Critical Coronary Artery Disease Research Articles

Investigation of Aortic Elastic Parameters [Aortic Distensibility and Aortic Strain] and Aorta Propagation Velocity in the Coronary Ectasia Patients with or without Critical Coronary Artery Disease

Investigation of Aortic Elastic Parameters [Aortic Distensibility and Aortic Strain] and Aorta Propagation Velocity in the Coronary Ectasia Patients with or without Critical Coronary Artery Disease

Investigation of Aortic Elastic Parameters [Aortic Distensibility (AD) and Aortic Straın (AS)] and Aortic Propagation Velocity in Dilated Cardiomyopathy Patients with or without Critical Coronary Artery Disease

PP-194 Dilated cardiomyopathy (DCM) is a progressive disease of heart muscle characterized by contractile dysfunction and ventricular dilatation with normal left ventricular wall thickness. There are many causes of cardiomyopathy including hereditary diseases, infections and toxins whereas ischemic

Framingham risk score and severity of coronary artery disease

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Easy-to-perform and reliable parameters are needed to predict the presence and severity of CAD and to implement efficient diagnostic and therapeutic modalities. We aimed to examine whether the Framingham risk scoring system can be used for this purpose. A total of 222patients (96women, 126men; mean age, 59.1 ± 11.9years) who underwent coronary angiography were enrolled in the study. Presence of > %50 stenosis in a coronary artery was assessed as critical CAD. The Framingham risk score (FRS) was calculated for each patient. CAD severity was assessed by the Gensini score. The relationship between the FRS and the Gensini score was analyzed by correlation and regression analyses. The mean Gensini score was 18.9 ± 25.8, the median Gensini score was 7.5 (0-172), the mean FRS was 7.7 ± 4.2, and the median FRS was 7 (0-21). Correlation analysis revealed a significant relationship between FRS and Gensini score (r = 0.432, p < 0.0001). This relationship was confirmed by linear regression analysis (β = 0.341, p < 0.0001). A cut-off level of 7.5 for FRS predicted severe CAD with a sensitivity of 68 % and a specificity of 73.6 % (ROC area under curve: 0.776, 95 % CI: 0.706-0.845, PPV: 78.1 %, NPV: 62.3 %, p < 0.0001). Our work suggests that the FRS system is a simple and feasible method that can be used for prediction of CAD severity. As the sample size was small in our study, further large-scale studies are needed on this subject to draw solid conclusions.

Screening for the Presence of Coronary Artery Disease

Screening for the Presence of Coronary Artery Disease

Coronary angiographic findings in patients with complete left bundle branch block in Erbil city /Iraq

Background and objective: The goal of this study was to determine the association of complete left bundle branch block (LBBB), site , severity & risk factors of coronary artery disease (CAD). Complete Left bundle branch block increases the risk of cardiac mortality, and prognosis is primarily determined by the underlying CAD. Because the presence of complete LBBB makes the noninvasive identification of CAD less informative, patients with complete LBBB often are referred for coronary angiography to assess the presence and severity of CAD. Methods: A total of 150 consecutive patients with complete LBBB admitted to the coronary care unit were enrolled from the age of 27 to 81 years with the mean age of 59.32 ± 10.5. Male 84 (56%), Female (44%). History, basal investigations echocardiography and virology screen were performed. Coronary angiography has been done for all patients for different reasons of presentation. Results: Critical CAD 70 (46.7%), Left ventricular systolic dysfunction (LVSD) 50 (33.3%). Hypertension found in 83 (55.3%), diabetes mellitus (DM) in 44 (30%), DM& left ventricular systolic dysfunction(LVSD) were more associated with critical CAD. Conclusion: In our study complete LBBB was more common among hypertensive patients. In DM patients was associated with severe CAD. With Left anterior descending artery being the most common artery involved.

