Predictor Of Coronary Artery Stenosis Research Articles

Triglyceride glucose index and triglyceride HDL ratio as predictors of coronary artery stenosis in diabetic and non-diabetic patients

Background and AimThe current study investigated the association between triglyceride-glucose index (TyG) and triglyceride/HDL-C indices and coronary atherosclerosis extent in diabetic and non-diabetic patients. Methods and ResultsIn this case-control study, 1538 individuals were classified into two groups: diabetic and non-diabetic subjects. Each group was further grouped as follows: (1) angiography+ (2) angiography–and (3) subjects without a history of cardiovascular diseases. The TyG and TG/HDL-C indices were compared between the subgroups of the diabetic (n=407) and non-diabetic (n=1131) groups. In both diabetic and non-diabetic patients, there was no significant association in TG/HDL-C; and diabetic subjects, angiography+ and angiography-groups had significantly higher TyG (p<0.05). A high TyG index was associated with a higher risk of angiography+ (OR: 1.883 (1.410-2.514)). ConclusionsThe TyG index, but not the TG/HDL-C, was an independent marker for predicting the severity of coronary stenosis in non-diabetic patients.

Associations of pro-protein convertase subtilisin-like kexin type 9, soluble low-density lipoprotein receptor and coronary artery disease: A case-control study

BackgroundLow-density lipoprotein receptor (LDLR) is the primary pathway for removal of cholesterol from the circulation, pro-protein convertase subtilisin-like kexin type 9 (PCSK9) is a secreted protease that binds to and promotes degradation of the LDLR protein. The goal of this case-control study was to investigate the role of soluble LDLR (sLDLR) and PCSK9 in coronary artery disease (CAD) and investigate the relationship between these two indices and CAD. MethodsIn a sample of 144 Chinese patients recruited between January 2018 and August 2018, 81 cases with mild and severe stenosis characterized by coronary angiograph (CAG) and 63 healthy controls were selected using the propensity score matching (PSM) based on demographics and medical history. sLDLR and PCSK9 concentrations were determined using enzyme-linked immunosorbent assay (ELISA), Immuno-precipitation (IP) and western blotting. Multivariable logistic models were used to assess the associations between the degree of coronary artery stenosis and the biomarkers of interest. ResultsHigher PCSK9 was found to be a significant predictor of coronary artery stenosis when comparing cases who had severe stenosis vs. controls (OR=1.016, 95%CI: 1.009, 1.024), and cases who had mild stenosis vs. controls (OR=1.009, 95%CI: 1.003, 1.015). sLDLR was positively corrected with PCSK9, which confounded the association between CAD and PCSK9. Compared to patients with mild-stenosis, patients with severe-stenosis also showed a higher level of PCSK9 (OR=1.007, 95%CI: 1.001, 1.013). ConclusionsThese findings suggest that elevated PSCK9 may contribute to the odds of developing CAD, with a higher degree of coronary artery stenosis.

The significance of coronary artery calcium score as a predictor of coronary artery stenosis in individuals referred for CT angiography.

Introduction: Cardiovascular diseases, including coronary artery disease (CAD), are among the most common causes of death in the elderly population. Recent studies have found that coronary artery calcium score (CACS) is a strong independent predictor of CAD. Here we aimed to investigate the association between CACS and demographic, clinical, laboratory, and CT angiographic findings inpatients with suspected CAD. Methods: From June 2008 to August 2018, we retrospectively reviewed 219 consecutive patients suspected with CAD who were referred for CT angiography in Rajaie Cardiovascular, Medical, and Research Center. Medical records were reviewed, and relevant demographic, clinical, laboratory and imaging were collected. Results: A total of 219 patients with an average age of 62.64±12.39 were included. Twelve patients(5.5%) had normal coronary angiography, and 50.2% had mild CAD. An obstructive CAD was found in97 patients (44.3%). The median CACS was 76.4 (IQR, 13.0-289.1). The frequency of obstructive CAD was 28.1% in the CACS <100 group, and 67.0% in CACS >100 group (P < 0.001). On multiple logistic regression analysis, age (OR=1.04 [1.01-1.07], P = 0.006), CACS (OR= 4.31 [2.33-7.98], P < 0.001), and neutrophil to lymphocyte ratio (NLR) (OR = 0.82 [0.68-0.98], P = 0.027) were independent predictors of obstructive CAD. Conclusion: We found a direct association between higher CACS and obstructive patterns in coronary CT angiography. Our findings indicate that the possibility of the presence of obstructive CAD was higher among symptomatic patients with older age, lower NLR, and CACS >100.

