Degree Of Coronary Artery Lesions Research Articles

A new model for predicting intravenous immunoglobin-resistant Kawasaki disease in Chongqing: a retrospective study on 5277 patients

Accurate evaluation of individual risk of intravenous immunoglobin (IVIG)-resistance is critical for adopting regimens for the first treatment and prevention of coronary artery lesions (CALs) in patients with Kawasaki disease (KD). Methods: The KD patients hospitalized in Chongqing Children’s Hospital, in west China, from October 2007 to December 2017 were retrospectively reviewed. Data were collected and compared between IVIG-resistant group and IVIG-responsive group. The independent risk factors were determined using multivariate regression analysis. A new prediction model was built and compared with the previous models. Results: A total of 5277 subjects were studied and eight independent risk factors were identified including higher red blood cell distribution width (RDW), lower platelet count (PLT), lower percentage of lymphocyte (P-LYM), higher total bile acid (TBA), lower albumin, lower serum sodium level, higher degree of CALs (D-CALs) and younger age. The new predictive model showed an AUC of 0.74, sensitivity of 76% and specificity of 59%. For individual’s risk probability of IVIG-resistance, an equation was given. Conclusions: IVIG-resistance could be predicted by RDW, PLT, P-LYM, TBA, albumin, serum sodium level, D-CALs and age. The new model appeared to be superior to those previous models for KD population in Chongqing city.

Novel Discovery of the Relationship of Clinical Phenotype of Coronary Heart Disease with Retinol Binding Protein 4, Lipoprotein-Related Phospholipase A2

To investigate the correlation between retinol binding protein 4 (RBP4), lipoprotein associated phospholipase A2 (LP-PLA2), we studied the clinical phenotype of coronary heart disease (CHD) and the severity of coronary artery disease. Our studies showed that the changes of retinol binding protein 4, LP-PLA2 serum concentration has a relation with the severity of coronary artery disease progression, but no clear relationship with the degree of coronary artery lesion and count. Furthermore, LP-PLA2 concentration increases with the increase of the severity of coronary artery disease and disease occurrences.

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

Association between insulin dosage and insulin usage time, and coronary artery lesions in patients with type 2 diabetes and coronary heart disease.

Insulin is used in the treatment of type 2 diabetes, with its usage reaching 30–50% in Western countries. The aim of the present study was to determine the association between insulin dosage (ID)/insulin usage time (IT) and coronary artery lesions in patients of type 2 diabetes with coronary heart disease. Based on the insulin using dosage, 353 type 2 diabetes patients were divided into the high-dose (≥0.5 IU/kg) and low-dose (<0.5 IU/kg) group. Selected coronary angiography was performed and the Gensini score was used to determine the degree of the coronary artery lesions. The homeostasis model assessment-insulin sensitivity (HOMA-IS) index was assessed by HOMA2. Data including age, gender, smoking, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG), glucose (Glu), hemoglobin A1c (HbA1c), C-peptide, ID, IT, diabetes duration time (DT), and IT/DT were collected. The association between insulin usage (both dose and time) and the coronary artery lesions in these patients was then determined. Statistical differences for the two groups for factors including C-peptide, HbA1c, ID, IT, DT, IT/DT and the Gensini score values (P<0.05) were identified. By contrast, no significant differences for factors such as gender, smoking history, age, BMI, TC, TG, LDL, HDL, fasting insulin, Glu, SBP and DBP were observed. The coronary artery damage Gensini score in insulin-insensitive individuals was significantly greater than that in the insulin-sensitive individuals. The Spearman analysis revealed that ID and IT, DT and IT/DT were positively correlated with the coronary artery damage Gensini score. The multivariate regression, the interquartile range method and receiver operating characteristic analyses showed that ID, ID/DT, IT had a greater effect on coronary vascular damage compared with DT. In conclusion, the degree of coronary artery lesions were correlated with ID, IT, DT, IT/DT. High doses of insulin or a high IT/DT ratio may aggravate coronary artery damage.

