Effort Angina Research Articles

PERIOPERATIVE COMPLICATIONS AND REMOTE RESULTS OF PERCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH STABLE ANGINA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim. To estimate the frequency of hospital complications and the long-term (duration of observation to 3 years) results of percutaneous coronary interventions (PCI) performed for stable effort angina in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. Hospital complications were recorded after PCI in a series of 605 patients with stable effort angina with a history of long-term smoking, among which 142 patients with COPD were identified by spirography. For the prospective part of the study, 135 COPD patients and 216 patients in the control group were selected. During long-term follow-up (up to 3 years), the incidence of major cardiovascular events (MACCE) was recorded. Results. No effect of COPD on the incidence of hospital complications after PCI was found. The relative risk (RR) of major cardiovascular events in the long-term period was 1.36 (95% confidence interval 0.97-1.90). RR of revascularization was 1.77 (95% confidence interval 1.11-2.82). Conclusion. COPD does not affect the incidence of hospital complications after PCI, but increases the risk of MACCE in the long-term, mainly due to repeated myocardial revascularization.

ACUTE ATORVASTATIN RECAPTURE THERAPY IN CORONARY ARTERY BYPASS GRAFTING

Aim . To assess the safety of the application of high-dose atorvastatin and its effect on metabolic parameters, such as the total level of nitric oxide and homocysteine in the blood plasma in patients with ischemic heart disease during a coronary artery bypass surgery (CABG). Material and methods . The study included 42 patients with stable effort angina II-IV functional class. A special criterion for selection was the taking atorvastatin at a dose of 20 mg/day for at least 30 days before patient was directed to surgical revascularization of the myocardium. Immediately before the intervention, the dose of atorvastatin was increased to the maximum allowed with subsequent taking of 40 mg/day. Complications after CABG, indicators of lipid metabolism and biochemical safety of statin use were analyzed. The duration of observation of results of the acute atorvastatin recapture therapy was 3 weeks during hospital period. We used modern enzymatic method for nitrogen oxides determination with the application of nitrate reductase. Determination of total homocysteine was performed by high performance liquid chromatography. Results. It was found that atorvastatin 80 mg for 12 hours and 2 hours before CABG in patients previously treated with atorvastatin 20 mg/day is well tolerated and leads to decrease in total levels of nitric oxide by 1.6 (0.18-10.8 ) μmol/l and homocysteine by 0.9 (0.17-2.69) μmol/l (p< 0.05 for both) Conclusion. It is assumed that the metabolic effects of high-dose therapy with atorvastatin may have a positive influence on the immediate postoperative period.

CLINICAL FEATURES OF MANIFESTATIONS OF MYOCARDIAL ISCHEMIA IN PATIENTS WITH STABLE ANGINA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim.To evaluate the comparative frequency of various manifestations of myocardial ischemia depending on chronic obstructive pulmonary disease (COPD), its severity and pulmonary hyperinflation (PHI) in patients with stable effort angina having indications for planned endovascular myocardial revascularization. Materials and methods. Systematically selected 605 patients with stable effort angina with a history of long-term smoking, among which spirography identified 142 patients with COPD, were checked for the incidence of various manifestations of myocardial ischemia, as estimated by the classification of Diamond A.G. (1983). Results.Atypical angina occurred in patients with COPD 1.6 times more often (p=0.021), and dyspnea without other manifestations of myocardial ischemia – 1.8 times more often (p=0.025) than in the control group. There was an increase in the incidence of atypical angina and dyspnea in COPD patients from grade III, and also in case of PHI. Conclusion.COPD leads to a change in the manifestations of myocardial ischemia in patients with stable angina, which is accompanied by an increase in the incidence of atypical angina and dyspnea in patients with severe COPD and in case of PHI.