Relationship of cystatin C with coronary artery disease and its severity

Cystatin C, which is an endogenous marker for renal function, is reported to be a novel marker for coronary atherosclerosis. In this study, we aimed to evaluate its role in determining the presence and also the severity of coronary atherosclerosis in patients with coronary artery disease (CAD). Eighty-eight patients who underwent elective coronary angiography were enrolled in the study. Patients with heart failure, renal failure, diabetes, and thyroid disease were excluded from the study. The study population was divided into three groups: individuals with normal coronary arteries, patients with critical CAD, and patients with noncritical CAD. We also analyzed the relationship of cystatin C levels with the presence and the severity of CAD and the number of vessels involved. The mean age of the study group was 51.73±9.21 years, and the majority were men (n=71, 80.7%). Cystatin C levels were significantly lower in patients with CAD (1334.86±93.45 vs. 836.49±411.29, P<0.001). It was significantly lower in patients with critical CAD compared with those with noncritical CAD and normal individuals (656.60±346.35, 1016.38±396.54, and 1334.86±393.45, P<0.001, respectively). Serum levels of cystatin C according to the numbers of coronary vessels such as none, single-vessel, two-vessel, three-vessel, and four-vessel disease were as follows: 1334.86±393.45, 801.67±418.70, 993.90±457.34, 744.09±354.53, and 682.30±294.43, respectively. Lower cystatin C levels may be associated with increased severity of CAD in clinically stable patients, whereas higher levels may indicate the presence of any vulnerable plaque. It may also guide the diagnostic and therapeutic options for the clinical scene on the presentation.

Serglycin is a novel adipocytokine highly expressed in epicardial adipose tissue

Much recent work has highlighted the key role of adipose tissue as an endocrine organ that secretes a number of adipocytokines, linking adiposity, especially intra-abdominal visceral fat, and the pathogenesis of cardiovascular and metabolic diseases. However, the role of epicardial adipose tissue (EAT), another important visceral fat depot situated in close proximity to epicardial coronary arteries and myocardium, has been less well studied. In this study, we sought to characterize EAT by comparing gene expression profiles of EAT, omental adipose tissue (OAT), and subcutaneous adipose tissue (SCAT) in patients who underwent elective coronary artery bypass graft surgery for critical coronary artery disease (CAD) and identify molecules involved in inflammation. A total of 15,304 probes were detected in all depots, and 231 probes were differentially expressed. Significantly higher expression of pro-inflammatory genes such as interleukin-1β, -6, and -8, and chemokine receptor 2 was observed in EAT, even when compared with OAT. Among them, serglycin was one of the most abundantly expressed genes in EAT. Serglycin expression was induced during adipocytic differentiation of 3T3L1 cells. Serglycin was secreted from adipocytes, and tumor necrosis factor-α stimulated its expression and secretion in adipocytes. Serglycin was also present in human serum samples. These results suggest that human EAT has strong inflammatory properties in patients with CAD and provide novel evidence that serglycin is an adipocytokine highly expressed in EAT.

TCT-490 Coronary Artery Disease and Tako-tsubo Cardiomyopathy: a Possible Association

Guido Parodi, Rodolfo Citro, Benedetta Bellandi, Eduardo Bossone, Stefano Del Pace, Marco Marrani, Fausto Rigo, Francesco Bovenzi, Renato Valenti, David Antoniucci Careggi Hospital, Florence, Italy, San Giovanni di Dio e Ruggi d’Aragona, Salerno, Salerno, Ospedale dell’Angelo, Mestre, Mestre, Ospedale campo di Marte, Lucca, Lucca Background: In the medical literature several cases of Tako-tsubo cardiomyopathy (TTC) with critical coronary artery disease (CAD) has been reported, and in the clinical practice several typical TTC cases shown significant stenosis of coronary arteries that cannot be related to the dysfunctional myocardium. The aim of this study is to evaluate the prevalence, clinical characteristics and outcome of patients with TTC and critical CAD in a large multicentre database. Methods: In the 26 participating centers, 450 patients admitted with the diagnosis of TTC (modified Mayo Criteria) underwent coronary angiography within 48 hours of hospital admission and were progressively included in the Tako-tsubo Italian Network (TIN) Registry. Results: Overall, 43 (9.6%) patients had at least 1 critical coronary stenosis ( 50%) not supplying the dysfunctional myocardium, or a previous myocardial revascularization (percutaneous or surgical), while 407 (90.4%) had not critical stenosis or truly normal coronary arteries. TTC patients with critical CAD were more likely to have advanced age, diabetes, familiar history of CAD, acute functional mitral regurgitation and a delayed left ventricular function recovery as compared with those without. At 6-month follow-up, the incidence of death, TTC recurrence and rehospitalization rates were similar between patients with critical CAD and patients with normal coronary arteries (Table). At multivariable Cox analysis, independent predictors of death were Charlson comorbidity index while the presence of CAD did not significantly influence mid-term outcome.

