Mild Coronary Heart Disease Research Articles

The Degrees of Coronary Heart Disease and the Degrees of New-Onset Blepharitis: A Nationwide Cohort Study.

In this study, we aimed to evaluate the association between the severity of coronary heart disease (CHD) and the subsequent severity of blepharitis. This retrospective population-based cohort study was conducted using the National Health Insurance Research Database (NHIRD) of Taiwan. The participants with a CHD diagnosis were divided into mild CHD and severe CHD groups at a 1:2 ratio, according to whether percutaneous coronary intervention (PCI) was performed. The main outcomes were the development of blepharitis and severe blepharitis with the application of antibiotics. Cox proportional hazard regression was performed to obtain the adjusted hazard ratio (aHR) for blepharitis, with a 95% confidence interval (CI) between the groups. There were 22,161 and 15,369 blepharitis events plus 9597 and 4500 severe blepharitis episodes in the mild and severe CHD groups, respectively. The severe CHD group showed a significantly higher incidence of blepharitis development (aHR, 1.275; 95% CI: 1.051-1.912, p = 0.0285), whereas the incidence of severe blepharitis was not significantly different between the groups (aHR, 0.981; 95% CI: 0.945-1.020, p = 0.3453). The cumulative probability of blepharitis was significantly higher in the severe CHD group than in the mild CHD group (p < 0.001). In the subgroup analyses, the correlation between severe CHD and blepharitis was more significant in patients older than 70 years compared to the younger group (p = 0.0115). In conclusion, severe CHD is associated with a higher incidence of blepharitis than mild CHD, and this correlation is more prominent in individuals older than 70 years.

The Extents of Coronary Heart Disease and the Severity of Newly Developed Dry Eye Disease: A Nationwide Cohort Study.

This study aimed to evaluate the potential association between coronary heart disease (CHD) severity and the subsequent dry eye disease (DED) with a different severity through the use of the National Health Insurance Research Database (NHIRD) of Taiwan. A retrospective cohort study was conducted. The CHD population was further divided into a severe CHD that had received coronary artery bypass graft (CABG) surgery group and a mild CHD that had received medicine group, then matched with a 1:2 ratio, and 29,852 and 14,926 CHD patients were put into the severe CHD and mild CHD groups, respectively. The primary outcomes were the development of DED and severe DED after CHD diagnosis. The Cox proportional hazards regression was used to produce the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of DED and severe DED between groups. There were 3440 and 1276 DED cases in the mild CHD and severe CHD groups, respectively. And another 37 and 48 severe CHD events were observed in the mild and severe CHD groups, respectively. The incidence of severe DED in the severe CHD group was significantly higher compared to the mild CHD group (aHR: 5.454, 95% CI: 1.551-7.180, p = 0.0001). The cumulative probabilities of DED and severe DED were significantly higher in the severe CHD group than the mild CHD group (both p < 0.0001). In the subgroup analysis, the correlation between severe CHD and DED was higher in the patients aged older than 70 years (p < 0.0001). In conclusion, severe CHD is associated with a higher incidence of severe DED with a higher cumulative incidence.

Four-dimensional quantification on left atrial volume-strain in coronary heart disease patients without regional wall motion abnormalities: Correlation with the severity of coronary stenosis.