P2266The predictor of mortality and neurological outcome in out-of-hospital cardiac arrest patients with non-ST-segment elevation

Abstract Background The prognosis of patients with out-of-hospital cardiac arrest (OHCA) remains poor. Coronary artery disease (CAD) is the most frequent cause of OHCA. The prompt evaluation and revascularization for coronary artery in OHCA patients with ST-segment elevation are recommended because they often have CAD. However, OHCA patients without ST-segment elevation also have any coronary stenosis in the non-negligible proportion. The predictor of mortality and neurological outcome in OHCA patients with no ST-segment elevation has not been sufficiently elucidated. Purpose We sought to investigate the predictor of mortality and neurological outcome at 30 days in OHCA patients without ST-segment elevation. Methods A total of 1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 252 cardiovascular arrest patients achieving the return of spontaneous circulation (ROSC) were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, 183 patients' electrocardiogram after ROSC were without ST-segment elevation. We performed coronary angiography (CAG) for 103 patients, who were eligible for final analysis. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, post-hospital care. Results Any coronary stenosis was founded in 50 patients (48.5%). Male (P=0.007), older age (P&lt;0.001), past history of coronary artery disease (CAD) (P=0.037) and diabetes mellitus (P=0.087) were associated with coronary artery stenosis on CAG findings. Age (OR 1.05; 95% confidence interval (CI) 1.02–1.08; P&lt;0.001), male (OR 5.33; 95% CI 1.37–20.7; P&lt;0.001) were independent predictors of coronary artery stenosis. Among those who had stenosis, 34 patients (68.0%) survived and 27 patients (54.0%) achieved good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. Successful revascularization by percutaneous coronary intervention (PCI) was not associated with low mortality (P=0.77). Past history of CAD (P=0.014) and high Syntax score (P=0.030) were associated with mortality. Bystander cardiopulmonary resuscitation (CPR) (P-0.021), pre-hospital ROSC (P&lt;0.001) was more frequent in patients with good neurological outcome. Pre-hospital ROSC (OR 14.7; 95% CI 3.1–69.3; P&lt;0.001) was independently predictive for good neurological outcome. Conclusions Successful PCI for OHCA patients with no ST-segment elevation was not a predictor of mortality. CAD past history and complex CAD was associated with mortality. Pre-hospital information such as pre-hospital ROSC was important to achieve good neurological outcome.

Latent tuberculosis infection among patients with coronary artery stenosis: A case-Control study.

The activation of the cell-mediated immune responses by Mycobacterium tuberculosis can promote atherogenesis. The aim of this study is to determine the frequency of latent tuberculosis infection (LTBI) among patients with coronary artery stenosis (CAS) and to explore the association between LTBI and development of CAS. We conducted a case-control study which included 183 patients' who underwent percutaneous coronary angiography (121 patients with CAS and 62 patients without as a control group). For all the study population, clinical evaluation, tuberculin skin test (TST), imaging studies (including chest radiography and echocardiography), laboratory investigations, and electrocardiography were carried out. Only for the patients with positive TST, QuantiFERON-TB Gold test was performed. Predictors of CAS were identified using univariate analyses (Yates' corrected Chi-square test or Fischer's exact test) followed by multivariate analysis (binary logistic regression). Among 29.5% of the study population, LTBI was detected, and among patients with CAS, 56.2% of patients had advanced CAS. After multivariate analysis, it was found that metabolic syndrome (MS) (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.5-22.6, P = 0.022) and LTBI (OR 2.5, 95% CI 1.2-17.3, P = 0.018) were the predictors of CAS among the study population, while only diabetes mellitus (DM) (OR 1.9, 95% CI 1.1-11.7, P = 0.031) was the predictor of advanced CAS. LTBI is associated with the development of CAS. In addition, MS is associated with CAS, while its related disorder, DM, is associated with advanced CAS.