Dilated cardiomyopathy secondary to coarctation of the aorta was completely resolved after stent implantation

Although rare in adults, coarctation of the aorta can present as an occult cause of cardiomyopathy. In this case report, we describe a 55-year-old man who presented to our clinic with new-onset symptoms of heart failure. Transthoracic echocardiography showed a dilated left ventricle with severely depressed systolic function. Cardiac catheterisation showed no critical coronary artery disease but a severe aortic coarctation just distal to the origin of the left subclavian artery, with a peak-to-peak systolic pressure gradient of 40 mmHg. We successfully implanted a balloon-expandable stent with good angiographic results. The procedure resulted in immediate clinical improvement. Six-months after stent implantation, the patient was free of symptoms and an echocardiographic examination showed completely normalised cardiac size and systolic function.

Role of coronary angiography MDCT in the clinical setting: changes in diagnostic workup in the real world

The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup. A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA). The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol. MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.

The relation of serum paraoxonase-1 activity with isolated coronary artery ectasia: an observational study

Coronary artery ectasia (CAE) is a congenital or acquired anomaly characterized with localized or diffuse dilatations of coronary arteries. Paraoxonase (PON-1) is a high-density lipoprotein-cholesterol (HDLC) associated antioxidant enzyme that prevents atherosclerosis. The aim of this study was to investigate serum paraoxonase-1 enzyme activity (SPA) in patients with CAE in comparison patients with coronary artery disease (CAD) and normal coronary arteries. We have evaluated 44 patients with isolated IKAE, 40 cases with normal coronary arteries (NCA), 40 cases with critical CAD (CAD) and 40 cases with minimal CAD (MCAD) in this cross-sectional observational study. Demographic and biochemical data of patients were collected. SPA was determined spectrophotometrically. Among-group comparisons, ANOVA, Kruskal-Wallis and Chi-square tests were used; Bonferroni test was used for post-hoc analysis, Pearson's correlation analysis to determine the parameters associated with the SPA. There were no differences among groups with regard to age, sex, presence of diabetes, hypertension and smoking (p>0.05 for all). The highest HDLC was detected in patients with NCA and lowest HDLC was detected in patients with CAD (respectively 52±15 mg/dL; 41±16 mg/d L, p=0.021). CAD and CAE groups were similar with respect to HDLC levels (p>0.05). The highest SPA level was detected in patients with NKA and the lowest SPA level was detected in patients with CAD (respectively 250.78±59.37U/L; 163.39±49.28 U/L, p=0.005). CAD and CAE groups were similar with respect to SPA levels (p>0.05). Both decreased SPA and decreased HDLC levels are closely related to the development of the CAE similar to CAD.

Cardioprotective radiotherapy: The circadian way

Radiotherapy (RT) has been established to improve both local control as well as overall survival rates in breast cancer. However, RT especially in left-sided breast cancer also irradiates a portion of the heart. Radiation associated toxicity to the heart assumes significance because of improval in survival of breast cancer patients. A circadian pattern has been reported in the myocardial oxygen demand and myocardial ischaemia with the cardiac tissue being more susceptible to injury between 6am and noon. Radiation damages blood vessels of all sizes causing an increase in capillary wall permeability and dilatation of vessels leading to the characteristic radiation erythema followed by an inflammatory cell infiltrate. Coronary artery spasm may be the reason behind some cases of sudden death occurring in patients after radiation therapy. Endothelial behaviour also has a circadian variation and vasodilation is significantly attenuated in the morning. Critical coronary artery disease occurs 10–15years after radiotherapy. Radiation in the morning hours may be one of the associated risk factor. The application of chrono-therapeutics with radiation therapy in carcinoma breast and in other chest wall irradiation, could possibly decrease the radiation associated cardiac toxicity.