Echocardiography is a time and cost-effective imaging modality, providing evidence of myocardial ischemia by detecting the regional wall motion abnormalities (RWMA). However, quite a few coronary heart disease (CHD) patients do not present RWMA. The left atrium (LA) plays an irreplaceable role in determining the prognosis and risk stratification of cardiovascular disease including CHD. In this present study, we intend to explore the myocardial mechanics changes of LA mainly using four-dimensional (4D) LA quantitative volume-strain in CHD patients without RWMA at rest but were confirmed by coronary angiography (CAG) and to figure out several variables of the LA that could contribute to the identification of those patients. We prospectively enrolled 76 patients who underwent two-dimensional echocardiography (2DE), four-dimensional echocardiography (4DE), and CAG for suspected CHD but without echocardiographic visible RWMA at rest. Patients diagnosed with CHD by CAG were furtherly divided into three groups according to the extent of coronary stenosis accessed by Gensini score (GS) as the mild, moderate, and severe CHD group. Twenty-four subjects with negative CAG results served as the control group. LA end-systolic anteroposterior diameter (LAAPD) and biplane LV ejection fraction (Biplane LVEF) were measured by 2DE; LA maximum volume (LAVmax), LA minimum volume (LAVmin), LA volume at the onset of atrial contraction (LAVpreA), LAVmax index (LAVmaxI), LA ejection volume (LAEV), LA ejection fraction (LAEF) accompanied by LA longitudinal strain during reservoir phase (LASr), conduit phase (LAScd), contraction phase (LASct) and LA circumferential strain during reservoir phase (LASr_c), conduit phase (LAScd_c), contraction phase (LASct_c) were measured by 4DE automatically. We compared these parameters between groups, explored how they change and whether they are related to the CHD severity. LAEF, LASr_c, and LASct_c was lower in CHD group compared with the control group (p = .031, .002, .004, respectively). Pearson correlation analysis showed that LASr, LASct, LASr_c, and LASct_c negatively correlated with the GS. Additionally, LASr of patients in the severe CHD group decreased significantly compared with those in the mild CHD group, moderate CHD group, and control group, demonstrating the highest area under the receiver operating characteristic (ROC) curve (AUC) (AUC = .736 [p = .003, 95% CI .589-.884], sensitivity 67.8%, specificity 70.6%) with the cut-off value of 17.5% for predicting severe CHD patients. Four-dimensional LA strain may provide new insight into identification and management for CHD patients and correlate with CHD severity. LASr showed good sensitivity (67.8%) and specificity (70.6%) for diagnosing severe CHD individuals.

A METHOD FOR DETECTING CORONARY ARTERY STENOSIS BASED ON ECG SIGNALS

Coronary heart disease (CHD) is a typical cardiovascular disease whose occurrence and development is a long process. Timely and accurate diagnosis of patients with varying degrees of coronary artery stenosis (VDCAS) is conducive to accurate treatment and prognosis assessment. This study aims to correctly classify VDCAS patients by utilizing multi-domain features fusion of single-lead 5-min ECG signals and machine learning methods, so as to provide reference for doctors to judge the CHD development process. ECG signals were collected from 206 subjects with CHD, mild CHD, thoracalgia and normal coronary angiograms (TNCA), and healthy. Then, the time, frequency, time–frequency, and nonlinear domain features of ECG signals were extracted to establish a multi-domain feature set. To get the optimum subset of features, the recursive feature elimination (RFE) and information gain (IG) were selected. Subsequently, eXtreme Gradient Boosting (XGBoost) and random forest (RF) were adopted for classification. Results indicated that RFE combined with XGBoost was significantly effective in classifying VDCAS patients. When the four categories of subjects (CHD, mild CHD, TNCA, and healthy) were classified, the average accuracy, sensitivity, specificity, and F1-score of the proposed method were 91.74%, 89.39%, 96.80%, and 90.09%, respectively. Besides, three categories of subjects (no stenosis, luminal narrowing [Formula: see text] 50%, and luminal narrowing [Formula: see text] 50%) and two categories of subjects (CHD and healthy) were also analyzed, and the average accuracy was 91.27% and 98.46%, respectively. The results suggest that the proposed method can provide reference for doctors to judge VDCAS patients.

