WorldWideScience

Sample records for artery disease trial

  1. Connective Tissue Reflex Massage for Type 2 Diabetic Patients with Peripheral Arterial Disease: Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Adelaida María Castro-Sánchez

    2011-01-01

    Full Text Available The objective of this study was to evaluate the efficacy of connective tissue massage to improve blood circulation and intermittent claudication symptoms in type 2 diabetic patients. A randomized, placebo-controlled trial was undertaken. Ninety-eight type 2 diabetes patients with stage I or II-a peripheral arterial disease (PAD (Leriche-Fontaine classification were randomly assigned to a massage group or to a placebo group treated using disconnected magnetotherapy equipment. Peripheral arterial circulation was determined by measuring differential segmental arterial pressure, heart rate, skin temperature, oxygen saturation and skin blood flow. Measurements were taken before and at 30 min, 6 months and 1 year after the 15-week treatment. After the 15-week program, the groups differed (P<.05 in differential segmental arterial pressure in right lower limb (lower one-third of thigh, upper and lower one-third of leg and left lower limb (lower one-third of thigh and upper and lower one-third of leg. A significant difference (P<.05 was also observed in skin blood flow in digits 1 and 4 of right foot and digits 2, 4 and 5 of left foot. ANOVA results were significant (P<.05 for right and left foot oxygen saturation but not for heart rate and temperature. At 6 months and 1 year, the groups differed in differential segmental arterial pressure in upper third of left and right legs. Connective tissue massage improves blood circulation in the lower limbs of type 2 diabetic patients at stage I or II-a and may be useful to slow the progression of PAD.

  2. Outcomes of anatomical vs. functional testing for coronary artery disease : Lessons from the PROMISE trial.

    Science.gov (United States)

    Shah, R; Foldyna, B; Hoffmann, U

    2016-08-01

    The development of coronary artery disease (CAD) is a major, final common pathway in heart disease worldwide. With a rise in stress testing and increased scrutiny on cost-effectiveness and radiation exposure in medical imaging, a focus on the relative merits of anatomic versus functional characterization of CAD has emerged. In this context, coronary computed tomography angiography (CCTA) is a noninvasive alternative to functional testing as a first-line test for CAD detection but is complimentary in its nature. Here, we discuss the design, results, and implications of the PROMISE trial, a randomized comparative effectiveness study of 10,003 patients across 193 sites in the United States and Canada comparing the prognostic and diagnostic power of CCTA and standard stress testing. Specifically, we discuss the safety (e. g., contrast, radiation exposure) of CCTA versus functional testing in CAD, the need for improved selection for noninvasive testing, the frequency of downstream testing after anatomic or functional imaging, the use of imaging results in clinical management, and novel modalities of CAD risk determination using CCTA. PROMISE demonstrated that in a real-world, low-to-intermediate risk patient population referred to noninvasive testing for CAD, both CCTA and functional testing approaches have similar clinical, economic, and safety-based outcomes. We conclude with open questions in CAD imaging, specifically as they pertain to the utilization of CCTA.

  3. A randomised trial comparing the effect of exercise training and weight loss on microvascular function in coronary artery disease

    DEFF Research Database (Denmark)

    Olsen, Rasmus Huan; Pedersen, Lene Rørholm; Jürs, Anders

    2015-01-01

    BACKGROUND: Coronary microvascular function is associated with outcome and is reduced in coronary artery disease (CAD) and obesity. We compared the effect of aerobic interval training (AIT) and weight loss on coronary flow reserve (CFR) and peripheral vascular function in revascularised obese CAD...... might impact prognosis of CAD through improvement of coronary microvascular function. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01724567....

  4. Design and intermediate results of the Lower Extremity Arterial Disease Event Reduction (LEADER* trial of bezafibrate in men with lower extremity arterial disease [ISRCTN41194621

    Directory of Open Access Journals (Sweden)

    Meade Thomas W

    2001-07-01

    Full Text Available Abstract Background Raised levels of both triglycerides and fibrinogen, each of which are reduced by bezafibrate, may contribute to lower extremity arterial disease (LEAD. This condition is characterized by a particularly high incidence of coronary heart disease (CHD and stroke, but is little studied thus far in randomised controlled trials. Method Patients were recruited through 85 practices in the British Medical Research Council General Practice Research Framework and through nine hospital vascular clinics. The treatment regimen, which is double-blind and placebo-controlled, is bezafibrate 400 mg/day. The 1568 patients recruited represent 86% of those eligible at screening. Results None of the anticipated side effects (mainly gastrointestinal differed between the two groups. Nearly 80% of the total person-years accrued at 3 years were spent on trial treatment. Bezafibrate significantly reduced total cholesterol by approximately 8.0% and low-density lipoprotein (LDL-cholesterol by approximately 9.0%, and increased high-density lipoprotein (HDL-cholesterol by approximately 11.0% initially, falling to about 6.0% at 3 years. Triglycerides were significantly reduced by about 23.0% and fibrinogen by about 14.0%. Plasma creatinine rose by approximately 11% in those on active treatment. All of these effects were highly significant (P Conclusion The trial recruited an unusually high proportion of eligible patients, ensuring the general applicability of its results. The fibrinogen-lowering and lipid-modifying effects of bezafibrate were confirmed. Although bezafibrate lowers fibrinogen, it has no effect on CRP; this suggests that the reduction in fibrinogen is due to an effect on its metabolism rather than suppression of an inflammatory response.

  5. A randomised trial comparing weight loss with aerobic exercise in overweight individuals with coronary artery disease

    DEFF Research Database (Denmark)

    Pedersen, Lene Rørholm Engelbrecht; Olsen, Rasmus H; Jürs, Anders

    2015-01-01

    BACKGROUND: We aimed to compare the effect of aerobic interval training (AIT) versus a low energy diet (LED) on physical fitness, body composition, cardiovascular risk factors and symptoms in overweight individuals with coronary artery disease (CAD). METHODS AND DESIGN: Seventy non...... their antihypertensive treatment reduced following LED (between-group, p = 0.032). Canadian Cardiovascular Society (CCS), New York Heart Association (NYHA) and anxiety scores were improved, while depressive symptoms remained unchanged. Intention-to-treat analyses including 65 participants (93%) were similar to per...... protocol analysis. CONCLUSION: Both interventions were feasible and effective in achieving the desired effects. LED was superior in improving body composition and blood pressure, whereas effects on lipids and symptoms were similar in the two groups. Thus, both AIT and LED improve the cardiovascular risk...

  6. Percutaneous coronary intervention versus bypass surgery for left main coronary artery disease: A meta-analysis of randomised trials

    NARCIS (Netherlands)

    G. Ferrante (Giuseppe); P. Presbitero (Patrizia); M. Valgimigli (Marco); M-C. Morice (Marie-Claude); P. Pagnotta (Paolo); G. Belli (Guido); E. Corrada (Elena); Y. Onuma (Yoshinobu); P. Barlis (Peter); D. Locca (Didier); E. Eeckhout; C. di Mario (Carlo); P.W.J.C. Serruys (Patrick)

    2011-01-01

    textabstractAims: We performed a meta-analysis of randomised trials comparing percutaneous coronary intervention (PCI) with stent implantation to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis (ULMCA). Methods and results: Pubmed and other

  7. [Upper extremity arterial diseases].

    Science.gov (United States)

    Becker, F

    2007-02-01

    Compared to lower limb arterial diseases, upper limb arterial diseases look rare, heterogeneous with various etiologies and a rather vague clinical picture, but with a negligible risk of amputation. Almost all types of arterial diseases can be present in the upper limb, but the anatomical and hemodynamic conditions particular to the upper limb often confuse the issue. Thus, atherosclerosis affects mainly the subclavian artery in its proximal segment where the potential of collateral pathway is high making the symptomatic forms not very frequent whereas the prevalence of subclavian artery stenosis or occlusion is relatively high. The clinical examination and the etiologies are discussed according to the clinical, anatomical and hemodynamic context.

  8. Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared to clopidogrel: Data from the PLATO trials

    DEFF Research Database (Denmark)

    Patel, Manesh R.; Becker, Richard C.; Wojdyla, Daniel M.;

    Abstract 14299: Cardiovascular Events in Acute Coronary Syndrome Patients With Peripheral Arterial Disease Treated With Ticagrelor Compared to Clopidogrel: Data From the PLATO Trial Manesh R Patel1; Richard C Becker1; Daniel M Wojdyla2; Håkan Emanuelsson3; William Hiatt4; Jay Horrow5; Steen Husted6...

  9. Dark chocolate and vascular function in patients with peripheral artery disease: a randomized, controlled cross-over trial.

    Science.gov (United States)

    Hammer, Alexandra; Koppensteiner, Renate; Steiner, Sabine; Niessner, Alexander; Goliasch, Georg; Gschwandtner, Michael; Hoke, Matthias

    2015-01-01

    Flavonoid-rich dark chocolate has positive effects on vascular function in healthy subjects and in patients at risk of atherosclerosis. The impact of dark chocolate on endothelial and microvascular function in patients with symptomatic peripheral artery disease (PAD) has not been investigated so far. In an investigator blinded, randomized, controlled, cross-over trial we assessed the effect of flavonoid-rich dark chocolate and cocoa-free control chocolate on flow-mediated dilatation (FMD) of the brachial artery and on microvascular function (assessed by Laser Doppler fluxmetry) in 21 patients with symptomatic (Fontaine stage II) PAD. Measurements were done in each patient on 2 single days, with an interval of 7 days, at baseline and at 2 hours after ingestion of 50 g dark chocolate or 50 g white chocolate, respectively. FMD remained unchanged after intake of dark chocolate (baseline and 2 hours after ingestion, %: 5.1 [IQR 4.4 to 7.3] and 5.5 [IQR 3.9 to 10.4]; p = 0.57, and after intake of white chocolate (baseline and 2 hours after ingestion, %: 6.4 [IQR 4.5 to 11.4] and 4.4 [IQR 2.6 to 8.7]; p = 0.14. Similarly, microcirculatory parameters were not significantly altered after intake of any chocolate compared with the respective baseline values. In conclusion, a single consumption of 50 g dark chocolate has no effect on endothelial and microvascular function in patients with symptomatic PAD.

  10. Menaquinone-7 Supplementation to Reduce Vascular Calcification in Patients with Coronary Artery Disease: Rationale and Study Protocol (VitaK-CAC Trial).

    Science.gov (United States)

    Vossen, Liv M; Schurgers, Leon J; van Varik, Bernard J; Kietselaer, Bas L J H; Vermeer, Cees; Meeder, Johannes G; Rahel, Braim M; van Cauteren, Yvonne J M; Hoffland, Ge A; Rennenberg, Roger J M W; Reesink, Koen D; de Leeuw, Peter W; Kroon, Abraham A

    2015-10-28

    Coronary artery calcification (CAC) develops early in the pathogenesis of atherosclerosis and is a strong and independent predictor of cardiovascular disease (CVD). Arterial calcification is caused by an imbalance in calcification regulatory mechanisms. An important inhibitor of calcification is vitamin K-dependent matrix Gla protein (MGP). Both preclinical and clinical studies have shown that inhibition of the vitamin K-cycle by vitamin K antagonists (VKA) results in elevated uncarboxylated MGP (ucMGP) and subsequently in extensive arterial calcification. This led us to hypothesize that vitamin K supplementation may slow down the progression of calcification. To test this, we designed the VitaK-CAC trial which analyses effects of menaquinone-7 (MK-7) supplementation on progression of CAC. The trial is a double-blind, randomized, placebo-controlled trial including patients with coronary artery disease (CAD). Patients with a baseline Agatston CAC-score between 50 and 400 will be randomized to an intervention-group (360 microgram MK-7) or a placebo group. Treatment duration will be 24 months. The primary endpoint is the difference in CAC-score progression between both groups. Secondary endpoints include changes in arterial structure and function, and associations with biomarkers. We hypothesize that treatment with MK-7 will slow down or arrest the progression of CAC and that this trial may lead to a treatment option for vascular calcification and subsequent CVD.

  11. Effects of exercise training on sleep apnoea in patients with coronary artery disease: a randomised trial.

    Science.gov (United States)

    Mendelson, Monique; Lyons, Owen D; Yadollahi, Azadeh; Inami, Toru; Oh, Paul; Bradley, T Douglas

    2016-07-01

    Overnight fluid shift from the legs to the neck and lungs may contribute to the pathogenesis of obstructive sleep apnoea (OSA) and central sleep apnoea (CSA). We hypothesised that exercise training will decrease the severity of OSA and CSA in patients with coronary artery disease (CAD) by decreasing daytime leg fluid accumulation and overnight rostral fluid shift.Patients with CAD and OSA or CSA (apnoea-hypopnoea index >15 events per h) were randomised to 4 weeks of aerobic exercise training or to a control group. Polysomnography, with measurement of leg, thoracic and neck fluid volumes and upper-airway cross-sectional area (UA-XSA) before and after sleep, was performed at baseline and follow-up.17 patients per group completed the study. Apnoea-hypopnoea index decreased significantly more in the exercise group than in the control group (31.1±12.9 to 20.5±9.4 versus 28.1±13.5 to 27.0±15.1 events per h, p=0.047), in association with a greater reduction in the overnight change in leg fluid volume (579±222 to 466±163 versus 453±164 to 434±141 mL, p=0.04) and by a significantly greater increase in the overnight change in UA-XSA in the exercise group (p=0.04).In patients with CAD and sleep apnoea, exercise training decreases sleep apnoea severity via attenuation of overnight fluid shift and an increase in UA-XSA.

  12. Imaging techniques to evaluate cell therapy in peripheral artery disease: state of the art and clinical trials.

    Science.gov (United States)

    Grimaldi, Vincenzo; Schiano, Concetta; Casamassimi, Amelia; Zullo, Alberto; Soricelli, Andrea; Mancini, Francesco Paolo; Napoli, Claudio

    2016-05-01

    Cell-based therapies, as potential approach to cure peripheral artery disease (PAD), have been clinically investigated after promising results in preclinical models. The so far published studies are very heterogeneous, as different cell sources, cell types, amounts of administered cells and delivering strategies have been used. Overall, cell therapies for PAD bring about a general improvement of patient's clinical condition, even though conclusions cannot be established due to the small size and non-randomized design of these trials. In this context, non-invasive imaging techniques, aimed to monitor angiogenesis and neovascularization after cell therapy, will help the follow-up of clinical studies. However, still much work is needed to establish advanced imaging procedure to overcome the limitation of the current techniques and to accumulate more data in large populations of patients. Here, we report the main imaging techniques employed to evaluate the outcome of the different cell-based therapies in PAD. Moreover, we focus on both published and ongoing clinical trials utilizing cell therapy in PAD.