Concomitant Transapical Transcatheter Aortic Valve Implantation and Minimally Invasive Direct Coronary Artery Bypass

We represent a successful minimally invasive combined off-pump procedure consisting of a transapical aortic valve implantation and a direct coronary artery bypass grafting in a woman with a severe aortic stenosis and a critical coronary artery disease. Due to her comorbidities, she was classified as a high-risk patient qualifying for a transcatheter procedure. We performed this combined procedure in a hybrid operation room, starting with the coronary bypass to maintain a coronary blood flow during the transapical valve implantation. The operation processed without any complications and she was discharged at the seventh postoperative day into the allocating hospital.

Identification of critical coronary artery disease

Sir, Although stigmata such as the occurence of ST-segment elevation (STE) in lead aVR, with concurrent ST-segment depression in leads II, III, aVF, and V3–V6, are highly suggestive of left main stem (LMS) occlusion,1 and were indeed present, in part, in the recently reported case,2 they also occur in left anterior descending (LAD) coronary artery occlusion,3,4 and, to a lesser extent, also in left circumflex artery occlusion,4 thereby justifying urgent triage for percutaneous intervention in virtually all patients with acute coronary syndrome characterized, as …

Successful On-Pump Coronary Artery Bypass Without Using Protamine

A 48-year-old woman presented with a history of angina and breathlessness on exertion. She was diagnosed to have critical left main stem coronary artery disease along with a blocked right coronary artery. She was also allergic to protamine. After multidisciplinary consultation, it was decided to use heparin without protamine for reversal. She underwent successful on-pump coronary artery bypass grafting (CABG) without excessive blood loss. The disadvantages were a longer total operating time and the use of blood products to achieve normal coagulation. This case report describes the successful management of this complex problem.

Deep venous thromboembolism and pulmonary embolization as a rare complication of diagnostic femoral catheterization and prevention of recurrence with inferior vena cava filter prior to cardiac surgery

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are rare complications after diagnostic femoral catheterization. A few clinical cases have been reported, especially in the setting of venous compression with an enlarging haematoma, mechanical groin compression or prolonged procedures. Similarly, clinically evident PE after cardiac surgery is also very rare, but may be catastrophic. In this article, we present a case of PE after silent (symptomless) DVT due to femoral catheterization. The patient had critical coronary artery disease and was a candidate of coronary artery bypass grafting. A inferior vena cava filter was implanted prior to cardiac surgery for prevention of a potential pulmonary embolus.

A doença coronária aumenta a mortalidade hospitalar de portadores de estenose aórtica submetidos à substituição valvar?

With the increase in life expectancy occurred in recent decades, it has been noted the concomitant increase in the prevalence of aortic stenosis and degenerative disease of atherosclerotic coronary artery. This study aims to evaluate the influence of atherosclerotic coronary artery disease in patients with critical aortic stenosis undergoing isolated or combined implant valve prosthesis and coronary artery by pass grafting. In the period of January 2001 to March 2006, there were analyzed 448 patients undergoing isolated implant aortic valve prosthesis (Group I) and 167 patients undergoing aortic valve prosthesis implant combined with coronary artery bypass grafting (Group II). Pre- and intra-operative variables elected for analysis were: age, gender, body mass index, stroke, diabetes mellitus, chronic obstructive pulmonary disease, rheumatic fever, hypertension, endocarditis, acute myocardial infarction, smoking, Fraction of the left ventricular ejection, critical atherosclerotic coronary artery disease, chronic atrial fibrillation, aortic valve operation prior (conservative), functional class of congestive heart failure, value serum creatinine, total cholesterol, size of the prosthesis used, length and number of distal anastomoses held in myocardial revascularization, duration of cardiopulmonary bypass and aortic clamping time. The statistical study employed invariant and multivariate analysis. Hospital mortality was 14.3% (64 deaths) in Group I, and 14.5% (58 deaths) in patients with atherosclerotic coronary artery disease associated criticism (Group IB) and 12.8% (six deaths) in which had this association (Group IA). Hospital mortality in Group II was 17.6% (29 deaths), and 16.1% (20 deaths) in patients undergoing implantation of prosthetic aortic valve combined to complete myocardial revascularization (Group II) and 20.9% (nine deaths) in the myocardial revascularization with incomplete (Group IIB). In patients undergoing implant isolated from aortic valve prosthesis, the presence of atherosclerotic coronary artery disease associated critical in at least two arteries, influenced the hospital mortality. In patients undergoing surgical treatment combined the number of coronary arteries with critical atherosclerotic disease and extent of coronary artery bypass grafting (complete or incomplete), did not affect the hospital mortality, but the realization of more than three anastomoses in the distal myocardial revascularization interfered.

