Selective Coronary Arteriography Research Articles

Cracking The Case of The Cryptic Coronary: Diagnostic Strategies for Anomalous RCA Originating from LAD

Background: Coronary artery anomalies are typically congenital, though they may remain undetected until routine cardiac catheterization is performed. With a detection rate of only 1.3%, these anomalies often go unnoticed. In rare cases, the right coronary artery may originate from the left coronary system, but this anomaly is generally benign. Case presentation: A 55-year-old male patient was diagnosed with NSTEMI and underwent coronary angiography. However, despite multiple attempts, the medical team could not cannulate into the right coronary ostium. The left coronary ostium was located in the left sinus of Valsalva. Selective left coronary arteriography revealed normal courses of the left main and LAD but identified a critical stenosis in the LCx and a possible CTO at the RCA ostium. The patient received a stent in the LCx and returned the following month for another angiography, during which he received a stent in the proximal LAD. However, during cine angiography, it was found that the patient had an anomalous RCA that originated from the mid-portion of LAD, coursing anteriorly to the pulmonary artery and down to the right atrioventricular groove. Subsequent CCTA confirmed the RCA's origin from the mid-LAD. Conclusion: The report finds a rare RCA origin in the mid-LAD. The heart and its complex arterial network may be examined thoroughly, appreciate to coronary CTA, a non-invasive imaging approach. This allows for effective interventional cardiovascular therapy and is helpful for medical cardiac abnormality detection and assessment. Keyword: Anomalous Right Coronary Artery, CT Coronary Angiography, RCA from LAD, Single Coronary Artery.

Post myocardial infarction left ventricular intramural dissecting hematoma: a case report describing a very rare complication

BackgroundDissecting intramural hematoma is a rare complication of acute myocardial infarction (AMI) and has been associated with increased mortality. There has been paucity of literature to establish protocols and guidelines for management in such cases.Case presentationWe hereby report the case of a 45-year-old male patient with left ventricular intramural dissecting hematoma (LV-IDH) who presented with chest pain and breathlessness and diagnosed as non-ST-elevation myocardial infarction (NSTEMI). Transthoracic echocardiography (TTE) was performed showing LV-IDH, confirmed with cardiac magnetic resonant imaging (cMRI). Selective coronary arteriography (CAG) was performed showing significant obstructive coronary artery disease (CAD). Further management with conservative approach involved discussion with patient, cardiothoracic surgeon and cardiology team including heart failure specialist and interventional cardiology.ConclusionsThis case describes a rare complication of AMI and also focuses on utility of TTE and cMRI in the diagnosis of this rare complication. Both diagnosis and management are challenging and have to be individualized in similar cases. Multidisciplinary care coordination is important in management of patients with this diagnosis.

Comprehensive Assessment of the Left Ventricular Systolic Function in the Elderly with Acute Myocardial Infarction Using Echocardiography.

AimTo evaluate the left ventricular (LV) systolic function in elderly with non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) using real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (STI).MethodsForty NSTEMI and forty STEMI patients after undergoing percutaneous coronary artery intervention (PCI) were enrolled. The myocardial segments were supplied by the infarct-related artery (Myo-IRA) which were indicated by the selective coronary arteriography (SCA). The LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV) and ejection fraction (LVEF) were acquired by 4D LV Volume Tom Tec. LV longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS), circumferential peak systolic strain (CPSS) of Myo-IRA segments, LV rotational peak degree in the base (rot-base) and in the apex (rot-apex), and twist were acquired by strain analysis software. Forty older healthy individuals were included as normal controls.ResultsThe LVEF of the NSTEMI and STEMI patients at 1 week after PCI were significantly lower (P<0.05), then, this parameter was improved in both groups after 3 months, but was still significantly lower than that of the controls (P<0.05). The LPSS, RPSS, CPSS of the Myo−IRA segments, rot−Base, rot−Apex and twist in both groups were significantly lower than those in the controls. The LPSS and CPSS of the Myo-IRA segments, rot−Base, rot−Apex and twist in NSTEMI patients were obviously higher than those in STEMI patients in 1 week and 3 months after PCI (P<0.05). After 3 months, the RPSS of NSTEMI patients was improved notably and was obviously higher than that of STEMI patients (P<0.05). All these values in STEMI and NSTEMI patients were improved after 3 months, apart from LPSS in STEMI patients (P>0.05), but were still significantly lower than those in the controls (P<0.05).ConclusionRT-3DE and STI can sensitively assess LV systolic function with different extents of transmural damage.

