Patients In Coronary Artery Disease Group Research Articles

Expression of platelet miR-223 in coronary artery disease patients and its clinical significance

Objective: To investigate the correlation of the expression of platelet microRNA-223 (miR-223) with the degree of platelet activation and the severity of coronary lesions in patients with coronary artery disease (CAD). Methods: A total of 204 consecutive patients underwent coronary artery angiography (CAG) at Beijing Anzhen Hospital between April and December 2016 were enrolled. According to CAG results, all the patients were divided into two groups: 112 patients in CAD group and 92 patients in control group. Real-time fluorescent quantitative PCR was used to detect the expression level of platelet miR-223 and mRNA of its target gene P2Y12. Flow cytometry was performed to detect the expression of platelet associated complement-1 (PAC-1). Results: Compared with control group, the expression level of platelet miR-223 in CAD group was higher [(1.27 (1.17, 1.32) vs 0.73 (0.64, 0.79), P<0.001], while the expression level of P2Y12 mRNA was lower [0.75 (0.51, 0.96) vs 1.00 (0.80, 1.64), P<0.001]. The positive expression rate of PAC-1 of CAD group was higher than that of control group (P<0.001). The expression level of platelet miR-223 was negatively correlated with the expression of P2Y12 (r=-0.39, P=0.02), but positively correlated with the expression of PAC-1 (r=0.50, P<0.001). The platelet miR-223 expression level had a positive correlation with the Gensini score in CAD group (r=0.90, P<0.001), but had no significant correlation with platelet aggregation (r=-0.06, P=0.36). Conclusion: The expression level of platelet miR-223 in patients with CAD may be an indicator for monitoring platelet activation and assessing the severity of CAD.

Assessment of the Correlation between Severity of Coronary Artery Disease and Waist-Hip Ratio.

AIM:This study was conducted to investigate the correlation between waist/hip ratio (WHR) as a measurement of obesity and severity of coronary artery disease (CAD) assessed by angiography in Kosovo.METHODS:The study included 82 patients with suspected or known CAD who were referred for coronary angiography. All patients were subjected to full individual medical history, clinical examination including measurement of arterial blood pressure, body weight, height, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, and waist/height ratio. Coronary angiography was performed using standard techniques to determine the presence and severity of coronary artery lesions with the Gensini score.RESULTS:Among the 82 patients in the study, the mean age in the CAD group was 66.76 ± 9.12 years and the mean age in the non-CAD group was 64.80 ± 8.30 years. Patients in the CAD group had a mean BMI of 28.17 ± 3.32 kg/m2 and those in the non-CAD group had a mean BMI of 28.76 ± 4.68 kg/m2. Patients in the CAD group had a mean waist/height ratio of 1.76 ± 7.56 and those in the non-CAD group had a mean waist/height ratio of 0.57 ± 0.08. Patient in the CAD group had a mean waist/hip ratio of 0.93 ± 0.06 and those in the non-CAD group had a mean waist/hip ratio of 0.88 ± 0.07. Thirty-seven patients (45.1%) had no coronary artery disease (Gensini score = 0), 15 (18.3%) had mild disease (Gensini score = 1-32), 14 (17.1%) had moderate disease (Gensini score = 32-58), and 16 (19.5%) had severe disease (Gensini score ≥ 58).CONCLUSION:There was a significant positive correlation between waist/hip ratio and presence of CAD in Kosovar patients.

Assessment of asymptomatic coronary artery disease in apparently uncomplicated type 2 diabetic patients: a role for lipoprotein(a) and apolipoprotein(a) polymorphism.

