Coronary Artery Disease Duration Research Articles

Atypical case of ischemic mitral regurgitation: pathogenetically based treatment

Introduction. The evolution of the study of mitral valve ischemic dysfunction influenced by fundamental and experimental research in recent years has led to a change of mitral leaflets role as a static component of the mitral valve in the pathogenesis of ischemic mitral regurgitation especially in the chronic myocardial ischemia.Objective. We report the clinical case of acute ischemic mitral regurgitation as a result of a chord rupture of the PML in a patient with unspecified duration of coronary artery disease without acute coronary syndrome and previous myocardial infarction including all stages of the diagnostic search and the results of surgical treatment.Conclusion. While performing reconstructive correction of the ischemic mitral regurgitation the possibility of reverse remodeling of the leaflets should be considered in case of removal the myocardial ischemia triggering factor. And therefore it is necessary to perform a full and adequate myocardial revascularization that combined with a full correction of all morphofunctional mitral valve changes guarantees the freedom from residual and recurrent mitral regurgitation.

Association between perceived health and adherence to treatment after percutaneous coronary intervention: A long-term follow-up study.

To identify associations between perceived health and treatment adherence six years after percutaneous coronary intervention. A non-experimental descriptive long-term follow-up study. Baseline data (n=416) were collected in 2013, with follow-up data collected in 2019 (n=154), using the EuroQoL scale, EuroQoL visual analogue scale, and Adherence of Patients with Chronic Disease Instrument. Data were analysed using descriptive statistics and multivariate methods. The average age of the 154 respondents was 68.5years (SD 7.01), with a majority males (n=118, 86.6%). Adherence to a healthy lifestyle, good perceived results of care, support from nurses, high sense of normality, low fear of complications, motivation, older age, and duration of coronary artery disease were associated with better general perceived health as well as its dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Support from nurses is a key factor to ensuring high perceived health among post-percutaneous coronary intervention patients. This support must be continuous and motivate the patient to adhere to a healthy lifestyle. Patients should feel comfortable sharing their problems and fears. This type of relationship will allow health care professionals to assess the patient's current situation and address potential problems about mobility, pain and discomfort, as well as anxiety and depression to strengthen the patient's sense of normality and enable them to confidently lead a normal life. The research aimed to gain knowledge about how perceived health is associated with treatment adherence six years after percutaneous coronary intervention. The results emphasise that a nurse's support of patients is crucial to the care process, as adherence to treatment showed a clear positive association with perceived health in the analysed sample of post-PCI patients.

Limitations of Cox Proportional Hazards Analysis in Mortality Prediction of Patients with Acute Coronary Syndrome

Abstract The aim of this study was to evaluate the possibility of incorrect assessment of mortality risk factors in a group of patients affected by acute coronary syndrome, due to the lack of hazard proportionality in the Cox regression model. One hundred and fifty consecutive patients with acute coronary syndrome (ACS) and no age limit were enrolled. Univariable and multivariable Cox proportional hazard analyses were performed. The proportional hazard assumptions were verified using Schoenfeld residuals, χ2 test and rank correlation coefficient t between residuals and time. In the total group of 150 patients, 33 (22.0%) deaths from any cause were registered in the follow-up time period of 64 months. The non-survivors were significantly older and had increased prevalence of diabetes and erythrocyturia, longer history of coronary artery disease, higher concentrations of serum creatinine, cystatin C, uric acid, glucose, C-reactive protein (CRP), homocysteine and B-type natriuretic peptide (NT-proBNP), and lower concentrations of serum sodium. No significant differences in echocardiography parameters were observed between groups. The following factors were risk of death factors and fulfilled the proportional hazard assumption in the univariable model: smoking, occurrence of diabetes and anaemia, duration of coronary artery disease, and abnormal serum concentrations of uric acid, sodium, homocysteine, cystatin C and NT-proBNP, while in the multivariable model, the risk of death factors were: smoking and elevated concentrations of homocysteine and NT-proBNP. The study has demonstrated that violation of the proportional hazard assumption in the Cox regression model may lead to creating a false model that does not include only time-independent predictive factors.

