Effect Of Coronary Angioplasty Research Articles

A comparative study on the effect of coronary angioplasty on left ventricular function in post myocardial infarction among patients with and without type-2 diabetes mellitus

Background and objectives. Coronary angioplasty is a common intervention for improving cardiac function postmyocardial infarction. However, the impact of this procedure in patients with type-2 diabetes mellitus (T2DM) compared to those without diabetes remains less understood. Material and methods. This study included 50 patients who underwent coronary angioplasty post-myocardial infarction. Patients were divided into two groups based on the presence (Group A) or absence (Group B) of T2DM, with 6 patients in each group. We assessed left ventricular function using echocardiography, focusing on ejection fraction and wall motion score, at baseline, and at 1, 3, and 6 months post-angioplasty. Additional data on clinical outcomes, functional status, cardiac biomarkers, medication use, comorbid condition management, and hemodynamic measurements were also collected. Results. Both groups showed improvement in left ventricular function post-angioplasty, with no significant difference in ejection fraction and wall motion score between the two groups at each follow-up. Clinical outcomes, functional status, and biomarker levels were comparable between groups. Medication compliance was high in both groups. The control of comorbid conditions and hemodynamic stability post-angioplasty were similarly maintained in both diabetic and nondiabetic patients. Conclusion. Coronary angioplasty positively impacts left ventricular function in post-myocardial infarction patients, irrespective of the presence of T2DM. Both diabetic and non-diabetic patients demonstrated similar improvements in cardiac function and overall clinical outcomes, suggesting that angioplasty is an effective intervention for post-myocardial infarction patients regardless of their diabetes status. Further studies with larger sample sizes are recommended to validate these findings.

Effects of Coronary Angioplasty on Inflammatory Markers and Lipid Profile in Patients with Cardiovascular Disease

Background: Although atherosclerosis is a major cause of mortality, little is known about the role of inflammation, and mediators of disease progression. In this study, serum levels of inflammatory markers were evaluated in stable atherosclerotic disease patients before and by 24 hours after coronary angioplasty and stenting. Methods: The study included 12 patients (eight women and four men) who underwent coronary angioplasty to implant a conventional wire-mesh cobalt-chromium stent. Changes in the lipid profile were investigated. The pro-inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukine-17 (IL-17) were measured by enzyme immunoassays. All patients received statins and reported being hypercholesterolemic, hypertensive, and sedentary. Results: TNF-α and IL-17 levels did not differ significantly before and after angioplasty. The total leukocyte count had a significant reduction when compared before (7.6; 6.5-10.6cells/µL) and after (6.78;5.2-8.2cells/µL) angioplasty, although, on the other hand, the CRP levels increased from 2.5 (0.0-14.75) to 8.0 (0.75-31mg/dL) (p<0.05). Patients had significantly higher average total cholesterol before (160; 148-193) then after (155; 122-172mg/dL) (p=0.0038), as well as HDL-cholesterol, before (41; 30-49) and after (33; 32-42mg/dL) (p=0.0192), and apolipoprotein-A levels, before (159;133-169) and after, (143; 115-150 mg/dL) (p<0.05) procedure. On the other hand, no significant differences were noticed on LDL-cholesterol, triglycerides, and apolipoprotein-B concentrations. Conclusion: The angioplasty procedure with stent implantation influenced lipoprotein metabolism specifically that of HDL, by leading to HDL-c and apolipoprotein-A reductions, as well as total leukocyte count, and CRP elevations by 24 hours after procedure.

