Vessel Disease Group Research Articles

Cystatin C: A better marker to detect coronary artery sclerosis

Nowadays, early detection and treatment can often keep chronic kidney disease patients from getting worse and prevent the occurrence of cardiovascular disease. Cystatin C (Cys-C) is a new marker for renal dysfunction. This study investigated whether Cys-C played an important role for screening coronary artery disease. The consecutive 88 outpatients (51 males and 37 females), who were suspected of having effort angina pectoris or asymptomatic ischemic heart disease, were enrolled. Serum Cys-C, which was obtained within 3 months before coronary angiography, was assessed with the presence or absence of coronary arteriosclerosis, the number of culprit arteries, and blood biochemical parameters. Mean serum Cys-C was 0.82+/-0.29 mg/l. Significant differences in the estimated creatinine clearance (p=0.036), hemoglobin A1c (p=0.01), left ventricular ejection fraction (p=0.01), creatinine (p=0.007), Cys-C (p=0.006), and high-density lipoprotein (HDL) cholesterol (p=0.001) were observed between the patients with or without coronary arteriosclerosis. Serum Cys-C was significantly greater in the multi-vessel disease (MVD) group than the 0 vessel disease (0VD) group (p<0.001). HDL cholesterol was significantly lower in the MVD group than the 0VD and single-vessel disease groups (p=0.002 and p=0.005, respectively). The results of this study suggest Cys-C might be one of the risk factors for coronary arteriosclerosis in the patients with suspected ischemic heart disease without any history of coronary artery disease. Cys-C was a useful marker to detect coronary artery disease and the level of Cys-C could reflect the severity of coronary arteriosclerosis.

Relationship between smoking and homocysteine concentration in ischemic stroke patients

To study the relationship between smoking and hyperhomocysteinemia (HHe) in ischemic stroke patients. The clinical data of 329 ischemic stroke patients with HHe and 306 age-matched ischemic stroke patients without HHe, including sex, symptoms, signs, history of smoking, and plasma homocysteine (Hcy), folate, and vitamin B(12) concentrations were compared. The ischemic stroke lesions were divided into 2 subtypes: large vessel disease group and small vessel disease group according to the TOAST system. The number of cigarettes smoked per day, cumulative year of smoking, and smoking index (number of cigarettes smoked per day X cumulative year of smoking), and ratio of males of the HHe group were all significantly higher than those of the non-HHe group, and the plasma homocysteine, folate, and vitamin B(12) concentrations of the HHe group were all significantly lower than those of the non-HHe group (all P < 0.01). Smoking index was positively correlated with the Hcy concentrations and negatively correlated with the folate and vitamin B(12) concentrations (all P < 0.01). The smoking proportion and Hcy concentration of the male patients were significantly higher than those of the female patients (both P < 0.01), and the plasma folate and vitamin B(12) concentrations of the male patients were all significantly lower than those of the female patients (P < 0.01 and P < 0.05). The number of cigarettes smoked per day, cumulative year of smoking, smoking index, and Hcy concentration of the large vessel disease group were all significantly higher than those of the small vessel disease group (all P < 0.01). Smoking and being male may be the risk factors of HHe in ischemic stroke patients. Smoking and HHe are prone to cause lesion in large vessel.

Comparison of Atherosclerotic Indicators between Cardio Ankle Vascular Index and Brachial Ankle Pulse Wave Velocity

