Number Of Stenotic Coronary Arteries Research Articles

Relationship Between Renal Dysfunction and Severity of Coronary Artery Disease in Japanese Patients

The relationship between renal dysfunction and the severity of coronary artery disease (CAD) was examined. The severity of CAD in 572 patients was graded according to the number of stenotic coronary arteries, and the estimated glomerular filtration rate (eGFR) was monitored for 3 years. Patients were stratified into 3 eGFR groups: normal (>75 ml x min(-1) x 1.73 m(-2)), mild reduction (60-75) and chronic kidney disease (CKD: <60). There were 161 patients in the CKD group. The average number of stenotic coronary arteries was larger in the CKD group than in the other groups (normal vs mild reduction vs CKD =1.35+/-0.07 (SE) vs 1.22+/-0.08 vs 1.69+/-0.08 vessel disease (VD), P<0.001). During the 3-year follow-up, the renal function of 13.8% of the patients worsened. Those who showed more deterioration of eGFR had more severe CAD than those who did not (1.20+/-0.06 vs 1.61+/-0.06 VD, P<0.001). Multivariate analysis revealed that the severity of CAD was independently and significantly associated with the deterioration of eGFR. Patients with CKD had more severe CAD, which may explain the high rate of cardiovascular events in these patients. Moreover, the prognosis of renal function was poor in patients with severe CAD, and CAD was found to be an independent risk factor for worsening of renal dysfunction.

Left ventricular ejection fraction measurements: accuracy and prognostic implications in a large population of patients with known or suspected ischemic heart disease

We sought to compare the reliability and prognostic implications of left ventricular (LV) ejection fraction (EF) measurements obtained in routine clinical practice. We retrospectively selected from our clinical database a group of 422 patients with known or suspected ischemic heart disease, studied by two-dimensional echocardiography, gated single-photon emission computed tomography (SPECT) and left ventriculography (LVG) for clinical purposes. In each diagnostic procedure LVEF was measured as done routinely. The LVEF values obtained by the three methods were similar and closely related. The correlation coefficient r was equal to 0.83 between echocardiographic and LVG, to 0.75 between gated SPECT and LVG and to 0.81 between echocardiographic and SPECT. During follow-up (median 41 months), 31 patients died. The values of LVEF obtained by echocardiography, gated-SPECT and LVG were all powerful predictors of all-cause mortality: chi(2) = 12.3 for echocardiography, 14.4 for gated SPECT and 14.5 for LVG. However, including LVEF values into a model based on patient age, sex, history of angina, evidence of previous infarction and number of stenotic coronary arteries, the ability to predict patient survival significantly increased only including LVEF values measured by gated SPECT (chi(2) = 40.6, P = 0.039). Thus, in a large cohort of unselected patients with known or suspected ischemic heart disease, the values of LVEF routinely measured by echocardiography, gated SPECT and LVG were closely correlated, and provided a powerful prognostic information, that was incremental to clinical variables for gated SPECT.

Operative results of coronary artery bypass grafting in women

Background: The relative mortality of coronary artery bypass grafting (CABG) surgery in women is not certain. The purpose of this study was to examine the results of primary, isolated CABG in a series of Taiwanese female patients. Methods: Medical records of 2055 patients (188 women and 1867 men), who underwent primary, isolated CABG at Taipei Veterans General Hospital from January 1, 1991 to December 31, 1999, were reviewed. The mortality rate, associated with clinical and operative variables, was compared between female and male patients. Results: The female patients had more diabetes (51.6% vs. 29.9%, P<0.01), more hypertension (77.1% vs. 65.0%, P<0.01), and more hypercholesterolemia (39.4% vs. 29.6%, P<0.01), as compared with men. Fewer women consumed cigarette smoking (17.0% vs. 52.1%, P<0.001). Fewer internal mammary artery grafts were used in women (43.1% vs. 57.3%, P<0.001). Nine female (4.8%) and 93 male patients (5.0%) died. There was no significant difference in hospital mortality between women and men. Other variables, including age, angina class, NYHA class, incidence of peripheral arterial occlusive disease, stenosis of left main coronary artery, number of stenotic coronary arteries, incidence of emergent operations, anastomosis number, aortic cross-clamping time, cardiopulmonary bypass time, and left ventricular ejection fraction, were not significantly different between female and male patients. Conclusions: Although the female patients were more frequently diabetic, hypertensive, and hypercholesterolemic, the hospital mortality of CABG in women was not significantly different from that in men. This result supports an aggressive surgical treatment for women with coronary artery disease.