The Relationship between Pulse Wave Velocity and Coronary Artery Stenosis and Percutaneous Coronary Intervention: a retrospective observational study

BackgroundArterial stiffness has been suggested as a valuable predictor of coronary artery stenosis (CAS). However, little data are available on aortic stiffness and CAS in patients who have previously undergone percutaneous coronary artery intervention (PCI). The aim of this study was to investigate the association of arterial stiffness to CAS in patients with a history of PCI and those without a history of PCI.MethodsWe retrospectively studied 1093 consecutive patients who had undergone coronary angiography (CAG). Arterial stiffness was determined by brachial-ankle pulse wave velocity (baPWV) measured prior to CAG.ResultsIn patients without a history of PCI, baPWV significantly increased in patients with CAS compared to that in patients without CAS (p < 0.001). However, among patients with a history of PCI, there was no significant difference in baPWV. Multivariate logistic regression analysis demonstrated that baPWV was an independent risk predictor for CAS in patients without a history of PCI, but not in those with a history of PCI (OR 1.106, 95% CI 1.039–1.177, p = 0.002). In CAS patients without a history of PCI, increased baPWV was significantly associated with multiple cardiovascular risk factors, multivessel involvement, and anatomical severity.ConclusionsPrediction of CAS by baPWV is significantly attenuated in patients with a history of PCI.

How can we detect the low risk patients for ischemic etiology in heart failure population?

In the recent issue of your journal I have read the article by Silva et al. with great interest [ [1] Silva F. Borges T. Ribeiro A. et al. Heart failure with reduced ejection fraction: should we submit patients without angina to coronary angiography?. Int. J. Cardiol. 2015; 190: 131-132 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ]. In their study, the authors reported that patients with heart failure with reduced ejection fraction (HFREF) and without angina and risk factors had high prevalence of angiographically significant coronary artery disease (CAD) and they suggested performance of routine coronary angiography (CA) in HFREF patients. It is known that CAD is the most common etiology in patients with heart failure [ [2] Fox K.F. Cowie M.R. Wood D.A. et al. Coronary artery disease as the cause of incident heart failure in the population. Eur. Heart J. 2001; 22: 228-236 Crossref PubMed Scopus (300) Google Scholar ]. In this paper, I would like to emphasize some confusing factors and possible overestimated incidence of CAD in patients with HFREF without angina and risk factors. In the present study of Silva et al., the authors suggested that the predictors of CAD as angina and conventional risk factors are mostly accepted. In a recent study, it has been reported that incidence of chest pain was not significantly different in HFREF patients who have coronary artery stenosis or not [ [3] Kosuga T. Komukai K. Miyanaga S. et al. Diabetes is a predictor of coronary artery stenosis in patients hospitalized with heart failure. Heart Vessels. Mar 31 2015; (Epub ahead of print) PubMed Google Scholar ]. Hence, it may be inappropriate to suggest the performance of routine CA by angina alone. In the present study, echocardiography has been performed to all patients. But, there is not another echocardiographic data except left ventricle ejection fraction. Echocardiography is one of the most sensitive techniques for detecting regional wall abnormalities [ [4] Feigenbaum H. Corya B.C. Dillon J.C. et al. Role of echocardiography in patients with coronary artery disease. Am. J. Cardiol. 1976; 37: 775-786 Abstract Full Text PDF PubMed Scopus (39) Google Scholar ]. To determine the akinetic, hypokinetic or dyskinetic wall segments may be useful to patients selection for performing CA, in addition to angina and risk factors. The authors should comment on the presence or absence of regional wall motion abnormalities in both patient groups and compare the groups regarding their wall motion score index, and akinetic, hypokinetic and dyskinetic wall segments. In HFERF patients, the presence of regional wall motion abnormalities may be a significant indicator of CAD. Therefore, it may affect the results of the present study of Silva et al. and the presence of higher levels of wall motion score indexes may overestimate the incidence of CAD in HFERF patients without angina and risk factors. In this sense, it may be a wrong approach to include these patients into the low risk patient group for ischemic etiology. Additionally, a novel echocardiographic calcification scores was found to be an independent indicator of significant CAD in a recent study [ [5] Hirschberg K. Reinhart M. Konstandin M. et al. Diagnostic and prognostic value of a novel cardiac calcification score for coronary artery disease by transthoracic echocardiography. Int. J. Cardiol. 2015; 190: 332-334 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar ], and it may be useful to identify low risk HFREF patients for ischemic etiology who may benefit from CA and revascularization.