Aortic pulse wave velocity has been used for evaluating atherosclerosis. Recently, the development of the volume plethysmographic method has made it possible to easily measure the index of the pulse wave velocity. The brachial ankle pulse wave velocity and cardio ankle vascular index are used for estimating the extent of atherosclerosis. The diagnostic usefulness of these indexes in predicting coronary artery disease was examined. The brachial ankle pulse wave velocity, the cardio ankle vascular index, and the high-sensitivity C-reactive protein were measured in 696 patients who had chest pain and underwent coronary angiography. Measurement values of brachial ankle pulse wave velocity were compared with those of cardio ankle vascular index in terms of the baseline covariates and the number of major coronary vessels involved (vessel disease). The brachial ankle pulse wave velocity was significantly correlated with age, systolic blood pressure, and diastolic blood pressure but not with the high-sensitivity C-reactive protein. The cardio ankle vascular index was correlated only with age and the high-sensitivity C-reactive protein. The average of both brachial ankle pulse wave velocity and cardio ankle vascular index values was greater in 3 vessel disease group than in 0 vessel disease group. The receiver operating characteristic curve showed that the diagnostic accuracy of coronary artery disease was significantly higher in the cardio ankle vascular index than in the brachial ankle pulse wave velocity (area under the curve +/- standard error: 0.691 +/- 0.025 vs. 0.584 +/- 0.026; P < .05). As a means of estimating the extent of atherosclerosis in large arteries, our results show that both brachial ankle pulse wave velocity and cardio ankle vascular index are useful and that cardio ankle vascular index may have some advantages in its application to patients taking blood pressure-lowering medication because of the minimum effect of blood pressure on its measurement values. The cardio ankle vascular index has increased performance over brachial ankle pulse wave velocity in predicting the coronary artery disease.

Level of alpha-granule membrane protein (CD62P) in coronary heart disease

To investigate the role of alpha-granule membrane protein (CD62P), marker of plate activation, in the patients with coronary heart disease (CHD) and to investigate the relationship between the severity of coronary artery stenosis and platelet activation. Peripheral blood samples were collected from 70 patients with CHD, including 28 cases of stable angina pectoris (SAP), 26 cases of unstable angina pectoris (UAP), and 16 cases of acute myocardial infarction (AMI), all of which underwent coronary arteriography, and 20 angiographically normal persons as no-CHD controls. The CD62P level was analyzed by flow cytometry (FCM). Coronary arteriography showed positivity in 70 of the 90 CHD patients. The CD62P positive rate of the UAP group was (28.3 +/- 20.1)%, significantly higher than those of the SAP group [(12.8 +/- 13.3)%] and no-CHD group [(9.9 +/- 6.4)%, both P < 0.05]. The CD62P positive rate of the double vessel disease group was (24.0 +/- 17.8)%, not significantly different from that of the three-vessel disease group [(22.6 +/- 20.4)%], but significantly higher than that of the single-vessel disease group [(11.1 +/- 8.5)%] and that of the no-CHD group [(9.9 +/- 6.4)%, both P < 0.05]. The platelet alpha-granule membrane protein CD62P level is higher in the UAP patients. It is related to the pathophysiological process of UAP and the severity of coronary artery stenosis.

The Value of the First Two Minutes of Heart Rate Recovery after Exercise Treadmill Test in Predicting the Presence and Severity of Coronary Artery Disease

Background and Objectives：The recent data has revealed that the first 1 minute and 2 minutes of heart rate recovery of patients who are being evaluated for chest pain and asymptomatic adults are associated with the overall mortality. However, the clinical significance of the heart rate recovery after exercise testing during the first 2 minutes for predicting the presence or severity of coronary artery disease and the correlation with the Duke treadmill score (DTS) have not been fully evaluated. Subjects and Methods：The study population included 39 patients with significant coronary artery stenosis and 39 subjects with normal coronary arteries. All of them underwent a treadmill exercise testing prior to coronary angiography. The differences in the heart rate recovery and the DTS between the two groups were investigated. The heart rate recovery and DTS between the multivessel disease group and single vessel disease group were also investigated. Results：The heart rate recovery during the second minute (calculated by the heart rate at 1 minute-the heart rate at 2 minute) after exercise and the DTS were significantly lower in the coronary artery disease group. These parameters were also significantly lower in the multivessel disease group than those in the single vessel disease group. The heart rate recovery during the second minute and the DTS had positive linear correlation (R=0.281, p<0.05). Conclusion：In this study, the heart rate recovery during the second minute was considered to be an additional important variable to predict the presence and severity of coronary artery disease. (Korean Circulation J 2007;37:432-436)

Evaluation of Fibronectin, Vitronectin, and Leptin Levels in Coronary Artery Disease: Impacts on Thrombosis and Thrombolysis