Coronary Arteries: Normal Anatomy With Historical Notes and Embryology of Main Stems.

Anatomy of subepicardial coronary arteries became a topic of investigation at autopsy in Florence (Italy) by Banchi in the early twentieth century, with the discovery of dominant and balanced patterns. Thereafter, in the 60's of the same century Baroldi in Milan did post-mortem injection with spectacular three-dimensional casts. Later Sones at the Cleveland Clinic introduced selective coronary arteriography for in vivo visualization of coronary arteries. In the present chapter we show these patterns, as well as normal variants of origin and course with questionable risk of ischemia, like myocardial bridge as well as origin of the left circumflex coronary artery from the right sinus with retroaortic course. As far as embryology, the coronary arteries and veins are epicardial in origin and finally connect the former with the aorta, and the latter with the sinus venosus. At the time of spongy myocardium, intramural blood supply derives directly by the ventricular cavities, whereas later, at the time of myocardial compaction, vascularization originates from the subepicardial network. The connection of the subepicardial plexus with the aorta occurs with prongs of the peritruncal ring, which penetrate the facing aortic sinuses. Septation of truncus arteriosus is not responsible for the final position of the coronary orifices. Infact in transposition of the great arteries coronary ostia are regularly located within facing sinuses of the anterior aorta.

The role of the fractional flow reserve in the coronary steal phenomenon evaluation caused by the coronary-pulmonary fistulas: case report and review of the literature

BackgroundCongenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; however, bilateral and multilateral fistulas are relatively rare. The steal phenomenon aroused from bilateral or multilateral CPFs, and was uncertain and seldom reported. We possess a new tool to assess the hemodynamic significance of coronary artery fistulas. This study aimed to describe the clinical presentation, diagnostic modalities, and management of the coincidentally detected congenital bilateral CPFs.Case presentationA case of a 52 year-old female with 10 years history of typical palpitations and chest tightness was presented. The selective coronary arteriography showed a right dominant coronary circulation without significant stenosis; however, with anomalous vessels originating from the proximal right and left anterior descending coronary arteries, draining into the pulmonary artery through a plexus of small vessels. We introduced the fractional flow reserve (FFR) to evaluate the hemodynamic significance of CPFs. The patient was successfully treated with coil embolization.ConclusionsWe presented the case of a female with typical palpitations and chest tightness due to the steal phenomenon that aroused from bilateral CPFs. The fistulas were safely and successfully closed by coil embolization. We showed a new tool for the sophisticated evaluation of the hemodynamic significance of CPFs using FFR measurement and temporary occlusion of the fistula with a standard balloon. FFR could be a promising means for the treatment of decision making of the CPFs.

P219 The role of color-coded duplex sonography in evaluating coronary-subclavian steal syndrome