Hyperhomocysteinemia is a risk factor for coronary arteriosclerosis in Japanese patients with type 2 diabetes.

An increased plasma homocysteine level is an important risk factor for vascular disease, including coronary atherosclerosis, in the general population. However, the role of hyperhomocysteinemia in the development of coronary artery disease (CAD) in patients with type 2 diabetes is unknown. Therefore, we have endeavored to determine the relationship between plasma homocysteine levels and the presence of coronary arteriosclerosis in patients with type 2 diabetes. The study group consisted of 145 Japanese patients (95 men and 50 women) who underwent routine coronary angiography to assess chest pain or suspected CAD. Plasma total homocysteine level, lipid level, and parameters of fibrinolytic activity were measured. All patients were identified as diabetic or nondiabetic by the new American Diabetes Association (ADA) criteria. The diagnoses of all patients studied were confirmed by coronary angiography. The severity of coronary artery stenosis was quantified using CAD scoring on the basis of prior reports, and subjects were graded as nonstenotic, stenotic single-vessel, stenotic two-vessel, or stenotic three-vessel based on the number of stenotic coronary arteries. Patients were classified into two groups: those with stenotic vessels and those without stenotic vessels. The plasma homocysteine level was significantly higher in patients with than in patients without stenotic vessels (13.8 +/- 3.9 vs. 11.7 +/- 3.9 mumol/l, respectively; P = 0.0009). The number of stenotic coronary arteries, which was used to grade each case as nonstenotic, stenotic single-vessel, stenotic two-vessel, or stenotic three-vessel, was related only to the total homocysteine level in the diabetic (diabetes mellitus [DM]) group, but it was associated with lipoprotein(a) in the nondiabetic (non-diabetes mellitus [non-DM]) group. Spearman's rank correlation test demonstrated that the plasma homocysteine level was strongly correlated with CAD score, both in the entire study group and in the DM group (P = 0.003 for the entire group and P = 0.011 for the DM group). Hyperhomocysteinemia, which was defined as total homocysteine level > 14.0 mumol/l, was seen in 57 (39.3%) of the patients. The CAD score was highest in diabetic patients with hyperhomocysteinemia (P < 0.05). There seems to be a clear relationship between hyperhomocysteinemia and an increased risk of coronary arteriosclerosis in Japanese patients with type 2 diabetes.

The number of stenotic coronary arteries and passive smoking exposure from husband in lifelong non-smoking women in Xi'an, China

The relationship between the number of stenotic coronary arteries and passive smoking exposure from the husband was examined in a retrospective study of 78 cases with stenotic coronary arteries and 83 controls with normal coronary arteries. All the 161 subjects were examined by coronary arteriography and were Chinese women who had never smoked cigarettes (i.e. lifelong non-smokers). The Pearson's and Spearman's correlation coefficients between the number of stenotic coronary arteries and passive smoking exposure indices were 0.27–0.29 and 0.25–0.28 (all with P < 0.01), respectively. The linear prediction equations from multiple regression analysis showed that passive smoking exposure, after adjustment for other major risk factors, was a significant predictive variable for the number of stenotic coronary arteries. The multiple response logistic regression model was used to estimate the odds ratio of stenotic coronary arteries for passive smoking exposure categories. The crude and adjusted odds ratios showed that the number of stenotic arteries increased with the amount of exposure to passive smoking from the husband. These results provide new evidence to support that passive smoking is causally associated with coronary heart disease.

