Early Diagnosis Of Coronary Artery Disease Research Articles

Diagnosis of coronary arteries stenosis using data mining

Cardiovascular diseases are one of the most common diseases that cause a large number of deaths each year. Coronary Artery Disease (CAD) is the most common type of these diseases worldwide and is the main reason of heart attacks. Thus early diagnosis of CAD is very essential and is an important field of medical studies. Many methods are used to diagnose CAD so far. These methods reduce cost and deaths. But a few studies examined stenosis of each vessel separately. Determination of stenosed coronary artery when significant ECG abnormality exists is not a difficult task. Moreover, ECG abnormality is not common among CAD patients. The aim of this study is to find a way for specifying the lesioned vessel when there is not enough ECG changes and only based on risk factors, physical examination and Para clinic data. Therefore, a new data set was used which has no missing value and includes new and effective features like Function Class, Dyspnoea, Q Wave, ST Elevation, ST Depression and Tinversion. These data was collected from 303 random visitor of Tehran's Shaheed Rajaei Cardiovascular, Medical and Research Centre, in 2011 fall and 2012 winter. They processed with C4.5, Naïve Bayes, and k-nearest neighbour (KNN) algorithms and their accuracy were measured by tenfold cross validation. In the best method the accuracy of diagnosis of stenosis of each vessel reached to 74.20 ± 5.51% for Left Anterior Descending (LAD), 63.76 ± 9.73% for Left Circumflex and 68.33 ± 6.90% for Right Coronary Artery. The effective features of stenosis of each vessel were found too.

Carotid ultrasound for the early diagnosis of atherosclerosis in chronic kidney disease.

Atherothrombotic disease (ATD) is a progressive disorder and its most common clinical manifestations, acute myocardial infarction and stroke, are responsible for the highest morbidity and mortality rates in the Western world. Sudden death due to infarction with no prior symptoms occurs in 50% of men and 64% of women.1 One of the main tools to control the incidence of vascular disease is prevention. Formulas are available to estimate cardiovascular risk (Framingham risk score, etc.)2 They are based on epidemiological studies that determine the risk of suffering a cardiovascular event (fatal or non-fatal) within 5 to 10 years.3 While the available system to calculate cardiovascular risk is easily generalisable, and universal, it does present some difficulties. The main drawback is its low sensitivity for detecting individuals at a high risk to suffer a cardiovascular event. Large epidemiological studies show that 62% of subjects with a prior history of myocardial infarction present none or only one of the cardiovascular risk factors,4 which, undoubtedly, prevents them from being properly identified at a time to take effective preventive actions. In recent years, there have been significant technological advances in medical imaging techniques, particularly in the field of vascular disease. Below, we describe the advantages, disadvantages and uses of imaging techniques in the general population and in chronic kidney disease (CKD) patients.

Value of dobutamine stress echocardiography combined with myocardial contrast echocardiography in early diagnosis of coronary artery disease

Objective To investigate the value of high-dose dobutamine stress echocardiography (DSE) combined with myocardial contrast echocardiography (MCE) in early diagnosis of coronary artery disease(CAD). Methods Dobutamine stress MCE and SonoVue contrast infusion were performed before an elective percutaneous coronary intervention in 38 patients with suspected CAD. The total and regional perfusion and wall motion (WM) were scored as normal or abnormal and attributed to the three main epicardial coronary arteries using a 16-segment left ventricular model. Results An intermediate stress level was obtained in 22 (58 ％) patients, and 9(24 ％ ) patients obtained peak stress. Twenty seven of 38 patients were diagnosed as CAD by quantitative coronary angiography. A perfusion defect was detected in 89％ and WM abnormality in 52％ of the patients at peak stress ( P ＜0.01). By perfusion,71％ of stenoses were both detected and correctly anatomically located,compared to 41 ％ by WM ( P ＜0.01). Conclusions DSE combined with MCE can increase the sensitivity of myocardial ischemia detection. Perfusion scoring is superior to WM scoring during stress MCE for diagnosing significant CAD. As a new non-invasive method,DSE combined with MCE could be used in early diagnosis of CAD. Key words: Echocardiography; Dobutamine; Microbubbles; Coronary disease; Myocardial ischemia