Abstract Background Coronary-subclavian steal syndrome is a rare phenomenon leading to dysfunction of left internal mammary artery (LIMA)-graft after coronary artery grafting with the occurrence of proximal stenosis of the left subclavian artery (LSA), which causes myocardial ischemia due to a blood-steal phenomenon through a fully patent LIMA-graft. Purpose To evaluate the role of color-coded duplex sonography (CCDS) in follow-up of all symptomatic patients with LIMA-graft after aorto-coronary bypass grafting (ACBG). Methods Two men and one woman with recurrence of angina pectoris symptoms and vertigo after ACBG with LIMA-LAD graft. Patients were hospitalized in cardiology for coronary graft assessment via selective coronary arteriography. Due to the discovery of fully patent grafts with a combination of varying degrees of proximal stenosis of the LSA, CCDS with a high-frequency linear probe was used to evaluate cervical arteries, LSA and the LIMA-graft flow rate applying functional probe for hyperemia (PH) of the left upper limb for hemodynamic assessment of significance of the steal syndrome. Results One woman at age 72 after ACBG – LIMA-LAD; RM1; RCA -s.v.g. Selective coronary arteriography showed patent bypass grafts with 70% proximal stenosis of LSA. The performed CCDS showed a LIMA-graft blood flow reduction from 36 ml/min to 12 ml/min in a sample for left upper limb hyperemia. There was a difference in the blood pressure of the upper limbs within 20 mmHg. Dobutamine stress echocardiography was performed, confirming ischemic zones in the LAD- peak segments. A 63 year old man after ACBG x 4 with a difference in blood pressure of upper limbs within 40 mmHg. The performed CCDS showed thrombosis of the left internal carotid artery, high-grade stenosis of the right internal carotid artery, high-grade stenosis of LSA, alternating blood flow in the left vertebral artery – a sign of hemodynamically significant steal syndrome. A 65 year old male after ACBG x 3 (LIMA-LAD, RCA, OM1 -s.v.g.). The selective coronary arteriography showed patent LIMA-graft with 50% proximal stenosis of LSA with a trans-stenotic pressure gradient of 20 mmHg. To identify the steal phenomenon we used CCDS, which showed a blood flow reduction into the LIMA-graft from 14.2 ml/min to 7.5 ml/ min - data of hemodynamically significant steal syndrome. Patients were treated with percutaneous transluminal angioplasty and stenting of the LSA with postprocedure reduction of angina pectoris complaints, no difference in the blood pressure of upper limbs and no reduction of LIMA-graft blood flow during the probe for hyperemia of the upper limb. Conclusion(s) Color-coded duplex sonography is an important and indispensable technique, part of the overall assessment of hemodynamics in case of coronary-subclavian steal syndrome and probably may prove to be a first method of choice in follow-up of all symptomatic patients with LIMA-LAD graft.

Atherosclerosis.

Atherosclerosis, the formation of fibrofatty lesions in the artery wall, causes much morbidity and mortality worldwide, including most myocardial infarctions and many strokes, as well as disabling peripheral artery disease. Development of atherosclerotic lesions probably requires low-density lipoprotein, a particle that carries cholesterol through the blood. Other risk factors for atherosclerosis and its thrombotic complications include hypertension, cigarette smoking and diabetes mellitus. Increasing evidence also points to a role of the immune system, as emerging risk factors include inflammation and clonal haematopoiesis. Studies of the cell and molecular biology of atherogenesis have provided considerable insight into the mechanisms that link all these risk factors to atheroma development and the clinical manifestations of this disease. An array of diagnostic techniques, both invasive (such as selective coronary arteriography) andnoninvasive (such as blood biomarkers, stress testing, CT and nuclear scanning), permit assessment of cardiovascular disease risk and targeting of therapies. An expanding armamentarium of therapies that can modify risk factors and confer clinical benefit is available; however, we face considerable challenge in providing equitable access to these treatments and in maximizing adherence. Yet, the clinical application of the fruits of research has advanced preventive strategies, enhanced clinical outcomes in affected individuals, and improved their quality of life. Rapidly accelerating knowledge and continued research promise to provide further progress in combating this common chronic disease.