Increased phosphodiesterase 3A/4B expression after angioplasty and the effect on VASP phosphorylation

The beneficial effects of coronary angioplasty are limited by the proliferation and migration of vascular smooth muscle cells leading to restenosis. We hypothesized that increased activity of phosphodiesterase (PDE) after angioplasty in response to growth factors such as platelet-derived growth factor (PDGF)-BB and fibroblast growth factor (FGF), leads to reduced cAMP levels, which, in turn, may contribute to vascular smooth muscle cell proliferation. In rats subjected to angioplasty, aortic expression and activity of PDE3/PDE4 were increased within 24 h and associated with reduced phosphorylation of vasodilator-stimulated phosphoprotein (VASP), a substrate for cAMP-dependent protein kinase A (PKA). Inhibition of PDE3 increased VASP phosphorylation in aortic rings from rats subjected to angioplasty, whereas inhibition of PDE4 or stimulation of adenylate cyclase with isoproterenol was without effect; however, combined inhibition of PDE3 and PDE4 produced a synergistic effect on VASP phosphorylation. In cultured vascular smooth muscle cells, exposure to PDGF-BB resulted in increased expression of PDE3, which was prevented by an inhibitor of PI3 kinase but not by inhibitors of the MAP kinase signaling pathway. In contrast, FGF increased the expression of PDE4 in vascular smooth muscle cells but did not influence expression of PDE3. This study shows that angioplasty results in increased expression/activity of PDE, possibly arising from stimulation by PDGF-BB and FGF, and decreased cAMP levels, which may promote restenosis. These results provide a rational explanation for the beneficial effects of PDE inhibitors.

The effect of coronary angioplasty on heart rate variability in hypertensives. Evaluation by novel mathematical methods

The effect of coronary angioplasty on heart rate variability in hypertensives. Evaluation by novel mathematical methods

The effect of coronary angioplasty on plasma NT‐proBNP level in patients with and without arterial hypertension

Aims. The purpose of the study was to assess the effect of percutaneous transluminal coronary angioplasty (PTCA) on plasma N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level in hypertensive and normotensive subjects with and without systolic left ventricular dysfunction. Methods and results. Forty patients affected by ischemic heart disease and submitted to PTCA were studied. The patients were divided into four groups: group I – 10 patients with essential arterial hypertension (HT) and normal left ventricular ejection fraction (EF); group II – 10 patients with HT and EF <55%; group III – 10 patients without HT and with normal EF; group IV – 10 patients without HT and with EF <55%. Blood samples were collected twice: 24 h before and after PTCA. The plasma NT‐proBNP concentrations increased significantly in group I (368±103 pg/ml vs 488±182 pg/ml; p<0.05), in group III (257±107 pg/ml vs 447±198 pg/ml; p<0.05), and in group IV (419±99 pg/ml vs 826±432 pg/ml; p<0.05) 24 h after PTCA. There were significant differences in the relative change in plasma NT‐proBNP concentrations between groups I and II, and between groups III and IV. Conclusions. Successful coronary angioplasty results in a rise in plasma NT‐proBNP concentration. The increase is less expressive in patients with systolic left ventricular dysfunction. The presence of hypertension does not affect NT‐proBNP concentration after PTCA.

Effect of coronary angioplasty on Helicobacter pylori IgG antibody: Lack of association between high sensitive C reactive protein and Helicobacter pylori IgG antibody levels

Effect of coronary angioplasty on Helicobacter pylori IgG antibody: Lack of association between high sensitive C reactive protein and Helicobacter pylori IgG antibody levels

Effect of Coronary Angioplasty on QT Dispersion

Background and Objectives:The change in QT dispersion (QTd) immediately after balloon angioplasty refl- ects the immediate impact of ischemia. We intended to analyze the immediate impact of ischemia on myocardial repolarization. Subjects and Methods:Forty-six patients who underwent percutaneous coronary intervention were enrolled. The standard 12-lead electrocardiogram (ECG) was recorded just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning. QTd was determined by the difference between the maximum and mi- nimum QT interval (QTi). We then calculated the corrected QTi (QTc) using Bazett's formula. QTd and QTi were compared according to the site of the ballooned vessel, number of ballooned vessels and history of acute myocardial infarction. Results:QTd just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning were 35.21±10.36 msec, 54.56±16.89 msec, 50.91±14.20 msec, 45.52±9.6 msec and 38.56±10.89 msec, respectively. QTd increased markedly during ballooning, but after myocardial ischemia was relieved, decreased rapidly. Ten minutes after ballooning, QTd was reduced to a similar level as that of baseline. There were no signi- ficant differences between the AMI and non-myocardial infarction groups, single-vessel and multi-vessel groups, and the location of the stenosed artery. There was no significant difference in QTi according to different stenosed vessel. Conclusion:QT (QTc) dispersion increased rapidly with myocardial ischemia and reduced rapidly after the myocardial ischemia was resolved. Therefore, increased QTd can be used as an early clue of myocardial