In this study, the levels of fibronectin, vitronectin, leptin, tissue plasminogen activator (t-PA), and lipid parameters were investigated in patients with coronary artery disease (CAD) and control group. The average plasma fibronectin levels in CAD patients group were significantly higher compared with the control group (p=0.006). Moreover, in patients with triple-vessel disease, plasma fibronectin levels were found to be significantly higher than those in the control group (p<0.05). Plasma vitronectin levels in patients with CAD were found to be significantly higher than those in the control group (p=0.000). In addition, in patients with double vessel disease plasma vitronectin levels were significantly higher than no vessel disease and control group, triple vessel disease was significantly higher as compared with no vessel disease, single vessel disease, and control group (p<0.05). We could not find any significant differences in t-PA values between CAD patients and control group. On the other hand, the average leptin levels in the group of patients were higher than those in the control group but there were no statistically significant differences found between them (p>0.05) because of high SD values. There was strong (+) correlation between fibronectin, vitronectin, and severity of disease [vitronectin/severity of disease, r = 0.5074 (p = 0.000), fibronectin/severity of disease, r = 0.2971 (p = 0.007)]. In conclusion, we can say that fibronectin and vitronectin have become greatly important in pathogenesis of coronary artery disease. High leptin levels may be contribute to platelet aggregation in patients with coronary artery disease. But, elevated serum levels of leptin cannot be useful diagnostic and monitoring markers in patients with coronary artery disease.

Automated Impedance Cardiography for Detecting Ischemic Left Ventricular Dysfunction during Exercise Testing

Automated impedance cardiography (ICG) is an attractive method for noninvasive hemodynamic evaluation. The objective of our study was to evaluate the feasibility and diagnostic value automated ICG in patients with suspected coronary artery disease (CAD). We measured stroke index (SI) and cardiac index (CI) in 65 patients with suspected CAD at rest and during bicycle exercise testing. All patients underwent subsequent cardiac catheterization including coronary angiography (CA). Depending on the results of CA, patients were divided into three groups, patients without significant CAD (group 0), single vessel disease (group 1) or multivessel disease (group 2–3). In a subset of 20 patients, automated ICG was compared to measurements of CI by the thermodilution (TD) method. Results: There were no significant differences in SI and CI at baseline between the three groups. At 75- and 100-watt exercise, patients in group 2–3 showed significantly lower mean values of SI and CI as compared to patients of group 0 and group 1 (all p < 0.05), indicating exercise-induced ischaemic left ventricular (LV) dysfunction. Three patients had to be excluded because of inappropriate quality of the ICG signals during exercise. Comparison of automated ICG with TD measurements of CI showed good correlations between both methods at rest (r = 0.73) and during exercise (r = 0.89–0.91). Conclusions: We conclude that hemodynamic monitoring by automated ICG is both feasible and practical during exercise testing. Automated ICG can provide reliable and valuable additional diagnostic information on LV function during exercise which is helpful for selecting those patients for angiography who are likely to benefit from coronary interventions.

Heart Rate Recovery in Coronary Artery Disease and the Changes of Exercise Parameters after Coronary Stenting

Background and Objectives：The recovery of the normal heart rate immediately after exercise is a function of vagal reactivation. An attenuated heart rate recovery during the first minute after graded exercise is believed to be a marker of reduced parasympathetic activity and has been proven to be an independent predictor of overall mortality. However, the clinical significance of an abnormal heart rate recovery in coronary artery disease and the changes in the exercise parameters after coronary stenting have not been fully evaluated. Subjects and Methods：The study population included 53 patients with a significant coronary artery stenosis and 25 subjects with a normal coronary artery. All underwent a treadmill exercise test prior to coronary angiography. The differences in the heart rate recovery and the Duke treadmill score between two groups were investigated. After coronary stenting, changes in the exercise parameters were evaluated during the follow-up treadmill exercise test in 22 coronary artery disease patients. Results：The frequencies of abnormal heart rate recovery (12% vs 38.3%, p＝0.014 and a moderate to high risk Duke treadmill score (4% vs 21.3%, p＝ 0.034 were significantly higher in the coronary artery disease group. The frequencies of these parameters were also significantly higher in the multivessel disease group than the single vessel disease group. After coronary stenting, most of the exercise parameters showed no significant changes but the Duke treadmill score improved significantly (p＝0.038. Conclusion：The frequency of abnormal heart rate recovery was significantly higher in the coronary artery disease group. The Duke treadmill score was significantly improved and is thought to be a useful follow up parameter after coronary stenting. (Korean Circulation J 2002;32(5 :420-426