A comprehensive evaluation of respiratory status in patients with coronary artery disease undergoing coronary artery bypass surgery

The aim of the study was to analyze a potential role of lung function for a comprehensive evaluation of respiratory system in patients undergoing the coronary artery bypass surgery. Methods. The study involved 662 patients. Spirometry, body plethysmography and the singlebreath diffusing capacity for carbon monoxide (DLCO) were measured in all patients. All patients were divided into three groups according to the results of pulmonary function tests: patients with a known history of respiratory disease (n = 74; 11.2%), patients with newly diagnosed respiratory disease (n = 222; 33.5%) and patients without any respiratory disorders (n = 366, 55.3%). An integral index was calculated which characterizes the comprehensive pulmonary function evaluation based on weight coefficients. Results . Bronchial obstruction parameters, forced and slow vital capacities and diffusing capacity of alveolarcapillary membrane greatly contributed to the pulmonary function integral index. This index did not differed significantly between patients with newly and previously diagnosed respiratory diseases; however, it was significantly higher in patients without any respiratory disorders. Conclusion. A correlation analysis of the pulmonary function integral index, clinical and demographic data confirmed an inverse relationship between the pulmonary function integral index and duration of coronary artery disease, hypertension, number of previous myocardial infarctions, functional class of angina pectoris and congestive heart failure along with generally accepted factors affecting pulmonary function such as age, body mass index, smoking, and industrial xenobiotics.

The influence of selected factors on the risk of myocardial infarction

The most important risk factors for heart attack are considered to be: lifestyle, smoking, high-calorie diet rich in animal fats, physiological and biochemical factors, elevated levels of cholesterol - especially LDL cholesterol, elevated concentration of triglycerides, hyperglycemia or diabetes, increased levels of homocysteine, elevated thrombotic factors. The aim of the study was to analyze the influence of selected factors on the risk of myocardial infarction. The study was conducted among patients with diagnosed coronary artery disease who reported to the family doctor for a check. The effect of selected variables: age, sex, duration of coronary artery disease, smoking, and LDL cholesterol on the risk of myocardial infarction was studied. The results were statistically analyzed. It was found that the incidence of myocardial infarction is higher in men than in women, especially of premenopausal age. In the age group 35-44 years, the risk of the disease in men is almost nine times higher than in women. The risk of heart attack increases with age in both men and women. Among smokers heart attacks are observed significantly more frequently, and the risk of heart attack in this group is more than 2-fold higher than in non-smokers. The longer the duration of coronary artery disease, the risk of myocardial infarction increases. In patients with elevated LDL cholesterol the risk of heart attack is more than 3-fold higher than in those with normal levels.

Uses and Limitations of 40 Slice Multi-Detector Row Spiral Computed Tomography for Diagnosing Coronary Lesions in Unselected Patients Referred for Routine Invasive Coronary Angiography

Background and Aims: The value of multi-detector row computed tomography (MDCT) in routine cardiology practice is uncertain. We examined the applicability of MDCT imaging for the diagnosis of obstructive coronary artery disease in a routine clinical setting. Methods: MDCT scanning (40 slice) was performed in 111 unselected patients referred for invasive coronary angiography (ICA) and findings were compared to an independent quantitative assessment of the ICA on a segmental, vessel and patient basis. Results: Sensitivity and positive predictive value for segmental disease (72.2 and 70.9% respectively, overall) were higher in patients aged ≧60 years and history of disease ≧1 year, whereas specificity and negative predictive value were high in all groups. In the patient-based analysis, sensitivity and positive predictive value (84.7 and 87.8%, respectively) were higher, the latter in keeping with the high-patient prevalence of disease, but specificity and negative predictive value (61.5 and 55.2%) were low. Conclusions: Usefulness of MDCT was significantly influenced by age, duration of coronary artery disease and female gender, and on a patient-based analysis its diagnostic accuracy was not sufficient to replace ICA in a routine clinical setting.

Benefit and Safety of Enhanced External Counterpulsation in Treating Coronary Artery Disease Patients with a History of Congestive Heart Failure

Enhanced external counterpulsation (EECP) is used to noninvasively treat refractory angina patients, including those with a history of heart failure. The International EECP Patient Registry was used to examine the benefit and safety of EECP treatment, including a 6-month follow-up, in 1,957 patients, 548 with a history of heart failure. The heart failure cohort was older, with more females, a greater duration of coronary artery disease, more prior infarcts and revascularizations. Significantly fewer heart failure patients completed the course of EECP, and exacerbation of heart failure was more frequent, though overall major adverse cardiac events (MACE, i.e. death, myocardial infarction, revascularization) during treatment were not significantly different. The angina class improved in 68%, with comparable quality of life benefit, in the heart failure cohort. At 6 months, patients with congestive heart failure maintained their reduction in angina but were significantly more likely to have experienced a MACE end point.