C-reactive protein as an indicator of risk of cardiovascular complications in patients with type 2 diabetes mellitus and its correction

The study included 74patients (22 men and 52 women) aged 48-75yr with type 2 diabetes mellitus (DM2). 62 (88,6%) of them had grade II hypertensive disease (grade II-III by the WHO/ISH-2010 classification), 46 (67%) presented with II- III class functional stable angina of effort, 7 patients survived myocardial infarction, two ones underwent coronary artery stenting. Patients of the main group (n=50) received oral hypoglycemic agents in combination with 1-exenatide (mimetic of glucagon-like peptide) in the form of two daily subcutaneous injections of 5 mcg for 1 month and 10 mcg during the next 5 months. Control patients (n=20) were given standard hypoglycemic therapy. Analysis of highly sensitive CRP demonstrated its increase to 3 mg/l and more in 72.8% of the patients that was responsible for the high risk of cardiovascular disorders. 22,8% of the patients had a CRP level 1,0-2,9 mg/l (moderate risk) and only in 4,2% it was lower than 1 mg/l (low risk). Six months of exenatide therapy resulted in normalization of glycemia, glycated hemoglobin and significant decrease of CRP level which suggested the improvement of the functional state of vascular endothelium due to reduction of chronic inflammation objectively reflected in the highly sensitive CRP level.

Сравнительная оценка антиангинальной эффективности и безопасности препарата никорандил на фоне базисной терапии β-адреноблокаторами у больных ишемической болезнью сердца со стабильной стенокардией

to demonstrate impact of addition of nicorandil to standard treatment in patients with stable ischemic heart disease (IHD) on clinical manifestations of the disease and safety of conducted therapy. We included in this double-blind placebo controlled study with parallel groups 120 patients with verified IHD and stable effort angina. During the entire study all patients received metoprolol (100 mg/day). Patients of main group were given nicorandil (10 mg twice a day for 2 weeks and 20 mg twice a day thereafter); patients of control group were given placebo. Study duration was 6 weeks. Addition of nicorandil was associated with significant reduction of number of anginal attacks both compared with control period and addition of placebo. Consumption of short acting nitrates significantly decreased on both nicorandil doses compared with control period. Adverse events were registered in 10 of 61 and 7 of 59 patients (16.4 and 11.9%) taking nicorandil and placebo, respectively (n.s.). Three patients withdrew from the study because of headache. Addition of nicorandil to standard therapy in patients with chronic IHD and stable effort angina promoted significant reduction of number of angina attacks. Good tolerability of nicorandil was also demonstrated.

Left-to-right shunt induced by an active fixation electrode

A 58-year-old gentlemen with a history of hypertension, diabetes, gastric ulcer, and pacemaker implantation was admitted with effort angina and …

Ассоциация полиморфизмов I/D и T-786С генов ACE и NOS3 с особенностями течения ишемической болезни сердца на фоне сахарного диабета 2-го типа

to study relationship of ACE insertion-deletion (I/D) polymorphism and NOS3 T-786C polymorphism with characteristics of the course of ischemic heart disease (IHD) at the background of diabetes mellitus. Were examined 114 patients with IHD, 29.8% of patients had type 2 diabetes mellitus. ACE and NOS3 polymorphisms were determined by allele-specific polymerase chain reaction with primers by "Lytech". Patients with combined pathology belonged to older age group, had increased frequency of obesity and predominance of functional class II chronic heart failure. In this group we detected association of D allele of the ACE gene with higher frequency of dyslipidemia and obesity. Among patients with IHD without diabetes we observed associations of ACE I/D and NOS3 T-786C polymorphisms (close and moderate, respectively) with severity of effort angina. We also found that frequency of dyslipidemia among carriers of II and TT genotypes was lower than among carriers of other genotypes. Presence of type 2 diabetes as background pathology leads to a change of character of association of ACE I/D and NOS3 T-786C polymorphisms with clinical characteristics of patients with IHD.