Origin and prevalence of right conus artery: A cadaveric study

Introduction: The human heart is mainly supplied by the right and left coronary artery. Conus artery is one of the essential branches of the right coronary artery (RCA). If this artery emerges directly from the anterior aortic sinus with no noticeable common trunk, this is known as the third coronary artery (TCA). Often, this anatomic variation left unvisualized during selective coronary arteriography. This study is an effort to notice the incidence and origin of the right conus artery in human cadaveric heart. Material and Methods: A total of 50 human cadaveric hearts were dissected, and the incidence and origin of conus artery were noted. Results: Out of the 50 hearts examined, 10 hearts had separate source of conus artery through anterior aortic sinus. Here, the artery is termed as TCA. In 11 cases, the conus artery show aortic origin with common opening of RCA. In 29 cases, conus artery arises outside the aorta from RCA. Among the 10 cases, origin of conus artery is directly from the aorta, 7 (14%) were male and 3 (6%) were female. Discussion and Conclusion: The occurrence of TCA is a blessing to a person and the one with TCA is less possibly to die from unexpected inherent death from cardiac pathology.

Evolution of post-mortem coronary imaging: from selective coronary arteriography to post-mortem CT-angiography and beyond.

Since the 1970s, remarkable efforts have been made in the post-mortem coronary study, especially by angiography, as an added tool to diagnose heart-related deaths. In more recent times, post-mortem CT (PMCT) and post-mortem CT-angiography (PMCTA) have become an established practice in numerous forensic units, because of the undeniable advantages these diagnostic instruments can offer: data acquisition times are increasingly fast, costs have become lower and, once acquired, data can be re-utilized and re-evaluated at any given time. This review aims to chart the history of post-mortem cardiac imaging, highlighting its evolution both in terms of methodology and technology as well as the contribution that forensic radiology has been able to offer to forensic pathology, not as an alternative to autopsy but as a guide and aid when performing one. Finally, the latest advances in the study of cardiac deaths are explored, namely by cardiac post-mortem MRI (PMMR), able to visualize all the various stages of a myocardial infarction, post-mortem MRI-angiography (PMMRA), useful in investigating coronary artery pathology and post-mortem cardiac micro-CT, able to provide near-histological levels of myocardial, coronary and valvular detail.

Multiple coronary cameral fistulae

A 56-year-old man with no known cardiac risk factors presented with dyspnea upon exertion. The vital signs were normal. Echocardiography showed normal left ventricular (LV) ejection fraction and no valvular disease, but moderate LV hypertrophy and LV diastolic dysfunction were noted. Rest and stress myocardial perfusion scintigraphy showed a reversible inferior-wall perfusion defect; therefore, an initial diagnosis of coronary artery disease was made. Coronary arteriography showed no atherosclerotic lesions in the 3 major coronary arteries; however, all 3 arteries communicated with the LV cavity through many small, diffuse fistulae (Figs. 1 and ​and2),2), resulting in complete LV contrast opacification. The coronary sinus appeared to be of normal size. The inferior-wall ischemia that was shown on nuclear stress imaging was attributed to coronary steal phenomenon. The patient was placed on medical therapy. Fig. 1 Selective coronary arteriography (30° right anterior oblique view; contrast agent, 6–8 mL iohexol) shows multiple fistulae arising from the distal left anterior descending and left circumflex coronary arteries and communicating ... Fig. 2 Selective coronary arteriography (30° right anterior oblique view; contrast agent, 5–7 mL iohexol) shows a maze of fine vessels arising from the distal right coronary artery and communicating with the left ventricular cavity.

Role of coronary computed tomography angiography for the diagnosis of coronary anomalies

Coronary anomalies are rare heart diseases that can cause sudden cardiac death, especially in young individuals. Coronary computed tomography angiography delivers a three-dimensional view of excellent quality with information of the origin, course and anatomic relationships of the anomalous vessel, allowing differentiation between benign and malignant variants, entities that require different management and treatment. To show that coronary computed tomography angiography is the non-invasive technique of choice for the evaluation of a coronary anomaly due to its high diagnostic accuracy. Between 2008 and 2014, 368 coronary computed tomography angiographies were carried out. Six (1.6%) patients had a coronary anomaly. The age of these six patients ranged from 38 to 82 years (five were women). The coronary computed tomography angiography was requested due to cardiac symptoms (angina and dyspnea) in two patients, after a selective coronary arteriography to obtain additional information of the coronary anomaly in three patients, and after a cardiorespiratory arrest in one patient. Three patients had an anomaly of the right coronary artery, two patients had an anomaly of the left coronary artery and one patient had absent left main coronary artery. In five patients the coronary anomaly was malignant. Coronary computed tomography angiography is a robust diagnostic method to evaluate patients with suspected coronary anomalies.