The Effectiveness of Android-Based ESMED on Decreasing Cholesterol Value and Blood Pressure among Risk of Chronic Heart Disease Patients

Coronary heart disease (CHD) is a leading cause of death and disability worldwide. This study used a quantitative method with a quasi-experimental design with a pre-post control group study approach. The study was conducted at the Puskesmas in Malang district. The inclusion criteria, such as patients with aged 25-50 years old, be able to operate an Android-based mobile with API 4.0. Data were analyzed using the Non-Parametric Wilcoxon Rank test. There was an increase in respondents in the risk category for mild CHD in the control and treatment groups. There was a significant effect of the application of Android-based ESMED applications on decreasing the total cholesterol and systolic blood pressure. There is still a cholesterol value of respondents at 200 mg/dl in the control group and treatment. The results of the systolic blood pressure among the control group and the treatment group showed that the range of systolic blood pressure from ??140-149 mmHg before and after receiving the intervention. The Android-based ESMED (Early Screening, Monitoring, and Education) application effectively reduces cholesterol and blood pressure in patients at risk for CHD.

Change of Inflammatory Factors in Patients with Acute Coronary Syndrome.

Background:Acute coronary syndrome (ACS) is closely related to unstable plaques and secondary thrombosis. The inflammatory cells in plaques and their inflammatory products may be the cause for plaque instability and ruptures. The study aimed to disclose the changes of inflammatory factors including serum intracellular adhesion molecule-1 (ICAM-1), chitinase-3-like protein 1 (YKL-40), and lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with ACS and its clinical significance.Methods:A total of 120 patients with coronary heart disease (CHD) were categorized into 2 groups: 69 with ACS and 51 with stable angina pectoris (SAP); 20 patients with chest pain and normal angiography served as a control group. The 120 patients with CHD were categorized into single-vessel disease group, double-vessel disease group, and three-vessel disease group based on the number of coronary artery stenosis. The severity of coronary artery stenosis was quantified based on coronary angiography using Gensini score. They were further divided into mild CHD group with its Gensini score <26 (n = 36), moderate CHD group with its Gensini score being 26–54 (n = 48) and severe CHD group with its Gensini score >54 (n = 36). Serum levels of ICAM-1, YKL-40, and Lp-PLA2 of different groups were determined by enzyme-linked immunosorbent assay. Correlation between ICAM-1, YKL-40, Lp-PLA2, and Gensini score was analyzed.Results:The levels of serum inflammatory factors ICAM-1, YKL-40, and Lp-PLA2 were significantly higher in the ACS group than those in control group and SAP group (all P < 0.05); and compared with control group, no significant difference was observed in terms of the serum ICAM-1, YKL-40, and Lp-PLA2 levels in the SAP group (P > 0.05).The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, single-vessel disease group, double-vessel disease group, and three-vessel disease group (all P > 0.05). The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, mild CHD group (Gensini score <26), moderate CHD group (Gensini score 26–54), and severe CHD group (Gensini score >54) (all P > 0.05).Conclusions:The serum levels of ICAM-1, YKL-40, and Lp-PLA2 were correlated with different clinical types of CHD, but not well correlated the severity and extent of artery stenosis, suggesting that ICAM-1, YKL-40, and Lp-PLA2 might be involved in occurrence of instability of atherosclerotic plaque, and might reflect the severity of CHD mostly through reflecting the plaque stability.

Association of N-acetyltransferase-2 polymorphism with an increased risk of coronary heart disease in a Chinese population.

We investigated the possible correlations between N-acetyltransferase-2 (NAT2) gene polymorphisms and the risk of coronary heart disease (CHD). CHD patients (113) and healthy controls (118) were enrolled from the First People's Hospital of Yuhang between January 2013 and June 2014. The patients were divided into mild CHD (N = 72) and severe CHD (N = 41) subgroups. DNA samples were extracted and the distributions of NAT2 polymorphisms were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Clinical characteristic indexes of severe CHD patients were also examined for relevant statistical analysis. WT, M1, M2, and M3 alleles were observed in both case and control groups. PCR-RFLP identified a wild-type homozygote, WT/WT; a mutant heterozygote, WT/Mx; and a mutant homozygote, Mx/Mx (x = 1, 2, and 3) variant of the NAT2 genotype. Mx/Mx differed significantly between case and control groups (P < 0.05); the frequencies of all four alleles did not differ significantly between case and control groups (P > 0.05). Slow acetylator genotype frequencies were notably higher in the case group than in the control group (P < 0.05). Individuals with the slow acetylator genotype were at 1.97-times higher risk of CHD and also displayed higher triglyceride and lower high-density lipoprotein cholesterol levels than those with the rapid acetylator genotype (P < 0.05). Therefore, the NAT2 polymorphism was believed to be associated with increased risk of CHD, with the NAT2 slow acetylator genotype serving as a risk factor for severe CHD in a Chinese population.