Prediction of Coronary Artery Disease Using Pulse Wave Velocity and Retinal Artery Lesions

Coronary artery disease (CAD) is the leading cause of death worldwide. The prevention and early diagnosis of CAD is important for the treatment of this disease. Since the coronary angiographic examination is not available for every hospital, the convenient, quick and cheap prediction marker is needed for the screening of the suspected CAD patients. The aim of this study was to assess whether the combination of brachial-ankle pulse wave velocity (baPWV) and staging of retinal artery lesions could be a useful approach to predict CAD in symptomatic patients, including atypical chest pain. To prove this question, 472 Chinese patients with suspected CAD underwent coronary angiography, the eye fundus examination and measurement of baPWV. The results show that the frequency of baPWV of 1,400 cm/s or retinal artery atherosclerosis of ≥ Stage 2 is higher in patients with CAD (n = 312) than those without CAD (n = 160, p < 0.001). Both baPWV and retinal artery atherosclerosis are correlated with the presence of CAD with and without typical chest pain (p < 0.001), indicating that the combination of the two indexes is an independent predictor of the presence of CAD (OR: 10.37, 95% CI: 5.72-18.81, p < 0.001). Either baPWV over 1,400 cm/s or retinal artery atherosclerosis of ≥ Stage 2 is a useful marker to predict the presence of CAD even with atypical chest pain. The combination of the two non-invasive methods is also useful for predicting CAD in symptomatic Chinese patients.

2SQ-05 細胞の力学応答を利用した血管機能評価 : 動脈硬化の早期診断(2SQ メカノバイオロジーの展開:基礎から医学的応用へ,日本生物物理学会第49回年会(2011年度))

2SQ-05 細胞の力学応答を利用した血管機能評価 : 動脈硬化の早期診断(2SQ メカノバイオロジーの展開:基礎から医学的応用へ,日本生物物理学会第49回年会(2011年度))

Estimation of vessel age and early diagnose of atherosclerosis in progeria syndrome by using echo-tracking

The stiffness of the arteries normally increases with age. Radiofrequency echo-tracking is a non-invasive ultrasound method which is able to detect the stiffness of the arteries, represented by the beta stiffness index. The estimation of biological age of vessels is possible on the basis of the normal age-group specific beta stiffness values. The beta stiffness index becomes higher in early stages of atherosclerosis as well, before any visible morphological changes. Hutchinson-Gilford progeria syndrome (HGPS) is rare genetic disorder resulting in accelerated aging including appearance of progressive atherosclerosis at an early age which determines the quality and term of life of these patients. Determination of vascular age and early diagnosis of atherosclerosis seems crucial. According to our knowledge, the estimation of vascular age detected with radiofrequency echo-tracking in HGPS patients, in contrast to the normal age-specific beta stiffness values, has not been published yet.

Proteomic profiling in apolipoprotein E-deficient mice during atherosclerosis progression

Atherosclerosis and related complications are a major worldwide cause of human morbidity and mortality. It is advantageous to perform atherosclerosis studies in the apolipoprotein E-deficient (Apo E(-/-)) mouse model, which develops atherosclerosis very fast in comparison to humans. The aim of this study was to compare serum protein profiles in Apo E(-/-) mice during atherosclerosis progression with the data of control C57BL/6 mice. Serum proteomic analyses were performed using surface-enhanced laser desorption/ionization-time of flight mass spectrometry (SELDI-TOF-MS). The protein profiles obtained using three different chips, CM-10 (weak cation exchange), H50 (reversed-phase) and IMAC-30 (immobilized metal affinity capture) were statistically analyzed using the ProteinChip data manager 3.0 program. At 20 weeks of age, all Apo E(-/-) mice developed early atherosclerotic lesions. The peak intensities of 742 serum protein/peptide clusters were found to be different between the atherosclerotic and control mice groups, and the differences reached statistical significance for 107 serum protein/peptide clusters (p<0.05). This study contributes to understanding the changes in serum protein/peptide profiles during atherosclerosis development and may inform discovery of new protein biomarkers for early diagnosis of atherosclerosis.