Relationship study on depression score, serum levels of sex hormones and coronary Gensini score in old men with coronary heart disease

Objective To reveal the relevance of the elderly male sex hormone changes and the occurrence of depression in the elderly, severity of coronary artery disease occurrence and sex hormone levels, depression status and coronary heart disease(CHD) in coronary heart disease patients. Methods Total of 300 elderly male patients underwent coronary angiography in the department of cardiology were collected, including 80 controls and 220 coronary heart disease patients. All coronary angiography elderly male patients admitted to hospital were analyzed by Hamilton Depression Scale (HAMD24 version), the patient's serum testosterone, estradiol levels and Gensini score of coronary after angiography were checked. The multiple linear regression analysis was used to investigate the correlation among coronary Gensini score, Hamilton Depression Scale score and serum testosterone. Results (1) The HAMD scores in CHD group were higher than those in controls ((23.82±11.74) vs (21.25±10.54)), and testosterone level was lower than that in controls ((11.23±4.46)ng/ml, (15.96±5.87)ng/ml, respectively), the difference was statistically significant (P<0.05). (2)Testosterone and HAMD score was negatively correlated (t=-3.562, P<0.05), and the correlation coefficient (R2) was 0.041, F value was 12.960 (P <0.01). (3)Testosterone and HAMD score was negatively correlated (t=-4.276, P<0.05), and the correlation coefficient (R2) was 0.058, F value was 18.286 (P <0.01). (4)Estradiol serum content and HAMD score showed no correlation.(5)Genisini scores were positively correlated with HAMD score (t=-3.977, P<0.05), the correlation coefficient (R2) was 0.045, F value was 14.175 (P <0.01). Conclusion Serum testosterone levels of the men are negatively correlated with coronary artery disease and depression levels.The degree of coronary artery lesions in patients with coronary heart disease was positively correlated with depression level of depression. Key words: Male; Depression; Serum sex hormone levels; Coronary Gensini score

ROLE OF PRE- AND POST-TRANSPLANT FACTORS IN THE DEVELOPMENT OF CORONARY DISEASE OF THE TRANSPLANT HEART

Aim: to assess the relationship between preand post-transplantation factors and degree of coronary artery lesion, reported by intravascular ultrasound study (IVUS) in patients who underwent orthotopic heart transplantation (OHT) surgery. Materials and methods. The study comprised of 27 patients who underwent OHT more than 2 years before. The age of patients was 46,8 ± 10,4 years old. All of them were preoperatively classified by HLA system. All patients received transthoracic echocardiography at terms of 1, 6, 12 and 24 months after OHT. Coronary angiography (CAG) and IVUS were performed at 24 ± 6 months. Results. In CAG none of the patients showed angiographic signs of CA stenosis, but changes of various degrees were detected by IVUS. Results obtained by IVUS were clustered to select two groups with different degree of coronary artery lesion. The donor’s age in Group 2 was evidently higher compared to Group 1 (34,77 ± 1,03 and 40,00 ± 2,04 years, respectively, p = 0,043). Donor-recipient coincidence frequency was lower in group with significant CA lesion (by 2,36, р = 0,003). The number of cardiac surgeries performed prior to OHT was higher in Group 2 (by 2,8, р = 0,008). Post-transplant factor analysis showed that the number of diabetes mellitus (DM) cases revealed after transplantation was more frequent in Group 2 (by 3,2 vs Group 1, р = 0,021). Conclusion. The degree of CA lesion according to IVUS at 24-month period after OTH was associated with several post-transplant factors, which were the presence of cardiac surgical interventions before transplantation, low HLA donor-recipient coincidence frequency, and donor’s age. The more significant CA lesion is, the more cases of DM after OHT occur.

Fragmented QRS scale and brain natriuretic peptide predict infarction in patients with acute myocardial infarction and heart attacks