Diabetes is a predictor of coronary artery stenosis in patients hospitalized with heart failure

In patients with heart failure, coronary artery disease is the most common underlying heart disease, and is associated with increased mortality. However, estimating the presence or absence of coronary artery disease in patients with heart failure is sometimes difficult without coronary imaging. We reviewed 155 consecutive patients hospitalized with heart failure who underwent coronary angiography. The patients were divided into two groups: patients with (N=59) and without (N=96) coronary artery stenosis. The clinical characteristics and blood sampling data were compared between the two groups. The patients with coronary artery stenosis were older than those without. The prevalence of diabetes mellitus (DM), dyslipidemia and a history of revascularization was higher in the patients with coronary artery stenosis. Patients with coronary artery stenosis tended to have wall motion asynergy more frequently than those without. On the other hand, the prevalence of atrial fibrillation (AF) was lower in patients with coronary artery stenosis. The serum hemoglobin level and estimated glomerular filtration rate were lower in patients with coronary artery stenosis than in those without. In the multivariate analysis, DM (odds ratio 3.517, 95% CI 1.601-7.727) was found to be the only the predictor of the presence of coronary artery stenosis in patients with heart failure. In conclusion, coronary imaging is strongly recommended for heart failure patients with DM to confirm the presence of coronary artery stenosis.

Comparison of Agatston CT coronary artery calcium score, Framingham score and blood biomarkers as predictors of coronary artery stenosis

Purpose: Coronary CT angiography (CCTA) with calcium scoring measured with Agatston score index provides a diagnosis of coronary atherosclerosis in patients with subclinical coronary plaque. We compared diagnostic accuracy of Agatston score, Framingham Risk score and multiple blood biomarkers in predicting coronary artery disease (CAD) that caused stenosis >50%. Methods: This retrospective single-center study is evaluating the role of Agatstone score in prognostication of coronary artery stenosis in patients who presented with atypical chest pain and non conclusive stress test result. The study included 368 patients with unknown coronary heart disease (mean age 62.2±7.7; 62% of females) who underwent CCTA and obtained Agatston score, in our Center from June 2012 till June 2013. Scanning was done with dual-source MDCT (Somatom Definition FLASH; Siemens Medical Solution, Munich, Germany) equipped with two 128-detector row units using the prospective or retrospective ECG-gating protocol and the mean received amount radiation was 6.85±9.74mSv. Exclusion criteria included pre-existing kidney failure (eGFR <60 mol/min/1.73m 2 ), atrial fibrillation, as well as incomplete data, Agatston score above 800. All patients with heart rate higher than 80/min received beta blocker. The mean heart rate during scanning was 60±9.3/min, and patients body mass index (BMI) 28±3.9. Patients with known cardiovascular risk factors, including hypertension (80%), diabetes mellitus (29%), dyslipidemia (71%) or smoking (25%), and Framingham risk score values (mean 20±11.9) were considered. Blood biomarkers included glucose, C-reactive protein (CRP), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and uric acid. Participants were divided in two groups, based on coronary artery stenosis greater than 50% (83; 23% of participants), and the other with stenosis smaller than 50% (285; 77% of participants). Frequency of demographic and clinical charasterics, blood biomarkers and risk factors were tested between the groups by using Chi square test and Student T test as appropriate. Relative Risk was calculated in context of developing coronary artery stenosis greater than 50% in participants with Agatston score above 100. Results: The most acccurate predictor of coronary artery stenosis greater then 50% was Agatstone Score (AUC 0.89, p<0.0001). Agatstone Score higher than 100, had relative risk for developing of coronary stenosis over 50% 15 times higher than values under 100. CRP (AUC 0.76), glucose (AUC

Carotid Artery Plaque and LDL-to-HDL Cholesterol Ratio Predict Atherosclerotic Status in Coronary Arteries in Asymptomatic Patients with Type 2 Diabetes Mellitus