Clinical Profile of Coronary Artery Disease In Valvular Heart Disease Undergoing Valve Replacement Surgery

Introduction: Clinical profile of Coronary artery disease in valvular heart disease undergoing valve replacement surgeryhas not been reported from North Eastern India. Aim: To study the Clinical profile of Coronary artery disease in valvular heart disease undergoing valve replacement surgery has Materials And Methods: We prospectively collected data of valvular heart disease above 35 years who were scheduled for valve surgery from December 2011 to November 2013..The baseline clinical characteristics which were analyzed were the age, gender, hypertension (blood pressure > 140/90 mm Hg and/ or those already taking treatment for hypertension), diabetes mellitus (fasting blood glucose >126 mg/dL and/or postprandial blood glucose >200 mg/dL and those who were on treatment for diabetes mellitus), smoking status &dyslipidemia (cholesterol >200 mg/dL and/or triglycerides >200 mg/dL and/or ,LDL>130 mg/dL and/or HDL<40 mg/dL ) . Selective coronary arteriography was performed by the Judkins technique The patients were divided into two groups based on presence of CAD. A comparasion of clinical paramaters between two groups were obtained Results: A total of 126 valvular disease cases were included in the study. overall prevalenceof coronary artery disease was 14.28% . Frequency of coronary artery disease among mitral, aortic, and combined mitral and aortic valve lesion is 3.13%, 33.33% and 21.05% respectively. In comparison to mitral valve disease, aortic valve disease and combined lesion having significantly high chances of coronary artery disease (p=0.001).On comparing the clinical characteristic of patients with CAD from those without having CAD, we observed that , mean age of the patients with coronary artery disease (59.45±10.58) are significantly high in comparison to without coronary artery disease (48.92±6.57).Coronary artery disease group also had significantly high prevalence of diabetes mellitus, hypertension, and dyslipidemia (p value of <0.001 for each) and also more likely to present with angina. Conclusion: We conclude that in patients with valvular heart disease undergoing valve replacement surgery, the overall prevalence of CAD is low at 14.28%.Patients having CAD are more likely to present with angina and have higher prevalence of cardiovascular risk factors.

Assessment of myocardial perfusion in chest pain and angiographically intact coronary arteries via single-photon emission computed tomography combined with X-ray computed tomography

Aim. To assess myocardium perfusion and functional state, by the data from single-photon computed emission tomography combined with X-ray computed tomography (SPECT/CT) at exercise testing circumstances, in patients with chest pain and intact coronary arteries. Material and methods. Totally, 31 patient studied, each of those underwent Holter ECG monitoring, selective coronary arteriography and SPECT/CT of myocardium at rest and in veloergometry. Results. In patients with unchanged coronary arteries there is a decrease of perfusion reserve, due to primary microcirculation disorders and secondary causes, that present with verified by visualizing radionuclide method SPECT/CT transient ischemia of myocardium. Conclusion. It is important to investigate thoroughly patients with chest pains and angiographically unchanged vessels; the role of perfusion scintigraphy in these patients is high.