Objective To investigate the acute myocardial infarction (AMI) patient's electrocardiogram appearing fragment QRS wave (fQRS) and brain natriuretic peptide (BNP) level and scope of coronary lesions,severe cardiac complications,and the cor relation of cardiac death.Methods For selected patients with AMI,whether based on electrocardiogram (ECG) appeared in fQRS group and non fQRS groups; immunofluorescence technique was used to detect the plasma BNP level in patients with AMI.Two groups of patients with serious cardiac events and coronary artery lesions scope were observed; Coronary artery lesion count and BNP level were recorded.Results The incidence of fragment QRS wave in patients with AMI was 34.0％,fQRS wave group height/three degree atri oventricular block,ventricular tachycardia/ventricular fibrillation,cardiac shock,cardiac death rate was higher than non fQRS wave group (P ＜0.05).fQRS wave group of plasma BNP and left ventricular end-diastolic diameter,the double branch lesion,multivessel lesions were significantly higher than that of non fQRS group (P ＜ 0.01) ; left ventricular ejection fraction,the single lesion was sig nificantly lower than non fQRS wave group (P ＜0.01).The BNP levels in single,double,and multivessel lesions in the group with the increase of the lesion count were increased.Conclusions The AMI patients with fQRS easily complicated with severe arrhythmia,and case fatality rate was high,the prognosis was poor.fQRS on electrocardiogram (ECG) and BNP level had a certain relationship with range and degree of coronary artery lesions,degree of indexes might be used as a prediction of coronary lesions,and multivessel lesions had certain prediction value. Key words: Electrocardiography; Natriuretic peptide, brain ; Myocardial infarction/complications; Acute disease; Heart diseases/etiology; Arrhythmias, cardiac/etiology; Shock, cardiogenic

Abstract 268: The Increased Visceral Fat Thickness In Nafld Patients Enhances The Risk Of Coronary Artery Stenosis

Background: Non alcoholic fatty liver disease (NAFLD) is an independent risk factor of cardiovascular disease (CVD). In this research, we want exploring the relationship between NAFLD, visceral fat thickness and the severity of coronary artery disease. Methods: 1, The relationship between NAFLD, visceral fat thickness and severity of coronary heart disease(323 people). 2, The correlation between severe NAFLD and visceral fat thickness in the severe stenosis of coronary heart disease(197 people). Results: 1, the proportion of NAFLD was significantly increased by 16% and 19% in different coronary artery stenosis than in the normal group. Along with the increasing degree of coronary artery stenosis, the total visceral fat thickness increase, especially the epicardial layer (the moderate stenosis increased by 23% and the severe stenosis increased by 54% than without stenosis). 2, In the severe coronary artery stenosis group, the patients were divided into NAFLD group and non NAFLD group. compared to non NAFLD group, the epicardial, liver, renal, before the perirenal fat and the coronary score significantly increased in the NAFLD group (10%, 22%, 32%, 36% and 27%, respectively) .Along with the increase of coronary score , the epicardial fat thickness was increased significantly (16% and 34%, respectively) in the non NAFLD group; but the epicardial thickness of the NAFLD group was slightly increased (8% and 8%, respectively), there was no significant difference among the subgroups. Furthermore,not only in NAFLD group but also in non NAFLD group, the visceral fat thickness of the other three sections have no significant change among the three subgroups. Conclusion: Both the NAFLD and the epicardial adipose layer thickening can increase the risk of coronary artery stenosis. In the patients with the severe coronary artery stenosis, the NAFLD patients are more likely to increase the accumulation of the visceral fat thickness than the non NAFLD patients. Under the same thickness of the epicardium, the degree of coronary artery lesions is lighter in the NAFLD patients; it may be related to AMPK wich may have the myocardial protective effects.

The Predictive Value of Brachial-Ankle Pulse Wave Velocity in Coronary Atherosclerosis and Peripheral Artery Diseases in Urban Chinese Patients