  13. Oral azithromycin in extended dosage schedule for chronic, subclinical Chlamydia pneumoniae infection causing coronary artery disease: a probable cure in sight? Results of a controlled preliminary trial

    Directory of Open Access Journals (Sweden)

    Dogra J

    2012-06-01

    Full Text Available Jaideep DograPoly Clinic, Central Government Health Scheme, Jaipur, Rajasthan, IndiaPurpose: Two mega trials have raised the question as to whether the hypothesis that infection plays a role in atherosclerosis is still relevant. This controlled preliminary trial investigated an extended dose of azithromycin in the treatment of Chlamydia pneumoniae infection causing coronary artery disease (CAD.Patients and methods: Forty patients with documentary evidence of CAD were screened for immunoglobulin G titers against C. pneumoniae and grouped into either the study group (patients with positive titer, n = 32 or control group (patients with negative titer, n = 8. Cases who met inclusion criteria could not have had coronary artery bypass graft surgery or percutaneous coronary intervention in the preceding 6 months. Informed consent was obtained from every patient. Baseline blood samples were analyzed for red blood cell indices, serum creatinine, and liver function tests, and repeated every 2 months. A primary event was defined as the first occurrence of death by any cause, recurrent myocardial infarction, coronary revascularization procedure, or hospitalization for angina. Patients in the study group received 500 mg of oral azithromycin once daily for 5 days, which was then repeated after a gap of 10 days (total of 24 courses in the 1-year trial period. The control group did not have azithromycin added to their standard CAD treatment.Results: In the study group, 30 patients completed the trial. Two patients had to undergo percutaneous coronary intervention in the initial first quarter of the 1-year trial period. In the control group, one patient died during the trial, one had to undergo coronary artery bypass graft surgery, and one had percutaneous coronary intervention.Conclusion: The patients tolerated the therapy well and there was a positive correlation between azithromycin and secondary prevention of CAD.Keywords: azithromycin, Chlamydia pneumoniae

  14. Renin angiotensin system inhibitors for patients with stable coronary artery disease without heart failure: systematic review and meta-analysis of randomized trials

    Science.gov (United States)

    Fakheri, Robert; Wandel, Simon; Toklu, Bora; Wandel, Jasmin; Messerli, Franz H

    2017-01-01

    Objective To critically evaluate the efficacy of renin angiotensin system inhibitors (RASi) in patients with coronary artery disease without heart failure, compared with active controls or placebo. Design Meta-analysis of randomized trials. Data sources PubMed, EMBASE, and CENTRAL databases until 1 May 2016. Eligibility criteria for selecting studies Randomized trials of RASi versus placebo or active controls in patients with stable coronary artery disease without heart failure (defined as left ventricular ejection fraction ≥40% or without clinical heart failure). Each trial had to enroll at least 100 patients with coronary artery disease without heart failure, with at least one year’s follow-up. Studies were excluded if they were redacted or compared use of angiotensin converting enzyme inhibitors with angiotensin receptor blockers. Outcomes were death, cardiovascular death, myocardial infarction, angina, stroke, heart failure, revascularization, incident diabetes, and drug withdrawal due to adverse effects. Results 24 trials with 198 275 patient years of follow-up were included. RASi reduced the risk of all cause mortality (rate ratio 0.84, 95% confidence interval 0.72 to 0.98), cardiovascular mortality (0.74, 0.59 to 0.94), myocardial infarction (0.82, 0.76 to 0.88), stroke (0.79, 0.70 to 0.89), angina, heart failure, and revascularization when compared with placebo but not when compared with active controls (all cause mortality, 1.05, 0.94 to 1.17; Pinteraction=0.006; cardiovascular mortality, 1.08, 0.93 to 1.25, Pinteraction14.10 deaths and >7.65 cardiovascular deaths per 1000 patient years) but not in those with low control event rates. Conclusions In patients with stable coronary artery disease without heart failure, RASi reduced cardiovascular events and death only when compared with placebo but not when compared with active controls. Even among placebo controlled trials in this study, the benefit of RASi was mainly seen in trials with higher

  15. Arterial stiffness as a risk factor for coronary artery disease.

    Science.gov (United States)

    Liao, Josh; Farmer, John

    2014-02-01

    Hypertension is a major modifiable risk factor, and clinical trials have demonstrated that successful reduction of elevated blood pressure to target levels translates into decreased risk for the development of coronary artery disease, stroke, heart failure, and renal failure. The arterial system had previously been regarded as a passive conduit for the transportation of arterial blood to peripheral tissues. The physiologic role the arterial system was greatly expanded by the recognition of the central role of the endothelial function in a variety of physiologic processes. The role of arterial function and structure in cardiovascular physiology was expanded with the development of a variety of parameters that evaluate arterial stiffness. Markers of arterial stiffness have been correlated with cardiovascular outcomes, and have been classified as an emerging risk factor that provides prognostic information beyond standard stratification strategies involving hypertension, diabetes, obesity, dyslipidemia and smoking. Multiple epidemiologic studies have correlated markers of arterial stiffness such as pulse-wave velocity, augmentation index and pulse pressure with risk for the development of fatal and nonfatal cardiovascular events. Additionally, measurements of arterial stiffness had clarified the results of clinical trials that demonstrated differing impacts on clinical outcomes, despite similar reductions in blood pressure, as measured by brachial and sphygmomanometry.

  16. A randomized trial of anesthetic induction agents in patients with coronary artery disease and left ventricular dysfunction

    Directory of Open Access Journals (Sweden)

    Singh Raveen

    2010-01-01

    Full Text Available The deleterious effects of anesthetic agents in patients suffering from coronary artery disease are well known. The risk increases when a patient has compromised ventricular function. There is a paucity of literature regarding the choice of the suitable agent to avoid deleterious effects in such patients. The use of etomidate and propofol has been considered superior to other intravenous anesthetic agents in these groups of patients. The aim of the present study is to compare the hemodynamic effects of anesthesia induction with etomidate, thiopentone, propofol, and midazolam in patients with coronary artery disease and left ventricular dysfunction. This randomized clinical trail was conducted at the All Indian Institute of Medical Sciences, New Delhi, India. Sixty patients with coronary artery disease and left ventricular dysfunction (ejection fraction < 45% scheduled for elective coronary artery bypass surgery participated in this study. After stabilization baseline hemodynamic data stroke volume variation and systemic vascular resistance index were recorded for all patients (Flo Trac TM sensor with Vigileo cardiac output monitor used for hemodynamic monitoring. The patients were randomly alloted to one of the four groups and the intravenous induction agent was administered for over 60 - 90 seconds (Group E - Etomidate 0.2 mg/Kg; Group M - Midazolam 0.15 mg/Kg; Group T - Thiopentone 5 mg/Kg; Group P - Propofol 1.5 mg/Kg. Hemodynamic data were recorded at one minute intervals starting from induction till seven minutes after intubation, - the end point of the present study. There was a significant decrease in the heart rate in comparison to the baseline(-7 to -15%, P = 0.001, mean arterial pressure (-27 to -32%, P = 0.001, cardiac index (-36 to -38%, P = 0.001, and stroke volume index (-27 to -34%, P = 0.001 after induction in all four groups. The hemodynamic response was similar in all the four groups. There was no significant change in central

  17. Effectiveness of a New Exercise Program after Lower Limb Arterial Blood Flow Surgery in Patients with Peripheral Arterial Disease: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Edita Jakubsevičienė

    2014-08-01

    Full Text Available Objective: The aim of this study was to evaluate the effectiveness of a supervised exercise program (SEP plus at home nonsupervised exercise therapy (non-SET on functional status, quality of life (QoL and hemodynamic response in post-lower-limb bypass surgery patients. Results: One hundred and seventeen patients were randomized to an intervention (n = 57 or a control group (n = 60. A new individual SEP was designed for patients with peripheral arterial disease (PAD and applied to the studied subjects of the intervention group who also continued non-SET at home, whereas those assigned to the control group received just usual SEP according to a common cardiovascular program. The participants of the study were assessed by a 6-min walking test (6 MWT, an ankle-brachial index (ABI, and the Medical Outcomes Study Short Form-36 (SF-36 of QoL at baseline, at 1 and 6 months after surgery. A significant improvement was observed in the walked distance in the intervention group after 6 months compared with the control group (p < 0.001. The intervention group had significantly higher QoL score in the physical and mental component of SF-36 (p < 0.05. Conclusions: A 6-month application of the new SEP and non-SET at home has yielded significantly better results in walking distance and QoL in the intervention group than in the controls.

  18. A randomized trial comparing the effect of weight loss and exercise training on insulin sensitivity and glucose metabolism in coronary artery disease

    DEFF Research Database (Denmark)

    Pedersen, Lene Rørholm; Olsen, Rasmus Huan; Jürs, Anders

    2015-01-01

    AIM: The majority of patients with coronary artery disease (CAD) exhibit abnormal glucose metabolism, which is associated with mortality even at non-diabetic glucose levels. This trial aims to compare the effects of a considerable weight loss and exercise with limited weight loss on glucose...... followed by 2-4 weeks' weight maintenance diet. Glucose tolerance, insulin action, β-cell function and suppression of lipolysis were assessed using a 3-h oral glucose tolerance test. ISI-composite and ISI-HOMA (=1/HOMA-IR) were calculated as surrogate measures of whole-body and hepatic insulin sensitivity......, respectively. Magnetic resonance imaging estimated abdominal adipose tissue. Twenty-six (74%) AIT and 29 (83%) LED participants completed intervention per protocol. LED increased ISI-composite by 55% and ISI-HOMA by 70% (p0.7) revealing a significant...

  19. The BEAUTIFUL study: randomized trial of ivabradine in patients with stable coronary artery disease and left ventricular systolic dysfunction - baseline characteristics of the study population

    DEFF Research Database (Denmark)

    NN, NN; Ferrari, R; Ford, I

    2008-01-01

    OBJECTIVES: Ivabradine is a selective heart rate-lowering agent that acts by inhibiting the pacemaker current If in sinoatrial node cells. Patients with coronary artery disease and left ventricular dysfunction are at high risk of death and cardiac events, and the BEAUTIFUL study was designed...... to evaluate the effects of ivabradine on outcome in such patients receiving optimal medical therapy. This report describes the study population at baseline. METHODS: BEAUTIFUL is an international, multicentre, randomized, double-blind trial to compare ivabradine with placebo in reducing mortality...... are expected in 2008, and should show whether ivabradine, on top of optimal medical treatment, reduces mortality and cardiovascular events in this population of high-risk patients....

  20. Randomized controlled trial of heart rate variability biofeedback in cardiac autonomic and hostility among patients with coronary artery disease.

    Science.gov (United States)

    Lin, I-Mei; Fan, Sheng-Yu; Lu, Hsueh-Chen; Lin, Tsung-Hsien; Chu, Chih-Sheng; Kuo, Hsuan-Fu; Lee, Chee-Siong; Lu, Ye-Hsu

    2015-07-01

    Hostility is a psychosocial risk factor that may decrease heart rate variability (HRV) in coronary artery disease (CAD) through cardiac autonomic imbalance. Heart rate variability biofeedback (HRV-BF) increases HRV indices and baroreflex gain. This study examines the effectiveness of HRV-BF in restoring cardiac autonomic balance and decreasing hostility among patients with CAD. One hundred and fifty-four patients with CAD were assigned randomly to receive 6 weeks of HRV-BF, in addition to the standard medical care received by the wait-list control (WLC) group. A 5-min electrocardiogram, blood pressure, and hostility were assessed pre-intervention, post-intervention, and at 1-month follow-up. The standard deviation of normal-to-normal intervals (SDNN), low frequency (LF), and log LF at post-intervention was significantly higher than that at pre-intervention in the HRV-BF group. Baseline log LF was significantly higher post-intervention and at follow-up after HRV-BF training than at pre-intervention. The treatment curve of log LF pre-session increased significantly after session 2, which was maintained to post-intervention. Expressive hostility, suppressive hostility, and hostility total score at post-intervention and one-month follow-up after HRV-BF were significantly lower than at pre-intervention. This study showed increased HRV and decreased expressive and suppressive hostility behavior in patients with CAD following HRV-BF.

  1. Coronary Artery Disease - Coronary Heart Disease

    Science.gov (United States)

    ... result of coronary artery disease, or CAD, said Edward A. Fisher, M.D., Ph.D., M.P. ... Problems and Disease • High Blood Pressure (HBP) • Metabolic Syndrome • Pericarditis • Peripheral Artery Disease (PAD) • Stroke • Vascular Health • ...

  2. Epigenetics and Peripheral Artery Disease.

    Science.gov (United States)

    Golledge, Jonathan; Biros, Erik; Bingley, John; Iyer, Vikram; Krishna, Smriti M

    2016-04-01

    The term epigenetics is usually used to describe inheritable changes in gene function which do not involve changes in the DNA sequence. These typically include non-coding RNAs, DNA methylation and histone modifications. Smoking and older age are recognised risk factors for peripheral artery diseases, such as occlusive lower limb artery disease and abdominal aortic aneurysm, and have been implicated in promoting epigenetic changes. This brief review describes studies that have associated epigenetic factors with peripheral artery diseases and investigations which have examined the effect of epigenetic modifications on the outcome of peripheral artery diseases in mouse models. Investigations have largely focused on microRNAs and have identified a number of circulating microRNAs associated with human peripheral artery diseases. Upregulating or antagonising a number of microRNAs has also been reported to limit aortic aneurysm development and hind limb ischemia in mouse models. The importance of DNA methylation and histone modifications in peripheral artery disease has been relatively little studied. Whether circulating microRNAs can be used to assist identification of patients with peripheral artery diseases and be modified in order to improve the outcome of peripheral artery disease will require further investigation.

  3. A review of antithrombotic therapy and the rationale and design of the randomized edoxaban in patients with peripheral artery disease (ePAD) trial adding edoxaban or clopidogrel to aspirin after femoropopliteal endovascular intervention

    NARCIS (Netherlands)

    Tangelder, Marco J D; Nwachuku, Chuke E.; Jaff, Michael; Baumgartner, Iris; Duggal, Anil; Adams, George; Ansel, Gary; Grosso, Michael; Mercuri, Michele; Shi, Minggao; Minar, Erich; Moll, Frans L.

    2015-01-01

    Compared with the coronary setting, knowledge about antithrombotic therapies after endovascular treatment (EVT) is inadequate in patients with peripheral artery disease (PAD). Based on a review of trials and guidelines, which is summarized in this article, there is scant evidence that antithrombotic

  4. Low-profile stent system for treatment of atherosclerotic renal artery stenosis: The GREAT trial

    NARCIS (Netherlands)

    Sapoval, M.; Zahringer, M.; Pattynama, P.; Rabbia, C.; Vignali, C.; Maleux, G.; Boyer, L.; Szczerbo-Trojanowska, M.; Jaschke, W.; Hafsahl, G.; Downes, M.; Beregi, J.P.; Veeger, N.; Talen, A.

    2005-01-01

    PURPOSE: The Palmaz Genesis Peripheral Stainless Steel Balloon Expandable Stent in Renal Artery Treatment (GREAT) Trial was designed to assess the safety and performance of a low-profile stent for the treatment of obstructive renal artery disease by looking at 6-month renal artery patency uniformly

  5. Low-profile stent system for treatment of atherosclerotic renal artery stenosis : The GREAT trial

    NARCIS (Netherlands)

    Sapoval, M; Zahringer, M; Pattynama, P; Rabbia, C; Vignali, C; Maleux, G; Boyer, L; Szczerbo-Trojanowska, M; Jaschke, W; Hafsahl, G; Downes, M; Beregi, JP; Veeger, N; Talen, A

    2005-01-01

    PURPOSE: The Palmaz Genesis Peripheral Stainless Steel Balloon Expandable Stent in Renal Artery Treatment (GREAT) Trial was designed to assess the safety and performance of a low-profile stent for the treatment of obstructive renal artery disease by looking at 6-month renal artery patency uniformly

  6. Peripheral Artery Disease and Diabetes

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More Peripheral Artery Disease & Diabetes Updated:Jan 26,2016 People with diabetes are ... life. This content was last reviewed January 2016. Diabetes • Home • About Diabetes • Why Diabetes Matters Introduction Cardiovascular ...

  7. Carotid Artery Disease

    Science.gov (United States)

    ... make them more vulnerable to damage. Tobacco use. Nicotine can irritate the inner lining of your arteries. ... your physical and mental capabilities such as strength, memory and speech. After that, your doctor may recommend: ...

  8. Beneficial effects on arterial stiffness and pulse-wave reflection of combined enalapril and candesartan in chronic kidney disease--a randomized trial.

    Directory of Open Access Journals (Sweden)

    Marie Frimodt-Møller

    Full Text Available BACKGROUND: Cardiovascular disease (CVD is highly prevalent in patients with chronic kidney disease (CKD. Inhibition of the renin-angiotensinsystem (RAS in hypertension causes differential effects on central and brachial blood pressure (BP, which has been translated into improved outcome. The objective was to examine if a more complete inhibition of RAS by combining an angiotensin converting enzyme inhibitor (ACEI and an angiotensin receptor antagonist (ARB compared to monotherapy has an additive effect on central BP and pulse-wave velocity (PWV, which are known markers of CVD. METHODS: Sixty-seven CKD patients (mean GFR 30, range 13-59 ml/min/1.73 m(2 participated in an open randomized study of 16 weeks of monotherapy with either enalapril or candesartan followed by 8 weeks of dual blockade aiming at a total dose of 16 mg candesartan and 20 mg enalapril o.d. Pulse-wave measurements were performed at week 0, 8, 16 and 24 by the SphygmoCor device. RESULTS: Significant additive BP independent reductions were found after dual blockade in aortic PWV (-0.3 m/s, P<0.05 and in augmentation index (-2%, P<0.01 compared to monotherapy. Furthermore pulse pressure amplification was improved (P<0.05 and central systolic BP reduced (-6 mmHg, P<0.01. CONCLUSIONS: Dual blockade of the RAS resulted in an additive BP independent reduction in pulse-wave reflection and arterial stiffness compared to monotherapy in CKD patients. TRIAL REGISTRATION: Clinical trial.gov NCT00235287.