Chemokines in patients with ischaemic heart disease and the effect of coronary angioplasty

Percutaneous coronary transluminal angioplasty (PTCA) may release inflammatory mediators such as chemokines. Monocyte chemoattractant protein-1 (MCP-1) and eotaxin (EOX) are monocyte- and eosinophil-specific chemokines involved in the inflammation and pathogenesis of coronary atherosclerosis. A total of 28 patients undergoing elective PTCA, 20 coronary artery disease (CAD) patients undergoing coronary angiography and 28 healthy controls were studied. In PTCA patients before the procedure, MCP-1 plasma levels (441±64 pg/ml) were similar to those of CAD patients (430±24 pg/ml), and significantly higher compared with controls (145±17 pg/ml, P<0.01). MCP-1 rose significantly after 3 and 6 months following PTCA (696±89 and 876±86 pg/ml, respectively, P<0.01 vs. before PTCA). EOX plasma levels (155±14 pg/ml) were similar to those of CAD patients (157±14 pg/ml), but significantly higher compared with controls (83.2±10 pg/ml, P<0.05). EOX rose significantly 24 h (273±41 pg/ml, P<0.05) but not 3 months after PTCA (160±20 and 158±19 pg/ml, respectively). These findings indicate that chemokine-induced monocyte- and eosinophil-specific chemoattraction is stimulated in patients with coronary artery disease. MCP-1 levels remain significantly elevated for at least 6 months following elective PTCA, suggesting an inflammatory stimulation.

Effect of Coronary Angioplasty on QT and JT Dispersion

Background:QT dispersion, reflecting inhomogenous ventricular repolarization, increases in myocardial ischemia. In addition, Many studies reported that prolonged QT dispersion reduced to normal after reperfusion treatment. We have carried out this study to evaluate the QT and JT dispersion before and after the angioplasty in patients with coronary artery diseases. Method and Materials:Seventy-two patients (55 men and 17 women: 18 acute myocardial infarction, 9 unstable angina and 45 stable angina who underwent percutaneous translu- minal coronary angioplasty were evaluated. Standard 12-lead electrocardiograms were recorded 24 hours before and 24 hours after angioplasty at a paper speed of 25 mm/sec. Results:There was no significant change in heart rate or the maximum or minimum QT interval after angioplasty. QT dispersion significantly decreased after angioplasty (p<0.05. And QTc dispersion (QTcd also similary reduced (p<0.01. JT dispersion (JTc and JTc dispersion (JTcd were not changed significantly. There were significant reduction in QTd and QTcd in the group of patients without acute myocardial infarction (p=0.005, 0.004, respectively but not in JTd and JTcd. However, in patients with acute myocardial infarction, all four dispersion were not reduced significantly. And in patients with multivessel angioplasty, there were significant reduction of QTd, QTcd, JTd and JTcd (p=0.016, 0.014, 0.036, 0.030, respectively. Conclusions:As changes in QT and JT dispersion reflect successful reperfusion by angioplasty, they can be accepted as promising test for assessing the effectiveness of angioplasty clinically. However the methodology still has several unresolved issues and larger, prospective clinical studies are needed. (Korean Circulation J 1998;28(8 :1280-1286

Effect of coronary angioplasty on QT dispersion

Increased QT dispersion (QT max – QT min [QTd]) reflects inhomogeneous ventricular repolarization that may provide a substrate for serious arrhythmias and is associated with adverse clinical outcomes in patients with heart disease. Effective treatment of acute myocardial infarction or ventricular arrhythmias may reduce QTd, but the effect of coronary revascularization on QTd in patients without these conditions is unknown. In this study, QTd was measured before and 4 and 24 hours after successful angioplasty in 94 patients without ongoing symptomatic myocardial ischemia or malignant arrhythmias. QTd decreased from 434 ± 17 msec before angioplasty to 354 ± 15 msec 4 hours ( p < 0.05) and 33 ± 14 msec 24 hours after angioplasty ( p < 0.05). QTd was improved in 64% of patients, worse in 28%, and unchanged in 8%. Thus angioplasty significantly improves QTd. This may reflect increased myocardial perfusion and may be inherently beneficial by reducing the propensity for arrhythmias. (Am Heart J 1997;134:399-405.)