Decreased baroreflex sensitivity in patients with stable coronary artery disease is correlated with the severity of coronary narrowing

Although studies have shown that arterial baroreflex sensitivity (BRS) is decreased in patients with acute myocardial infarction, BRS changes in patients with stable coronary artery disease (CAD) have not been studied extensively. We assessed BRS by the phenylephrine method in 55 normotensive and nondiabetic patients with chronic effort angina, old myocardial infarction, or both. The control group consisted of 24 age-matched patients without coronary lesions. To identify factors that determine BRS in stable CAD, we performed multivariate analysis using age, sex, left ventricular ejection fraction, pulmonary artery wedge pressure, resting systolic blood pressure, resting heart rate, the number of stenotic coronary arteries, history of myocardial infarction, and the presence or absence of angina pectoris as variables. BRS was significantly lower in patients with CAD than in control subjects (5.9 ± 2.9 vs 6.9 ± 2.4 ms/mm Hg, p < 0.05). In patients with CAD, BRS was inversely correlated with age, the resting heart rate, and the number of stenotic coronary vessels (p < 0.001, p < 0.005, and p < 0.005, respectively), but was independent of other clinical parameters, including the history of myocardial infarction. In control subjects, BRS was significantly correlated only with age. These results indicate that BRS is decreased in patients with stable CAD, and this decrease is correlated with the extent and severity of coronary narrowing.

Measurement of coronary artery calcium with dual-slice helical CT compared with coronary angiography: evaluation of CT scoring methods, interobserver variations, and reproducibility.

This study was performed to evaluate new scoring methods for quantitating coronary artery calcifications with helical CT and to compare the results with those of quantitative coronary angiography in patients with suspected coronary artery disease. Unenhanced dual-slice helical CT and coronary angiography were performed within 24 hr of each other in 101 patients with symptoms of coronary artery disease. Coronary artery calcifications with a density above 90 H were identified on each slice and, with the same regions of interest, quantitative scoring was performed at thresholds of 90 H (new) 130 H (old). Two mathematical algorithms (one new and one old) were evaluated for both thresholds (yielding four scoring systems). By CT imaging, we defined disease as a score of greater than zero. By angiography, we defined disease as a 50% or greater reduction in the luminal diameter of any major vessel. Interobserver variations in calcification scoring were evaluated. Seventeen of our patients. also underwent a second, consecutive CT scan to determine reproducibility. With the new threshold and the new algorithm, the sensitivity, specificity, and accuracy of helical CT in predicting disease were 88%, 52%, and 76%, respectively. We found a moderate positive association between the total CT calcification score and the number of stenotic coronary arteries at angiography (Pearson's correlation coefficient, .43; p = .05 [analysis of variance]). The accuracy and the area under the receiver operating characteristic curve were higher with the new threshold and the new algorithm. Interobserver agreement in calcification scoring was high (intraclass correlation coefficient, .99 [n = 85]), as was reproducibility (intraclass correlation coefficient, .94 [n = 17]). Reproducibility was higher when scoring was based on the new threshold and the new algorithm. The quantity of coronary artery calcifications as measured by helical CT correlated positively with obstructive coronary artery disease as measured by angiography. Interobserver agreement and reproducibility were excellent. A new scoring method showed promise.