The New European Questionnaire for Assessment of Quality of Life of Patients With Ischemic Heart Disease: HeartQoL

Quality of life (QL) of patients with ischemic heart disease (IHD) is a combination symptoms of the disease, physical state, emotional status, and social-laboring functioning. Until recently there were no universal questionnaire allowing to perform comparative analysis of QL of patients with effort angina (EF), survivors of myocardial infarction (MI) and chronic heart failure (CHF). Therefore, European Association of Cardiovascular Prevention and Rehabilitation conducted a study with the aim of developing universal questionnaire for assessment of QL in patients with IHD - HeartQol. The study enrolled 6384 patients with angina, MI, or CHF across 22 countries (315 in Russia). Patients completed a battery of questionnaires and Mokken scaling analysis was used to identify most important guestions for assessment of QL questions to be included into the HeartQoL questionnaire.

The Results of the Method Percutaneous Intracoronary Intervention in Patients of Both Male and Female

To assess gender differences among patients subjected to percutaneous coronary intervention (PCI) according to data of the "Register of performed operations of percutaneous transluminal coronary angioplasty (PTCA)". The Register was conducted from 1996 to 2012 years and comprised 4890 patients (4121 men and 769 women). Women compared to men were older (58.2+/-8.6 vs 53.4+/-8.3 years; <0.001), had higher body mass index (31.4+/-5.3 vs 29.0+/-4.4 kg/m2; <0.001), level of total cholesterol (5.6+/-1.5 vs 5.3+/-1.3 mmol/l%; <0.001), systolic (141.1+/-22.2 vs 135.1+/-20.8 mmHg, <0.001) and diastolic blood pressure (86.5+/-11.8 vs 85.4+/-12.0 mmHg; =0.014). Compared to male cohort females more often had diabetes mellitus (22.5% vs 10.0%; <0.001), arterial hypertension (92.1 vs 75.6%; <0.001), family history of ischemic heart disease (IHD) (31.3 vs 23.4%; <0.001). Moreover, severe functional classes of effort angina (class III-IV 62.8 vs 50.0%; <0.001) and heart failure (NYHA class III-IV 28.1 vs 13.4%; <0.001) were more often detected in women. In men more frequent were smoking (45.4 vs 9.9%; <0.001), alcohol consumption (26.6 vs 9.0%; <0.001) and history of myocardial infarction (51.8 vs 40.2%; <0.001). Linear heart dimensions were larger in men. Men had more severe left ventricular (LV) asynergy (15.9+/-15.1 vs 13.7+/-14.7%; <0.001) and lower LV ejection fraction (54.5+/-8.7 vs 55.4+/-8.6 %; =0.03). As compared with men, portion of women subjected to primary PTCA was higher (14.3 vs 9.2%; <0.001), likewise coronary stenting was more often performed in women (93.6 vs 88.5%; <0.001). Optimal angiographic results were more frequently achieved in women (97.9 vs 96.4%; =0.04). Incidence of post-punctional hematoma was higher in female cohort (15.0 vs 4.6%; <0.001). There were no significant differences between men and women in post-operative mortality and rate of major adverse noncardiac events after primary and planned PTCA. Despite the detected clinical, functional, and echocardiographic gender differences both for men and women PCI was safe and highly efficient method of IHD treatment.

Enhanced P-selectin expression on platelet-a marker of platelet activation, in young patients with angiographically proven coronary artery disease.