Assessment for regional and global systolic function of left ventricle in patients with coronary arterial disease by longitudinal layer-specific strain

Objective To analyze longitudinal layer-specific strain in endocardial, midcardial and epicardial layers of left ventricle (LV) by two-dimensional speckle tracking imaging(2D-STI) in patients with coronary heart disease (CHD) and to evaluate the regional or global systolic function of LV. Methods Seventy-eight patients with suspected CHD were divided into CHD group (46 subjects) and control group (32 subjects) according to the results of selective coronary arteriography. According to the stenosis degree or number of coronary arteries, the CHD group was divided into mild stenosis group (corresponding blood-supply vessel stenosis 50%-75%), severe stenosis group(corresponding blood-supply vessel stenosis ≥75%) or single-vessel stenosis group, multi-vessel stenosis group. Two-dimensional images with high frame rate were recorded in apical four-chamber, long-axis, two-chamber of LV in all subjects. The strain parameters by EchoPAC analysis software included territorial longitudinal strain(TLS) of endocardial, midcardial and epicardial layers (TLSendo, TLSmid, TLSepi) and global longitudinal strain (GLS) of endocardial, midcardial and epicardial layers ( GLSendo, GLSmid, GLSepi). Results Regardless of with or without corresponding blood-supply coronary artery stenosis and range of coronary artery stenosis, TLSendo, TLSmid, TLSepi and GLSendo, GLSmid, GLSepi all showed a gradient decrease(P 0.05). Compared with the mild stenosis group, TLSendo, TLSepi of severe stenosis group decreased significantly(P 0.05). Moreover, compared with the control group, GLSendo, GLSmid, GLSepi of single-vessel stenosis group and multi-vessel stenosis group decreased significantly(P<0.05). Compared with the single-vessel stenosis group, GLSendo, GLSmid, GLSepi of multi-vessel stenosis group decreased significantly(P<0.05). For predicting corresponding blood-supply vessel stenosis ≥75%, the sensitivity and specificity were 55.6%, 72.6% and 57.8%, 76.4%, when the cut-off of TLSendo and TLSepi were 20.5% and 15.5% respectively. For predicting multi-vessel stenosis, the sensitivity and specificity were 54.5%, 71.4%; 50.0%, 87.5% and 63.6%, 87.5%; when the cut-off of GLSendo, GLSmid, GLSepi were 21.5%, 17.5% and 16.5% respectively. Conclusions Systolic dysfunction of LV happened through all layers in CHD patients. The longitudinal strain of layer-specific by 2D-STI can accurately evaluate the regional and global systolic function of LV in patients with CHD, which can also be used to predict the degree or range of coronary artery stenosis. Key words: Echocardiography; Coronary artery disease; Ventricular function, left; Two-dimensional speckle tracking imaging

AFFECT DISORDERS AND LIFE QUALITY IN CORONARY HEART DISEASE PATIENTS UNDER DIFFERENT TREATMENT APPROACHES

Aim. To study the prevalence of anxiety-depression symptoms and life quality (LQ) in coronary arteries disease patients (CHD) under a variety of treatment strategies: conservative therapy (CT) and revascularization (MR) — percutaneous intervention (PCI) and coronary bypass (CBG). Material and methods. Totally 106 patients studied with various types of CHD, confirmed with selective coronary arteriography (CAG): 54 (50,91%) of patients underwent CT, 52 (49,06%) underwent MR. All included patients were questioned with the Score by Moscow SRI of Psychiatry. For anxiety and depression disorders we used in-hospital score of anxiety and depression (HADS), Beck depression scale (BDI), Spielberger test for diagnostics of reactive (RA) and personal (PA) anxieties, and for LQ — the Modified Seattle Questionnaire for Angina patients (MSQA). Statistics was done with MS Excel and STATISTICA 6,0 software. Results. By the data of screening questionnaire, in the whole selection of 106 patients with CHD the signs of anxiety-depression disorder (ADD) were marked in 81 (76,48%), were absent in 25 (23,52%) of patients. Higher values of depression by HADS were in the group of CT (7,13±3,58) vs MR (5,73±3,58) (р<0,05), and BDI in the group of CT (16,28±10,55) vs MR (12,0±7,51) (р<0,01). LQ parameter by MSQA was significantly higher in MR group — 27,37±4,44, comparing to CT group — 24,2±5,63 (р<0,001). Mild level of depression by DBI was marked more frequently in CT group comparing to MR group — 46,29% vs 23,08% (р<0,01). Conclusion. By the data of psychometric tests there is higher level of ADD in the group of CT comparing to MR. LQ value by MSQUA in the group of MR (PCI or CBG) was significantly higher in the group of CT.

