients were divided into four groups: ischemic, infarcted, nonischemic, and normal. Dynamic imaging was performed on all subjects. The systolic peak strain (Smax), systolic strain rate (SRmax), time to peak strain (PTs), and time to peak strain rate (PTsr) in every cardiac cycle were measured. A total of 1,253 out of 1,712 (96.5%) segments were successfully analyzed with VVI. Smax and SRmax of the ischemic and infarcted segments were impaired in CAD patients. Optimal sensitivity and specificity were obtained with strain and strain rate cutoffs of -14.08% and -0.83 s(-1) , respectively, for detecting ischemic segments and -6.65% and -0.38 s(-1) , respectively, for detecting infarcted segments. The PTs and PTsr were significantly longer in the ischemic and infarcted segments compared to those of the control group. Utilizing VVI, the longitudinal strain, strain rate, and peak time in CAD patients are easy to obtain and reproducible. Strain and strain rate cutoff values of abnormal myocardium are valuable for detecting ischemia and infarction. The PTs and PTsr values possibly estimate myocardium asynchrony in CAD patients.

Association Between Green Tea Intake and Coronary Artery Disease in a Chinese Population

There is still conflicting evidence that green tea may protect against coronary atherosclerosis therefore the present study investigated the association between green tea consumption and arteriographically determined coronary atherosclerosis in a Chinese population. The study population consisted of 520 consecutive patients (379 men and 141 women) who underwent coronary arteriography for the first time. Patients were divided into 2 groups (Non-coronary artery disease [CAD] and CAD groups) according to the results of coronary arteriography. After adjusting the established and potential confounders, green tea consumption was associated with a reduced risk of CAD in male patients, with an adjusted odds ratio (OR) of 0.62 (95% confidence interval, 0.38-1.01) compared with those who did not drink green tea. Compared to non-tea drinkers, the adjusted ORs were 1.09 (0.61-1.96) in male patients consuming less than 125 g of dried green tea leaves per month, 0.36 (0.19-0.71) for 125-249 g per month and 0.36 (0.17-0.73) for > or =250 g per month, with a statistically significant test for trend (P<0.001). Similar dose-response relationships were also observed for frequency, duration, concentration and starting age of green tea drinking in male patients. In female patients, no inverse association was found between green tea consumption and CAD. Green tea consumption can protect against the development of coronary atherosclerosis in Chinese male patients.

Clinical analysis of Level of glutathione redox-state in patients with acute coronary syndrome

Objective To study the changes and clinical significance of glutathione redox-state in patients with coronary heart disease (CHD). Methods Based on both with or without atherogenic risk factors and the result of coronary arteriography, 118 patients were calssified into three groups: control group( n =30) ,risk group(n =28) and CHD group (n =60). Venous blood sample was obtained, then the plasma reduced glutathione ( GSH) and oxidized glutathione (GSSC) were measured by using glutathione reductase recycling method. Redox potential(EhCSH/GSSG) was calculated using Nernst equation. According to clinical situation,CHD group was divided into two subgroups:un-stable angina pectoris( UAP) group(n = 32) and acute myocardial infarction (AMI) group (n =28). Results From control group to risk group,then to CHD group,GSH gradually decreased,and there was significant difference between CHD group and control group (P 0.05). Conclusions Body's an-tioxidant capacity decreases and the oxidative stress exists in artherosclerosis, and furthermore there is a certain degree of relevance between oxidative stress and hyperlipoidemia,all these show that improving this situation may decelerate or prevent the formation and progress of artherosclerosis. Key words: Coronary disease; Glutathione; Redox-state

6600 Analysis of dosimetric factors associated with gastrointestinal and blood toxicities in patients with locally advanced pancreatic cancer treated with concurrent chemoradiation therapy