Effects of glomerular filtration rate on the severity of coronary heart disease.

Chronic kidney disease (CKD) is considered to be one of the most common risk factors for cardiovascular diseases. Glomerular filtration rate (GFR) is the best method of testing level of kidney function and determining stage of kidney disease. The aim of this study was to examine the impact of renal function on severity of coronary heart disease (CHD). The present study included 918 patients undergoing elective coronary angiography. GFR was evaluated by simplified Modification of Diet in Renal Disease (MDRD) formula (mL/min/1.73 m2). The extent and severity of CHD were evaluated according to SYNTAX score. According to SYNTAX score, 416 patients had normal coronary arteries or nonsignificant CHD (control group), 267 had mild CHD (SYNTAX score: 1-22), 129 had moderate CHD (SYNTAX score: 23-32), and 106 had severe CHD (SYNTAX score: ≥33). Estimated GFR values (median [25th-75th percentiles]) were 99.00 (83.00-116.00) in the control group, 85.00 (73.00-101.00) in the mild CHD group, 87.00 (73.25-101.75) in the moderate CHD group, and 81.00 (65.00-101.00) in the severe CHD group. According to Spearman's rank correlation analysis, a negative correlation found between MDRD and SYNTAX score was statistically significant (p<0.001, r=-0.268). Renal function is an important predictor of presence and severity of angiographic CHD in patients without severe renal impairment. Negative correlation between MDRD and SYNTAX score was determined. This simple biochemical test can be used in determining risk of cardiovascular disease aside from other risk factors during routine clinical practice.

Levels of acylation stimulating protein and the complement component 3 precursor are associated with the occurrence and development of coronary heart disease.

The aim of the present study was to investigate whether acylation stimulating protein (ASP) and complement component 3 (C3) are associated with the occurrence and development of coronary heart disease (CHD). The participants of the study were divided into three groups, including the healthy control (n=42), metabolic syndrome (MS, n=56) and CHD (n=62) groups. An enzyme-linked immunosorbent assay was used to measure the ASP concentrations, while an immunoturbidimetric assay was employed to determine the C3 concentrations. In addition, coronary angiography was performed to determine the severity of coronary artery disease in the CHD group. The CHD group was divided into three subgroups, according to the final Gensini score of coronary artery stenosis for each patient (mild, ≤20 points; moderate, 21–40 points; severe, >40 points). Western blotting and quantitative reverse transcription-polymerase chain reaction (RT-PCR) were performed to analyze the protein and mRNA expression levels of C3 in the CHD subgroups and the healthy control group. The concentrations of ASP and C3 in the CHD group were found to be significantly higher compared with the control and MS groups. In addition, the levels of ASP and C3 in the mild and moderate CHD subgroups were significantly higher compared with the healthy controls or mild CHD patients. Furthermore, the protein expression levels of C3 in the moderate and severe CHD patients were found to be significantly higher compared with the healthy individuals and the mild CHD patients. The quantitative RT-PCR results revealed that the mRNA expression levels of C3 in the moderate and severe CHD patients were significantly higher compared with the healthy control group and the mild CHD patients. Furthermore, the mean levels of C3 transcripts in the severe CHD patients were found to be higher compared with the moderate CHD subgroup (P<0.05). Therefore, ASP and C3 were found to be associated with the occurrence and development of CHD; thus, may be used as novel indexes for CHD.

Mitral annulus displacement measured by two-dimensional speckle tracking imaging to assess the left ventricular longitudinal systolic function in coronary heart disease.