Clinical Features and Coronary Backgrounds of Coexistent Peripheral Vascular Disease in Japanese Coronary Artery Disease Patients

By use of noninvasive tests (Doppler segmental pressure study, supraorbital Doppler flow analysis, and segmental plethysmography), coexistent carotid (CTD) or lower extremity peripheral vascular disease (PVD) were diagnosed and correlated with subjective symptoms, coronary risk factors (CRFs), coronary arteriograms (CAGs), cardiac hemodynamics, and infarct size in 121 consecutive patients with documented coronary artery disease (CAD). PVD was found in 16.5%, CTD in 33.1%, and both PVD and CTD in 9.9% of the patients studied; 20% of PVD patients and 47.5% of CTD patients were asymptomatic with respect to coexistent PVD or CTD. There were no significant differences between the presence or absence of PVD or CTD as regards number of CRFs, Killip classification, cardiac hemodynamics, or number of stenotic coronary arteries. However, serum creatine kinase (CK) and CKMB release curves in the PVD group showed significantly higher peak CK and peak CKMB values than those in the PVD(-) group (4096 +/- 5408/282 +/- 263 vs 1706 +/- 1715/179 +/- 186, p less than 0.05) because of the higher prevalence (100%) of multivessel disease on CAG. Investigation of the relationship of CRFs to coexistent PVD revealed that the smoking ratio in men (86.7%) and the hypertension ratio in women (80%) were extremely high in PVD patients, and statistically significant differences between PVD(+) patients and PVD(-) groups were found with respect to the obesity ratio (p less than 0.05) in men and the hypercholesterolemia ratio (p less than 0.05) and obesity ratio (60%, p less than 0.05) in women.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of homocysteinemia and hypercholesterolemia in angiographically defined coronary heart disease

Total serum homocysteine and cholesterol levels were determined in 163 male patients with typical angina who were subjected to coronary angiography. The prevalence of homocysteinemia in coronary heart disease (CHD) was 41.9%. Serum homocysteine levels were significantly elevated (p less than 0.05) in patients with major occlusion in two or three coronary arteries. Furthermore, the prevalence of homocysteinemia correlated positively (p less than 0.05) with the number of coronary vessels that were occluded. The prevalence of hypercholesterolemia was 34.9%, but, in contrast to homocysteinemia, no graded strength of association with the number of stenotic coronary arteries could be demonstrated. The results suggest that homocysteinemia may contribute significantly to the development of coronary heart disease.

Determinants of ventricular arrhythmias in mildly symptomatic patients with coronary artery disease and influence of inducible left ventricular dysfunction on arrhythmia frequency

To determine the relation among ventricular arrhythmias, prognostic factors and reversible ischemia in coronary artery disease, 131 drug-free, minimally symptomatic patients were studied by radionuclide angiography and 24 hour Holter electrocardiographic monitoring. High grade ventricular arrhythmias (couplets, salvos of premature ventricular complexes and R on T phenomenon) were observed in 33 patients (25%) and were related to lower rest and exercise ejection fraction, greater number of stenotic coronary arteries and higher prevalence of regional wall motion abnormalities at rest (all p less than or equal to 0.1). Among patients with subnormal rest ejection fraction, high grade arrhythmias occurred with greater prevalence in those with reversible left ventricular dysfunction (reduction in ejection fraction) during exercise compared with those with a normal ejection fraction response (59 versus 23%, p less than 0.05), a relation observed principally in patients with multivessel disease. These data indicate that in minimally symptomatic patients with coronary artery disease, arrhythmias are related to both extent of disease and severity of regional and global ventricular dysfunction and are most prevalent in patients with ventricular dysfunction and evidence of inducible ischemia, factors indicating poor long-term prognosis during medical therapy.

Ventricular arrhythmias in relation to coronary artery stenosis and left ventricular performance.

