Lack Of Coronary Artery Disease Research Articles

Lack of Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography.

Aim Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. Methods The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. Results There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. Conclusion The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.

Successful surgical weight loss with laparoscopic sleeve gastrectomy for morbid obesity prior to kidney transplantation

Morbid obesity in kidney transplant (KT) candidates is associated with increased complications and graft failure. Multiple series have demonstrated rapid and significant weight loss after laparoscopic sleeve gastrectomy (LSG) in this population. Long-term and post-transplant weight evolutions are still largely unknown. A retrospective review was performed in eighty patients with end-stage kidney disease (ESKD) who underwent LSG in preparation for KT. From a median initial BMI of 43.7kg/m2 , the median change at 1-year was -10.0kg/m2 . Successful surgical weight loss (achieving a BMI<35kg/m2 or an excess body weight loss >50%) was attained in 76.3% and was associated with male gender, predialysis status, lower obesity class and lack of coronary artery disease. Thirty-one patients subsequently received a KT with a median delay of 16.7months. Weight regain (increase in BMI of 5kg/m2 postnadir) and recurrent obesity (weight regain+BMI>35) remain a concern, occurring post-KT in 35.7% and 17.9%, respectively. Early LSG should be considered for morbidly obese patients with ESKD for improved weight loss outcomes. Early KT after LSG does not appear to affect short-term surgical weight loss. Candidates with a BMI of up to 45kg/m2 can have a reasonable expectation to achieve the limit within 1year.

Markers for Inflammation and Oxidative Stress in Patients with Coronary Artery Disease and Microvascular Disease – Is there a Difference?

Abstract Introduction: The clinical significance of inflammation (and markers such as resistin, hsCRP) and oxidative stress (e.g. 8-isoprostanes) for microvascular disease (MVD) and coronary artery disease (CAD) is still elusive. Aims: To determine the role of the markers for inflammation and oxidative stress as independent markers for MVD. Methods: Ninety consecutive patients were recruited: twenty-five of them had CAD; thirty – MVD and thirty-five were controls. The latter included patients with atypical chest pain, risk factors, lack of coronary artery disease and negative adenosine test. Coronary angiography was performed in all participants. The adenosine test was performed in those without CAD, hs CRP, resistin in plasma and urine 8-isoprostanes were measured. The correlation of all these indicators with CAD and MVD was analyzed. Results: The 8-isoprostanes showed significant differences between patients with MVD and CAD (0,055/0,52 pg/mmol Cre; p = 0,028). The same trend was found between CAD patients and the control group (0,055/0,003 pg/mmol Cre; p = 0,041); as well as between those with MVD and the control group (0,52/0,003 pg/mmol Cre; p = 0,001). The highest values of 8-isoprostanes were detected in patients with MVD – 0,52 pg/mmol Cre. Markers for inflammation were similar in patients with MVD and CAD (hsCRP- p = 0,091; resistin − p = 0,32). Conclusions: hs CRP, resistin and 8-isoprostanes are involved in the pathogenesis of both CAD and MVD. However, oxidative stress is probably more important for MVD, therefore 8-isoprostanes can be a part of panel of markers for its detection and analysis.

Myocardial infarction with no coronary artery obstruction (MINOCA): Mystery solved

Myocardial infarction with no coronary artery obstruction (MINOCA) is a heterogenous clinical entity characterized by clinical signs of acute myocardial infarction (AMI), lack of coronary artery disease (stenosis ≥50%) and obvious cause for acute presentation at the time of angiography. The prevalence of MINOCA in patients with the diagnosis of AMI is between 1% and 14%. It is more common in women and patients presenting as a non-ST elevation myocardial infarction (NSTEMI). Although dependant on the cause, the prognosis of MINOCA is severe with one-year mortality at about 3.5%. Various patophysiological mechanisms that cause MINOCA include: plaque disruption, coronary artery spasm, spontanious disection of coronary arteries, coronary thrombosis/embolism and coronary microvascular dysfunction. Defining the cause of MINOCA enables the doctor to choose the optimal form of treatment.

Accessory Left Ventricular Chamber

Accessory Left Ventricular Chamber

Effect of time on the prevalence of diabetes in the urban African of Rhodesia.

A diabetes survey was conducted in the same African urban township as one done eleven years previously, together with a further survey in a rural area. In the urban survey the prevalence rate rose insignificantly from 0.10 per cent to 0.28 per cent, while no diabetes was discovered in the rural study. A minimal increase of new diabetics was seen during the same period in both the medical wards and obstetric unit, but the disease has not reached the proportions seen either in Europeans or indeed in Africans from certain parts of Southern Africa. A lack of coronary artery disease in diabetes is emphasized. These findings are discussed in the light of experience elsewhere, and some etiologic factors are suggested.