To assess the clinical utility of measuring mitral annulus displacement (MAD) by two-dimensional speckle tracking for the rapid evaluation of left ventricular longitudinal systolic function in patients with coronary heart disease (CHD). Left ventricular longitudinal systolic function was evaluated by MAD using speckle tracking echocardiography in 30 healthy volunteers (controls) as well as in 30 patients with mild, 30 patients with moderate, and 30 patients with severe CHD. All participants had their apical four-chamber and two-chamber view echocardiographic images recorded. Left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction were calculated by the biplane Simpson method. MAD of interventricular septum (MADsep), left ventricular lateral wall (MADlat), and the middle point of the mitral annulus (MADmid) were measured offline with speckle-tracking echocardiography. MADmid% was defined as MADmid divided by left ventricular end-diastolic diameter. MADmid% was 16.9 ± 1.9, 11.8 ± 3.2, 11.8 ± 2.9, and 10.3 ± 3.6, respectively, in controls and in patients with mild, moderate, and severe CHD. All MAD indexes were lower in patients with moderate or severe CHD than in controls or patients with mild CHD. MAD is an early and rapid index for the assessment of left ventricular longitudinal systolic function in patients with different degrees of coronary artery disease.

SIGNIFICANCE OF SMALL DENSE LOW-DENSITY LIPOPROTEINS IN CORONARY HEART DISEASE

Low-density lipoprotein (LDL) particles are heterogeneous with respect to their size, density, and lipid composition, and the size of LDL particles is chiefly determined by their lipid contents. Small dense LDL particles have been suggested to be highly atherogenic compared to large buoyant LDL. Our case-control studies have shown that the LDL particle size determined by gradient gel electrophoresis was remarkably smaller in patients with coronary heart disease (CHD), irrespective of the presence of diabetes and the differences in clinical situation and severity of CHD. In addition, small dense LDL-cholesterol concentration evaluated by heparin magnesium precipitation was significantly higher in severe stable CHD and acute coronary syndrome compared with non-CHD subjects and patients with mild CHD, while large LDL-cholesterol estimated by subtracting the small dense LDL-cholesterol concentration from the LDL-cholesterol concentration, were somewhat lower in stable CHD compared with healthy subjects. Further more, reduced LDL particle size and elevated small dense LDL-cholesterol levels were significantly associated with metabolic dyslipidemia in Metabolic syndrome. These suggest that the predominance of small dense LDL and high levels of small dense LDL-cholesterol are very promising risk marker for CHD.

Small LDL-Cholesterol is Superior to LDL-Cholesterol for Determining Severe Coronary Atherosclerosis

Recent evidence suggests that small dense low-density lipoprotein (sd-LDL) particles are more atherogenic than large-LDL in spite of their lower cholesterol content. This study aimed to determine whether sd-LDL-cholesterol (sd-LDL-C) is superior to LDL-C as a biomarker of coronary heart disease (CHD). LDL particle size determined by gradient gel electrophoresis and sd-LDL-C concentrations quantified by heparin-magnesium precipitation were compared between 482 stable CHD patients and 389 non-diabetic subjects without CHD who were not receiving any lipid-lowering drugs. Both male and female CHD patients had significantly smaller LDL particles and lower large-LDL-C concentrations (estimated by subtracting the sd-LDL-C concentration from the LDL-C concentration), and significantly higher sd-LDL-C concentrations than the control subjects. LDL-C concentrations were modestly higher and sd-LDL-C concentrations were significantly higher in 258 patients with angiographically documented severe CHD than in the patients with mild CHD irrespective of treatment by LDL-lowering drugs and history of myocardial infarction and/or coronary revascularization. Large-LDL-C concentrations, in contrast, were similar between the two groups. Multivariate logistic regression analysis revealed that sd-LDL-C levels were significantly associated with severe CHD independently of LDL-C. sd-LDL-C levels are more powerful than LDL-C levels for the determination of severe stable CHD.