  9. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating pat

  10. Risk of Stroke in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention versus Optimal Medical Therapy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Taglieri, Nevio; Bacchi Reggiani, Maria Letizia; Ghetti, Gabriele; Saia, Francesco; Dall’Ara, Gianni; Gallo, Pamela; Moretti, Carolina; Palmerini, Tullio; Marrozzini, Cinzia; Marzocchi, Antonio; Rapezzi, Claudio

    2016-01-01

    Background Stroke is a rare but serious adverse event associated with percutaneous coronary intervention (PCI). However, the relative risk of stroke between stable patients undergoing a direct PCI strategy and those undergoing an initial optimal medical therapy (OMT) strategy has not been established yet. This study sought to investigate if, in patients with stable coronary artery disease (SCAD), an initial strategy PCI is associated with a higher risk of stroke than a strategy based on OMT alone. Methods We performed a meta-analysis of 6 contemporary randomized control trials in which 5673 patients with SCAD were randomized to initial PCI or OMT. Only trials with stent utilization more than 50% were included. Study endpoint was the rate of stroke during follow up. Results Mean age of patients ranged from 60 to 65 years and stent utilization ranged from 72% to 100%. Rate of stroke was 2.0% at a weighted mean follow up of 55.3 months. On pooled analysis, the risk of stroke was similar between patients undergoing a PCI plus OMT and those receiving only OMT (2.2% vs. 1.8%, OR on fixed effect = 1.24 95%CI: 0.85–1.79). There was no heterogeneity among the studies (I2 = 0.0%, P = 0.15). On sensitivity analysis after removing each individual study the pooled effect estimate remains unchanged. Conclusions In patients with SCAD an initial strategy based on a direct PCI is not associated with an increased risk of stroke during long-term follow up compared to an initial strategy based on OMT alone. PMID:27391212

  11. Risk of Stroke in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention versus Optimal Medical Therapy: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Nevio Taglieri

    Full Text Available Stroke is a rare but serious adverse event associated with percutaneous coronary intervention (PCI. However, the relative risk of stroke between stable patients undergoing a direct PCI strategy and those undergoing an initial optimal medical therapy (OMT strategy has not been established yet. This study sought to investigate if, in patients with stable coronary artery disease (SCAD, an initial strategy PCI is associated with a higher risk of stroke than a strategy based on OMT alone.We performed a meta-analysis of 6 contemporary randomized control trials in which 5673 patients with SCAD were randomized to initial PCI or OMT. Only trials with stent utilization more than 50% were included. Study endpoint was the rate of stroke during follow up.Mean age of patients ranged from 60 to 65 years and stent utilization ranged from 72% to 100%. Rate of stroke was 2.0% at a weighted mean follow up of 55.3 months. On pooled analysis, the risk of stroke was similar between patients undergoing a PCI plus OMT and those receiving only OMT (2.2% vs. 1.8%, OR on fixed effect = 1.24 95%CI: 0.85-1.79. There was no heterogeneity among the studies (I2 = 0.0%, P = 0.15. On sensitivity analysis after removing each individual study the pooled effect estimate remains unchanged.In patients with SCAD an initial strategy based on a direct PCI is not associated with an increased risk of stroke during long-term follow up compared to an initial strategy based on OMT alone.

  12. Efficacy of folic acid supplementation on endothelial function and plasma homocysteine concentration in coronary artery disease: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Yi, Xin; Zhou, Yanli; Jiang, Dingsheng; Li, Xiaoyan; Guo, Yi; Jiang, Xuejun

    2014-05-01

    The aim of the present study was to conduct an updated meta-analysis of relevant randomized controlled trials (RCTs) in order to estimate the effect of folic acid supplementation on endothelial function and the concentration of plasma homocysteine in patients with coronary artery disease (CAD). An extensive search of PubMed was conducted to identify RCTs that compared folic acid with placebo therapy. The mean difference (MD) and 95% confidence interval (CI) were used as a measure of the correlation between folic acid supplementation and endothelial function/plasma homocysteine concentration. Of the 377 patients included in this analysis, 191 patients underwent folic acid supplementation and 186 individuals underwent placebo treatment. Compared with the use of a placebo, folic acid supplementation alone exhibited significant efficacy on increasing flow-mediated dilation (FMD; MD, 57.72 μm; 95% CI, 50.14-65.31; Pfolic acid and placebo groups (P>0.05). Therefore, the meta-analysis indicated that 5 mg folic acid daily supplementation for >4 weeks significantly improved FMD and lowered the concentration of plasma homocysteine in patients with CAD. However, more RCTs are required in order to confirm these observations.

  13. Carotid Artery Disease

    Science.gov (United States)

    ... Kawasaki Disease Long Q-T Syndrome Marfan Syndrome Metabolic Syndrome Mitral Valve Prolapse Myocardial Bridge Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic Fever Sick Sinus Syndrome Silent Ischemia Stroke Sudden ...

  14. New trial designs and potential therapies for pulmonary artery hypertension.

    Science.gov (United States)

    Gomberg-Maitland, Mardi; Bull, Todd M; Saggar, Rajeev; Barst, Robyn J; Elgazayerly, Amany; Fleming, Thomas R; Grimminger, Friedrich; Rainisio, Maurizio; Stewart, Duncan J; Stockbridge, Norman; Ventura, Carlo; Ghofrani, Ardeschir H; Rubin, Lewis J

    2013-12-24

    A greater understanding of the epidemiology, pathogenesis, and pathophysiology of pulmonary artery hypertension (PAH) has led to significant advances, but the disease remains fatal. Treatment options are neither universally available nor always effective, underscoring the need for development of novel therapies and therapeutic strategies. Clinical trials to date have provided evidence of efficacy, but were limited in evaluating the scope and duration of treatment effects. Numerous potential targets in varied stages of drug development exist, in addition to novel uses of familiar therapies. The pursuit of gene and cell-based therapy continues, and device use to help acute deterioration and chronic management is emerging. This rapid surge of drug development has led to multicenter pivotal clinical trials and has resulted in novel ethical and global clinical trial concerns. This paper will provide an overview of the opportunities and challenges that await the development of novel treatments for PAH.

  15. Pregnancy associated plasma protein-A as a marker for myocardial infarction and death in patients with stable coronary artery disease: A prognostic study within the CLARICOR Trial

    DEFF Research Database (Denmark)

    Iversen, Kasper; Teisner, Børge; Winkel, Per;

    2011-01-01

    OBJECTIVE: Pregnancy associated plasma protein-A (PAPP-A) is a potential new marker for vulnerable plaques in the coronary arteries only examined in stable coronary disease (CAD) in patients undergoing coronary angiography. Here we address the prognostic value of serum PAPP-A in unselected stable...

  16. Peripheral arterial disease: clinical and cost comparisons between duplex US and contrast-enhanced MR angiography--a multicenter randomized trial.

    NARCIS (Netherlands)

    Vries, M. de; Ouwendijk, R.; Flobbe, K.; Nelemans, P.J.; Kessels, A.G.H.; Schurink, G.H.; Vliet, J.A. van der; Heijstraten, F.M.J.; Cuypers, P.W.; Duijm, L.E.M.; Engelshoven, J.M. van; Hunink, M.G.M.; Haan, M.W. de

    2006-01-01

    PURPOSE: To prospectively determine the clinical and economic consequences of replacing duplex ultrasonography (US) with contrast material-enhanced magnetic resonance (MR) angiography for the initial imaging work-up of patients with peripheral arterial disease (PAD). MATERIALS AND METHODS: This rand

  17. Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Non-Sleepy Obstructive Sleep Apnea : The RICCADSA Randomized Controlled Trial

    NARCIS (Netherlands)

    Peker, Yüksel; Glantz, Helena; Eulenburg, Christine; Wegscheider, Karl; Herlitz, Johan; Thunström, Erik

    2016-01-01

    RATIONALE: Obstructive sleep apnea is common in patients with coronary artery disease, many of whom do not report daytime sleepiness. First-line treatment for symptomatic obstructive sleep apnea is continuous positive airway pressure, but its value in patients without daytime sleepiness is uncertain

  18. Impact of different exercise training modalities on the coronary collateral circulation and plaque composition in patients with significant coronary artery disease (EXCITE trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Uhlemann Madlen

    2012-09-01

    Full Text Available Abstract Background Exercise training (ET in addition to optimal medical therapy (OMT in patients with stable coronary artery disease (CAD has been demonstrated to be superior to percutaneous coronary interventions (PCI with respect to the composite endpoint of death, myocardial infarction, stroke, revascularization and hospitalization due to worsening of angina. One mechanism leading to this superiority discussed in the literature is the increase in coronary collateral blood flow due to ET. Until now, data demonstrating the positive effect of ET on the collateral blood flow and the functional capacity of the coronary collateral circulation are still lacking. Methods/design The EXCITE trial is a three-armed randomized, prospective, single-center, open-label, controlled study enrolling 60 patients with stable CAD and at least one significant coronary stenosis (fractional flow reserve ≤0.75. The study is designed to compare the influence and efficacy of two different 4-week ET programs [high-intensity interval trainings (IT versus moderate-intensity exercise training (MT in addition to OMT] versus OMT only on collateral blood flow (CBF. The primary efficacy endpoint is the change of the CBF of the target vessel after 4 weeks as assessed by coronary catheterization with a pressure wire during interruption of the antegrade flow of the target vessel by balloon occlusion. Secondary endpoints include the change in plaque composition as assessed by intravascular ultrasound (IVUS after 4 weeks, myocardial perfusion as analyzed in MRI after 4 weeks and 12 months, peak oxygen uptake (V02 peak, change in endothelial function and biomarkers after 4 weeks, 3, 6 and 12 months. The safety endpoint addresses major adverse cardiovascular events (death from cardiovascular cause, myocardial infarction, stroke, TIA, target vessel revascularization or hospitalization after 12 months. Discussion The trial investigates whether ET for 4 weeks increases the CBF in

  19. Impact of biodegradable versus durable polymer drug-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 15 randomized trials

    Institute of Scientific and Technical Information of China (English)

    Zhang Yaojun; Tian Nailiang; Dong Shengjie; Ye Fei; Li Minghui; Christos V.Bourantas; Javaid Iqbal

    2014-01-01

    Background Drug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes.However,the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.Methods We searched Medline,the Cochrane Library and other internet sources,without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES.Safety endpoints were ST (definite,definite/probable),mortality,and myocardial infarction (MI).Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR).Results We identified 15 randomized controlled trials (n=17 068) with a weighted mean follow-up of 20.6 months.There was no statistical difference in the incidence of definite/probable ST between durable polymer-and biodegradable polymerDES; relative risk (RR) 0.83; 95% confidence interval (CI) 0.62-1.11; P=0.22.Biodegradable polymer DES had similar rates of definite ST (RR 0.94,95% CI 0.66-1.33,P=0.72),mortality (RR 0.94,95% C/0.82-1.09,P=0.43),MI (RR 1.08,95% CI 0.92-1.26.P=0.35),MACE (RR 0.99,95% CI 0.91-1.09,P=0.85),and TLR (RR,0.94,95% CI 0.83-1.06,P=0.30) compared with durable polymer DES.Based on the stratified analysis of the included trials,the treatment effect on definite ST was different at different follow-up times:≤1 year favoring durable polymer DES and >1 year favoring biodegradable polymer DES.Conclusions Biodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES.Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.

  20. Inflammation in coronary artery diseases

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun

    2011-01-01

    The concept that atherosclerosis is an inflammation has been increasingly recognized,and subsequently resulted in great interest in revealing the inflammatory nature of the atherosclerotic process.More recently,a large body of evidence has supported the idea that inflammatory mechanisms play a pivotal role throughout all phases of atherogenesis,from endothelial dysfunction and the formation of fatty streaks to plaque destabilization and the acute coronary events due to vulnerable plaque rupture.Indeed,although triggers and pathways of inflammation are probably multiple and vary in different clinical entities of atherosclerotic disorders,an imbalance between anti-inflammatory mechanisms and pro-inflammatory factors will result in an atherosclerotic progression.Vascular endothelial dysfunction and lipoprotein retention into the arterial intima have been reported as the earliest events in atherogenesis with which inflammation is linked.Inflammatory has also been extended to the disorders of coronary microvasculature,and associated with special subsets of coronary artery disease such as silent myocardial ischemia,myocardial ischemia-reperfusion,cardiac syndrome X,variant angina,coronary artery ectasia,coronary calcification and in-stent restenosis.Inflammatory biomarkers,originally studied to better understand the pathophysiology of atherosclerosis,have generated increasing interest among researches and clinicians.The identification of inflammatory biomarkers and cellular/molecular pathways in atherosclerotic disease represent important goals in cardiovascular disease research,in particular with respect of the development of therapeutic strategies to prevent or reverse atherosclerotic diseases.

  1. Revascularisation versus medical treatment in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Windecker, Stephan; Stortecky, Stefan; Stefanini, Giulio G;

    2014-01-01

    OBJECTIVE: To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN: Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials ...

  2. Could Peripheral Arterial Disease Be Your Problem?

    Science.gov (United States)

    ... exercise and yoga classes and has returned to teaching. Fast Facts Peripheral arterial disease (P.A.D.) occurs when a fatty material called plaque (pronounced plak) builds up on the inside walls of the arteries that carry blood from ...

  3. Clinical Trials in Peripheral Vascular Disease: Pipeline and Trial Designs: An Evaluation of the ClinicalTrials.gov Database

    Science.gov (United States)

    Subherwal, Sumeet; Patel, Manesh R.; Chiswell, Karen; Tidemann-Miller, Beth A.; Jones, W. Schuyler; Conte, Michael S.; White, Christopher J.; Bhatt, Deepak L.; Laird, John R.; Hiatt, William R.; Tasneem, Asba; Califf, Robert M.

    2014-01-01

    Background Tremendous advances have occurred in therapies for peripheral vascular disease (PVD); however, until recently it has not been possible to examine the entire clinical trial portfolio of studies for treatment of PVD (both arterial and venous disease). Methods and Results We examined interventional trials registered in ClinicalTrials.gov from October 2007 through September 2010 (n=40,970) and identified 676 (1.7%) PVD trials (n=493 arterial only, n=170 venous only, n=13 both arterial and venous). Most arterial studies investigated lower extremity peripheral artery disease and acute stroke (35% and 24%, respectively), while most venous studies examined deep vein thrombosis/pulmonary embolus prevention (42%) or venous ulceration (25%). A placebo-controlled trial design was used in 27% of the PVD trials, and 4% of the PVD trials excluded patients aged >65 years. Enrollment in at least 1 US site decreased from 51% in 2007 to 41% of trials in 2010. Compared with non-cardiology disciplines, PVD trials were more likely to be double-blinded, investigate use of devices and procedures, and have industry sponsorship and assumed funding source, and less likely to investigate drug and behavioral therapies. Geographic access to PVD clinical trials within the United States is limited to primarily large metropolitan areas. Conclusions PVD studies represent a small group of trials registered in ClinicalTrials.gov, despite the high prevalence of vascular disease in the general population. This low number, compounded by the decreasing number of PVD trials in the United States, is concerning and may limit the ability to inform current clinical practice of patients with PVD. PMID:25239436

  4. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial

    DEFF Research Database (Denmark)

    Fox, Kim; Ford, Ian; Steg, P Gabriel

    2008-01-01

    BACKGROUND: Ivabradine specifically inhibits the I(f) current in the sinoatrial node to lower heart rate, without affecting other aspects of cardiac function. We aimed to test whether lowering the heart rate with ivabradine reduces cardiovascular death and morbidity in patients with coronary artery......, double-blind, placebo-controlled, parallel-group trial. 5479 patients received 5 mg ivabradine, with the intention of increasing to the target dose of 7.5 mg twice a day, and 5438 received matched placebo in addition to appropriate cardiovascular medication. The primary endpoint was a composite.......9) beats per minute (bpm). Median follow-up was 19 months (IQR 16-24). Ivabradine reduced heart rate by 6 bpm (SE 0.2) at 12 months, corrected for placebo. Most (87%) patients were receiving beta blockers in addition to study drugs, and no safety concerns were identified. Ivabradine did not affect...

  5. Dual anterior descending coronary artery associated with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Siqueira Luciane da L. V.

    2003-01-01

    Full Text Available The patient is a male with risk factors for coronary artery disease, who was referred for cardiac catheterization after acute myocardial infarction in the inferior wall. The patient underwent transluminal coronary angioplasty in the right coronary artery with successful stent implantation.

  6. Intracranial Large Artery Occlusive Disease

    Institute of Scientific and Technical Information of China (English)

    Wong KS; Li H; Kay R

    2000-01-01

    @@Intracranial large artery stenosis is the most commonly found vascular lesion in stroke patient of Chinese, Hispanic and African ancestry. There .have been few studies on the epidemiology, pathophysiology, treatment and prognosis of this important disease. Recent advances in technology provide safe and reliable investigation for studying large number of patients. Transcranial Doppler is an easily accessible, cheap and reliable method to diagnose intracranial stenosis. It is suitable for screening for and monitoring the progress of intracranial stenosis. Magnetic resonance angiography and CT angiography provide the morphology of lumenal stenosis but are less accessible.

  7. Peripheral Arterial Disease (P.A.D.)

    Science.gov (United States)

    ... page please turn Javascript on. Peripheral Artery Disease (P.A.D.) What is P.A.D.? Arteries Clogged With Plaque Peripheral arterial ... Escape (Esc) button on your keyboard.) Why Is P.A.D. Dangerous? Click for more information Blocked ...