Prediction of functional and psychological status after percutaneous transluminal coronary angioplasty

Objective: To examine symptom, functional status, and psychological status profiles after percutaneous transluminal coronary angioplasty (PTCA) and determine indicators of outcome. Design: Descriptive and correlational with repeated measures. Setting: Hospital or home (2.1 days before PTCA) and home (3.9 and 10.2 months after discharge). Measures: Self-administered questionnaires (developed for study) for functional status (personal and instrumental activities of daily living), and cardiac symptoms (chest pain and shortness of breath at rest and on exertion). General Health Questionnaire 16 for psychological status. Patients: One hundred thirty with PTCA (mean age 57 years, 84% male, 15% with prior PTCA). Results: Chest pain and shortness of breath at rest and on exertion decreased and functional and psychological status improved 3.9 months after PTCA, with measures maintained at 10.2 months. At 3.9 months after PTCA, poorer psychological status was predicted by having had a longer duration of coronary artery disease before PTCA. Post-PTCA indicators of poor psychological status were continued chest pain and shortness of breath on exertion and not working. The presence of post-PTCA chest pain on exertion and not working were also correlated with reduced functional status. Conclusions: Although pre-PTCA variables such as duration of coronary artery disease can predict post-PTCA outcome, the use of variables measured after PTCA may also provide clinicians with accurate estimates of functional and psychological status after PTCA. (Heart Lung ® 1999;28:276-83.)

Activated and Total Coagulation Factor VII, and Fibrinogen in Coronary Artery Disease

Fibrinogen (FBG) and total coagulation factor VII (FVIIc) concentrations are higher in those patients with coronary artery disease who are at increased future risk of acute ischemic events. The relationship between activated factor VII (FVIIa) and cardiovascular events, however, has not been intensively studied. Data were collected from 401 consecutive patients who underwent coronary angiography because of suspected coronary artery disease. Conventional risk factors FVIIc, FVIIa and FBG were assessed in relation to the severity of coronary artery disease, left ventricular ejection fraction, and previous clinical events. A strong positive correlation was found between FVIIa and FVIIc (p < 0.001), but neither FVIIa nor FVIIc correlated with FBG. No correlation was found between FVIIa, FVIIc or FBG levels and stenosis score for the severity of coronary artery disease, and all were similar in patients with stable or unstable angina pectoris. Multivariate regression analysis showed FVIIc to be higher in women (p = 0.004), and positively related to triglycerides (p = 0.001) and HDL cholesterol (p = 0.006), but not to a previous myocardial infarction or total cholesterol. FVIIa, on the other hand, was lower in patients with a previous myocardial infarction (p = 0.004), higher in women (p = 0.001) and those that previously had undergone percutaneous transluminal coronary angioplasty (p = 0.039), and positively related to total cholesterol (p = 0.011), duration of coronary artery disease (p = 0.032), and smoking (p = 0.008). FBG was positively associated with a previous myocardial infarction (p = 0.013), hypertension (p = 0.016), smoking (p = 0.005), and the thrombocyte count (p < 0.001). Finally, stepwise logistic regression analysis verified a previous myocardial infarction to be negatively associated with FVIIa (p = 0.03), and positively with FBG (p = 0.03), total cholesterol (p = 0.02), and the severity of coronary artery disease (p < 0.001). In conclusion, in patients suspected of coronary artery disease undergoing cardiac catheterization, FVIIa was decreased and FBG increased in those who had a previous myocardial infarction. FVIIa, FVIIc, or FBG levels were not, however, related to the severity of coronary artery disease, and they were similar in patients with stable or unstable angina pectoris.

Long-term prognosis of transient acute myocardial ischemia at rest

A medical approach to treatment was adopted in 652 patients with documented myocardial ischemia at rest during both the acute and fellow-up phases. No patient underwent coronary revascularization during hospitalization and only 86 patients (13%) underwent coronary bypass surgery within 8 months from discharge. During hospitalization 13 patients died. In the remaining group (639 patients), the likelihood of death in the 10-year period after discharge was 28% for all patients and 20% for cardiac causes only. A series of factors studied during the acute stage were assessed in an effort to predict long-term outcome. The following noninvasive characteristics, listed in decreasing order of statistical significance, were found to be significant univariate predictors of survival: abnormal basal electrocardiogram, duration of coronary artery disease, previous myocardial infarction, pattern of STT changes during episodes of ischemia at rest, age and systemic hypertension. The average annual mortality rate for patients with T-wave changes, ST-segment elevation and ST-segment depression was 0.9, 1.8 and 3%, respectively. The Cox survival analysis identified abnormal basal electrocardiogram, duration of coronary artery disease and pattern of ST-T changes as significant, independent predictors of death. When invasive characteristics were entered in the model, number of ≥50% narrowed coronary arteries, left ventricular ejection fraction, abnormal basal electrocardiogram and smoking habit were found to be independent and additive prognostic variables. Thus, long-term prognosis of patients with ischemia at rest is related to the severity of anatomic impairment, independent of the pattern of ST-T changes observed during the acute phase. However, noninvasive features can also be used to assess prognosis in ischemia at rest and to select high-risk populations.