Screening for Coronary Artery Disease in Patients With Diabetes

Coronary artery disease (CAD) accounts for a large fraction of the morbidity, mortality, and cost of diabetes. Recognizing this, nearly 10 years ago the American Diabetes Association published a consensus recommendation that clinicians consider a risk factor-guided screening approach to early diagnosis of CAD in both symptomatic and asymptomatic patients. Subsequent clinical trial results have not supported those recommendations. Since the prior consensus statement, newer imaging methods, such as coronary artery calcium scoring and noninvasive angiography with computed tomography (CT) techniques, have come into use. These technologies, which allow quantitation of atherosclerotic burden and can predict risk of cardiac events, might provide an approach to more widespread coronary atherosclerosis screening. However, over this same time interval, there has been recognition of diabetes as a cardiovascular disease (CVD) equivalent, clear demonstration that medical interventions should provide primary and secondary CVD risk reduction in diabetic populations, and suggestive evidence that percutaneous coronary revascularization may not provide additive survival benefit to intensive medical management in patients with stable CAD. This additional evidence raises the question of whether documenting asymptomatic atherosclerosis or ischemia in people with diabetes is warranted. More data addressing this issue will be forthcoming from the BARI 2-D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial. Until then, for patients with type 2 diabetes who are asymptomatic for CAD, we recommend that testing for atherosclerosis or ischemia, perhaps with cardiac CT as the initial test, be reserved for those in whom medical treatment goals cannot be met and for selected individuals in whom there is strong clinical suspicion of very-high-risk CAD. Better approaches to identify such individuals based on readily obtained clinical variables are sorely needed.

Associação entre perfil lipídico e adiposidade corporal em mulheres com mais de 60 anos de idade

To verify the association between lipid profiles and overall or central obesity in women over the age of 60. The sample was comprised of 388 women over the age of 60 (mean 69; standard deviation 5.9 years). The lipid profile was determined using total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C) and triglyceride (TG) levels. Overall obesity was determined using the body mass index (BMI) and skin fold (SF) measurements. Central obesity was determined using the waist circumference (WC) and waist--hip ratio (WHR). Statistical analysis was conducted using age adjusted partial correlation and one way ANOVA (p<0.05). The mean values found for the adiposity variables and lipid profile components indicate an elevated atherogenic risk. In addition, the indicators for overall and central obesity were directly related to TG levels and inversely related to HDL-C levels. The partial correlation analysis and the largest variance found for WC and WHR in comparison to the lipidogram components indicate that both methods could be useful in the early diagnosis of atherosclerosis.

Stress echocardiography: refining the diagnosis of coronary artery disease

Echocardiography is the most widely used non-invasive imaging method incardiology worldwide. Several reasons justify its success, the mostimportant being its ability to answer easily and repeatedly the pertinentclinical questions posed every day by clinicians about their patients. Inaddition, it has accommodated itself to the continuous technological andscientific developments of the last five decades. The early diagnosis ofcoronary artery disease (CAD) is extremely important, since it can be used toidentify a subgroup of patients at higher risk of developing cardiovascularevents, including sudden death. In addition, knowing that a patient has CADmay be extremely useful in different ways, including for risk stratificationafter an acute coronary syndrome, planning a therapeutic strategy, includingthe ideal method of revascularisation and, most importantly, guiding andmonitoring the intervention. The role of stress echocardiography in its different modalities has beenwell established over the years, demonstrating a high sensitivity andspecificity in the diagnosis of previously unknown CAD, as well as inassessing patients with chronic CAD and after revascularisationprocedures.

Towards early diagnosis of atherosclerosis — role of shear stress

Towards early diagnosis of atherosclerosis — role of shear stress

Use of Natriuretic Peptides for Non-invasive Assessment of Stable Coronary Artery Disease

Coronary artery disease (CAD) is the leading cause of death in adults, accounting for more than 480,000 deaths in the US and 1.95 million deaths in Europe each year. There is considerable interest in early diagnosis of CAD, because obstructive coronary artery disease can exist with minimal or no symptoms and can progress rapidly. In patients with symptoms suggestive of CAD, a variety of tests and biomarkers are available to assess the risk of future cardiovascular events and to identify patients for further diagnostic work-up with coronary angiography.