The relationship between ischaemic heart disease and occurrence of ventricular arrhythmias has been studied in a prospective investigation of 41 patients with severe stable angina pectoris. The patients had a median age of 54 years (range 38–67). Following the therapeutic evaluation of the patients, they were subjected to exercise testing, 24 h ambulatory ECG monitoring, selective coronary arteriography, ventriculography and cardiac catheterization. Nineteen patients had been under treatment with a beta blocking agent, 16 with verapamil, three with both and three had not been receiving any anti-anginal treatment. The treatment was discontinued over a period of three days prior to coronary arteriography and haemodynamic measurements. A comparison of the patients under treatment with a beta blocking agent and those receiving verapamil demonstrated no difference in the non-invasive and invasive variables. Ventricular arrhythmias were found in only one patient during exercise testing. The occurrence of ST segment deviation during exercise was not correlated with the number of stenotic coronary vessels due to low maximum heart rate and treatment. A heart rate during maximum exercise of < 120/min was observed significantly more frequently in patients with multivessel disease. The data of the 24 h Holter monitoring were analysed in order to evaluate whether the prevalence (percentage number of patients with ventricular ectopic beats) or the persistence (number of 6 h periods with ventricular ectopic beats) is the better indicator of myocardial function and coronary artery anatomy. The results demonstrated a significant correlation between a high persistence and elevated left ventricular enddiastolic presure, high dp/dt/max/P, reduced ejection fraction as well as the number of stenotic coronary arteries and hypokinetic segments in the left ventricular wall. The latter correlation especially applies when the hypokinesia is localized to the anterior wall of the left ventricle. It is concluded from this investigation that a high persistence of ventricular arrhythmias during 24 h of ECG monitoring reflects multivessel disease and poor left ventricular function. The combination of a high persistence of complicated ventricular arrhythmias and only a slight rise in heart rate during maximum exercise can possibly identify a group with an especially high risk of sudden cardiac death.

Variations in and significance of systolic pressure during maximal exercise (treadmill) testing: Relation to severity of coronary artery disease and cardiac mortality

Variations in clinical noninvasive systolic pressure at the point of symptom-limited exercise on a treadmill were examined in six groups of subjects: 5,459 men and 749 women classified into three categories each. Among the men, 2,532 were asymptomatic healthy, 592 were hypertensive and 1,586 had clinical manifestations of coronary heart disease (that is, typical angina pectoris, prior myocardial infarction or sudden cardiac arrest with resuscitation). Among the women, 244, 158 and 347 were in the corresponding clinical categories. None had had cardiac surgery; all had follow-up status ascertained by periodic mail questionnaires. Reported deaths were reviewed and classified by three cardiologists; 140 deaths were attributed to coronary heart disease, 118 of them in the men classified as having coronary heart disease. The majority of maximal systolic blood pressure readings were reported to the nearest centimeter rather than millimeter of pressure. Retesting of 156 persons from 1 to 32 months later showed that pressure values agreed within 10 percent in two thirds, the overall mean difference was only 8.6 mm Hg and the correlation at maximal exercise was superior to that of the resting observations just before exercise. Hypertensive patients had a significantly greater body weight than normotensive persons. Among men, the lowest maximal systolic pressure was observed in the group with coronary heart disease; among women, the lowest mean pressure was found in the healthy group. Patients with coronary heart disease were slightly older, and only the women showed a significant correlation in maximal pressure with age. Only 5 percent of the variation in maximal systolic pressure in the patients with coronary heart disease was due to a shortened duration of exercise. Maximal systolic pressures correlated fairly well (r equals 0.46 to 0.68 for the various groups) with resting systolic pressure, and this relation was independent of the diagnosis of cardiovascular disease in both men and women. Relations between pressure and the number of stenotic coronary arteries and imparied ejection fraction at rest were examined in 22 men without and 182 men with coronary artery disease. Lower maximal systolic pressures were often associated with two or three vessel disease or reduced ejection fraction, or both. The prognostic value of maximal systolic pressure for subsequent death due to coronary heart disease was examined in the men with coronary heart disease. The annual rate of sudden cardiac death decreased from 97.9 per 1,000 men to 25.3 and 6.6 per 1,000 men as the range of maximal systolic pressure increased from less than 140 to 140 to 199 and to 200 mm Hg or more, respectively. Cardiomegaly, Q waves in the resting electrocardiogram and persistent postexertional S-T depression were more common in men with the lowest systolic pressure at maximal exercise.