In patients with uncomplicated diabetes, there is low probability of finding significant coronary artery disease (CAD) by noninvasive tests. Therefore, screening for its presence is not justified, and it is important to find reliable predictors of silent CAD to identify patients with uncomplicated diabetes for further screening. The relationship between lipoprotein(a) [Lp(a)], apolipoprotein(a) [apo(a)] polymorphism, and silent CAD has never been studied. We investigated the association of Lp(a) and apo(a) polymorphism with angiographically documented asymptomatic CAD in type 2 diabetic patients without evident complications. A total of 1,323 diabetic patients without any clinical and electrocardiographic evidence of CAD were evaluated. Of 121 patients with highly positive results of exercise electrocardiography (ECG) (n = 30) or positive results on exercise thallium scintigraphy (n = 91), 103 subjects showed angiographically documented CAD (CAD group). Of 1,106 patients with negative results on exercise ECG, 103 subjects without CAD (NO CAD group) were selected and matched by age, gender, and duration of diabetes to patients in the CAD group. In patients in the NO CAD group, results of exercise ECG, 48-h ambulatory ECG, and stress echocardiography were negative for CAD. The CAD group had higher Lp(a) levels (21.7 +/- 17.7 vs. 15.2 +/- 19.0 mg/dl; P = 0.0093) than the NO CAD group, and a percentage of subjects had at least one small apo(a) isoform (68.9 vs. 29.1%; P = 0.0000) higher than the NO CAD group. Logistic regression analysis showed that apo(a) phenotypes (odds ratio [OR] 8.13, 95% CI 3.65-21.23), microalbuminuria (5.38, 2.44-11.88), smoking (2.72, 1.31-5.64), and Lp(a) levels (2.41, 1.15-5.03) were predictors of asymptomatic CAD. Our investigation reports the first evidence of an independent association of Lp(a) and apo(a) polymorphism with asymptomatic CAD. This suggests that Lp(a) levels and apo(a) phenotypes could be used together with other risk factors as markers of asymptomatic CAD in patients with diabetes.

Exercise electrocardiography test in patients with aortic stenosis: Differential features from that of coronary artery disease

Background and aim of the study: Studies that have been conducted with an exercise test in patients with aortic stenosis (AS) have demonstrated that results of an exercise test can mimic that of coronary artery disease (CAD). The objective of our study was to investigate if there was any differential feature(s) of an exercise test in patients with AS compared to those with CAD. Methods: We prospectively studied 42 patients with AS (AS group, age 37±23, range 8–75) with an averaged maximal gradient of 42±19 mmHg (range 26–95). All patients had undergone a coronary angiography within 1 week of the exercise test and none had CAD. Another 100 patients with CAD, diagnosis proven with coronary angiography, comprised our second group for the comparison (CAD group). Cornell protocol was used in all patients. Results: ST-segment depression was observed in all patients (160±25 μV in AS group and 170±20 μV in CAD group, P>0.05). Thirty-four (81%) patients in AS group and 88 (88%) patients in CAD group exceeded the classical threshold for the test positivity ( P>0.05). ST/HR slopes derived from heart rate adjustment to ST-segment level did not differ between the study groups (3.2±2.3 and 3.7±2.2 μV/beat/min, in AS and CAD groups, respectively, P>0.05). Recovery-phase patterns of ST-segment in heart rate domain were quite different between AS and CAD (clockwise loop: 86% vs. 0%; counterclockwise loop: 9% vs. 88% in AS group and CAD group, respectively, both P<0.0001). Percentage of intermediate loop was 5% in AS group and 12% in CAD group ( P>0.05). Conclusions: Our study demonstrated that patients with AS could be distinguished from those with CAD with the method of rate-recovery loop analysis.

INFRARENAL ABDOMINAL AORTIC ANEURYSM ASSOCIATED WITH CORONARY ARTERY DISEASE

A retrospective review of 108 patients who underwent infrarenal abdominal aortic ancurysm (AAA) repair during the recent 9 years was designed to investigate whether an association of coronary artery disease (CAD) influenced the operative results and long-term survival. Patients associated with CAD was defined as those having a medical history of angina or myocardial infarction, or those presenting ST·T abnormality or abnormal Q wave in ECG. CAD was clinically found in 57 (53%) operations. Coronary angiography (CAG) was performed in only 2 patients with CAD. Two patients died of multi-organ failure due to massive bleeding. There was no cardiac death during the perioperative period. Two patients in CAD group had angina attack during postoperative period, but patients without CAD had no cardiac complication. One patient with unstable angina in history, whose preoperative CAG showed less than 50 percent of stenotic lesion in right and left coronary arteries, suddenly died of coronary spasm 65 days after successful AAA repair. In 26 late deaths, 6 died of cardiac events. There was no significant difference in perioperative cardiac mortality, morbidity and long-term survival rate between CAD group and non-CAD group. The results show that AAA repair can be performed at low risk by intra- and postoperative intensive cardiac care. CAG should be selectively performed only in patients with unstable angina, and if there is reasonable indication of CABG, coronary revasuralization must be done prior to AAA repair.