Von Willebrand Factor and Factor VIII: C in Acute Cerebrovascular Disease

Elevated von Willebrand factor (vWF) is a risk factor in the development of acute myocardial infarction. The importance of vWF and factor VII:C in the pathogenesis of cerebrovascular disease (CVD) is poorly defined. We studied 208 cases of stroke whose pathological type was defined by cranial computed tomography. Cerebral infarcts were grouped according to the Oxfordshire Community Stroke Project (OCSP) clinical classification. The results in patients were compared with 184 healthy reference subjects. In patients, vWF and FVIII:C levels were determined initially and after three months. Patients were followed prospectively for six months or until death. Levels of vWF and FVIII:C were elevated initially (1.86 IU/ml and 2.20 U/ml respectively) and after 3 months (1.51 IU/ml and 1.90 U/ml) compared with a healthy reference population (1.26 IU/ml and 1.49 U/ml p = 0.0001). In the initial sample, vWF was associated with age (p = 0.01). FVIII:C was related to age (p = 0.04), gender (p = 0.007 higher for females) and a history of diabetes mellitus (2.56 U/ml vs. 2.16 U/ml in non-diabetics, p = 0.008). Initial vWF levels were higher in subjects with large vessel disease (TACI/PACI) group compared with the small vessel disease (LACI) group [2.12 IU/ml, (n = 112) vs. 1.48 IU/ml (n = 59) respectively, p = 0.0001] and similarly in initial FVIII:C levels (2.43 U/ml vs. 1.87 U/ml, p = 0.0001). Analysis of six-month case fatality, vWF levels were associated with risk of death [p = 0.01, OR 1.73 (1.12, 2.66) for an increase of I U/ml], even after allowing for stroke type. The relationship of vWF with stroke mortality has not previously been described. Although we have not demonstrated a causal role for vWF in the pathogenesis of CVD, elevated circulating levels of vWF may be associated with increased risk of death following stroke. A prospective study would be required to establish whether vWF is predictive for the development of CVD.

Dipyridamole electrocardiography test for the assessment of the severity of coronary artery disease.

The purpose of this study was to investigate the relationship of dipyridamole-induced ST changes to the severity of coronary artery disease. The subjects were 100 patients without myocardial infarction who underwent coronary arteriography for the diagnosis of coronary artery disease. The dipyridamole injection test (D) (0.568 mg/kg/4 min), and symptom-limited treadmill exercise test (T) were performed separately. Body surface electrocardiographic mapping of 87 leads was performed in both tests. The incidences of significant ST depression greater than or equal to 0.10 mV, number of leads showing significant ST depression (nST) and the maximal voltage of ST depression (maxST) in D and T were compared to the number of diseased coronary arteries. In patients without significant coronary stenosis (0VD group), the incidence of ST depression in the dipyridamole test was significantly lower than that in the treadmill test (D 9% vs T 47%, p less than 0.01). While, in one vessel disease (1VD), two vessel disease (2VD), and three vessel disease (3VD) groups, there was no significant difference in the incidence of ST depression between the dipyridamole test and the treadmill test (in 1VD, D 44% vs. T 65%; in 2VD, D 67% vs. T 93%; and in 3VD, D 93% vs. T 96%). In the dipyridamole test, nST was 0.6 +/- 2.4 in 0VD, 4.5 +/- 6.9 in 1VD, 4.1 +/- 4.5 in 2VD, and 10.6 +/- 8.1 in 3VD. Significant differences were found between 0VD and 1VD (P less than 0.05), 0VD and 3VD (P less than 0.01), 1VD and 3VD (P less than 0.01), and 2VD and 3VD (p less than 0.01). The maxST in the dipyridamole test was 0.02 +/- 0.04 mV in 0VD, 0.10 +/- 0.12 mV in 1VD, 0.13 +/- 0.11 mV in 2VD, and 0.22 +/- 0.11 mV in 3VD. Significant differences were found between 0VD and 1VD (p less than 0.01), 0VD and 2VD (p less than 0.01), 0VD and 3VD (p less than 0.01), 1VD and 3VD (p less than 0.01), and 2VD and 3VD (P less than 0.01). For the diagnosis of 3VD, the dipyridamole ECG test had as high a sensitivity (93% vs 96%), higher specificity (68% vs 38%, p less than 0.01), and higher predictive accuracy (75% vs 54%, p less than 0.01) than the treadmill test.(ABSTRACT TRUNCATED AT 400 WORDS)