  8. Left Coronary Artery-Pulmonary Artery Fistula in Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Orhan Veli Doğan

    2012-08-01

    Full Text Available Coroner artery fistula which is rare and congenital or acquired arise from whole coroner artery drainage all of cardiac chamber and great artery. Although coroner artery fistula is uncommon, it can cause significant mortality and morbidity rates. The article is presented which coroner artery disease and coroner-pulmonary artery fistula was accomplishment committed. Sixty three year-old male patient admitted to the hospital with chest pain. Non-ST myocardial infarction was diagnosed in the examinations. After coroner angiography, it was found coronary artery disease in addition between LAD proximal portion and main pulmonary artery fistula. Fistula repair and coronary bypass were performed successfully under cardiopulmonary bypass. Without hemodynamic problem in intensive care and service follow-up, the patient was discharged from the hospital in the seventh postoperative day. We think that surgical treatment of coronary fistulas in patients with coronary artery lesion is done at the earliest time would enable improvement in mortality and morbidity rates.

  9. [New trial designs and potential therapies for pulmonary artery hypertension].

    Science.gov (United States)

    Gomberg-Maitland, Mardi; Bull, Todd M; Saggar, Rajeev; Barst, Robyn J; Elgazayerly, Amany; Fleming, Thomas R; Grimminger, Friedrich; Rainisio, Maurizio; Stewart, Duncan J; Stockbridge, Norman; Ventura, Carlo; Ghofrani, Ardeschir H; Rubin, Lewis J

    2014-10-01

    A greater understanding of the epidemiology, pathogenesis, and pathophysiology of pulmonary artery hypertension (PAH) has led to significant advances, but the disease remains fatal. Treatment options are neither universally available nor always effective, underscoring the need for development of novel therapies and therapeutic strategies. Clinical trials to date have provided evidence of efficacy, but were limited in evaluating the scope and duration of treatment effects. Numerous potential targets in varied stages of drug development exist, in addition to novel uses of familiar therapies. The pursuit of gene and cell-based therapy continues, and device use to help acute deterioration and chronic management is emerging. This rapid surge of drug development has led to multicenter pivotal clinical trials and has resulted in novel ethical and global clinical trial I concerns. This paper will provide an overview of the opportunities and challenges that await the development of novel treatments for PAH. (J Am Coil Cardiol 2013;62:D82-91) ©2013 by the American College of Cardiology Foundation.

  10. Genetics of Coronary Artery Disease

    DEFF Research Database (Denmark)

    McPherson, Ruth; Tybjærg-Hansen, Anne

    2016-01-01

    Genetic factors contribute importantly to the risk of coronary artery disease (CAD), and in the past decade, there has been major progress in this area. The tools applied include genome-wide association studies encompassing >200,000 individuals complemented by bioinformatic approaches, including...... factors and identify those individuals who will benefit most from statin therapy. Such information also has important applications in clinical medicine and drug discovery by using a Mendelian randomization approach to interrogate the causal nature of many factors found to associate with CAD risk...... have led to a broader understanding of the genetic architecture of CAD and demonstrate that it largely derives from the cumulative effect of multiple common risk alleles individually of small effect size rather than rare variants with large effects on CAD risk. Despite this success, there has been...

  11. [Risk factors for arterial disease].

    Science.gov (United States)

    Madoery, Roberto; Rubin, Graciela; Luquez, Hugo; Luquez, Cecilia; Cravero, Cecilia

    2004-01-01

    The risk factors of arterial disease (FREA) predict a future damage over the vascular system of the human body. Its detection are considered a key for the diagnostic as well as for the preventive and even curative strategies. For a long time, scientist considered those factors originated as a consecuence of large studies during the middle of the last century, with current validity up to our days. A simple classification spoke of them as traditionals. Further investigations described the so called new or emergents.factors that where joint together accordingly to their actions: coagulation factors, psicosocial, inflamatories and infectious. A recent classification, taking into account the type of impact, divided them into; causatives, predisposals and conditionals. Also, it was described a mechanism, the oxidative power, with consecuences over the endothelium, in the last part of the process. Before, another mechanism was described: the insulin resistance and the hiperinsulinism, bases for the Metabolic Syndrome, that includes a number of traditional risk factors.

  12. Revascularisation versus medical treatment in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Windecker, Stephan; Stortecky, Stefan; Stefanini, Giulio G;

    2014-01-01

    OBJECTIVE: To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN: Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials...... stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. DATA SOURCES: Medline and Embase from 1980......: Among patients with stable coronary artery disease, coronary artery bypass grafting reduces the risk of death, myocardial infarction, and subsequent revascularisation compared with medical treatment. All stent based coronary revascularisation technologies reduce the need for revascularisation...

  13. Gene therapy and angiogenesis in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Kastrup, Jens

    2010-01-01

    -blind placebo-controlled trials could not confirm the initial high efficacy of either the growth factor protein or the gene therapy approaches observed in earlier small trials. The clinical studies so far have all been without any gene-related serious adverse events. Future trials will focus on whether...... an improvement in clinical results can be obtained with a cocktail of growth factors or by a combination of gene and stem cell therapy in patients with severe coronary artery disease, which cannot be treated effectively with current treatment strategies....... of VEGF and FGF in patients with coronary artery disease. The initial small and unblinded studies with either recombinant growth factor proteins or genes encoding growth factors were encouraging, demonstrating both clinical improvement and evidence of angiogenesis. However, subsequent larger double...

  14. Screening asymptomatic patients with diabetes for unknown coronary artery disease: Does it reduce risk? An open-label randomized trial comparing a strategy based on exercise testing aimed at revascularization with management based on pharmacological/behavioural treatment of traditional risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be Diagnosed and treated early in Diabetics?

    Directory of Open Access Journals (Sweden)

    Romano Stefania

    2009-12-01

    Full Text Available Abstract Background Coronary artery disease is the leading cause of morbidity and mortality in patients with type 2 diabetes. Screening for asymptomatic coronary artery disease with treatment by means of revascularization seems to be an appealing option for prevention. The utility of such a strategy has never been challenged in a randomized trial. Methods/Design In the present study a cohort of diabetic patients without any symptoms and without known coronary artery disease will be screened at two diabetes outpatients services. Those with intermediate or high risk (equal or greater than 10% according to the Italian risk chart will be asked to participate and enrolled. They will be seen and followed in order to provide the best adherence to medical therapy. Half of the patients will be randomized to undergo an exercise tolerance testing while the other group will continue to be regularly seen at diabetes outpatients services. Best medical/behavioral therapy will be offered to both groups. Those patients with a positive exercise tolerance testing will be studied by coronary angiography and treated according to the severity of coronary lesions by percutaneous stenting or surgery. The objective of the study is to evaluate the efficacy of the screening strategy aimed at revascularization. A cost-effectiveness analysis will be performed at the end of the follow up. Discussion The study will provide useful information about prevention and treatment of diabetic patients at high risk of coronary events. It will be made clearer if detection of silent coronary artery disease has to be recommended and followed by treatment. Given the simplicity of the study protocol, it will be easily transferable to the real world. Trial registration (ClinicalTrials.gov: NCT00547872

  15. The history of surgical treatment for occlusive carotid artery diseases

    Directory of Open Access Journals (Sweden)

    Ding-biao ZHOU

    2014-01-01

    Full Text Available In this article, the history of surgical treatment for occlusive carotid artery diseases is briefly reviewed. It is emphasized that, after the results of large cohort, multicenter, randomized clinical trials, including North American Symptomatic Carotid Endarterectomy Trial (NASCET and European Carotid Surgery Trial (ECST, were reported in 1991, the important role of carotid endarterectomy (CEA for the surgical treatment of carotid atherosclerosis had already been confirmed. Although it has a late start in China, CEA has a bright and promising future.

  16. Ischemic stroke: carotid and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, P.; Goulao, A. [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

    2005-03-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

  17. Segmented Coronary Artery Aneurysms and Kawasaki Disease

    Directory of Open Access Journals (Sweden)

    Hamid Reza Ghaemi

    2011-05-01

    Full Text Available Kawasaki disease (KD is an acute vasculitis syndrome of unknown etiology. It occurs in infants and young children,affecting mainly small and medium-sized arteries, particularly the coronary arteries. Generalized microvasculitis occurs in the first 10 days, and the inflammation persists in the walls of medium and small arteries, especially the coronary arteries, and changes to coronary artery aneurysms.We report the case of a 10-month-old girl referred to our center three months after the onset of disease due to the aneurysmsof the coronary arteries. During the acute phase of her illness, she received 2 gr/kg intravenous gamma globulin; and afterher referral to us, the patient was treated by antiaggregant doses of acetylsalicylic acid (ASA (5 mg/kg and Warfarin (1 mg/daily. At three months’ follow-up, the aneurysms still persisted in the echocardiogram.

  18. Gene therapy and angiogenesis in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Kastrup, Jens

    2010-01-01

    Not all patients with severe coronary artery disease can be treated satisfactorily with current recommended medications and revascularization techniques. Various vascular growth factors have the potential to induce angiogenesis in ischemic tissue. Clinical trials have only evaluated the effect...... of VEGF and FGF in patients with coronary artery disease. The initial small and unblinded studies with either recombinant growth factor proteins or genes encoding growth factors were encouraging, demonstrating both clinical improvement and evidence of angiogenesis. However, subsequent larger double...... an improvement in clinical results can be obtained with a cocktail of growth factors or by a combination of gene and stem cell therapy in patients with severe coronary artery disease, which cannot be treated effectively with current treatment strategies....

  19. Arterial hypertension and chronic liver disease

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, S

    2005-01-01

    This review looks at the alterations in the systemic haemodynamics of patients with chronic liver disease (cirrhosis) in relation to essential hypertension and arterial hypertension of renal origin. Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic...... the development of chronic liver disease, and arterial hypertension is rarely manifested in patients with cirrhosis, even in those with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial...

  20. Common genetic loci influencing plasma homocysteine concentrations and their effect on risk of coronary artery disease

    NARCIS (Netherlands)

    Meurs, van J.B.J.; Pare, G.; Schwartz, S.M.; Hazra, A.; Tanaka, T.; Vermeulen, S.H.; Cotlarciuc, I.; Yuan, X.; Malarstig, A.; Bandinelli, S.; Bis, J.C.; Morn, H.; Brown, M.J.; Chen, C.; Chen, Y.D.; Clarke, R.J.; Dehghan, A.; Erdmann, J.; Ferrucci, L.; Hamsten, A.; Hofman, A.; Hunten, D.J.; Goel, A.; Johnson, A.D.; Kathiresan, S.; Kampman, E.; Kiel, D.P.; Kiemeney, L.A.; Chambers, J.C.; Kraft, P.; Lindemans, J.; McKnight, B.; Nelson, C.P.; O'Donnell, C.J.; Psaty, B.M.; Ridken, P.M.; Rivadeneira, F.; Rose, L.M.; Seedoif, U.; Siscovick, D.S.; Schunkert, H.; Selhub, J.; Ueland, P.M.; Vollenweiden, P.; Waeben, G.; Waterworth, D.M.; Watkins, H.; Witteman, J.C.M.; Heijen, den M.; Jacques, P.; Uitterlinden, A.G.; Koonet, J.S.; Rader, D.J.; Reilly, M.P.; Moose, V.; Chasman, D.I.; Samani, N.J.; Ahmadi, K.R.

    2013-01-01

    Background: The strong observational association between total homocysteine (tHcy) concentrations and risk of coronary artery disease (CAD) and the null associations in the homocysteinelowering trials have prompted the need to identify genetic variants associated with homocysteine concentrations and

  1. Patterns of disease distribution of lower extremity peripheral arterial disease.

    Science.gov (United States)

    Chen, Qian; Shi, Yang; Wang, Yutang; Li, Xiaoying

    2015-03-01

    Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis that is associated with an increased risk of mortality and cardiovascular (CV) events. Peripheral arterial disease involves the arteries distal to the aortic bifurcation in a nonuniform manner. Studies have shown that symptoms and prognosis of patients with PAD vary according to the location and size of the affected artery. Several modalities have been used to identify the location of PAD, including noninvasive evaluations and invasive procedures. Peripheral arterial disease has a risk factor profile similar to that associated with coronary artery disease (ie, age, gender, diabetes, smoking, hypertension, and hyperlipidemia). Many studies have shown that the distribution, extent, and progression of PAD are influenced by CV risk factors but the findings are not consistent. Management strategies for PAD are different for proximal and distal PAD. The objective of this review is to discuss the patterns of diseases distribution in patients with PAD.

  2. Acoustic detection of coronary artery disease.

    Science.gov (United States)

    Semmlow, John; Rahalkar, Ketaki

    2007-01-01

    Coronary artery disease (CAD) occurs when the arteries to the heart (the coronary arteries) become blocked by deposition of plaque, depriving the heart of oxygen-bearing blood. This disease is arguably the most important fatal disease in industrialized countries, causing one-third to one-half of all deaths in persons between the ages of 35 and 64 in the United States. Despite the fact that early detection of CAD allows for successful and cost-effective treatment of the disease, only 20% of CAD cases are diagnosed prior to a heart attack. The development of a definitive, noninvasive test for detection of coronary blockages is one of the holy grails of diagnostic cardiology. One promising approach to detecting coronary blockages noninvasively is based on identifying acoustic signatures generated by turbulent blood flow through partially occluded coronary arteries. In fact, no other approach to the detection of CAD promises to be as inexpensive, simple to perform, and risk free as the acoustic-based approach. Although sounds associated with partially blocked arteries are easy to identify in more superficial vessels such as the carotids, sounds from coronary arteries are very faint and surrounded by noise such as the very loud valve sounds. To detect these very weak signals requires sophisticated signal processing techniques. This review describes the work that has been done in this area since the 1980s and discusses future directions that may fulfill the promise of the acoustic approach to detecting coronary artery disease.

  3. Evaluation of Peripheral Arterial Disease in Prediabetes

    Directory of Open Access Journals (Sweden)

    Elham Faghihimani

    2014-01-01

    Conclusions: Peripheral arterial disease is common in asymptomatic diabetes and prediabetes patients. Management of hypertensive prediabetes patients and early detection of PAD in this group as well as in asymptomatic patients is important.

  4. Adventitial cystic disease of the axillary artery.

    Science.gov (United States)

    Elster, Eric A; Hewlett, Stanley; DeRienzo, Damian P; Donovan, Sean; Georgia, Jeff; Yavorski, Chester C

    2002-01-01

    Adventitial cystic disease (ACD) is an extremely rare cause of arterial and venous insufficiency, with only 317 reported cases in the world literature. These lesions have been previously described in the popliteal fossa, external iliac artery, and distal brachial, radial, and ulnar arteries as well as in the proximal saphenous vein at the ankle. We describe here the first reported case of this disease in a proximal vessel, the axillary artery. A 33-year-old man was evaluated for upper extremity arterial insufficiency and was diagnosed with ACD on the basis of physical examination and radiographic findings, which was confirmed by pathological assessment. The patient was treated by excision of the lesion and interposition vein bypass. As this represents the first case of ACD in the proximal vasculature, it demonstrates that these lesions can occur in axial blood vessels.

  5. Four-year clinical follow-up of the ABSORB everolimus-eluting bioresorbable vascular scaffold in patients with de novo coronary artery disease: The ABSORB trial

    NARCIS (Netherlands)

    D. Dudek (Dariusz); Y. Onuma (Yoshinobu); J.A. Ormiston (John); L. Thuesen (Leif); K. Miquel-Hébert (Karine); P.W.J.C. Serruys (Patrick)

    2012-01-01

    textabstractAims: The first-in-man ABSORB Cohort A trial demonstrated the bioresorption of the ABSORB BVS (Abbott Vascular, Santa Clara, CA, USA) at two years. This report describes the 4-year clinical outcomes. Methods and results: The ABSORB Cohort A trial enrolled 30 patients with a single de nov

  6. Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Trial.

    Science.gov (United States)

    da Silva Guimarães, Sheila; de Souza Cruz, Wanise; da Silva, Licinio; Maciel, Gabrielle; Huguenin, Ana Beatriz; de Carvalho, Monicque; Costa, Bárbara; da Silva, Geisiane; da Costa, Carlos; D'Ippolito, João Alvaro; Colafranceschi, Alexandre; Scalco, Fernanda; Boaventura, Gilson

    2017-03-25

    During cardiac failure, cardiomyocytes have difficulty in using the substrates to produce energy. L-carnitine is a necessary nutrient for the transport of fatty acids that are required for generating energy. Coronary artery graft surgery reduces the plasma levels of L-carnitine and increases the oxidative stress. This study demonstrates the effect of L-carnitine supplementation on the reverse remodeling of patients undergoing coronary artery bypass graft. Patients with ischemic heart failure who underwent coronary graft surgery were randomized to group A - supplemented with L-carnitine or group B controls. Left ventricular ejection fraction, left ventricular systolic and diastolic diameters were assessed preoperatively, 60 and 180 days after surgery. Our study included 28 patients (26 [93.0%] males) with a mean age ± SD of 58.1 ± 10.5 years. The parameters for the evaluation of reverse remodeling did not improve after 60 and 180 days of coronary artery bypass grafting in comparison between groups (p > 0.05). Evaluation within the L-carnitine group showed a 37.1% increase in left ventricle ejection fraction (p = 0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and diastolic diameters, respectively. L-carnitine supplementation at a dose of 50 mg/kg combined with artery bypass surgery did not demonstrate any additional benefit in reverse remodeling. However, evaluation within the L-carnitine group may indicate a clinical benefit of L-carnitine supplementation.