We-W39:2 Early diagnosis of atherosclerosis by non-invasive ultrasound to improve cardiovascular event prediction

We-W39:2 Early diagnosis of atherosclerosis by non-invasive ultrasound to improve cardiovascular event prediction

Influence of age and hypertension on the association between small artery compliance and coronary artery disease

Small artery elasticity index (SAEI) as determined by a new non-invasive pulse-wave contour analysis has been used to identify abnormalities of the arterial wall associated with aging, hypertension (HT), endothelial dysfunction, and coronary artery disease (CAD). The present study examined the influence and interaction of CAD risk factors on the association between SAEI in risk-associated patients with CAD (case subjects, n = 178) and without CAD (control subjects, n = 202). Case subjects had a lower SAEI than control subjects, and age was consistently and negatively correlated with SAEI. The HT was related to reduced SAEI in female subjects overall and in male case subjects. In male patients with hypertension, the association between SAEI and CAD was significant (P < .05) after considering conventional risk factors of CAD. In conclusion, age and HT should be considered when using SAEI in the early diagnosis of CAD, and lower SAEI could be of greatest diagnostic value in male patients with HT.

Is Arterial Stiffness Useful in Differentiating Patients with Coronary Artery Disease from Risk Factor Only Patients?

Background and Objectives:The endothelial function, carotid intima-media thickness (CIMT) and arterial stiffness are known as surrogates of atherosclerosis, but it is not clear whether these surrogates can discriminate patients with coronary artery disease (CAD) from those with risk factor. The intention was to compare these 3 surrogates in patients with CAD and those with risk factor only. Subjects and Methods: Forty-three patients with CAD (mean age:58, 32 men), 18 age and sex matched healthy people (mean age: 52, 9 men) and 16 patients (mean age:53, 12 men) with atherosclerosis risk factor only were enrolled. The endothelial function (flow-mediated brachial artery dilation, FMD) and CIMT were measured by high-resolution ultrasound and the arterial stiffness by an oscillometric method. Results:There was a significant difference between the CAD and risk factor groups (3.46±1.3% vs. 5.77±2.54%, p 0.05) in the measured FMD. The CIMT showed a significant difference between the CAD and healthy groups (0.89±0.14 mm vs. 0.78±0.07 mm, p 0.05). There were significant differences among all groups in relation to the arterial stiffness (CAD group:1524±289 cm/sec, risk group:1342±202 cm/sec, healthy group:1195±119 cm/sec, p<0.05). The arterial stiffness showed significant correlation with the FMD (r=-0.322, p=0.005) and CIMT (r=0.310, p=0.007). Conclusion:Of the 3 surrogates, the arterial stiffness measurement showed the best reliability in differentiating the CAD from the risk factor only groups as well as from healthy subjects. This study suggests the arterial stiffness can be used as a novel noninvasive test for early diagnosis of CAD in patients at high risk of atherosclerosis. (Korean Circulation J 2004;34(9):845-855)

Relation between coronary artery disease, risk factors and intima-media thickness of carotid artery, arterial distensibility, and stiffness index.

Atherosclerosis is a diffuse process that involves vessel structures. In recent years, the relation of noninvasive parameters such as intima-media thickening (IMT), arterial distensibility (AD), and stiffness index (SI) to cardiovascular diseases has been researched. However, we have not found any study that has included all these parameters. The aim of this study is to examine the relation between the presence of coronary artery disease (CAD) and its risk factors to AD, SI, and IMT, which are the noninvasive predictors of atherosclerotic process in the carotid artery. Included in the study were 180 patients who were diagnosed as having CAD by coronary angiography (those with at least > or = 30% stenosis in the coronary arteries) and, as a control group, 53 persons who had normal appearing coronary angiographies. IMT, AD, and SI values of all the patients in the study were measured by echo-Doppler imaging (AD formula = 2 x (AoS - AoD)/PP x AoD, SI formula = (SBP/DBP)/([AoS - AoD]/AoD). Significantly increased IMT (0.82 +/- 0.1, 0.57 +/- 0.1, p<0.05), decreased AD (0.25 +/- 0.9, 0.37 +/- 0.1, p<0.05), and increased SI (13 +/- 4, 8 +/- 3, p<0.05) values were detected in the CAD group compared to the control group. A significant correlation was found between IMT and presence of diabetes mellitus (DM), systolic blood pressure, total cholesterol, and presence of plaque in carotids, and age. In the coronary artery disease group there was a significant correlation between AD and age, systolic blood pressure, and HDL cholesterol levels, while there was no significant correlation with plaque development. A significant correlation was also found between stiffness index and systolic blood pressure and age; however, there was no relation between number of involved vessels and IMT, AD, and SI. We found sensitivity, specificity, and positive predictive and negative predictive values for CAD diagnosis to be 70%, 75%, 77%, and 66%, respectively. In CAD cases, according to data in this study, IMT and SI increased while AD decreased, and this was detected by carotid artery Doppler ultrasonography. Therefore, it was concluded that these cheaper, noninvasive, and easily available parameters could be used in early diagnosis of CAD.