Availability and limitations of thallium-201 myocardial SPECT quantitative analysis: Assessment as daily routine procedure for ischemic heart disease

To determine the availability and limitations of the detection of ischemic lesions by stress thallium-201 myocardial SPECT as the daily routine procedure, we compared and evaluated the detectability of the quantitative analysis (%uptake and washout rate (WR)) and visual evaluation in 104 patients with effort angina and 17 normal subjects. Visual evaluation combined with WR analysis resulted in significantly higher sensitivity (88.0%) but lower specificity (60.2%) than the other methods. The sensitivity by visual evaluation was quite low in multivessel disease (MVD), and in the regions supplied by mild coronary stenosis or by the left circumflex artery. These were markedly improved by combining visual evaluation and WR analysis, but sensitivity in the MVD group was unsatisfactory even with this analytic method in comparison with the single vessel disease group. One of the causes of low sensitivity in the MVD group might be the "true negative": No induction of the ischemia in the regions of milder stenosis, or the regions supplied by the collateral coronary flow. We therefore conclude that the combination of visual evaluation as a qualitative analysis and WR analysis as a quantitative analysis, is the most useful daily routine procedure as a screening test for detecting ischemia.

冠動脈硬化を有する患者における大動脈脈波速度 冠動脈撮影所見との対比

This study was conducted to investigate the relationship between aortic pulse wave velocity (PWV) and coronary atherosclerosis. We measured PWV in 105 subjects (84 males and 21 females; age 59 +/- 0.5) who received coronary angiographic examination (CAG). PWV was measured by simultaneous recording of pulse waves from the left carotid and the left femoral arteries, electrocardiogram and phonocardiogram. The subjects were classified into 4 groups according to the number of major coronary arteries having stenosis, that is, N group with normal CAG, 1 vessel disease (VD) group, 2VD group and 3VD group. The PWV value was significantly greater only in 3VD group (n = 10, age 63 +/- 3.6, PWV 10.0 +/- 0.88 m/sec) than that in N group (n = 18, age 53 +/- 2.0, PWV 8.0 +/- 0.34 m/sec). No significant difference was observed between PWV value in N group and that in all patients with coronary artery stenosis (n = 87, age 60 +/- 2.0, PWV 8.9 +/- 0.2 m/sec). To further investigate the relationship between PWV values and CAG findings, we used a CAG score which means the sum of the points assigned to each coronary artery segment (American Heart Association) according to the severity of stenosis (0, 1, 2, 3, and 4 for normal, less than 49% stenosis, 50 to 74% stenosis, 75 to 99% stenosis, and complete occlusion, respectively). The PWV values significantly correlated with the CAG score and also with age by a simple regression analysis. Multivariate analysis, however, revealed that PWV values did no longer correlate with CAG score. PWV values still significantly correlated with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Crohn’s colitis and sarcoidosis