Coronary artery disease (CAD) is one of the most common diseases throughout the world. To investigate the relationship between brachial-ankle pulse wave velocity (baPWV) and arterial atherosclerosis and peripheral artery disease (PAD) and its potential diagnostic value in diagnosing arterial sclerosis, a self-designed questionnaire and special machine designed by Colin Corp., Ltd. were implemented to measure the level of baPWV and the ankle-brachial index (ABI) and their relations to coronary and peripheral artery atherosclerosis. The results showed that baPWV and ABI were equally effective at predicting stenosis of the coronary arteries and stenosis of the arteries of the lower extremities. Different levels of baPWV with corresponding ABI can express different degrees of arterial sclerosis and peripheral artery lesion to a certain extent. Measurement of both baPWV and ABI is thus highly recommended in clinical investigation. Arterial wave reflection is a major determinant of left ventricular function, coronary perfusion, and cardiovascular risk. We investigated whether arterial wave velocity can detect atherosclerosis of the coronary arteries and peripheral arteries in patients with documented coronary artery diseases. Our goal was to investigate the relationship between baPWV and arterial atherosclerosis and PAD and their potential diagnostic value. Two hundred and seventy-two patients ranging in age from 45-92 years (mean: 66.87+/-11.42 years) were selected from the Department of Cardiology of our hospital. A carefully designed questionnaire was used to gather baseline data for each patient. All patients underwent cardioangiography and were divided into four groups according to their Gensini scores: a control group, and groups with a mild, moderate, or severe degree of stenosis. One hundred and five of these patients simultaneously underwent angiography of the lower extremities and were divided into four groups according to the degree of artery stenosis: a control group, and groups with a mild, moderate, or severe degree of stenosis. Grouping of baPWV levels was made according to Japanese surveys. Bilateral baPWV and ABI were measured using non-invasive arterial atherosclerosis measuring equipment. In the coronary artery groups based on Gensini score, ABI in the group with a high degree of stenosis was significantly lower than that in the control and moderate stenosis groups, while the baPWV was significantly higher than that in the control and mild stenosis groups. In the grouping of baPWV levels, it was indicated that the ABI level was significantly different between each group. The ABI<0.9 in groups with baPWV<1,400 cm/s and >2,100 cm/s was higher than that in other groups. In the grouping by angiography of the lower extremities, the ABI level was decreased with increasing degree of artery stenosis while the baPWV levels were increased under the same circumstance (p<0.05 or p<0.01). Logistic regression analysis indicated that relatively low ABI, high baPWV, abnormal fasting blood glucose, and smoking were independent risk factors for the development of cardiovascular diseases. The simultaneous measurement of bilateral baPWV and ABI using the newly developed equipment presented herein is highly recommended, and should play an important role in predicting the possibility of cardiovascular diseases and the degree of coronary artery lesions. It is important to note that baPWV is not only one of the risk factors in the presence of coronary stenosis, but also a substitute index of target-organ damage, another parameter in predicting PAD. The current study indicated that a baPWV>1,800 cm/s often follows a severe coronary artery event, while baPWV>2,100 cm/s may be related to potential PAD. baPWV measurement is helpful to make new standard of diagnosing PAD in Chinese cohorts.

Importance of mitral regurgitation in ischaemic heart disease—more than just a bystander

This editorial refers to ‘Prognostic influence of mitral regurgitation prior to a first myocardial infarction’† by J. Zamorano et al. , on page 343 Coronary artery disease (CAD) prognosis has been known for many years to depend on many factors, including the degree of left ventricular (LV) dysfunction as well as the presence of inducible ischaemia, viable dysfunctioning myocardium, and degree of coronary artery lesions. Mitral regurgitation (MR) is often a bystander and is a frequent finding after acute myocardial infarction (AMI) (in 15–64% of patients). It is an independent predictor of cardiovascular mortality,1–4 and results from many factors, such as papillary muscle dysfunction and/or mitral annulus dilatation, and LV remodelling with papillary muscle migration causing malcoaptation of the leaflets and excess valvular tenting with loss of systolic annular contraction.2 Myocardial viability in the infarct area reduces infarct expansion and ventricular remodelling, and prevents the development of MR. In the study by Golia et al. 1 of 191 patients after uncomplicated AMI, MR was present in 58.6% of the patients and it was significant (>grade 1) in 26 patients (13.6%). It was associated with increased age, lower regional wall motion score index during dobutamine stress echocardiography, more severe CAD, and more frequent anterior/inferior infarctions. At multivariate analysis the extent of LV dysfunction and the presence of MR were significantly related to mortality. Auscultation may not detect a murmur due to decreased turbulence, and echocardiography should be performed routinely on all patients for diagnosis. A regurgitant volume ≥30 mL, or an effective regurgitant orifice ≥2 mm2 defines a high-risk group.4,5 Many papers have focused on the importance of correcting MR during coronary artery bypass grafting (CABG) for a better long-term prognosis, even when there is no definite major organic cause (such … *Tel: +351 21 8465469; fax: +351 21 8465469. E-mail address: branco.online{at}mail.telepac.pt