The Effects of Coronary Angioplasty on the Global and Regional Left Ventricular Function in Patients with Angina Pectoris after Anterior Myocardial Infarction

Thirty-one patients (29 men and 2 women, mean age 49±10 years) were evaluated to investigate the effects of percutaneous transluminal coronary angioplasty (PTCA) on left ventricular function (LV) in patients with angina pectoris after anterior wall myocardial infarction. LV functions and LV regional wall motion scores were obtained by means of a semiquantitative method using left ventriculography. Coronary angiographies and left ventriculographies were done just before and 182 ± 160 days after the angioplasty of the left anterior descending (LAD) artery lesion. It had been found that LV ejection fraction had increased and anterolateral, apical, and septal wall motion scores had decreased significantly after PTCA in accordance with the patients' clinical status. The improvement was more prominent in patients with poor LV function. However, LV functions did not show any significant improvement in patients who develop restenosis after PTCA.

Effect of coronary angioplasty on precordial QT dispersion

Dispersion of the QT interval is a measure of inhomogeneity of ventricular repolarization. Because ischemia is associated with regional abnormalities of conduction and repolarization, we hypothesized that the surface electrocardiographic interval dispersion would increase in patients with symptomatic coronary artery disease in the absence of myocardial infarction and that successful revascularization would reduce QT interval dispersion. Thirty-seven consecutive patients with ischemia due to 1-vessel coronary artery disease without prior myocardial infarction who underwent percutaneous transluminal coronary angioplasty (PTCA) were evaluated. Standard 12-lead electrocardiograms were performed 24 hours before, 24 hours after, and late (>2 months) after PTCA. Precordial QT interval dispersions were determined from differences in the maximum and minimum corrected QT intervals. Mean QT interval dispersion before PTCA was 60 ± 9 ms, immediately after PTCA 23 ± 14 ms (p < 0.001), and late after PTCA 29 ± 18 ms (p < 0.001 vs before PTCA). The shortest precordial QT interval increased immediately after PTCA (367 ± 40 vs 391 ± 39 ms; p < 0.02) and then remained stable late after PTCA (376 ± 36 ms, p = NS vs immedately after PTCA). Symptomatic recurrent ischemia in 8 patients with documented restenosis increased QT interval dispersion (56 ± 15 ms [p < 0.01] vs 25 ± 14 ms immediately after PTCA), which decreased again after successful repeat PTCA (22 ± 13 ms [p < 0.01] vs before the second PTCA). QT interval dispersion decreases after successful coronary artery revascularization and increases with restenosis. Therefore, QT interval dispersion may be a marker of recurrent ischemia due to restenosis after PTCA.

Vasoreactivity and restenosis after coronary angioplasty in the atherosclerotic pig model

The effect of coronary angioplasty on coronary spasm remains unknown. We examined the effects of balloon angioplasty, using an oversized balloon, on coronary hypercontraction and eventual restenosis in a pig model of coronary spasm. We performed balloon angioplasty, using an oversized balloon at the site of coronary spasm superimposed on atherosclerosis with 6 (group A, n = 14) or 1 (group B, n = 14) atmospheres of inflation pressure in miniature pigs. Using coronary angiography we assessed the coronary basal diameter and diameter change in response to histamine and serotonin before, immediately after, and 4 weeks after angioplasty. Histological examinations were performed immediately after and 4 weeks after the angioplasty. Before angioplasty, histamine- and serotonin-induced hypercontraction was reproducibly noted at the atherosclerotic site. Immediately after angioplasty, the coronary diameter became larger (P < 0.01) than before angioplasty in group A, but there was no significant difference in group B. The hypercontraction in group A was abolished immediately after and 4 weeks after angioplasty, whereas the hypercontraction in group B was unchanged. Histological examination revealed medial necrosis immediately after and medial fibrosis 4 weeks after angioplasty, which were more prominent in group A. Four weeks after angioplasty, the magnitude of restenosis was greater in group A than in group B. Angioplasty using an oversized balloon with the higher atmosphere of inflation pressure abolished coronary hypercontraction immediately after and 4 weeks after angioplasty, which probably resulted from the irreversible damage to medial smooth muscles; however, this did not prevent restenosis.