Relationship between HLA molecules and late restenosis after coronary stent placement

ObjectiveThe objective of this study is to confirm whether there is relation between the human leucocyte antigen (HLA) locus and restenosis after percutaneous coronary intervention (PCI) holds in our patient population and whether it can be useful as a prognostic factor. MethodsWe examined the HLA phenotypes in 46 consecutive patients (39 men, 7 women, mean age of 57±9years) who had successful stent implantation in the coronary artery. Selective coronary arteriography was performed 6months after coronary stenting to assess the presence of restenosis. The HLA phenotyping was performed for HLA-A,-B,-C antigens by Terasaki microlymphocytotoxicity technique and for HLA-DR alleles with PCR-SSP technique. ResultsRestenosis(R+) was present in 12 (26.1%) patients (11 men, 1 woman, mean age of 57±10years). For HLA Class I antigens frequency of HLA-B62 and HLA-CW2 antigen was slightly higher in restenotic patients but did not reach statistical significance. For HLA-DR alleles restenotic patients had higher frequencies for HLA-DRB1∗01(R+ %25, R− %14.7), and HLA-DR11(R+ %41.7, R− %20.6), without reaching statistical significance and lower frequencies for DR7(R+ %0, R− %17.6) and D13(R+%8.3, R− %32.4) and HLA-DR53 (R+ %25, R− %35.3) without reaching statistical significance. ConclusionIn conclusion, results show that there was no relationship between the development of restenosis and HLA-subtypes.

A Study on Vascular Retinal Alterations in Patients with Coronary Artery Disease.

The paper describes the study carried out on a sample of 27 coronary artery disease patients, aiming to determine a correlation between coronary artery disease and anomalies in the retinal circulation. Patients underwent selective coronary arteriography and fundus fluorescein angiography that allowed us to investigate the dye dynamics and to detect abnormalities of time evolution, vessel walls, and flux. During the fluorescein angiography we measured time events as the choroidal flush (ta) the start of the laminar phase (tb), and the end of the laminar phase (tc) and we took pictures that were digitally processed in order to compute the ROI1/ROI2 value, assumed as a numerical index of ischemia of the optic disc. In the examined sample we found ta = 61 +/- 109, tb = 65 +/- 107, tc = 159 +/- 155, and ROI1/ROI2 = 0.968 +/- 0.300. Normal ranges for these parameters were determined by the fundus fluorescein angiography of a control group of 10 patients, unaffected by coronary artery disease and ischemic pathology of the retinal network; we found ta = 12 +/- 4, tb = 16 +/- 8.5, tc = 44 +/- 9.3, and ROI1/ROI2 = 0.735 +/- 0.086. Eighty-five percent of coronaropatic patients showed ischemia of the optic disc, 89% anomalies of the epi-peripapillar network, 70% anomalies of the papillo-macular network, and 89% evidence of at least two findings of ischemia; 85% of patients showed a value of ROI1/ROI2 out of the normal range. The unpaired Student's t-test between the coronaropatic and the control group does not show significant differences between ta and tb; on the contrary, those with coronary disease and the control group were statistically different for tc (p </= 0.02). Moreover, we have found a correlation between the numerical index of optic disc ischemia and the severity of coronary artery disease (r = 0.68, p </= 0.01). Hence, the vascular abnormalities shown by the fluorescein angiography can constitute valid noninvasive markers and can advise further cardiological tests for a coronary artery disease not yet diagnosed.