<h3>Objectives</h3> To investigate the association between distribution of body fat and coronary heart disease (CHD) by analysing the correlation between body fat distribution measures and incidence, type and severity of coronary heart disease. <h3>Methods</h3> One hundred and ninety-seven patients (male 118 and female 79) with suspected coronary heart disease were studied by the case-contral method, who were divided into acute infarction (AMI) group (n=52), angina group (n=100) and non-CHD group (n=45);and according to the results of coronary arteriography they were divided into: normal group (n=45), Single-vessel disease group (n=48) double -vessel disease group (n=51) and triple-vessel disease group (n=53).Blood lipids were detected by the standard method. Body surveying index consisting of the patients9 height, weight, neck circumference and waist circumference was measured and body mass index (BMI) were computed. Analysis the correlation between body fat distribution measures and incidence, type and severity of coronary heart disease. CHD risk factors were collected by logistic multivariate regression analysis. <h3>Results</h3> 1. Male and female have different features in distribution of body fat, and CHD has different characteristic in them (p&lt;0.05); 2. Compared with non-CHD group and angina groups, weight and waist circumference were higher in AMI group (p&lt;0.05). Compared with non-CHD group, neck circumference were higher in angina and AMI groups (p=0.009 &amp; 0.000); 3. In the four groups divided by vessel disease, there were significant difference in neck circumference (p=0.014), compared with double and triple vessel disease groups neck circumference were lower in single-vessel disease group (p=0.011&amp;0.002); 4. Multiple correlative analysis showed BMI, NC and WC were positively correlated with TG and vLDLc, WC was also correlated with chd and HDLc (p&lt;0.05), NC was positively correlated with type coronary heart disease and the number of diseased vessels (p=0.000 &amp; 0.002). 5. Logistic multivariate analysis indicated that BMI (β=0.162, p=0.003); NC (β=0.222, p=0.000), diabetes (β=1.154, p=0.047) were closely related to the hazard of CHD. <h3>Conclusions</h3> 1. The associations with lipid were stronger for BMI and waist circumference than it for neck circumference; 2. Compared with WC and BMI, neck circumference offered greater sensitivity for the diagnosis in coronary artery disease, and associated with the number of diseased vessels; 3. BMI and NC were important risk factors of coronary artery disease; 4. Distribution and Content of fat should be comprehensively evaluated by various body fat distribution measures, so that risk evaluation of CHD can be provided.

Blood volume flow and sonagram disturbance in diseased common carotid arteries: one year follow-up.

A pulsed Doppler velocimeter with an adjustable range gated time system and a double transducer probe has been used to measure velocity and volume flow in follow-up studies of 100 patients with extra-cranial cerebro-vascular disease. The patient material was subgrouped according to whether the disease involved the carotid or vertebral arteries unilaterally or bilaterally. The results showed an unexpected and unexplained trend towards an improvement in mean volume blood flow in the common carotid arteries over the course of 1 year except in those patients who initially presented with four vessel disease in whom there was a trend towards deterioration. In contrast to this spectral analysis of the blood velocity flow showed evidence of deterioration with an increase in flow disturbance and damping. This deterioration was observed either in the vessel originally found with disease or by involvement of an additional vessel showing evidence of disease at the time of follow-up. The deterioration in sonagram appearance was statistically significant in the two and four vessel disease groups (0.025 greater than P greater than 0.01) the remaining two groups showed a similar trend towards deterioration but the numbers of patients in these two groups was probably too small to attain statistical significance.

Risk factor and sex differences in single versus multiple vessel coronary artery disease.

We analyzed 305 patients with either single or multiple vessel disease, as demonstrated by coronary arteriography, to determine risk factor and sex differences. Women accounted for more than one fourth of the patients with single vessel disease (group A), but for only one seventh of the individuals with multiple vessel disease (group B). Group A patients were younger and had fewer risk factors, and fewer abnormalities on chest roentgenogram, ECG, and stress test than those in group B. The better reported prognosis for patients with single (versus multiple) vessel coronary artery disease may be due to (1) slightly younger age, (2) greater representation by women, (3) fewer functional abnormalities as assessed by noninvasive tests, and (4) a lower incidence of cardiac risk factors. The presence of hypertension and diabetes seemed most likely to defeat the biologic advantage enjoyed by women over men in resistance to the development of atherosclerotic heart disease.