Myocardial Revascularization Before Abdominal Aortic Aneurysmorrhaphy: Effect of Coronary Angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) has assumed an increasing role in the preoperative preparation of patients with an abdominal aortic aneurysm (AAA). The influence of this modality on perioperative morbidity and long-term outcome has not been substantiated. To determine the effect of PTCA, we analyzed a cohort of 2,452 patients who underwent repair of an AAA between 1980 and 1990 at our institution. We compared the cardiac morbidity, mortality, and survival of patients who had preoperative coronary revascularization by PTCA or coronary artery bypass grafting (CABG). The overall perioperative mortality for the 2,452 patients was 2.9%. Preoperative coronary revascularization was necessary in 100 patients (4.1%)--86 had CABG and 14 had PTCA. Of these 100 patients, 95% had cardiac symptoms. Patients selected for PTCA, in comparison with CABG, had significantly less three-vessel disease but not significant differences in cardiac history or ejection fraction. During the study period, the use of PTCA increased significantly. The perioperative rate of myocardial infarction for patients with prior CABG was 5.8% in comparison with 0% for those with prior PTCA. No hospital deaths occurred in either group. The median interval between coronary revascularization and repair of an AAA was 10 days for PTCA and 68 days for CABG. The 3-year survival was not statistically different between CABG (82.8%) and PTCA (92.3%) groups. The rate of late cardiac events (at 3 years) was 56.5% in the PTCA group and 27.3% in the CABG group. We conclude that PTCA as part of a highly selective approach to coronary revascularization before repair of an AAA minimizes cardiac-related events and death.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of coronary angioplasty on late potentials one to two weeks after acute myocardial infarction

In survivors of acute myocardial infarction (AMI), the restoration of anterograde flow in the infarct artery, even if accomplished beyond the time for myocardial salvage, may reduce the frequency of subsequent arrhythmic events and sudden death. Twelve subjects (8 men and 4 women, aged 39 to 69 years) with a first AMI, signal-averaged electrocardiographic late potentials, and an occluded infarct artery were prospectively identified. Seven (group I) had successful coronary angioplasty 6 to 15 days after AMI, and 5 (group II) were managed conservatively. Follow-up signal-averaged electrocardiography was performed 3 to 7 months later. From baseline to follow-up, the 7 group I subjects had a significant change in QRS duration (117 ± 13 [mean + SD] to 102 ± 10 ms), root-meansquare voltage (10.4 ± 4.7 to 31.0 ± 7.6 μV), and low-amplitude signal duration (47.5 ± 8.5 to 32.4 ± 5.2 ms) (p ≤ 0.05 for all 3 variables). No group I patient had a late potential at follow-up. In contrast, the 5 group II patients showed no change in QRS duration or low-amplitude signal duration from baseline to follow-up, and all 5 had a late potential at follow-up. At follow-up, the root-meansquare voltage was significantly greater and the low-amplitude signal and QRS durations significantly less in group I than in group II (p < 0.05 for all 3 variables). Thus, in our patients, the mechanical restoration of anterograde perfusion in an occluded infarct artery 1 to 2 weeks after AMI caused the resolution of signal-averaged electrocardiographic late potentials.