Exercise-induced changes in the ST segments of the electrocardiogram were compared with the results of coronary arteriography in 73 consecutive patients referred for preoperative evaluation of coronary artery disease. Eighteen patients had single-, 25 double-, and 30 triple-vessel disease. Thirteen were taking digitalis alone, 28 were taking beta blockers alone, 21 had beta blockers and digitalis and 11 had no cardiac drugs. Exercise induced elevation of the ST segment in 11 patients, all with a predominant lesion in the left anterior descending coronary artery. ST depression with an upsloping ST segment was observed in patients with one-, two-, and three-vessel disease and it was the most common type of ST change in patients with single-vessel disease. Horizontal ST depression was most common in two-vessel disease and downsloping ST segment in three-vessel disease.There was a good correlation between the number of stenosed vessels and ST changes caused by exercise, expressed as the sum of ST segment displacements in twelve leads recorded immediately after the end of exercise (Σ/ST/) or as ST depression per unit increase in heart rate during exercise (“m” (ST/HR)). The latter was obtained by linear regression of ST displacement and heart rate measured at three or four different workloads in the lead with the greatest displacement of the ST segment. The mean values of Σ/ST/ were 0.58+−0.030 mV in single-vessel, 0.97+−0.41 mV in double-vessel and 1.58+−0.46 mV in triple-vessel disease. The mean values of “m” (ST/HR) were 0.0024+−0.0013 mV·min−1·beat−1 in single-vessel, 0.0042+−0.0012 in double-vessel, and 0.0078+−0.0033 in triple-vessel disease. These differences were highly significant (p<0.01–0.001) and there was only minimal overlap between the single- and triple-vessel groups. Digitalis caused a slight (statistically nonsignificant) increase in Σ/ST/but not in “m” (ST/HR).

Correlation analysis associated with Holter electrocardiogram and treadmill exercise test in diagnosis of coronary artery disease

Objective To investigate the diagnostic value of treadmill exercise tests (TET), Hoher electro-cardiogram in coronary artery disease(CAD) patients. Methods 144 patients who clinically diagnosed as CAD,un-derwent TET and Hoher electrocardiogram. Then the patients with the positive results were examined by coronary arte-riography(CAG). According to the results of CAG the diagnostic value of TET and Hoher electrocardiogram was per-formed with comparative analysis. Results The sensitivity, specificity and evaluated accuracy rates of TET were 93.3% ,72. 2% and 73. 8% respectively. But the sensitivity,specificity and positive evaluated accuracy rates of Hol-ter electrocardiogram to examine myocardial iachemia were 76.7%, 88.4%, 57.1%. Conclusions The combined examination of TET and Holter electrocardiogram could preliminarily estimate the stenosis site of coronary artery. For the patients with unconditional GAG, those two examinations could increase the diagnostic reliability of positive rate of myocardial isehemia, and on this basis to enhance the diagnostic level of the stenosis site of coronary artery. Key words: Holter electrocardiogram; Treadmill exercise tests; Coronary arteriography; Coronary artery disease

Primary study of carotid atherosclerosis plaque biomechnics using ultrasonic velocity vector imaging in patients with coronary artery disease

Objective To assess the changes of the velocity,strain and strain rate on the corresponding vascular of plaque and without plaque,bard plaque and soft plaque,the cupular part of fiber cowl and shoulder of plaque.Methods Eighty-six patients with coronary artery disease(CAD)according to the results of coronary arteriography and 50 normal subjects underwent the high frequency ultrasound,and carotid artery intima media thickness(IMT)was detected.The velocity,strain and stain rate of carotid were obtained by velocity vector imaging(VVI)speckle tracking technique.Results The level of IMT in CAD patients was higher than that in normal control(P＜0.05).The systolic maximum velocity of carotid with normal contract was higher significantly than that of carotid without plaque with CAD(P＜0.05).The systolic maximum velocity and strain rate of soft plaque in carotid atherosclerosis were higher significantly than those of hard plaque(P＜0.001,P＜0.05).The maximum velocity and strain rate of fabric cowl in carotid atheroscIerosis plaque were lower significantly than those of plaque shoulder(P＜0.05,P＜0.00 1).Conclusions VVI technique could early detect the elasticity degree of blood vessel wall,artherosclerosis and the mechanism asynchrony of the plaque intima.The value difference could be used as the predictive parameter and quantization for artherosclerosis and plaque instability. Key words: Ultrasonography; Coronary disease; Carotid stenosis; Atherosclerosis; Velocity vector imaging

Coronary Artery Diagnosis Aided by Neural Network

Coronary Artery Diagnosis Aided by Neural Network Coronary artery disease is due to atheromatous narrowing and subsequent occlusion of the coronary vessel. Application of optimised feed forward multi-layer back propagation neural network (MLBP) for detection of narrowing in coronary artery vessels is presented in this paper. The research was performed using 580 data records from traditional ECG exercise test confirmed by coronary arteriography results. Each record of training database included description of the state of a patient providing input data for the neural network. Level and slope of ST segment of a 12 lead ECG signal recorded at rest and after effort (48 floating point values) was the main component of input data for neural network was. Coronary arteriography results (verified the existence or absence of more than 50% stenosis of the particular coronary vessels) were used as a correct neural network training output pattern. More than 96% of cases were correctly recognised by especially optimised and a thoroughly verified neural network. Leave one out method was used for neural network verification so 580 data records could be used for training as well as for verification of neural network.