Left ventricular function in patients with and without myocardial infarction and one, two or three vessel coronary artery disease

Ninety-six patients with chest pain were studied to determine the relation between left ventricular function and severity of coronary artery disease in patients with and without a history of myocardial infarction. Coronary arteriography was performed obtaining cineangiograms (60 frames/sec) and large roll film angiograms (2 to 6 frames/sec) for precise definition of the coronary anatomy. The criteria for diagnosis of myocardial infarction were a typical history, a rise and fall in serum glutamic oxaloacetic transaminase levels and evolutionary S-T segment changes associated with Q waves of at least 0.03 second. Left ventricular function was assessed by measurement of left ventricular end-diastolic pressure and volume, and left ventricular ejection fraction, mass and compliance. Fifteen patients had normal findings; 81 were classified according to number of diseased vessels and presence or absence of myocardial infarction. There were no group differences in age or heart rate. Left ventricular end-diastolic pressure was abnormally increased in patients with three vessel disease and myocardial infarction. Left ventricular end-diastolic volume was increased and the ejection fraction was reduced in patients in each vessel disease group with myocardial infarction. Although ejection fraction was reduced in patients with three vessel disease without myocardial infarction, it was further reduced when infarction occurred. Left ventricular mass increased in patients with three vessel disease with or without myocardial infarction. Values for ventricular compliance were reduced in all patients with myocardial infarction and were lower in those with two and three vessel disease and infarction than in those with two and three vessel disease without infarction. These findings suggest that a previous history of myocardial infarction needs to be considered together with anatomic abnormalities of the coronary arteries in assessing cardiac performance in patients with ischemic heart disease. In patients with one, two or three vessel coronary artery disease, a previous myocardial infarction significantly alters left ventricular performance; the ejection fraction is a more sensitive measurement of left ventricular function than left ventricular end-diastolic pressure or volume.

Clinical and hemodynamic aspects of single vessel coronary artery disease

Two-hundred consecutive patients with arteriosclerotic heart disease underwent complete clinical and hemodynamic evaluation. Fifty-two patients (26 per cent) had significant single vessel coronary artery disease and were compared to 148 patients with more extensive coronary artery disease and to a group of 14 normal patients. The single vessel disease group, when compared to the diffuse disease group, was characterized by a shorter duration of angina pectoris, lower frequency of a history of congestive heart failure or cardiomegaly, and a lower frequency of electrocardiographic (ECG) evidence of a transmural myocardial infarction. The combination of angina pectoris for three or more years with cardiomegaly was the only factor which completely separated the two coronary disease groups. Cardiomegaly, when present in single vessel involvement, was always due to left anterior descending (LAD) disease, together with an anterior infarction on ECG and left ventricular asynergy. The single vessel disease group included 32 patients with LAD disease, 17 with RCA, and 3 with circumflex artery involvement. Resting hemodynamics in these 52 patients (other than a higher left ventricular end-diastolic pressure and wall stress) were not significantly different from hemodynamics in a normal group. Patients with diffuse disease were characterized by many hemodynamic alterations and by left ventricular (LV) asynergy, when compared to the single vessel disease or normal groups. The diffuse disease group had a lower ejection fraction (EF) and an increased frequency of LV asynergy and coronary collateral circulation than did the LAD group. In the single vessel disease group LV asynergy did not correlate with the ECG. LV synergy, however, was not found in any patient in the LAD group with abnormal Q waves on ECG. The single vessel disease group included only five patients with increased end-diastolic volume (EDV) and all had LAD involvement, increased LV end-diastolic pressure, and decreased EF. The remaining 47 patients with normal LV-EDV revealed that the LAD group had abnormal pressure-volume relationships, indicating a decreased compliance of the left ventricle.

Changes in performance on WAIS, trail making test and finger tapping test associated with carotid artery surgery.

47 patients with vascular disease were divided into small vessel disease group (SVD), large vessel disease operated group (LVD-O) and large vessel disease nonoperated group (LVD-N). They were tested during their first hospitalization and at a follow-up some months later. There were no significant changes for any group on the Trail Making Test and on the Finger Tapping Test. On the WAIS the SVD made significant gains on the Verbal IQ (VIQ), Performance IQ (PIQ) and Full Scale IQ (FSIQ); the LVD-O made significant gains on PIQ and FSIQ; and the LVD-N made no significant gains on any of the three scores. Dividing the LVD-O by lesion laterality, the leftside lesioned group made significant gains on PIQ and FSIQ, while the right-side lesioned group made significant gains on all three measures.