Arterial responses to balloon coronary angioplasty: An intravascular ultrasound study

Objectives. The purpose of this study was to examine the coronary artery response to percutaneous transluminal coronary angioplasty by using intravascular ultrasound.Background. The immediate effects of coronary angioplasty on arterial wall geometry and surface appearance are understood poorly. Most of the available data are derived from small necropsy series, inferred from animal models or extrapolated from in vitro studies. High frequency intravascular ultrasound provides transmural images of coronary arteries in vivo.Methods. We used intravascular ultrasound to study 29 patients before or after, or both, successful coronary angioplasty.Results. The angiographic diameter narrowing was 72 ± 13% before and improved to 19 ± 11% after angioplasty. Calcium was visualized in 7 (24%) of the 29 angioplasty sites by fluoroscopy versus 15 (52%) of sites by intravascular ultrasound (p = 0.022). Arterial dissection after angioplasty was observed in 8 (27%) of cases by contrast angiography versus 24 (83%) by intravascular ultrasound (p < 0.001). Intravascular ultrasound detected extensive dissection at the angioplasty site in 11 (73%) of the 15 calcified plaques and in only 3 (21%) of the 14 noncalcified plaques (p = 0.024). Arterial expansion (defined as the area within the external elastic membrane at the angioplasty site greater than that of the proximal reference segment) occurred in 29% of calcified plaques compared with 86% of noncalcified plaques (p = 0.007).Conclusions. Intravascular ultrasound is more sensitive than angiography for identifying arterial calcium and dissection at the site of angioplasty. At the site of angioplasty, arterial dissection occurred more frequently in calcified plaques whereas arterial expansion occurred more frequently in noncalcified plaques. Successful angioplasty causes a continuum of arterial responses that vary importantly with plaque composition.

Origin of the left main coronary artery from the right aortic sinus with retroaortic course of the anomalistically arising artery

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Effects of Coronary Angioplasty after Thrombolysis on Left Ventricular Function Assessed Using Radionuclide Ventriculography

Radionuclide ventriculography was used to assess left ventricular function in patients who had coronary angioplasty within 48 h of intravenous thrombolysis using anistreplase for acute myocardial infarction. Ventricular function was assessed on the basis of ejection fraction and wall motion at 3 and 12 months after infarction in the angioplasty group (n = 47) and in a control group (n = 45) who received anistreplase but no surgical intervention. Twentynine of these patients were followed up at 18-24 months when end-systolic and end-diastolic volumes were measured in addition to ejection fraction and wall motion assessment. No significant difference was found between the angioplasty and control groups in any of the measured parameters at any time after infarction. We conclude that routine coronary angioplasty carried out immediately after thrombolytic therapy using anistreplase has no long-term benefit in terms of improved left ventricular function.

Abnormal left ventricular filling pattern in patients with single vessel coronary artery disease: effect of angioplasty.

To study the effect of coronary angioplasty (PTCA) on left ventricular (LV) diastolic filling, mitral Doppler flow tracings of 15 patients with isolated stenosis of the left anterior descending coronary artery (LAD) and normal systolic LV function were recorded before PTCA as well as 24 h and 3 months after successful PTCA. Compared to control subjects, patients with LAD stenosis exhibited an abnormal LV filling velocity pattern before PTCA. The day following PTCA, the ratios of the early peak diastolic velocity to the peak late diastolic velocity and of the time velocity integral of the early diastolic filling phase to the time velocity integral of the late diastolic filling phase were unchanged. Despite the absence of clinical evidence of restenosis, LV filling remained abnormal 3 months after PTCA. The results suggest that abnormalities of the LV filling velocity in patients with isolated LAD stenosis and normal systolic function may persist as long as 3 months after PTCA.

Long-Term Results of Coronary Balloon Angioplasty

Long-term results after coronary balloon angioplasty are characterized by an eventful early period up to six months, with about a 30% recurrence rate per lesion, and by a stable situation thereafter. Myocardial infarction due to the dilated site is extremely rare during follow-up because the smooth, elastic, inner lining of a restenosis is much less prone to thrombosis than the initial plaque. A positive effect of coronary angioplasty on survival has not been documented, but there is clear functional improvement over the natural course of the untreated disorder. The improvement is comparable to that attained by bypass surgery if repeat angioplasty during the first months is considered as part of the procedure rather than as proof of failure.