Clinical application and value of 3 Tesla contrast enhanced whole-heart coronary magnetic resonance angiography

To investigate the clinical application, feasibility and value of 3 T whole-heart contrast enhanced free-breathing navigator-gated three-dimensional coronary magnetic resonance angiography (CE-CMRA). 3 T CE-CMRA was used to examine patients with suspected coronary heart disease (CAD). Gd-BOPTA (0.2 mmol/kg) was injected intravenously with slow infusion rate (0.3 ml/s) to perform enhancement. Data were post-processed to obtain principal branches of coronary artery and picture quality was evaluated. According to results of selective coronary arteriography (SCAG), the diagnostic accuracy of CE-CMRA for diagnosing CAD was judged by means of detecting significant stenosis (> 50%) of the principal branches based on the 9 segments of coronary artery. Twenty-three out of 26 patients successfully completed the examination. The mean scanning time was (10.4 ± 2.1) minutes, 178 out of 202 (88.1%) SCAG demonstrated segments could be evaluated by CE-CMRA. The imaging quality was superior in proximal and middle segments of coronary artery principal branches than in distal segments. Based on patient-level, there were 9 positive cases and 14 negative cases examined by CE-CMRA compared with 11 positive cases and 12 negative cases examined by SCAG, respectively. The whole diagnose accordance rate of CE-CMRA was 91.3% (21/23) compared with SCAG. The sensitivity, specificity and negative predictive values were 81.8% (9/11), 88.5% (169/191) and 98.8% (9/31) respectively. 3 T CE-CMRA is a feasible non-invasive imaging modality for diagnosing CAD, especially to detect significant stenosis in proximal and middle segments of coronary artery principal branches. However, the detecting efficacy is limited in assessing stenosis of distal segment and small branches of coronary artery.

Correlation between high sensitive C-reactive protein, lipoprotein(a), blood uric acid and severity of coronary artery disease

To discuss the relationship between high sensitive C-reactive protein (hs-CRP), lipoprotein (Lp)(a), blood uric acid (BUA) and severity of coronary artery disease (CHD). A total of 813 cases of suspected or established coronary atherosclerotic heart disease patients were recruited. The patients received selective coronary arteriography and they were divided into normal and CHD groups according to the result of selective coronary arteriography. The dividing mark was coronary artery stenosis more than 50% by selective coronary arteriography. Patients in CHD group were further divided into 1-4 vessel disease. Blood glucose, cholesterol, triglyceride, LDL-ch, hs-CRP and BUA were detected by automatic biochemical analyzer. Among them, 754 cases (CHD group, 92.7%) were confirmed as coronary heart disease while 59 cases (control group, 7.3%) confirmed as non-coronary heart disease. There were significantly difference between two groups (P < 0.05): hs-CRP (7.12 ± 4.48 vs 1.71 ± 1.42) mg/L, Lp(a) (0.45 ± 0.42 vs 0.18 ± 0.03) mmol/L and BUA (402 ± 103 vs 327 ± 88) µmol/L. The levels of hs-CRP, Lp(a) and BUA in different number of diseased coronary vessels significantly differed from each other (P < 0.05). A comparison of 1-vessel disease group versus 4 vessel disease group was as follows: hs-CRP (3.59 ± 2.93 vs 13.11 ± 3.00) mg/L, Lp(a) (0.37 ± 0.25 vs 0.58 ± 0.17) mmol/L and BUA (384 ± 126 vs 444 ± 91) µmol/L. Logistic regression analysis showed that hs-CRP, Lp(a) and BUA were independent risk factors of coronary artery disease. The elevations of hs-CRP, LP(a) and BUA promote the establishment and development of coronary artery disease. A joint detection of hs-CRP, Lp(a) and BUA shows a comparatively great value in evaluating high-risk groups and the patient's condition. And it provides references for an active intervention of clinical coronary heart disease.

Coronary-Cameral Fistula with Angina Pectoris

Coronary-cameral fistula (CCF) is an anomalous connection between a coronary artery and cardiac chamber. Most of CCFs are discovered incidentally during angiographic evaluation for coronary vascular disorder. We report a case of CCF with angina pectoris. Selective coronary arteriography revealed diffuse CCF involving the left anterior descending artery (LAD) emptying into left ventricle (LV) and showed significant two-vessel coronary artery stenosis.