Prevalence and prognostic value of perfusion defects detected by stress technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in diabetics. Early diagnosis of CAD and identification of high-risk subgroups, followed by appropriate therapy, may therefore enhance survival. This study sought to determine the value of stress myocardial perfusion single-photon emission computed tomography (SPECT) with technetium-99m sestamibi to detect perfusion defects and predict cardiac events in asymptomatic diabetics. One hundred eighty asymptomatic diabetics without known CAD who underwent 2-day stress technetium-99m sestamibi SPECT were followed up for 36 ± 18 months. End points were defined as hard (myocardial infarction or cardiac death) or total events (myocardial infarction, cardiac death, or late revascularization). Logistic regression analysis evaluated clinical variables, type of stress, exercise treadmill test (ETT), and SPECT as predictors of end points. Perfusion defects were found in 26% of patients (15% reversible, 6% mixed, and 5% fixed). Clinical or ETT variables were not associated with perfusion defect type or with hard events. However, male gender predicted total events (chi-square 3.3; p = 0.01). An abnormal SPECT significantly increased the risk of hard events (chi-square 5.4; p = 0.001) and total events (chi-square 7.4; p = 0.0001). Extensive defects determined the highest risk of total events (chi-square 18.8; p = 0.0001). Event rates increased according to SPECT: 2% of hard events per year and 5% of total events per year in patients with normal SPECT versus 9% per year and 38% per year, respectively, in those with abnormal SPECT. Importantly, a normal SPECT identified a relatively low-risk subgroup of patients. Thus, stress technetium-99m sestamibi SPECT was useful in evaluating asymptomatic diabetics for the presence of CAD, and effectively risk-stratified this population.

Quantification of coronary artery calcification in patients with FH using EBCT.

Calcification of the coronary vessel wall is regarded as a marker of advanced coronary atherosclerosis. To test whether patients with heterozygous familial hypercholesterolemia (FH) exhibit excessive calcification of the coronary vessel wall, we quantified coronary artery calcium in LDL-apheresis treated FH-patients with known severe coronary artery disease (CAD) (n = 10), in patients with moderate hypercholesterolemia and known severe CAD (n = 10), and in asymptomatic controls (n = 10) using electronic beam CT. The total coronary calcium score (Agatston-Score), the number of calcified lesions and the calcified plaque volume were evaluated for this study. CAD-patients with FH, although on average 10 years younger, had a significantly higher total coronary calcium score (702/2018/2890), number of lesions (34/43/49) and calcified plaque volume (700/1818/2313) compared to patients with CAD only (480/641/1362, 10/16.5/22, 480/588/1209, respectively) and controls (10/47/137, 2/4/10, 15/50/144, respectively). Furthermore, we observed a significant correlation (r = 0.93; P < 0.01) between LDL-cholesterol levels (pretreatment levels of the CAD-FH group) and the total coronary calcium score in all three groups. Our results demonstrate that coronary artery calcification is more extensive in CAD-patients with FH than in CAD-patients with moderate hypercholesterolemia. In addition, we provide evidence that the amount of calcium in the coronary vessel wall in FH patients result from a long lasting history of elevated LDL-Cholesterol levels. These findings emphasize the significance of LDL-cholesterol as a risk factor for atherosclerosis and underline the importance of early diagnosis of CAD and early cholesterol lowering therapy in FH patients.

The Utility of Four Biochemical Markers in the Triage of Chest Pain Patients

Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.