To investigate the clinical predictors of coronary atherosclerosis and to assess the utility of maximum-IMT for predicting coronary atherosclerosis in asymptomatic type 2 diabetic patients. One hundred one Japanese patients with type 2 diabetes underwent computed tomography coronary angiography. Definitions of coronary artery stenosis and vulnerable coronary plaque were luminal narrowing of ≥50% and any coronary plaque with positive vessel remodeling and low attenuation, respectively. Carotid intima-media thickness (IMT) was assessed using B-mode ultrasound. Of the 101 patients, 40 had coronary artery stenosis without vulnerable coronary plaque, 7 had vulnerable coronary plaque without coronary artery stenosis, and 23 had coronary artery stenosis with vulnerable coronary plaque. Male sex (p=0.031), duration of diabetes (p=0.024), systolic blood pressure (SBP) (p=0.039), and the LDL/HDL ratio (LDL/HDL) (p=0.013) were independent predictors of coronary artery stenosis and the LDL/HDL (p=0.042) independently predicted vulnerable coronary plaque by logistic regression analyses. Areas under the curves in receiver operating characteristic curve analysis of the maximum-IMT, LDL/HDL, and these two parameters combined were 0.711 (95% CI 0.601-0.820), 0.618 (0.508-0.728), and 0.732 (0.632-0.831), respectively, for predicting coronary artery stenosis and 0.655 (0.537-0.773), 0.629 (0.504-0.754), and 0.710 (0.601-0.818), respectively, for predicting vulnerable coronary plaque. Male sex, duration of diabetes, elevated SBP, and LDL/HDL were independent predictors of coronary artery stenosis. LDL/HDL was an independent predictor of vulnerable coronary plaque. Maximum-IMT predicted both coronary stenosis and vulnerable coronary plaque. Adding LDL/HDL improved the prediction of coronary artery stenosis and vulnerable coronary plaque.

Usefulness of Albuminuria as Predictor for Coronary Artery Stenosis, Regardless of Estimated Glomerular Filtration Rate, in Patients With Type 2 Diabetes Mellitus

The aim of the present study was to evaluate the independent predictors of coronary artery stenosis in patients with type 2 diabetes mellitus (DM) and subclinical atherosclerosis. A total of 232 patients with type 2 DM and subclinical atherosclerosis underwent multislice computed tomography coronary angiography. Subclinical atherosclerosis was determined by the carotid intima-media thickness (IMT) or carotid plaque. Multislice computed tomography coronary angiography revealed significant coronary stenosis (>50% in diameter) in 71 subjects (31%). The subjects who had significant coronary stenosis were much older and had had a longer duration of DM. In particular, the log-transformed albumin/creatinine ratio (ACR) was greater in the subjects with significant coronary stenosis compared to the subjects without significant coronary stenosis. The age- and gender-adjusted odds ratio for significant coronary stenosis increased in proportion to albuminuria with a given estimated glomerular filtration rate. The ACR as a continuous variable (odds ratio 4.167, 95% confidence interval 1.497 to 11.599) or categorical variable (ACR >30 μg/mg, odds ratio 4.619, 95% confidence interval 1.562 to 13.659) was associated with an increased risk of significant coronary stenosis, independent of conventional cardiovascular risk factors. In receiver operating characteristic analysis, the ACR had an additive effect with carotid IMT for predicting significant coronary stenosis (area under the curve 0.625 with carotid IMT; area under the curve 0.710 with carotid IMT plus ACR, p = 0.0144). In conclusion, the presence of albuminuria is an independent predictor for significant coronary stenosis in patients with type 2 DM and subclinical atherosclerosis.

Reduced Antegrade Flow in the Coronary Sinus Is a Predictor of Coronary Artery Stenosis in Hypertensive Patients

The purpose of this study was to evaluate the feasibility of assessing blood flow in the coronary sinus by transthoracic Doppler echocardiography for detecting coronary artery stenosis in hypertensive patients. Flow in the coronary sinus was studied in 105 participants who all had undergone coronary angiography: 35 nonhypertensive patients, 34 hypertensive patients without coronary artery disease (CAD), and 36 hypertensive patients with CAD. The antegrade phase of flow in the coronary sinus was analyzed and compared among the groups. Multivariate analysis for blood flow and coronary artery stenosis was done. Compared with the nonhypertensive patients, the hypertensive patients without CAD had significantly higher blood flow (9.36 ± 5.94 vs 5.84 ± 2.91 mL/stroke and 584.45 ± 177.32 vs 327.68 ± 125.48 mL/min, respectively; P < .001) in the coronary sinus. Compared with the hypertensive patients without CAD, those with CAD had significantly lower blood flow (5.18 ± 0.72 vs 9.36 ± 5.94 mL/stroke and 352.51 ± 156.18 vs 584.45 ± 177.32 mL/min; P < .001) and a lower velocity time integral (13.14 ± 2.51 vs 19.85 ± 4.89 cm; P < .01). Stepwise multiple regression analysis indicated that the coronary sinus diameter, velocity time integral, and heart rate significantly correlated with the blood flow per minute in the coronary sinus in each group, and the flow per minute was the independent determinant of the percent stenosis diameter. The sensitivity, specificity, and accuracy for the prediction of severe stenosis (>70%) in the left coronary artery were 91.07%, 87.76%, and 88.49% for blood flow of less than 220 mL/min in the coronary sinus. Transthoracic Doppler echocardiography can effectively depict blood flow changes in the coronary sinus, and reduced antegrade flow is a sensitive and specific predictor of coronary artery stenosis in hypertensive patients.