  7. Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease

    Science.gov (United States)

    Ohba, Keisuke; Sugiyama, Seigo; Sumida, Hitoshi; Nozaki, Toshimitsu; Matsubara, Junichi; Matsuzawa, Yasushi; Konishi, Masaaki; Akiyama, Eiichi; Kurokawa, Hirofumi; Maeda, Hirofumi; Sugamura, Koichi; Nagayoshi, Yasuhiro; Morihisa, Kenji; Sakamoto, Kenji; Tsujita, Kenichi; Yamamoto, Eiichiro; Yamamuro, Megumi; Kojima, Sunao; Kaikita, Koichi; Tayama, Shinji; Hokimoto, Seiji; Matsui, Kunihiko; Sakamoto, Tomohiro; Ogawa, Hisao

    2012-01-01

    events over 47.8±27.5 months. Conclusions Microvascular CAS causes distinctive clinical features and endothelial dysfunction that are important to recognize as nonobstructive coronary artery disease so that optimal care with calcium channel blockers can be provided. Clinical Trial Registration URL: www.umin.ac.jp/ctr. Unique identifier: UMIN000003839. PMID:23316292

  8. Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: A meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II, and SoS trials

    NARCIS (Netherlands)

    J. Daemen (Joost); H. Boersma (Eric); M. Flather (Marcus); J. Booth (Jean); R.H. Stables (Rodney); A. Rodriguez (Alfredo Chapin); G.A. Rodriguez-Granillo (Gaston); W.A. Hueb (Whady Armindo); P.A. Lemos Neto (Pedro); P.W.J.C. Serruys (Patrick)

    2008-01-01

    textabstractBackground - Randomized trials that studied clinical outcomes after percutaneous coronary intervention (PCI) with bare metal stenting versus coronary artery bypass grafting (CABG) are underpowered to properly assess safety end points like death, stroke, and myocardial infarction. Pooling

  9. Moyamoya disease associated with an anterior inferior cerebellar artery arising from a persistent trigeminal artery

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A.; Sawada, A.; Takase, Y.; Kudo, S. [Department of Radiology, Saga Medical School, 5-1-1, Nabeshima, Saga, 849-8501 (Japan); Koizumi, T. [Department of Neurosurgery, Saga Medical School, 5-1-1, Nabeshima, Saga, 849-8501 (Japan)

    2002-07-01

    The authors present a case of moyamoya disease associated with a persistent trigeminal artery from which the anterior inferior cerebellar artery arose. We reviewed previously reported cases of moyamoya disease associated with persistent carotid-basilar arterial anastomosis and investigated the embryology of this rare arterial variation. (orig.)

  10. The role of coronary artery disease in heart failure.

    Science.gov (United States)

    Lala, Anuradha; Desai, Akshay S

    2014-04-01

    Enhanced survival following acute myocardial infarction and the declining prevalence of hypertension and valvular heart disease as contributors to incident heart failure (HF) have fueled the emergence of coronary artery disease (CAD) as the primary risk factor for HF development. Despite the acknowledged role of CAD in the development of HF, the role of coronary revascularization in reducing HF-associated morbidity and mortality remains controversial. The authors review key features of the epidemiology and pathophysiology of CAD in patients with HF as well as the emerging data from recent clinical trials that inform the modern approach to management.

  11. Psychosocial Complications of Coronary Artery Disease

    OpenAIRE

    Karimi-Moonaghi, Hossein; Mojalli, Mohammad; Khosravan, Shahla

    2014-01-01

    Background: Cardiovascular diseases are the leading causes of death around the world. The coronary artery disease (CAD) is one of the most common diseases in this category, which can be the trigger to various psychosocial complications. We believe that inadequate attention has been paid to this issue. Objectives: The purpose of the present study was to explore the psychosocial complications of CAD from the Iranian patients’ perspective. Patients and Methods: A qualitative design based on the ...

  12. Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65-74 years from a population screening study (VIVA trial)

    DEFF Research Database (Denmark)

    Grøndal, Nikolaj Fibiger; Søgaard, Rikke; Lindholt, Jes S.

    2015-01-01

    treatment was initiated in 34·8 per cent of the participants. CONCLUSION: Preventive actions were started in one-third of the attenders. The long-term effect of this on morbidity and mortality is an important part of future analysis. The trial confirms that the prevalence of AAA in Denmark has decreased...

  13. Bioresorbable scaffolds in the treatment of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2013-03-01

    Full Text Available Yaojun Zhang,1,2 Christos V Bourantas,1 Vasim Farooq,1 Takashi Muramatsu,1 Roberto Diletti,1 Yoshinobu Onuma,1 Hector M Garcia-Garcia,1 Patrick W Serruys11Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; 2Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of ChinaAbstract: Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.Keywords: bioresorbable scaffold, drug-eluting stent, biodegradable, design, mechanism, coronary artery disease

  14. Ivabradine in stable coronary artery disease without clinical heart failure

    DEFF Research Database (Denmark)

    Fox, Kim; Ford, Ian; Steg, Philippe Gabriel

    2014-01-01

    BACKGROUND: An elevated heart rate is an established marker of cardiovascular risk. Previous analyses have suggested that ivabradine, a heart-rate-reducing agent, may improve outcomes in patients with stable coronary artery disease, left ventricular dysfunction, and a heart rate of 70 beats per...... minute or more. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of ivabradine, added to standard background therapy, in 19,102 patients who had both stable coronary artery disease without clinical heart failure and a heart rate of 70 beats per minute or more (including 12......,049 patients with activity-limiting angina [class ≥II on the Canadian Cardiovascular Society scale, which ranges from I to IV, with higher classes indicating greater limitations on physical activity owing to angina]). We randomly assigned patients to placebo or ivabradine, at a dose of up to 10 mg twice daily...

  15. Long-term outcome in patients treated with sirolimus-eluting stents in complex coronary artery lesions: 3-year results of the SCANDSTENT (Stenting Coronary Arteries in Non-Stress/Benestent Disease) trial

    DEFF Research Database (Denmark)

    Kelbaek, H.; Klovgaard, L.; Helqvist, S.;

    2008-01-01

    data of the long-term outcome of patients with complex coronary artery lesions. METHODS: We randomly assigned 322 patients with total coronary occlusions or lesions located in bifurcations, ostial, or angulated segments of the coronary arteries to have SES or BMS implanted. RESULTS: At 3 years, major...... performed between 1 and 3 years after the index treatment (p = NS). According to revised definitions, stent thrombosis occurred in 5 patients (3.1%) in the SES group and in 7 patients (4.4%) in the BMS group (p = NS); very late stent thrombosis was observed in 4 versus 1 patient. CONCLUSIONS: A continued...

  16. Testosterone and coronary artery disease.

    Science.gov (United States)

    Schwarcz, Monica D; Frishman, William H

    2010-01-01

    Cardiovascular disease remains the leading cause of death in most of the developed world despite advances in both prevention and treatment. At the same time, the incidence rates of cardiovascular disease differ greatly between the genders, with men more likely than women to manifest ischemic heart disease. This observation has prompted new research initiatives to explain the discrepancy in heart disease prevalence and incidence between the sexes. Whether androgens affect cardiovascular disease adversely remains a contentious issue, with some data pointing to a deleterious effect of androgens on lipid profiles, and other studies revealing androgens' possible benefits on cardiovascular function. This review will examine the relationship between the endogenous production of androgen as well as the exogenous replacement of testosterone in men and the possible links to cardiovascular disease. The role of testosterone in male cardiovascular health is not completely understood, and additional studies are needed to explain its effect on atherosclerosis and its complications.

  17. Noninvasive evaluation of peripheral arterial disease.

    Science.gov (United States)

    Barnes, R W

    1978-08-01

    Doppler ultrasound is the most simple, inexpensive, accurate and versatile of the available noninvasive screening techniques to assess peripheral vascular diseases. The four fundamental components of peripheral arterial evaluation with this technique are assessment of blood velocity signal, measurement of resting ankle pressure, determination of segmental leg blood pressures, and measurement of ankle pressure response to exercise or reactive hyperemia. Plethysmography permits graphic recording of pulse-wave morphology, determination of digit blood pressure, and pulsatile responses to compression maneuvers. These techniques are useful in objectively quantifying peripheral arterial occlusive disease, predicting the results of operative therapy, monitoring the success of arterial reconstruction during surgery, and following the physiologic status of the patient after surgery.

  18. Distal arterial occlusive disease in diabetes is related to medial arterial calcification.

    Science.gov (United States)

    Chantelau, E; Lee, K M; Jungblut, R

    1997-01-01

    In diabetes mellitus, peripheral arterial occlusive disease predominantly affects the lower leg (tibial and peroneal vessel disease). Our study suggests that this feature is related to the presence of forefoot medial arterial calcification.

  19. Carotid artery stenting in patients with coexistent carotid and coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    LUO Jian-fang; HUANG Wen-hui; WANG Shuo; DAI Cheng-bo; LI Guang; CHEN Ji-yan; ZHOU Ying-ling; WANG Li-juan

    2007-01-01

    @@ Atherosclerotic disease, as a systemic process, affects all arteries to varying degrees. In particular,coexistent carotid and coronary artery diseases are common; Management of such patients has been a point of continuing controversy.

  20. Haemodynamic evaluation of carotid artery disease

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T

    1989-01-01

    evaluating therapeutic modalities or natural history of carotid artery disease should therefore include a test capable of assessing cerebral haemodynamics. However, most studies, invasive as well as non-invasive, have focused on the ability of the test to diagnose the ICA lesions itself, rather than...

  1. Beneficial effects on arterial stiffness and pulse-wave reflection of combined enalapril and candesartan in chronic kidney disease--a randomized trial

    DEFF Research Database (Denmark)

    Frimodt-Møller, Marie; Kamper, Anne-Lise; Strandgaard, Svend

    2012-01-01

    Cardiovascular disease (CVD) is highly prevalent in patients with chronic kidney disease (CKD). Inhibition of the renin-angiotensinsystem (RAS) in hypertension causes differential effects on central and brachial blood pressure (BP), which has been translated into improved outcome. The objective...

  2. Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease

    Science.gov (United States)

    Patel, Manesh R.; Conte, Michael S.; Cutlip, Donald E.; Dib, Nabil; Geraghty, Patrick; Gray, William; Hiatt, William R.; Ho, Mami; Ikeda, Koji; Ikeno, Fumiaki; Jaff, Michael R.; Jones, W. Schuyler; Kawahara, Masayuki; Lookstein, Robert A.; Mehran, Roxana; Misra, Sanjay; Norgren, Lars; Olin, Jeffrey W.; Povsic, Thomas J.; Rosenfield, Kenneth; Rundback, John; Shamoun, Fadi; Tcheng, James; Tsai, Thomas T.; Suzuki, Yuka; Vranckx, Pascal; Wiechmann, Bret N.; White, Christopher J.; Yokoi, Hiroyoshi; Krucoff, Mitchell W.

    2016-01-01

    The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease. PMID:25744011

  3. Withholding or Continuing Beta-Blocker Treatment Before Dipyridamole Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease? a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Babak Fallahi

    2013-01-01

    Full Text Available Although it has been shown that acute beta-blocker administration may reduce the presence or severity of myocardial perfusion defects with dipyridamole stress, little information is available about the potential effect of chronic beta-blocker treatment on the sensitivity of dipyridamole myocardial perfusion imaging (DMPI.Methods As a randomized clinical trial, one hundred twenty patients (103 male and 17 female with angiographically confirmed CAD who were on long-term beta blocker therapy ([greater than or equal to]3 months enrolled in a randomized clinical trial study. The patients were allocated into two groups: Group A (n=60 in whom the beta-blocker agent was discontinued for 72h before DMPI and Group B (n=60 without discontinuation of beta-blockers prior to DMPI.ResultsNo significant difference was noted between the groups concerning age, sex, type of the injected radiotracer and number of involved coronary vessels. The mean rank of total perfusion scores for whole myocardium (irrespective of reversibility or irreversibility in group B was not significantly different from that of group A, (65.75 vs. 55.25, P=0.096. Regarding the only irreversible perfusion defects, the mean rank of perfusion score in group B was higher than that of group A for whole myocardium (72 vs. 49, P=0.0001; however, no difference was noted between two groups for only reversible perfusion defects (61.0 vs. 60.0, P=0.898. The overall sensitivity of DMPI for the diagnosis of CAD in group A (91.7% was not statistically different from group B (90%.ConclusionBeta-blocker withholding before DMPI did not generally affect the sensitivity of the test for the diagnostic purposes in our study. Thus, beta-blocker withdrawal for just the purpose of diagnostic imaging is not mandatory particularly when medication discontinuation may cause the patients to face increased risk of heart events.

  4. PERIPHERAL ARTERIAL DISEASE IN THE LEG

    Directory of Open Access Journals (Sweden)

    Nair P

    2014-09-01

    Full Text Available INTRODUCTION: Peripheral arterial disease (PAD is a condition characterized by atherosclerotic occlusive disease of the lower extremities. While PAD is a major risk factor for lower-extremity amputation, it is also accompanied by a high likelihood for symptomatic cardiovascular and cerebrovascular disease. Atherosclerosis accounts for more than 90% of cases of PAD, and uncommon vascular syndromes account for the remaining 10%. The femoral and popliteal arteries are affected in 80% to 90% of symptomatic PAD patients, the tibial and peroneal arteries in 40% to 50%, and the aortoiliac arteries in 30%.Although 65–75% of patients with PAD are asymptomatic, the classic presenting symptom is usually described as muscle cramps, fatigue or pain in the lower legs induced by exercise and rapidly relieved by rest; often the symptom location indicates the level of arterial involvement. RISK FACTORS: Diabetes and smoking are the strongest risk factors for PAD. Other well-known risk factors are advanced age, hypertension, and hyperlipidemia. DIAGNOSIS: PAD can be easily and accurately diagnosed by calculating the ankle-brachial index (ABI.The ABI is defined as the ratio of the systolic blood pressure in the ankle divided by the systolic blood pressure at the arm. The tools required to perform the ABI measurement include a hand-held 5–10 MHz Doppler probe and a blood pressure cuff. MANAGEMENT: Most patients' symptoms improve with optimal medical treatment and invasive intervention is often not required. Smoking cessation and exercise are considered the two most important treatments for PAD. CONCLUSION: Symptomatic PAD often impairs a patient's quality of life and untreated disease can lead to limb loss. Aggressive management of atherosclerotic risk factors, a structured exercise program, use of antiplatelet agents and when indicated percutaneous or surgical revascularizations are the keys for successful management.

  5. Prevalence of type 2 diabetes is higher in peripheral artery disease than in coronary artery disease patients.

    Science.gov (United States)

    Silbernagel, Guenther; Rein, Philipp; Saely, Christoph H; Engelberger, Rolf P; Willenberg, Torsten; Do, Dai-Do; Kucher, Nils; Baumgartner, Iris; Drexel, Heinz

    2015-03-01

    Type 2 diabetes mellitus and pre-diabetes are risk factors for atherosclerosis and are highly prevalent in patients with coronary artery disease. However, the prevalence of impaired glucose metabolism in patients with peripheral artery disease is not as well elucidated. We aimed at comparing prevalence rates of type 2 diabetes mellitus and pre-diabetes, which were diagnosed according to the current American Diabetes Association criteria, among 364 patients with peripheral artery disease, 529 patients with coronary artery disease and 383 controls. The prevalence of type 2 diabetes mellitus in peripheral artery disease patients was 49.7%. It was significantly higher in these patients than in coronary artery disease patients (34.4%; p disease group with the coronary artery disease group (p disease group with controls (p prevalence of pre-diabetes among non-diabetic subjects was high in all three study groups (64.5% in peripheral artery disease patients, 63.4% in coronary artery disease patients and 61.8% in controls), without significant between-group differences. In conclusion, the prevalence of type 2 diabetes mellitus is even higher in peripheral artery disease patients than in coronary artery disease patients. This observation underlines the need to consider impaired glucose regulation in the management of peripheral artery disease.

  6. Plasma pentraxin 3 levels do not predict coronary events but reflect metabolic disorders in patients with coronary artery disease in the CARE trial.