The predictive value of serum advanced fibrinogen and uric acid for acute coronary event risk

To study the serum advanced fibrinogen (FIB) and uric acid (UA) in predicting acute coronary events risk. 264 patients hospitalized with the suspected diagnosis of coronary heart disease (CHD) were divided into 2 groups according to the results of coronary arteriography: acute coronary event group (n = 195, 141 males and 54 females, aged 62 +/- 12, with laboratory and electrocardiogram proven acute myocardial infarction or unstable angina pectoris and obvious stricture of main coronary artery > 75%) and control group (n = 69, 31 males and 38 females, aged 65 +/- 9, without acute coronary event and with normal coronary artery or stricture of branches of coronary artery less than 50%). A week before the coronary arteriography fast peripheral venous blood samples were collected. The blood sugar, blood-lipid, FIB, and UA were determined. The FIB level of the acute coronary event group was 4.09 g/L +/- 1.36 g/L, significantly higher than that of the control group (3.52 g/L +/- 1.37 g/L, P < 0.05). The UA level of the acute coronary event group was 320 micromol/L +/- 91 micromol/L, not significantly different from that of the control group (302 micromol/L +/- 104 micromol/L, P > 0.05). Excluding the influence of age, sex, blood pressure, blood sugar, etc. multivariate analysis showed that FIB was a significant variable associated with acute coronary events, but UA, not entering the regression equation, was not an independent risk factor. When FIB and UA were both at high levels, acute coronary events risk was much higher than when any single index was at a high level. High FIB and UA jointly accelerate the development of atherosclerosis. It may be important to use the index of FIB associated with UA to predict acute coronary risk.

QT Dispersion in Sarcoidosis

QT dispersion (QTd) is the maximal interlead difference in QT interval on surface 12-lead ECG. An increase in QTd is found in various cardiac diseases. Sarcoidosis augments inhomogeneity in ventricular repolarization by sarcoid granuloma, which significantly correlates with ventricular fibrillation. Changes in QTd in the course of sarcoidosis have not been investigated previously. The study included 35 patients with systemic sarcoidosis. The diagnosis of systemic sarcoidosis was made by biopsy. Thallium scintigraphy was performed in all patients with systemic sarcoidosis. Cardiac sarcoidosis was diagnosed in 16 patients based on abnormal thallium scintigraphy and normal coronary arteriography results. QTd, corrected QTd (cQTd), maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT, and minimum corrected QT intervals were measured. Twenty-four healthy subjects represented the control group for QT interval analysis. In the cardiac sarcoidosis group, mean QTd (+/- SD) was significantly greater than in the noncardiac sarcoidosis group and control group (49.50 +/- 10.86 ms, 28.14 +/- 11.02 ms, and 27.08 +/- 10.41 ms, respectively; p < 0.001). cQTd was significantly greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group and control group (53.17 +/- 10.44 ms, 30.61 +/- 10.94 ms, and 29.01 +/- 10.52 ms, respectively; p < 0.001). QTmax (440 +/- 15.01 ms, 409 +/- 14.86 ms, and 410 +/- 13.21 ms; p < 0.001) and cQTmax (449 +/- 16.31 ms, 417 +/- 12.51 ms, and 418 +/- 11.76, respectively; p < 0.001) were also significantly greater in patients with cardiac sarcoidosis. In a limited follow-up group (11 cardiac and 9 noncardiac sarcoidosis patients), the incidence of premature ventricular contraction (PVC) on ECG was greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group (36% and 0%, respectively; p < 0.05). A medium correlation existed between QTd and PVC (r = 0.331, p < 0.05). QTd, cQTd, QTmax, and cQTmax are prolonged in patients with cardiac sarcoidosis compared to the patients with noncardiac sarcoidosis and control subjects. The incidence of PVC on ECG was greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group.