Association of Coronary Artery Stenosis with Carotid Atherosclerosis in Asymptomatic Type 2 Diabetic Patients

Carotid atherosclerosis assessed by ultrasound is an established surrogate marker for systemic atherosclerosis. This study aimed to evaluate the association between coronary artery stenosis assessed by coronary computed tomography angiography (CCTA) and intima-media thickness (IMT) in asymptomatic type 2 diabetic patients. In a cross-sectional study, carotid IMT was measured by ultrasound and CCTA in 169 asymptomatic type 2 diabetic patients. Among 169 patients, 77 (46%) had coronary artery stenosis on CCTA. Multivariate logistic regression analysis revealed four independent predictors of coronary artery stenosis: diabetes duration (OR 4.07, 95%CI 2.34-7.12; p< 0.001), gender (OR 1.66, 95% CI 1.05-2.61; p=0.029), dyslipidemia (OR 2.07, 95%CI 1.34-3.18; p=0.001), and max-IMT (OR 2.71, 95%CI 1.70-4.33; p< 0.001). By ROC curve analyses, the area under the curve (AUC) for max-IMT was 0.73 (95%CI 0.66-0.81; p< 0.001) and mean-IMT was 0.64 (95%CI 0.56-0.73; p=0.001). The cut-off level for the greatest sensitivity and specificity for max-IMT was 1.55 mm (sensitivity 0.90, specificity 0.46), and mean-IMT was 1.05 mm (sensitivity 0.55, specificity 0.72). Carotid IMT was associated with coronary artery stenosis assessed by CCTA in asymptomatic type 2 diabetic patients. Measurement of both mean- and max-carotid IMT is useful for selecting asymptomatic type 2 diabetic patients who should undergo CCTA screening.

High Aortic Stiffness Assessed by Pulse Wave Velocity is an Independent Predictor of Coronary Artery Calcification and Stenosis in Suspected Coronary Artery Disease Patients

Background and Objectives:Aortic stiffness is an independent predictor of cardiovascular mortality and of all other causes in hypertensive patients. The object of this study was to investigate whether aortic stiffness, measured by pulse wave velocity (PWV), could be used as an independent predictor for detecting coronary artery atherosclerosis. Subjects and Methods:PWV was measured by an invasive method. All patients (n=187, M/F= 77/110) were suspected as having the coronary artery disease (CAD) and underwent coronary angiography. CAD was classified as that with or without calcification and stenosis and was classified by the calcification segments and stenotic vessel numbers. Results:Coronary artery calcification was significantly associated with diabetes mellitus (p<0.001), the waist/hip circumference ratio (p=0.012), hypertension (p=0.002), age (p<0.001) and PWV (p<0.001). Multiple logistic regression analysis revealed that coronary artery calcification was highly associated with age (OR=1.052, p=0.023) and PWV (OR=1.213, p<0.001). Significant coronary artery stenosis was associated with hypertension (p=0.002), diabetes mellitus (p=0.015), age (p=0.004), waist/hip circumference ratio (p=0.019), systolic blood pressure (p=0.007), pulse pressure (p=0.016), low density lipoprotein levels (p=0.004) and PWV (p<0.001). Multivariate analysis showed that PWV (OR=1.370, p<0.001) and low density lipoprotein levels (OR=1.022, p=0.006) were the best predictors of coronary artery stenosis. Patients with severe coronary atheosclerosis exhibited a greater increased aortic PWV. Conclusion:A high aortic PWV is an independent marker for coronary artery stenosis and calcification in suspected CAD patients. The aortic PWV could be used as an independent predictor for ischemic heart disease in patients with suspected CAD. (Korean Circulation J 2004;34(5):468-476)

Common carotid intima–media thickness is correlated with myocardial flow reserve in patients with coronary artery disease: a useful non-invasive indicator of coronary atherosclerosis