    Science.gov (United States)

    Miyazaki, Tetsuro; Chiuve, Stephanie; Sacks, Frank M; Ridker, Paul M; Libby, Peter; Aikawa, Masanori

    2014-01-01

    Chronic inflammation closely associates with obesity, metabolic syndrome, diabetes mellitus, and atherosclerosis. Evidence indicates that the immunomodulator pentraxin 3 (PTX3) may serve as a biomarker of these cardiometabolic disorders, but whether PTX3 predicts cardiovascular complications is unknown. We examined the association of plasma PTX3 levels with recurrent coronary events via a prospective, nested, case-control design in the CARE trial. Among 4159 patients who had a prior myocardial infarction 3 to 20 months before enrollment and also had total cholesterol levels metabolic disorders. Low plasma PTX3 levels correlated with high body-mass index, waist circumference, and triglycerides; and with low HDL cholesterol. Overall, PTX3 levels correlated inversely with the number of metabolic syndrome components. PTX3 levels also correlated inversely with apoCIII and tissue plasminogen activator, but did not associate with CRP. Although the study further links low PTX3 levels with various features associated with metabolic syndrome, the results do not indicate that PTX3 can predict recurrent coronary events among MI survivors.

  7. Coronary artery bypass grafting for Kawasaki disease

    Institute of Scientific and Technical Information of China (English)

    GUO Hong-wei; CHANG Qian; XU Jian-ping; SONG Yun-hu; SUN Han-song; HU Sheng-shou

    2010-01-01

    Background Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5±0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months),clincal angina disappeared or improved. Cardiac function was in Class Ⅰ-Ⅱ (NYHA).Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

  8. Peri-procedural use of rivaroxaban in elective percutaneous coronary intervention to treat stable coronary artery disease. The X-PLORER trial.

    Science.gov (United States)

    Vranckx, P; Leebeek, F W G; Tijssen, J G P; Koolen, J; Stammen, F; Herman, J-P R; de Winter, R J; van T Hof, A W J; Backx, B; Lindeboom, W; Kim, S-Y; Kirsch, B; van Eickels, M; Misselwitz, F; Verheugt, F W A

    2015-08-01

    Patients on rivaroxaban requiring percutaneous coronary intervention (PCI) represent a clinical conundrum. We aimed to investigate whether rivaroxaban, with or without an additional bolus of unfractionated heparin (UFH), effectively inhibits coagulation activation during PCI. Stable patients (n=108) undergoing elective PCI and on stable dual antiplatelet therapy were randomised (2:2:2:1) to a short treatment course of rivaroxaban 10 mg (n=30), rivaroxaban 20 mg (n=32), rivaroxaban 10 mg plus UFH (n=30) or standard peri-procedural UFH (n=16). Blood samples for markers of thrombin generation and coagulation activation were drawn prior to and at 0, 0.5, 2, 6-8 and 48 hours (h) after start of PCI. In patients treated with rivaroxaban (10 or 20 mg) and patients treated with rivaroxaban plus heparin, the levels of prothrombin fragment 1 + 2 at 2 h post-PCI were 0.16 [0.1] nmol/l (median) [interquartile range, IQR] and 0.17 [0.2] nmol/l, respectively. Thrombin-antithrombin complex values at 2 h post-PCI were 3.90 [6.8]µg/l and 3.90 [10.1] µg/l, respectively, remaining below the upper reference limit (URL) after PCI and stenting. This was comparable to the control group of UFH treatment alone. However, median values for thrombin-antithrombin complex passed above the URL with increasing tendency, starting at 2 h post-PCI in the UFH-alone arm but not in rivaroxaban-treated patients. In this exploratory trial, rivaroxaban effectively suppressed coagulation activation after elective PCI and stenting.

  9. Study on the screening program and risk factors of carotid artery stenosis with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    李庆祥

    2013-01-01

    Objective The purpose of this research project was to evaluate the relationship and risk factors between coronary artery disease and carotid artery stenosis (CAS) ,screened by duplex ultra-sonography.Methods 1339 patients with coronary artery disease were enrolled into this

  10. Peripheral artery disease of the legs - self-care

    Science.gov (United States)

    Peripheral vascular disease - self-care; Intermittent claudication - self-care ... may prescribe the following medicines to control your peripheral artery disease. DO NOT stop taking these medicines ...

  11. Links between arterial and venous disease.

    Science.gov (United States)

    Prandoni, P

    2007-09-01

    An increasing body of evidence suggests the likelihood of a link between arterial and venous disease. According to the results of recent studies, atherosclerosis and venous thromboembolism (VTE) share common risk factors, including age, obesity, diabetes mellitus and metabolic syndrome. Atherosclerosis has the potential to promote the development of thrombotic disorders in the venous system. Another scenario assumes that the two clinical conditions are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Several recent studies have consistently shown that patients with VTE of unknown origin are at a higher risk of cardiovascular diseases, including atherosclerotic complications, than patients with secondary VTE and matched control individuals. Future studies are needed to clarify the nature of this association, to assess its extent and to evaluate its implications for clinical practice.

  12. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

    Science.gov (United States)

    ... Force Recommendations Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults ... on Screening for Peripheral Artery Disease (PAD) and Cardiovascular Disease (CVD) Risk Assessment with Ankle Brachial Index (ABI) ...

  13. A randomised, double-blind, placebo-controlled, multicentre study of the safety and efficacy of BIOBYPASS (AdGVVEGF121.10NH) gene therapy in patients with refractory advanced coronary artery disease: the NOVA trial

    DEFF Research Database (Denmark)

    Kastrup, Jens; Jørgensen, Erik; Fuchs, Shmuel

    2011-01-01

    Genes encoding vascular endothelial growth factor (VEGF) can potentially augment myocardial perfusion in patients with coronary artery disease (CAD). We conducted a randomised, double-blind, placebo-controlled gene therapy study with the adenovirus carrying VEGF121 (BIOBYPASS [AdGVVEGF121.10NH])....

  14. Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease.The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Investigators

    NARCIS (Netherlands)

    M.T. Roe (Matthew); A. Vahanian (Alec); R.A. Harrington (Robert Alex); D.M. Prosper; K.S. Pieper (Karen); E.J. Topol (Eric); D.L. Bhatt (Deepak); A.M. Lincoff (Michael); M.L. Simoons (Maarten); R.M. Califf (Robert); E.M. Ohman (Magnus); K. Karsch (Karl); M.M. Kitt (Michael); W. Ruzyllo (Witold); K.M. Akkerhuis (Martijn)

    2000-01-01

    textabstractBACKGROUND: A proportion of patients who present with suspected acute coronary syndrome (ACS) are found to have insignificant coronary artery disease (CAD) during coronary angiography, but these patients have not been well characterized. METHODS AND RESULTS: Of the 5767

  15. Renovascular heart failure: heart failure in patients with atherosclerotic renal artery disease.

    Science.gov (United States)

    Kawarada, Osami; Yasuda, Satoshi; Noguchi, Teruo; Anzai, Toshihisa; Ogawa, Hisao

    2016-07-01

    Atherosclerotic renal artery disease presents with a broad spectrum of clinical features, including heart failure as well as hypertension, and renal failure. Although recent randomized controlled trials failed to demonstrate renal artery stenting can reduce blood pressure or the number of cardiovascular or renal events more so than medical therapy, increasing attention has been paid to flash pulmonary edema and congestive heart failure associated with atherosclerotic renal artery disease. This clinical entity "renovascular heart failure" is diagnosed retrospectively. Given the increasing global burden of heart failure, this review highlights the background and catheter-based therapeutic aspects for renovascular heart failure.

  16. Echocardiographic evaluation of coronary arteries in congenital heart disease.

    Science.gov (United States)

    Freire, Grace; Miller, Michelle S

    2015-12-01

    Among populations of patients with the congenital heart disease, there is considerable diversity in the anatomy of the coronary arteries. Understanding these anatomical differences is vitally important in directing interventions and surgical repair. In this report, the authors describe the echocardiographic evaluation of the variants of coronary artery anatomy in the following lesions: transposition of the great arteries, congenitally corrected transposition of the great arteries, double-inlet left ventricle, common arterial trunk, tetralogy of Fallot, and double-outlet right ventricle.

  17. Arterial Wall Properties and Womersley Flow in Fabry Disease

    Directory of Open Access Journals (Sweden)

    Dimitriadis Emilios

    2002-01-01

    Full Text Available Abstract Background Fabry disease is an X-linked recessive lysosomal storage disease resulting in the cellular accumulation of globotriaosylceramide particularly globotriaosylceramide. The disease is characterized by a dilated vasculopathy with arterial ectasia in muscular arteries and arterioles. Previous venous plethysomographic studies suggest enhanced endothelium-dependent vasodilation in Fabry disease indicating a functional abnormality of resistance vessels. Methods We examined the mechanical properties of the radial artery in Fabry disease, a typical fibro-muscular artery. Eight control subjects and seven patients with Fabry disease had a right brachial arterial line placed allowing real time recording of intra-arterial blood pressure. Real time B-mode ultrasound recordings of the right radial artery were obtained simultaneously allowing calculation of the vessel wall internal and external diameter, the incremental Young's modulus and arterial wall thickness. By simultaneously measurement of the distal index finger-pulse oximetry the pulse wave speed was calculated. From the wave speed and the internal radial artery diameter the volume flow was calculated by Womersley analysis following truncation of the late diastolic phase. Results No significant difference was found between Fabry patients and controls for internal or external arterial diameters, the incremental Young's modulus, the arterial wall thickness, the pulse wave speed and the basal radial artery blood flow. Further, no significant difference was found for the radial artery blood flow in response to intra-arterial acetylcholine or sodium nitroprusside. Both drugs however, elevated the mean arterial flow. Conclusions The current study suggests that no structural or mechanical abnormality exists in the vessel wall of fibro-muscular arteries in Fabry disease. This may indicate that a functional abnormality downstream to the conductance vessels is the dominant feature in

  18. Relationship of Albuminuria and Renal Artery Stent Outcomes: Results From the CORAL Randomized Clinical Trial (Cardiovascular Outcomes With Renal Artery Lesions).

    Science.gov (United States)

    Murphy, Timothy P; Cooper, Christopher J; Pencina, Karol M; D'Agostino, Ralph; Massaro, Joseph; Cutlip, Donald E; Jamerson, Kenneth; Matsumoto, Alan H; Henrich, William; Shapiro, Joseph I; Tuttle, Katherine R; Cohen, David J; Steffes, Michael; Gao, Qi; Metzger, D Christopher; Abernethy, William B; Textor, Stephen C; Briguglio, John; Hirsch, Alan T; Tobe, Sheldon; Dworkin, Lance D

    2016-11-01

    Randomized clinical trials have not shown an additional clinical benefit of renal artery stent placement over optimal medical therapy alone. However, studies of renal artery stent placement have not examined the relationship of albuminuria and treatment group outcomes. The CORAL study (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) is a prospective clinical trial of 947 participants with atherosclerotic renal artery stenosis randomized to optimal medical therapy with or without renal artery stent which showed no treatment differences (3(5.8% and 35.1% event rate at mean 43-month follow-up). In a post hoc analysis, the study population was stratified by the median baseline urine albumin/creatinine ratio (n=826) and analyzed for the 5-year incidence of the primary end point (myocardial infarction, hospitalization for congestive heart failure, stroke, renal replacement therapy, progressive renal insufficiency, or cardiovascular disease- or kidney disease-related death), for each component of the primary end point, and overall survival. When baseline urine albumin/creatinine ratio was ≤ median (22.5 mg/g, n=413), renal artery stenting was associated with significantly better event-free survival from the primary composite end point (73% versus 59% at 5 years; P=0.02), cardiovascular disease-related death (93% versus 85%; P≤ 0.01), progressive renal insufficiency (91% versus 77%; P=0.03), and overall survival (89% versus 76%; P≤0.01), but not when baseline urine albumin/creatinine ratio was greater than median (n=413). These data suggest that low albuminuria may indicate a potentially large subgroup of those with renal artery stenosis that could experience improved event-free and overall-survival after renal artery stent placement plus optimal medical therapy compared with optimal medical therapy alone. Further research is needed to confirm these preliminary observations.

  19. Haemostatic function in coronary artery disease (CAD).

    Science.gov (United States)

    Gupta, A; Sikka, M; Madan, N; Dwidedi, S; Rusia, U; Sharma, S

    1997-04-01

    Tests to evaluate haemostatic function bleeding time (BT), prothrombin time (PT) partial thromboplastin time with kaolin (PTTK), thrombin time (TT), platelet count, platelet function tests (platelet adhesiveness and microthrombus index) and plasma fibrinogen levels were performed in 30 patients of coronary artery disease (14 myocardial infarction, 16 angina pectoris) and 20 age and sex matched controls. There was no statistically significant difference in platelet adhesiveness and mean microthrombus index in patients and controls. The BT, PT, PTTK and TT were normal in all patients and controls. Stepwise logistic regression analysis showed that plasma fibrinogen was an independent risk factor in the production of CAD.

  20. Cerebellar cortical infarct cavities and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Cocker, Laurens J.L. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Kliniek Sint-Jan Radiologie, Brussels (Belgium); Compter, A.; Kappelle, L.J.; Worp, H.B. van der [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht (Netherlands); Luijten, P.R.; Hendrikse, J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands)

    2016-09-15

    Cerebellar cortical infarct cavities are a newly recognised entity associated with atherothromboembolic cerebrovascular disease and worse physical functioning. We aimed to investigate the relationship of cerebellar cortical infarct cavities with symptomatic vertebrobasilar ischaemia and with vascular risk factors. We evaluated the MR images of 46 patients with a recent vertebrobasilar TIA or stroke and a symptomatic vertebral artery stenosis ≥50 % from the Vertebral Artery Stenting Trial (VAST) for the presence of cerebellar cortical infarct cavities ≤1.5 cm. At inclusion in VAST, data were obtained on age, sex, history of vertebrobasilar TIA or stroke, and vascular risk factors. Adjusted risk ratios were calculated with Poisson regression analyses for the relation between cerebellar cortical infarct cavities and vascular risk factors. Sixteen out of 46 (35 %) patients showed cerebellar cortical infarct cavities on the initial MRI, and only one of these 16 patients was known with a previous vertebrobasilar TIA or stroke. In patients with symptomatic vertebrobasilar ischaemia, risk factor profiles of patients with cerebellar cortical infarct cavities were not different from patients without these cavities. Cerebellar cortical infarct cavities are seen on MRI in as much as one third of patients with recently symptomatic vertebral artery stenosis. Since patients usually have no prior history of vertebrobasilar TIA or stroke, cerebellar cortical infarct cavities should be added to the spectrum of common incidental brain infarcts visible on routine MRI. (orig.)

  1. Study of Coronary Artery Disease in Single Aortic Valvular Disease

    Institute of Scientific and Technical Information of China (English)

    张斌; 杨伟民; 占亚平

    2003-01-01

    Objectives To analyze the results of coronary angiographies (GAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p <0.01).Conclusions Angina pectoris is not sensitive for diagnosis of CAD in single aortic valve heart disease.The probability of combination of CAD in degenerative aortic valve disease is higher than that in aortic valve disease with other causes. Coronary angiography is strongly suggested for these patients.

  2. Evaluation of Asymptomatic Peripheral Arterial Disease by Ankle-brachial Index in Patients with Concomitant Coronary Arterial Disease

    Directory of Open Access Journals (Sweden)

    Hosein Vakili

    2012-12-01

    Full Text Available Background: Peripheral arterial disease is associated with adverse cardiovascular outcomes. As such, it is found that screening for peripheral arterial disease (PAD improves risk assessment. Thus, intensive risk factor modification and medical treatment in these patients are necessary. Objectives: The purpose of this study was to determine the prevalence of asymptomatic peripheral arterial disease in patients with concomitant coronary arterial disease. Methods: Asymptomatic peripheral arterial disease was investigated in 400 patients (60% males, 40% females, aged 59.7± 11.3 with a documented coronary arterial disease. Results: Among patients with documented CAD, 12% had asymptomatic PAD with the ABI ratio of less than 0.9. Conclusions: It is advisable to screen for PAD not only as a disease but also as a risk assessment method for atherosclerosis.

  3. Drug-eluting stents in the management of peripheral arterial disease.

    Science.gov (United States)

    Bosiers, Marc; Cagiannos, Catherine; Deloose, Koen; Verbist, Jürgen; Peeters, Patrick

    2008-01-01

    Since major meta-analyses of randomized controlled trials in interventional cardiology showed the potential of drug-eluting stents in decreasing restenosis and reintervention rates after coronary artery stenting, one of the next steps in the treatment of arterial occlusive disease is the transfer of the active coating technology towards peripheral arterial interventions. In this manuscript, we aim to provide a literature overview on available peripheral (lower limb, renal, and supra-aortic) drug-eluting stent applications, debate the cost implications, and give recommendations for future treatment strategies.