Comparison of multi-slice CT (MSCT) and Tl-201 myocardial SPECT in detection of coronary artery disease; relation to coronary arteriography

Aim: To evaluate the diagnostic potentials of MSCT and Tl-201 SPECT in the assessment of coronary artery disease. Methods: Twenty-four patients (15 men, 9 women, 42–79 years) with clinically suspected coronary artery disease (CAD) were studied by Tl-201 myocardial SPECT and MSCT. MSCT data were obtained with 12 × 0.75 mm, 420ms rotation, 16 slice multi-detector raw CT scanner (SOMATOM Sensation, Siemens) using non-ionic contrast, 80ml, 4ml/sec. Multiplanar reconstruction techniques were used for evaluation of coronary arteries. Tl-201 myocardial SPECT were performed at stress with adenosine and at rest. Data from MSCT and Tl-201 SPECT were compared territory by territory (divided into two segments; LAD and RCA/LCx) and related to coronary arteriography, in which more than 60% stenoses are regarded as significant. Results: MSCT and Tl-201 SPECT showed agreement in 35 out of 48 segments (73%). Out of 13 disagreed segments (27%), Tl-201 SPECT was superior in 8 segments and MSCT was superior in 5 segments. Sensitivities and specificities of MSCT and Tl-201 SPECT by coronary arteriography are 81.8%, 73.0% and 86.3%, 80.7%, respectively. Two segments in agreement between MSCT and SPECT were different from the results of coronary arteriography. Myocardial bridge in two cases were detected as significant stenoses by MSCT but showed normal perfusion in Tl-201 SPECT. Conclusion: MSCT and Tl-201 SPECT exhibited good agreement in the assessment of coronary artery disease, but, Tl-201 SPECT has higher sensitivity and specificity for the detection of jeopardized myocardium than MSCT. In the assessment of coronary artery disease, CT angiography using MSCT could be useful non-invasive diagnostic tool with complementary information of Tl-201 SPECT.

Influence of Respiratory Disease on Perioperative Cardiac Risk in Patients Undergoing Elective Surgery for Abdominal Aortic Aneurysm

We retrospectively reviewed perioperative cardiac complications in a series of 214 patients who underwent surgical treatment for infrarenal aortic aneurysm between 1992 and 1996. There were 192 men and 22 women, with a mean age of 68.3 years. Cardiac risk factors included angina in 28% of patients and previous myocardial infarction in 25%. Resting electrocardiography was normal in 80 patients (37.5%). Depending on clinical findings, thallium-201 scintigraphy was undertaken in 76 patients (35.5%) and led to elective coronary arteriography in 22 patients (10%). Results of coronary arteriography revealed lesions in 14 patients. Aortic reconstruction was performed by the transperitoneal route in all patients. Procedures consisted of aortoaortic bypass (63%), aortobiiliac bypass (27.5%), or aortobifemoral bypass (9.5%). Nine patients (4.2%) died within the first 30 postoperative days. The cause of death was myocardial infarction (MI) in two patients (1%), colonic necrosis in two (1%), acute pancreatitis in one (0.5%), acute renal insufficiency in three (1.4%), and multiple organ failure in one patient (0.5%). Nonfatal cardiac complications were observed in 15 patients (7%). Statistical analysis of risk factors revealed two predictors of perioperative cardiac complications, i.e., history of chronic bronchitis and reoperation. On review of the literature, we cannot propose a routine preoperative work-up. Prospective multicentric studies are needed to determine the predictive value of current preoperative screening methods.

Detection and Evaluation of Asymptomatic Myocarditis in Schoolchildren: Report of Four Cases

Data on the prevalence of myocarditis in children are limited. Autopsy studies have shown that myocarditis is often undiagnosed. We attempted to investigate the clinical features of asymptomatic myocarditis in four schoolchildren detected during a mass ECG screening in schoolchildren. To evaluate asymptomatic myocarditis, we clinically examined 12 schoolchildren who were referred to Shiga University of Medical Science Hospital, Otsu, Japan, because of abnormal ST or T waves detected during ECG screening. None of the 12 children had experienced any episodes suggesting cardiac disease or Kawasaki disease. Cardiac function and myocardial viability were assessed by two-dimensional echocardiography (2-DE), thallium-201 (201Tl) myocardial scintigraphy, and cardiac catheterization. Endomyocardial biopsy specimens were examined histologically. Endomyocardial biopsy specimens revealed histologic evidence of myocarditis in 4 of the 12 children with abnormal ST or T waves. Abnormal tracer perfusion was observed on 201Tl myocardial scintigrams in these four children, but the results of coronary arteriography were normal. 2-DE showed left ventricular hypokinesis in one child and left ventricular enlargement in one of the four children with histologic evidence of myocarditis. A second endomyocardial biopsy specimen was obtained in two of four children, showing persistent myocarditis in one child. This type of screening program and indepth evaluation using 2-DE and 201Tl myocardial scintigraphy appear to be helpful in identifying children with myocarditis. The present histologic investigations suggested that even asymptomatic myocarditis might result in persistent heart damage.