Background: The common carotid intima–media thickness (IMT) is correlated with the angiographically determined coronary artery stenosis. However, their correlation is weak, which limits the clinical application of the IMT as a predictor of coronary artery stenosis. The IMT reflects diffuse early-phase atherosclerosis, whereas the angiographically determined coronary artery stenosis is a late-phase phenomenon. The latter is localized and rapidly progressive with plaque rupture and acute thrombosis. Instead of the angiographically determined coronary artery stenosis, we employed myocardial flow reserve (MFR) that reflects diffuse early-phase coronary atherosclerosis and impaired coronary vasodilatation function. We evaluated the relationship between the IMT and the MFR. Methods: Twenty-three patients with angiographically diagnosed coronary artery disease (CAD) underwent B-mode ultrasound examination to measure their common carotid IMT and positron emission tomography (PET) with dipyridamole intervention to obtain their MFR. We also performed B-mode ultrasound examination in 21 patients with hypertension without CAD and in 15 control subjects. Results: The common carotid IMT in patients with CAD was thickened (0.92±0.15 vs. 0.81±0.14 mm in patients with hypertension (P<0.05) and 0.69±0.13 mm in control subjects (P<0.01)). The IMT was inversely correlated with the MFR (r=0.51, P<0.01). The correlations between the MFR and most of the coronary risk factors (age, blood pressure, serum cholesterol level and triglyceride level, HbA1c level, smoking index) did not reach statistical significance. Conclusions: Thickened common carotid IMT is also an indicator of reduced MFR or early-phase coronary atherosclerosis.

Mechanism of luminal narrowing in cardiac allograft vasculopathy: Inadequate vascular remodeling rather than intimal hyperplasia is the major predictor of coronary artery stenosis

Background: Despite increasing knowledge about degree and distribution pattern of intimal hyperplasia in cardiac allograft vasculopathy, coronary artery remodeling is only poorly understood in this disease. Methods: To evaluate vascular geometry, intravascular ultrasound was used to characterize 57 advanced lesions in 35 consecutive transplant recipients. Lumen, plaque, and vessel area in these target lesions were compared with proximal and distal reference sites. Results and Conclusions: Vascular remodeling by compensatory local vessel enlargement (positive remodeling) and circumscript vascular constriction (negative remodeling) could be demonstrated. Plaque area in stenotic lesions was significantly increased compared with the mean reference site (5.6 ± 3.0 mm 2 versus 2.8 ± 1.5 mm 2, p < 0.001); however, inadequate compensatory enlargement rather than intimal hyperplasia was shown to be the most important predictor of luminal obstruction ( r = 0.77, p < 0.001). (Am Heart J 1998;135:628-33.)

The clinical significance of exercise-induced left ventricular wall motion abnormality occurring at a low heart rate

We studied the relationship between the heart rate at the time of onset of exercise-induced wall motion abnormality and the severity of coronary artery disease in 89 patients who underwent exercise oquilibrium radionuclide ventriculography as part of their svaluation for coronary artery disease. Segmental wall motion was scored with a five-point system (3 = normal; −1 = dyskinesis); a decrease of one score defined the onset of wall motion abnormality. The onset of wall motion abnormality at ≤70% of maximal predicted heart rate had 100% predictive accuracy for coronary artery disease and higher sensitivity than the onset of ischemic ST segment depression at similar heart rate during exercise: 36% (25 of 69 patients with coronary disease) vs 19% (13 of 69 pationts), p = 0.01. Wall motion abnormality occurring at ≤70% of maximal predicted heart rate was present in 49% of patients (23 of 47) with critical stenosis (≥90% luminal diameter narrowing), and in only 5% of patients (2 of 42) without such severe stenosis, p < 0.001. The sensitivity of exercise-induced wall motion abnormality occurring at a low heart rate for the presence of severe coronary artery disease was similar to that of a deterioration in wall motion by more than two scores during exercise (49% vs 53%) or an absolute decrease of ≥5% in exercise left ventricular ejection fraction (49% vs 45%). However, the early onset of wall motion abnormality was more specific for the identification of patients with critical stenosis than deterioration of exercise wall motion by two or more scores (95% vs 71%, p < 0.01) and decrease in ejection fraction (95% vs 79%, p < 0.05). Therefore, the onset of exercise-induced wall motion abnormality at ≤70% maximal predicted heart rate is a relatively infrequent but strong predictor of coronary artery stenosis, implies severe disease, and is superior to exercise ECG in predicting disease presence and severity.