  4. Advanced glycation end products in patients with peripheral artery disease

    NARCIS (Netherlands)

    de Vos, Lisanne Carlijn

    2016-01-01

    Peripheral artery disease (PAD) is a disease in which stenosis or occlusion occurs of the arteries of the lower limbs. The most common underlying disease is atherosclerosis. The main presenting symptom of these patients is intermittent claudication, which is typical leg pain during walking that disa

  5. Osteoprotegerin independently predicts mortality in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Bjerre, Mette; Hilden, Jørgen; Kastrup, Jens

    2014-01-01

    Objectives. To elucidate the prognostic power of serum osteoprotegerin (OPG) in patients with stable coronary artery disease (CAD). Methods. Serum OPG levels were measured in the CLARICOR trial cohort of 4063 patients with stable CAD on blood samples drawn at randomization. The follow-up was 2.6 ...

  6. Common genetic loci influencing plasma homocysteine concentrations and their effect on risk of coronary artery disease

    NARCIS (Netherlands)

    J.B.J. van Meurs (Joyce); G. Paré (Guillaume); S.M. Schwartz (Stephen); A. Hazra (Aditi); T. Tanaka; S.H.H.M. Vermeulen (Sita); I. Cotlarciuc (Ioana); X. Yuan (Xin); A. Mälarstig (Anders); S. Bandinelli (Stefania); J.C. Bis (Joshua); H.J. Blom (Henk); M.J. Brown (Morris); C. Chen (Christopher); R. Clarke (Robert); A. Dehghan (Abbas); J. Erdmann (Jeanette); L. Ferrucci; A. Hamsten (Anders); A. Hofman (Albert); D. Hunter (David); A. Goel (Anuj); A.D. Johnson (Andrew); S. Kathiresan (Sekar); E. Kampman (Ellen); D.P. Kiel (Douglas); L.A.L.M. Kiemeney (Bart); J.C. Chambers (John); P. Kraft (Peter); J. Lindemans (Jan); B. McKnight (Barbara); C.P. Nelson (Christopher P.); C.J. O'Donnell (Christopher); B.M. Psaty (Bruce); P.M. Ridker (Paul); F. Rivadeneira Ramirez (Fernando); L.M. Rose (Lynda); U. Seedorf (Udo); D.S. Siscovick (David); H. Schunkert (Heribert); J. Selhub (Jacob); P.M. Ueland (Per); P. Vollenweider (Peter); G. Waeber (Gérard); D. Waterworth (Dawn); H. Watkins (Hugh); J.C.M. Witteman (Jacqueline); M. den Heijer (Martin); P.F. Jacques (Paul); A.G. Uitterlinden (André); J.S. Kooner (Jaspal); D.J. Rader (Daniel); M.P. Reilly (Muredach); V. Mooser (Vincent); D.I. Chasman (Daniel); N.J. Samani (Nilesh); K.R. Ahmadi (Kourosh)

    2013-01-01

    textabstractBackground: The strong observational association between total homocysteine (tHcy) concentrations and risk of coronary artery disease (CAD) and the null associations in the homocysteinelowering trials have prompted the need to identify genetic variants associated with homocysteine concen

  7. Prediction of Coronary Artery Disease by B-Mode Sonography

    Directory of Open Access Journals (Sweden)

    J Kheirkhah

    2010-09-01

    Full Text Available Background: Although coronary angiography is gold standard for diagnosis of coronary artery disease, it is nevertheless an invasive and potentially hazardous procedure. The aim of this study was to investigate the predictive value of carotid and femoral artery Intima-Media Thickness (IMT for detection of coronary artery disease.Methods: The present study comprised 100 consecutive patients referred for coronary angiography due to symptoms of ischemic heart disease. Ultrasound assessment of common carotid and common femoral artery were performed with an ultrasound device equipped with a high-resolution transducer. IMT was measured in the common carotid and common femoral artery (10 mm proximal to the deep femoral artery origin. Results: There were 25 cases in each of single (S, double (D and triple (T vessel disease and 25 in significant left main diseases groups of patients. In regard to common carotid artery IMT was 0.78 mm in S, 0.84 mm in D, 0.97 mm in T and 1.05 mm in left main disease groups. There was a significant correlation between IMT measured in the carotid artery and severity of coronary artery disease (P = 0.0001. With respect to common femoral artery IMT was 0.66 mm in S group, 0.73 mm in D group, 0.84 mm in T groups and 0.85 mm in patients with left main disease.. There is a significant correlation between IMT (measured in the common femoral artery and severity of coronary artery disease (P = 0.0001.Conclusion: Our results indicated that early atherosclerosis in both carotid and femoral arteries were highly predictive of coronary involvement and IMT being associated with the number of coronary vessels disorder.

  8. Intravascular ultrasound for angiographically indeterminant left main coronary artery disease.

    Science.gov (United States)

    Parashara, D K; Jacobs, L E; Ledley, G S; Yazdanfar, S; Oline, J; Kotler, M N

    1994-01-01

    The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography.

  9. Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Karimi Fatemeh

    2007-01-01

    Full Text Available Abstract Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8% had significant ( Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

  10. Evaluation of Peripheral Arterial Disease in Prediabetes

    Science.gov (United States)

    Faghihimani, Elham; Darakhshandeh, Ali; Feizi, Awat; Amini, Masoud

    2014-01-01

    Background: The prevalence of prediabetes in the world continues to increase. These patients have elevated the risk of atherosclerosis. The current study was designed to assess the prevalence of peripheral arterial disease (PAD) and its related risk factors in prediabetes patients. Methods: This was the case-control study in which 135 adults in three groups: Diabetes, prediabetes, and normal were studied. We evaluated the prevalence of PAD through the measurement of ankle-brachial index (ABI). All the patients were interviewed about demographic and medical data, including age, sex, disease duration, body mass index, hypertension (HTN), fasting blood glucose, hemoglobin A1C (HbA1C), lipid profile, and medication use. Results: The prevalence of PAD in diabetes patients was higher than the normal group (8.5%vs. 0.0%) (P < 0.05), but the differences between prediabetes compared with diabetes and normal group were not significant. The mean level of ABI in normal, prediabetes, and diabetes group was (1.11 ± 0.11), (1.09 ± 0.12), and (1.05 ± 0.03) respectively (P < 0.1). There were marginally significant differences of ABI observed between the normal group and the diabetes group. The observed differences between groups in the ABI were significant after adjusting the effects of age and sex (P < 0.05). There was an association observed between ABI and HbA1C in diabetes patients (r = 0.249, P < 0.01) and a significant association seen between PAD and HTN in the prediabetes group (P < 0.01). Conclusions: Peripheral arterial disease is common in asymptomatic diabetes and prediabetes patients. Management of hypertensive prediabetes patients and early detection of PAD in this group as well as in asymptomatic patients is important. PMID:25317291

  11. Association factor analysis between osteoporosis with cerebral artery disease

    Science.gov (United States)

    Jin, Eun-Sun; Jeong, Je Hoon; Lee, Bora; Im, Soo Bin

    2017-01-01

    Abstract The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified

  12. Hormones and arterial stiffness in patients with chronic kidney disease.

    Science.gov (United States)

    Gungor, Ozkan; Kircelli, Fatih; Voroneanu, Luminita; Covic, Adrian; Ok, Ercan

    2013-01-01

    Cardiovascular disease constitutes the major cause of mortality in patients with chronic kidney disease. Arterial stiffness is an important contributor to the occurrence and progression of cardiovascular disease. Various risk factors, including altered hormone levels, have been suggested to be associated with arterial stiffness. Based on the background that chronic kidney disease predisposes individuals to a wide range of hormonal changes, we herein review the available data on the association between arterial stiffness and hormones in patients with chronic kidney disease and summarize the data for the general population.

  13. Noninvasive assessment of coronary artery disease.

    Science.gov (United States)

    DePace, N L; Hakki, A H; Weinreich, D J; Iskandrian, A S

    1983-10-01

    This study determines whether a mathematical model can be used to assess noninvasively the extent of coronary artery disease (CAD). The model was based on stepwise multivariate discriminant analysis of data obtained in 99 patients from clinical and nonhemodynamic exercise variables, or from radionuclide determination of left ventricular function at rest or during exercise, or both. The extent of CAD was assessed by a scoring system and by the number of diseased vessels. The variables selected by this method (Q-wave infarction, exercise LV ejection fraction, change in systolic blood pressure from rest to exercise, sex and diabetes mellitus) yielded a predictive accuracy of 82% for the identification of patients with extensive CAD (score greater than or equal to 35). Slightly better results were achieved by a subgroup of 77 patients who had adequate exercise end points (exercise heart rate greater than or equal to 120 beats/min, or angina or ST depression during exercise). In these patients, the predictive accuracy was 84%. The model also identified patients with "light" CAD (score less than or equal to 10) with a predictive accuracy of 82%. Thus, noninvasive assessment of the extent of CAD is possible with a stepwise multivariate discriminant analysis of clinical, electrocardiographic and left ventricular function assessed by radionuclide ventriculography at rest and during exercise. The scoring system was superior to the conventional method of classifying patients according to the number of diseased vessels.

  14. Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

    Science.gov (United States)

    Samak, Mostafa; Fatullayev, Javid; Sabashnikov, Anton; Zeriouh, Mohamed; Schmack, Bastian; Ruhparwar, Arjang; Karck, Matthias; Popov, Aron-Frederik; Dohmen, Pascal M.; Weymann, Alexander

    2016-01-01

    Total arterial revascularization is the leading trend in coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD). Adding to its superiority to vein conduits, arteries allow for a high degree of versatility and long-term patency, while minimizing the need for reintervention. This is especially important for patients with multi-vessel coronary artery disease, as well as young patients. However, arterial revascularization has come a long way before being widely appreciated, with some yet unresolved debates, and advances that never cease to impress. In this review, we discuss the evolution of this surgical technique and its clinical success, as well as its most conspicuous limitations in light of accumulated published date from decades of experience. PMID:27698339

  15. Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Ghabili K

    2011-10-01

    Full Text Available Abolhassan Shakeri Bavil1, Kamyar Ghabili2, Seyed Ebrahim Daneshmand3, Masoud Nemati3, Moslem Shakeri Bavil4, Hossein Namdar5, Sheyda Shaafi61Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran; 5Department of Cardiology, Tabriz University of Medical Sciences, Tabriz, Iran; 6Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial.Objectives: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA stenosis in a group of Iranian patients with peripheral arterial disease.Methods: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs and the origins of the internal and external arteries were scanned with B-mode ultrasonogaphy. Significant ICA stenosis, >70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥3.5.Results: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six

  16. Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from Peripheral Academic Research Consortium (PARC).

    Science.gov (United States)

    Patel, Manesh R; Conte, Michael S; Cutlip, Donald E; Dib, Nabil; Geraghty, Patrick; Gray, William; Hiatt, William R; Ho, Mami; Ikeda, Koji; Ikeno, Fumiaki; Jaff, Michael R; Jones, W Schuyler; Kawahara, Masayuki; Lookstein, Robert A; Mehran, Roxana; Misra, Sanjay; Norgren, Lars; Olin, Jeffrey W; Povsic, Thomas J; Rosenfield, Kenneth; Rundback, John; Shamoun, Fadi; Tcheng, James; Tsai, Thomas T; Suzuki, Yuka; Vranckx, Pascal; Wiechmann, Bret N; White, Christopher J; Yokoi, Hiroyoshi; Krucoff, Mitchell W

    2015-03-10

    The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease.

  17. Advanced glycation end products in patients with peripheral artery disease

    OpenAIRE

    de Vos, Lisanne Carlijn

    2016-01-01

    Peripheral artery disease (PAD) is a disease in which stenosis or occlusion occurs of the arteries of the lower limbs. The most common underlying disease is atherosclerosis. The main presenting symptom of these patients is intermittent claudication, which is typical leg pain during walking that disappears during rest. Patients with progressed disease may suffer from rest pain, ulcers and are at risk for amputation. An estimated prevalence of the patients suffering from PAD is 200 million, whi...

  18. Effects of residual coronary artery disease on results of coronary artery bypass grafting.

    Science.gov (United States)

    Iskandrian, A S; Hakki, A H; Nestico, P F; DePace, N L; Goel, I P; Kane, S

    1984-10-01

    To assess the effects of residual coronary artery disease (non-revascularized coronary vessels) after coronary artery bypass grafting on symptoms and exercise left ventricular function, we categorized 77 patients into 3 groups according to the extent of residual coronary artery disease: group I (n = 17) had no residual coronary artery disease (residual score = 0); group II (n = 30) had light residual coronary artery disease (score of 1 to 9, mean 4.7); and group III (n = 30) had moderate residual coronary artery disease (score greater than or equal to 10, mean 23). Sixty patients were asymptomatic after coronary artery bypass grafting (14 in group I, 24 in group II, and 22 in group III), but the remaining patients had occasional angina pectoris. The resting left ventricular ejection fraction was significantly higher in group I than in the remaining 2 groups (56 +/- 18% in group I, 47 +/- 19% in group II, and 43 +/- 16% in group III, P less than 0.05). The exercise left ventricular ejection fraction was also significantly higher in group I (61 +/- 16% in group I, 51 +/- 18% in group II and 45 +/- 18% in group III, P less than 0.01). The ejection fraction response to exercise was abnormal in 5 patients in group I, 15 patients in group II, and 19 patients in group III. Thus, coronary artery bypass grafting results in symptomatic improvement, even in patients with residual coronary artery disease. The presence of residual coronary artery disease, however, may be a determinant of exercise left ventricular function in these patients.

  19. Mendelian randomization studies in coronary artery disease.

    Science.gov (United States)

    Jansen, Henning; Samani, Nilesh J; Schunkert, Heribert

    2014-08-01

    Epidemiological research over the last 50 years has discovered a plethora of biomarkers (including molecules, traits or other diseases) that associate with coronary artery disease (CAD) risk. Even the strongest association detected in such observational research precludes drawing conclusions about the causality underlying the relationship between biomarker and disease. Mendelian randomization (MR) studies can shed light on the causality of associations, i.e whether, on the one hand, the biomarker contributes to the development of disease or, on the other hand, the observed association is confounded by unrecognized exogenous factors or due to reverse causation, i.e. due to the fact that prevalent disease affects the level of the biomarker. However, conclusions from a MR study are based on a number of important assumptions. A prerequisite for such studies is that the genetic variant employed affects significantly the biomarker under investigation but has no effect on other phenotypes that might confound the association between the biomarker and disease. If this biomarker is a true causal risk factor for CAD, genotypes of the variant should associate with CAD risk in the direction predicted by the association of the biomarker with CAD. Given a random distribution of exogenous factors in individuals carrying respective genotypes, groups represented by the genotypes are highly similar except for the biomarker of interest. Thus, the genetic variant converts into an unconfounded surrogate of the respective biomarker. This scenario is nicely exemplified for LDL cholesterol. Almost every genotype found to increase LDL cholesterol level by a sufficient amount has also been found to increase CAD risk. Pending a number of conditions that needed to be fulfilled by the genetic variant under investigation (e.g. no pleiotropic effects) and the experimental set-up of the study, LDL cholesterol can be assumed to act as the functional component that links genotypes and CAD risk and

  20. ARTERIAL STIFFNESS AND CHRONIC KIDNEY DISEASE: CAUSES AND CONSEQUENCES

    Directory of Open Access Journals (Sweden)

    J. D. Kobalava

    2015-09-01

    Full Text Available Chronic kidney disease (CKD is associated with increased cardiovascular risk. CKD is characterized by accelerated aging of vessels in which the age-related arterial stiffness increase is exacerbated by a number of uremia-related processes. Increased arterial stiffness is associated with structural and functional disorders, as well as with the increase in cardiovascular mortality in patients with CKD. Increased arterial stiffness is diagnosed at an early stage of CKD. Modern understanding of the mechanisms of increased risk of cardiovascular complications in CKD, the factors contributing to the loss of elasticity of the arteries, arterial stiffness increase consequences are analyzed. Data illustrating the twoway interaction between CKD and arterial stiffness and mechanisms of accelerated progression of arterial stiffness in CKD are presented.

  1. Skin autofluorescence is increased in patients with carotid artery stenosis and peripheral artery disease

    NARCIS (Netherlands)

    Noordzij, Marjon J.; Lefrandt, Joop D.; Loeffen, Erik A. H.; Saleem, Ben R.; Meerwaldt, Robbert; Lutgers, Helen L.; Smit, Andries J.; Zeebregts, Clark J.

    2012-01-01

    Advanced glycation end products (AGEs) have a pivotal role in atherosclerosis. We evaluated skin autofluorescence (SAF), a non-invasive measurement of tissue AGE accumulation, in patients with carotid artery stenosis with and without coexisting peripheral artery occlusive disease (PAOD). SAF was mea

  2. [Aftermaths of lesions of coronary arteries in Kawasaki disease].