P-selectin (CD62p) exposure is an established marker for platelet activation. P-selectin exposure can trigger variety of thrombotic and inflammatory reactions. In patients with coronary artery disease (CAD), platelets are activated, and hence, there is increased P-selectin exposure. The role of P-selectin exposure in patients on treatment with statins and anti-platelets is conflicting. A case-control study was performed to determine P-selectin exposure in consecutively recruited 142 patients (age≤55years) with angiographically proven CAD on treatment and 92 asymptomatic controls. P-selectin exposure was determined by flow cytometry. Data on conventional risk factors were obtained along with estimation of levels of thrombotic [fibrinogen, lipoprotein (a), tissue plasminogen activator, plasminogen activator inhibitor-1, homocysteine and von Willebrand factor] and anti-thrombotic factors (antithrombin III). The P-selectin exposure was compared among patient groups who had different modes of presentation of CAD and categories of CAD disease severity. The patients were followed up for a period of 26months. The results indicate that P-selectin exposure was significantly elevated in patients (mean±SD 9.24±11.81) compared to controls (mean±SD 1.48±2.85) with p<0.0001. Similarly, conventional risk factors were significantly elevated in patients. P-selectin exposure showed significant negative correlation with antithrombin III levels. P-selectin exposure was higher in patients who presented with acute coronary syndromes than those who presented with effort angina. Cardiovascular event rate was 6% on follow-up. The study establishes that thrombotic-inflammatory pathways enhancing P-selectin exposure unrelated to treatment might be activated in patients, while the event rate remained lowered, and hence, treatment strategies should be inclusive to control these factors.

Atherosclerosis regression of intima-media wall thickness of internal carotid artery with long term use of flavonoids &amp; antioxidants

Introduction: Free radicals of oxygen causes an abnormal intravascular lipid peroxidase activity and start process of atherosclerosis within blood vessels. Atherosclerosis reversal has been studied in humans and animals. Flavonoids are of plant origin and these are special antioxidant molecules. Arthrosclerosis regression was studied with long term use of Flavonoids and other antioxidants. Material and Methods: This prospective controlled trial study was done on 80 ischemic heart disease patients with effort angina having ST segment depression or elevation of more than 1mm in their normal electrocardiogram. 46 subjects of Group A taken as STUDY group were given Flavonoids Antioxidant combination for a period of 9 months as an adjuvant therapy along with routine medical management. Results of baseline study were compared with follow up results of the same group and also with another 27 subjects of Group B taken as control. Results: The results showed improved myocardial functions, improved lipid profile picture and highly significant reduction of Intima-media thickness of Common carotid artery examined with High resolution B-mode ultrasonography. Mean values of Intima-media thickness (mm) in case of experimental group were 0.92±0.11 at baseline and 0.84±0.10 at follow up. These results in control group at baseline were 0.93±0.12 and at follow up were 0.96±0.15. Data is statistically highly significant (p 0.05) in case of control group. Conclusion: The results of study have clearly reflected that these compounds were able to reduce atherosclerotic plaque present in major and minor arteries.

InVivo Molecular Imaging of Ruptured Coronary Atherosclerotic Plaque Using IVUS, OCT, and FDG-PET/CT.

An 83-year-old man was transferred to our hospital due to worsening effort angina pectoris. Electrocardiogram during chest pain at rest showed ST-segment elevation with hyperacute T waves and negative U waves in leads V2 through V4 ([Figure 1A][1]). Sublingual administration of nitroglycerin

TCTAP C-188 Bilateral Carotid Artery In-stent-restenosis in a Patient with Malignant Atherosclerosis

### Patient initials or identifier number SKB ### Relevant clinical history and physical exam Mr. SKB 65 years male presented with recurrent syncope for 2 months and effort angina (CCS-Class-III) for 6 months. Bilateral lower limb claudication with nocturnal leg pain for 1 year. Risk Factors:

A Case of Very Late (3 Years) Transcatheter Heart Valve Thrombosis

A 78-year-old man presented with effort dyspnea and angina due to severe aortic stenosis and concomitant coronary artery disease. He underwent percutaneous transluminal coronary angioplasty with drug-eluting stents on the left main coronary artery and left anterior descending artery followed by

TCTAP C-160 The Effective Use of GuideLiner Catheter for Heavily Calcified and Tortuous Just Proximal Left Anterior Descending Intervention

### Patient initials or identifier number 114850 ### Relevant clinical history and physical exam An 87-year-old man admitted to our hospital with effort angina pectoris for one month. He had many risk factors hypertension, dyslipidemia, current smoking, diabetes mellitus, chronic kidney disease,