Abstract 5498: The Cumulative Risk of Stroke and Death From Carotid Endarterectomy Followed by Coronary Artery Bypass Surgery in Patients With Concomitant Critical Coronary and Carotid Stenosis

Background: Coexisting critical coronary artery disease (CAD) requiring coronary artery bypass grafting (CABG) and critical carotid stenosis requiring carotid endarterectomy (CEA) is becoming increasingly common. The reported incidence of stroke and death as perioperative complications of CABG range from 1.1 to 3.8% and 1 to 3%, respectively. The cumulative risk of stroke and death in patients undergoing a CEA followed by CABG in a high-risk subset, as described above, is not well defined. Objective: To determine the cumulative risk of in-hospital stroke and death when CEA precedes CABG, and also if a preceding history of transient ischemic attack (TIA)/cerebrovascular accident (CVA) increases the risk of in-hospital stroke and death. Methods: Using ICD-9 codes we identified 114 consecutive patients in our institution who were scheduled to undergo a staged CEA followed by CABG. Records of all patients were reviewed to identify comorbidities and confirm the incidence of all-cause mortality and stroke. The patients were further divided into two groups based on the presence or absence of a prior history of TIA/CVA. Results: Three patients died after CEA, 111 patients proceeded to CABG. Conclusion: Cumulative risk of stroke and death from both procedures should be considered in these patients. Despite CEA procedure aimed at reducing the risk of perioperative stroke from CABG, 3.6% of the patients in our study had a nonfatal CVA after CABG. Patients with a prior history of TIA/CVA did not show a significant increase in periprocedural risk of stroke and death. Table 1 Cumulative risk of nonfatal CVA and Death Table 2 Risk of nonfatal CVA and Death based on a history of TIA/CVA

Electrocardiographic and echocardiographic parameters in hypertensive patients with chest pain concomitant with CAD (coronary artery disease) or with normal or minimal CAD

Objectives Hypertension is a disease entity associated with chest pain, independent of critical CAD by the fact that about 20% of patients with typical angina have normal coronary angiogram. So we investigated significant electrocardiographic and echocardiographic parameters in hypertensive patients with chest pain, who were concomitant with CAD and no CAD. Method Hypertensive patients with chest pain who underwent coronary angiogram between Oct. 2006 and Feb. 2007 at Busan Paik Hospital of Inje University were identified using the database of the same hospital.

Free Anterolateral Thigh Flap Coverage for Post-sternotomy Mediastinitis: Report of a Case

Post-sternotomy mediastinitis is a rare and very troublesome complication of cardiac surgery. A 49-year-old male patient with critical left main coronary artery disease underwent urgent coronary artery bypass grafting surgery by means of median sternotomy. Unfortunately, the patient developed mediastinitis and a spacious defect was left after adequate debridement. Reconstructive plastic surgery with free anterolateral thigh flap coverage was used for treating this problem. We believe that it is the first application of such an anterolateral thigh free flap for treating an extensive tissue defect caused by a deep sternal wound infection after cardiac surgery.