TCTAP C-119 Recurrent Thrombosis with Prasugrel

### Patient initials or identifier number M.M. ### Relevant clinical history and physical exam A 56 year-old man was admitted to our hospital for effort angina. His coronary risk factors were smoking, hypertension and dyslipidemia. His ECG was normal, and there was no hypokinesis in echo

TCTAP C-158 Minimal Contrast Use for Chronic Total Occlusion Intervention in a Patient with Chronic Renal Failure

### Patient initials or identifier number A 60-year-old man ### Relevant clinical history and physical exam This is a 60-year-old man has history of nephrotic syndrome with chronic kidney disease stage V, hypertension, dyslipidemia for more than 10 years. He had effort angina for several months.

Association of Some Homozygous Genotypes of Genes Regulating Inflammation, Destruction and Angiogenesis With Laboratory Markers of Atherosclerosis Course in Men With Stable Effort Angina

Great number of factors stimulating or inhibiting production of proteins in inflammatory process influence serum levels of markers of inflammation. A number of homozygous genotypes of inflammation, destruction, and angiogenesis genes have been found to be associated with basic clinical-laboratory indices of inflammation and atherosclerotic process. The revealed genetic markers can be used as complimentary markers of prognosis of the disease course.

Carotid and femoral intima-media thickness as an early atherosclerotic marker. Advantages and limits

The intima-media thickness (IMT) is defined as the distance between the hyperechogenic inner (blood-intima interface) and outer line (media-adventitia interface) of the arterial wall. It is a surrogate marker of atherosclerotic damage. No consensus guidelines are available on which site and how carotid IMT sampling should be performed, and comparison among data from different studies is difficult. IMT is the "phenotype" of the early phases of atherosclerotic disease and is related to the main traditional risk factors. Moreover, IMT is a marker of organ damage either in the heart or in other vascular districts. Although threshold IMT values for the prediction of cardiovascular events have not been identified, high IMT values are associated with an increased occurrence of cardiovascular events. Indeed, an IMT > or = 0.9 mm was demonstrated to be associated with an increased cardiovascular risk even after age adjustment. The value of IMT as an independent risk factor is still under debate, especially in young patients at intermediate risk. Moreover, the IMT regression reported in therapeutic trials with statins and antihypertensive drugs was only weakly or not at all associated with a decrease in cardiovascular events. In comparison to carotid IMT, femoral IMT is more strictly correlated with the severity of coronary artery disease and the need for revascularization in effort angina. The simultaneous measurement of carotid and femoral IMT may improve risk stratification in patients with coronary heart disease. The challenge for the future is to establish an IMT cut-off value for a better definition of the individual cardiovascular risk. Such cut-off value may be derived from the combined measurement of carotid and femoral IMT.

Aortic dissection or coronary artery perforation?

A 73-year-old woman, diabetic, presented with effort angina of Canadian Cardiological Society (CCS) scale III for the last two months. Coronary angiogram revealed multiple significant stenosis of the left anterior descending artery (LAD) and the right coronary artery (RCA). After she was presented to heart team and refused surgical revascularization we proceeded with PCI. LAD was successfully treated with one drug eluting stent. After that we proceeded with RCA intervention. After first balloon inflation huge contrast extravasation (4x4cm) was noticed in projection of aortic wall. Patient was stable, procedure was temporary interrupted and because of suspicion on aortic dissection urgent echocardiography and CT scan of aorta was performed. Echocardiography did not show fluid accumulation in pericardium while CT scan excluded aortic dissection and showed perforation of ostial RCA with cranial intrapericardial contrast extravasation. After that procedure was continued with implantation of three DE stents in RCA. Final angiogram showed successful sealing of ruptured ostial RCA without any contrast leak. During the following days there was no evidence of fluid in the pericardium, also MSCT coronarography confirmed normal flow in RCA and LAD. After five days patient was safely discharged from hospital.