    Science.gov (United States)

    Vostokova, A A; Grunina, E A; Klemenov, A V

    2016-01-01

    Kawasaki disease, also known as cutaneous-mucous-glandular mucocutaneous glandular syndrome, is acute systemic vasculitis of small-to-medium calibre arteries, frequently involving coronary arteries, affect almost exceptionally children, with reports concerning cases of Kawasaki syndrome in 20-to-30-year-old adults being extremely rare. The most serious manifestation of Kawasaki disease is coronaritis and formation of coronary artery aneurysms. The dynamics of the formed coronary aneurysms and, consequently, the fate of patients may be different. Thrombosis of an aneurysm in the early period of the disease and stenosing of the affected coronary artery later on present possible complications of Kawasaki disease and potential causes of myocardial infection in young adults. Increased risk of coronary artery thromboses in Kawasaki disease is conditioned by a decrease in velocity of blood flow and its turbulent pattern in the aneurysms, endothelial dysfunction due to currently existing or endured coronaritis and thrombocytosis typical of this pathology. Predisposing factors of coronary artery stenosing are unfavourable haemodynamic conditions appearing at the sites of the "entry" and "exit" of the aneurysm. Described herein are two case reports of myocardial infarction, one of which being a complication of an acute case of Kawasaki disease in a 29-year-old patient, with the second one being a consequence of coronary artery stenosing in a 25-year-old patient who had endured Kawasaki disease in his childhood.

  3. Echocardiographic evaluation of external iliac artery Doppler waveform in patients with coronary artery disease.

    Science.gov (United States)

    Styczynski, Grzegorz; Szmigielski, Cezary; Kaczynska, Anna; Kuch-Wocial, Agnieszka

    2014-04-01

    Visual interpretation of the Doppler waveform in the common femoral or distal external iliac artery (EIA) was reported to be useful in screening for proximal peripheral artery occlusive disease (PAOD) in patients with lower limb ischemia. Commonly patients with coronary artery disease (CAD) referred for echocardiography have coexistent arterial pathology. Therefore, we decided to study whether echocardiographic evaluation of the distal EIA flow can be useful for detection of PAOD in patients with CAD. We studied 150 consecutive patients (pts) with CAD referred for echocardiography. At the end of an echocardiographic examination, evaluation of the flow in the distal EIA with an echocardiographic probe was performed. The Doppler waveform was classified as normal-with early diastolic flow reversal or abnormal-without early diastolic flow reversal. Echocardiographic findings were compared in a blinded fashion with the results of the ankle brachial index measurements (ABI). Based on the ABI ≤ 0.9, peripheral artery disease was diagnosed in 54 pts (36%) and abnormal external iliac Doppler waveform was found in 27 pts (18%). Sensitivity of abnormal external iliac Doppler waveform in predicting PAOD was 48%, specificity 99%, positive predictive value (PPV) 96%, and negative predictive value 77%. Peripheral arterial occlusive disease is common in patients with CAD referred for echocardiographic study. Echocardiographic assessment of distal EIA Doppler waveform has low sensitivity, but high specificity and high PPV in the diagnosis of peripheral arterial occlusive disease.

  4. Moyamoya Disease with Peripheral Pulmonary Artery Stenoses and Coronary Artery Fistulae

    Directory of Open Access Journals (Sweden)

    Lindsay Reardon

    2009-01-01

    Full Text Available Moyamoya is a progressive disorder of the cerebral vasculature. Our report describes a rare case of Moyamoya disease with distal peripheral pulmonary artery stenoses and coronary fistulae in a 12-year-old Caucasian female patient.

  5. [Is coronary artery disease different in women?].

    Science.gov (United States)

    Schiele, François; Chopard, Romain

    2014-01-01

    Coronary artery disease (CAD) is the primary cause of death in women. Although acute coronary syndrome (ACS) is relatively infrequent in young women, failure to recognize ACS in this population can incur a major risk and registry data show that there is still plenty of room for improvement in this area. Women may suffer from "classical" CAD with development of atherosclerosis with a delay of about 10 years as compared to men, reflecting hormonal protection in women. Besides this classical presentation, angina in women often corresponds to impaired microcirculation, a syndrome known to associate typical angina, demonstrable myocardial ischemia, but no lesions on the coronary angiography. Finally, spasm, spontaneous dissection or coronary thrombosis through endothelial rupture are more frequent in women. The influence of risk factors on the development of CAD is comparable in both women and men. Recent registry studies show that in France, in particular, diabetes, obesity, and smoking are all risk factors that are on the rise in women. In addition, certain other risk factors are more specific to women, namely psycho-social stress. The methods to evaluate risk and detect CAD were mainly developed in male study populations, and these tools thus perform less well in female patients. In case of ACS, women benefit just as much from invasive management, but are at greater risk of iatrogenic complications, particularly with anti-thrombotic therapy or during revascularization procedures.

  6. "Obesity paradox" in coronary artery disease.

    Science.gov (United States)

    Akin, Ibrahim; Nienaber, Christoph A

    2015-10-26

    Obesity used to be among the more neglected public health problems, but has unfolded as a growing medical and socioeconomic burden of epidemic proportions. Morbid obesity is linked to traditional cardiovascular risk factors like, hypertension, hyperlipidemia and diabetes, and suspected to incur increased morbidity and mortality in the Western and even third world populations. This patient cohort is also at greater risk to develop coronary artery disease. Recent population-based registries revealed that 43% and 24% of all cases of coronary revascularization were carried out in overweight and obese patients, respectively. However, despite evidence of a positive correlation between obesity and increased cardiovascular morbidity, some authors have described a better clinical outcome in overweight and obese patients, a phenomenon they coined "obesity paradoxon". Thus, there is an ongoing debate in light of conflicting data and the possibility of confounding bias causing misconception and challenging the "obesity paradox". In this review article we present the current evidence and throughly discuss the validity of the "obesity paradoxon" in a variety of clinical settings.

  7. Suppression of ischemia in arterial occlusive disease by JNK-promoted native collateral artery development.

    Science.gov (United States)

    Ramo, Kasmir; Sugamura, Koichi; Craige, Siobhan; Keaney, John F; Davis, Roger J

    2016-08-09

    Arterial occlusive diseases are major causes of morbidity and mortality. Blood flow to the affected tissue must be restored quickly if viability and function are to be preserved. We report that disruption of the mixed-lineage protein kinase (MLK) - cJun NH2-terminal kinase (JNK) signaling pathway in endothelial cells causes severe blockade of blood flow and failure to recover in the murine femoral artery ligation model of hindlimb ischemia. We show that the MLK-JNK pathway is required for the formation of native collateral arteries that can restore circulation following arterial occlusion. Disruption of the MLK-JNK pathway causes decreased Dll4/Notch signaling, excessive sprouting angiogenesis, and defects in developmental vascular morphogenesis. Our analysis demonstrates that the MLK-JNK signaling pathway is a key regulatory mechanism that protects against ischemia in arterial occlusive disease.

  8. Bioresorbable scaffolds in the treatment of coronary artery disease

    NARCIS (Netherlands)

    Y. Zhang (Yaojun); C.V. Bourantas (Christos); V. Farooq (Vasim); T. Muramatsu (Takashi); R. Diletti (Roberto); Y. Onuma (Yoshinobu); H.M. Garcia-Garcia (Hector); P.W.J.C. Serruys (Patrick)

    2013-01-01

    textabstractDrug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inh

  9. Leptospirosis and Peripheral Artery Occlusive Disease

    Science.gov (United States)

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-01-01

    Abstract Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44–1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58–1.95). The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population. PMID:26986166

  10. Detection of coronary artery disease with MCG.

    Science.gov (United States)

    Hailer, B; Van Leeuwen, P

    2004-11-30

    The diagnosis of cardiac ischemia related to coronary artery disease (CAD) is a clinical challenge. Despite many methods clinically available, the predictive value of each is still limited. Magnetocardiography (MCG) offers new insights in the electrogenesis of the disease. In the last decade a number of studies using biomagnetometers have dealt with the identification of CAD patients using coronary angiography as a gold standard. As the availability of these systems is limited, studies have focused either on exercise-induced ischemia or on chronic ischemia and the infarct scar at rest. Different parameters have been developed based on signal morphology, time intervals, source parameters or magnetic field map analysis. Concerning signal morphology, main work concentrates on ST-depression, ST-T signal amplitude as well as QRS and ST-T integrals. Dealing with time intervals, most studies focus on the QT interval. The evaluation of of QT dispersion spatially in the MCG, reflecting regional heterogeneity of repolarization, improved the identification of CAD patients. Besides the calculation of the equivalent current dipole during de- and repolarization, parameters of the magnetic field orientation were used to identify CAD patients and localize exercise-induced ischemic regions. Heart rate adjusted alteration in the magnetic field orientation allowed the quantification of ischemia-induced changes in MCG. The estimation of current density (CDV) further enabled to separate healthy subjects from CAD patients at rest. In the course of interventional therapy CDV maps returned toward that of healthy subjects.Thus, there is justification for routine clinical use of the MCG in the diagnosis of CAD.

  11. Astaxanthin vs placebo on arterial stiffness, oxidative stress and inflammation in renal transplant patients (Xanthin: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Robertson Iain K

    2008-12-01

    Full Text Available Abstract Background There is evidence that renal transplant recipients have accelerated atherosclerosis manifest by increased cardiovascular morbidity and mortality. The high incidence of atherosclerosis is, in part, related to increased arterial stiffness, vascular dysfunction, elevated oxidative stress and inflammation associated with immunosuppressive therapy. The dietary supplement astaxanthin has shown promise as an antioxidant and anti-inflammatory therapeutic agent in cardiovascular disease. The aim of this trial is to investigate the effects of astaxanthin supplementation on arterial stiffness, oxidative stress and inflammation in renal transplant patients. Method and Design This is a randomised, placebo controlled clinical trial. A total of 66 renal transplant recipients will be enrolled and allocated to receive either 12 mg/day of astaxanthin or an identical placebo for one-year. Patients will be stratified into four groups according to the type of immunosuppressant therapy they receive: 1 cyclosporine, 2 sirolimus, 3 tacrolimus or 4 prednisolone+/-azathioprine, mycophenolate mofetil or mycophenolate sodium. Primary outcome measures will be changes in 1 arterial stiffness measured by aortic pulse wave velocity (PWV, 2 oxidative stress assessed by plasma isoprostanes and 3 inflammation by plasma pentraxin 3. Secondary outcomes will include changes in vascular function assessed using the brachial artery reactivity (BAR technique, carotid artery intimal medial thickness (CIMT, augmentation index (AIx, left ventricular afterload and additional measures of oxidative stress and inflammation. Patients will undergo these measures at baseline, six and 12 months. Discussion The results of this study will help determine the efficacy of astaxanthin on vascular structure, oxidative stress and inflammation in renal transplant patients. This may lead to a larger intervention trial assessing cardiovascular morbidity and mortality. Trial Registration

  12. Peripheral arterial disease and revascularization of the diabetic foot.

    Science.gov (United States)

    Forsythe, R O; Brownrigg, J; Hinchliffe, R J

    2015-05-01

    Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration. In addition to peripheral arterial disease, functional changes in the microcirculation also contribute to the development of a diabetic foot ulcer, along with other factors such as infection, oedema and abnormal biomechanical loading. Peripheral arterial disease typically affects the distal vessels, resulting in multi-level occlusions and diffuse disease, which often necessitates challenging distal revascularisation surgery or angioplasty in order to improve blood flow. However, technically successful revascularisation does not always result in wound healing. The confounding effects of microvascular dysfunction must be recognised--treatment of a patient with a diabetic foot ulcer and peripheral arterial disease should address this complex interplay of pathophysiological changes. In the case of non-revascularisable peripheral arterial disease or poor response to conventional treatment, alternative approaches such as cell-based treatment, hyperbaric oxygen therapy and the use of vasodilators may appear attractive, however more robust evidence is required to justify these novel approaches.

  13. Genetic Variants Are Not Associated with Outcome in Patients with Coronary Artery Disease and Left Ventricular Dysfunction: Results of the Genetic Sub-study of the Surgical Treatment for Ischemic Heart Failure (STICH) Trials

    Science.gov (United States)

    Feldman, Arthur M.; She, Lilin; McNamara, Dennis M.; Mann, Douglas L.; Bristow, Michael R.; Maisel, Alan S.; Wagner, Daniel R.; Andersson, Bert; Chiariello, Luigi; Hayward, Christopher S.; Hendry, Paul; Parker, John D.; Racine, Normand; Selzman, Craig H.; Senni, Michele; Stepinska, Janina; Zembala, Marian; Rouleau, Jean; Velazquez, Eric J.; Lee, Kerry L.

    2015-01-01

    Objectives and Background We evaluated the ability of 23 genetic variants to provide prognostic information in patients enrolled in the Genotype Sub-studies of the Surgical Treatment for Ischemic Heart Failure (STICH) trials. Methods Patients in STICH Hypothesis 1 were randomized to medical therapy with or without CABG (Coronary Artery Bypass Grafting). Those in STICH Hypothesis 2 were randomized to CABG or CABG with left ventricular reconstruction. Results In patients assigned to STICH Hypothesis 2 (n=714), no genetic variant met the pre-specified Bonferroni-adjusted threshold for statistical significance (p<0.002); however, several met nominal prognostic significance: variants in the β2-adrenergic receptor gene (β2-AR Gln27Glu) and in the A1-adenosine receptor gene (A1-717 T/G) were associated with an increased risk of a subject dying or being hospitalized for a cardiac problem (p=0.027 and 0.031, respectively). These relationships remained nominally significant even after multivariable adjustment for prognostic clinical variables. However, none of the 23 genetic variants influenced all-cause mortality or the combination of death or cardiovascular hospitalization in the STICH Hypothesis 1 population (n=532) by either univariate or multivariable analysis. Conclusion We were unable to identify the predictive genotypes in optimally treated patients in these two ischemic heart failure populations. PMID:25592552

  14. Peripheral Arterial Occlusive Disease - an Interdisciplinary Approach

    Directory of Open Access Journals (Sweden)

    Groechenig E

    2003-01-01

    Full Text Available Vascular diseases are the most common diseases and the most common causes of death in developed countries. Many medical disciplines deal with vascular diseases and there is no strict and clear concept in education and training of these physicians. In German-speaking countries "angiology" was established several years ago. The angiologist is a highly qualified physician, who, in most cases, comes from internal medicine (a minority from dermatology. Although peripheral arterial disease (PAD is the most frequent disease angiology deals with, the angiologist has to have a broad knowledge of general vascular medicine and has to be qualified in all diagnostic and therapeutic procedures. PAD is just like the tip of an iceberg and has to be mentioned as a severe disease with a bad overall prognosis similar to that of Duke-B colon carcinoma. So, global access with staging and grading of atherosclerosis, evaluation of concomitant diseases, control of risk factors and adequate treatment of PAD is the gold standard. Therefore, several medical specialities are involved with the angiologist functioning as the integrative "general manager" between the disciplines for the welfare of the patient. Periphere arterielle Verschlußkrankheit - ein interdisziplinärer Ansatz. Gefäßkrankheiten sind die häufigsten Erkrankungs- und Todesursachen in den industrialisierten Ländern. Gefäßerkrankungen können sich an verschiedensten Organen manifestieren und dazu führen, daß unterschiedliche medizinische Disziplinen damit beschäftigt werden, ohne daß häufig eine gefäßspezifische Ausbildung vorhanden ist. Um diesem Umstand Rechnung zu tragen, wurde in den deutschsprachigen Ländern vor einigen Jahren der Additivfacharzt für Angiologie eingeführt. Der Angiologe ist ein hochqualifizierter Spezialist mit einer internistischen (seltener dermatologischen Basisausbildung. Der Angiologe hat einerseits ein breites Wissen über die allgemeine Gefäßpathologie und

  15. DISCOVER: Dutch Iliac Stent trial: COVERed balloon-expandable versus uncovered balloon-expandable stents in the common iliac artery: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bekken Joost A

    2012-11-01

    Full Text Available Abstract Background Iliac artery atherosclerotic disease may cause intermittent claudication and critical limb ischemia. It can lead to serious complications such as infection, amputation and even death. Revascularization relieves symptoms and prevents these complications. Historically, open surgical repair, in the form of endarterectomy or bypass, was used. Over the last decade, endovascular repair has become the first choice of treatment for iliac arterial occlusive disease. No definitive consensus has emerged about the best endovascular strategy and which type of stent, if any, to use. However, in more advanced disease, that is, long or multiple stenoses or occlusions, literature is most supportive of primary stenting with a balloon-expandable stent in the common iliac artery (Jongkind V et al., J Vasc Surg 52:1376-1383,2010. Recently, a PTFE-covered balloon-expandable stent (Advanta V12, Atrium Medical Inc., Hudson, NH, USA has been introduced for the iliac artery. Covering stents with PTFE has been shown to lead to less neo-intimal hyperplasia and this might lower restenosis rates (Dolmatch B et al. J Vasc Interv Radiol 18:527-534,2007, Marin ML et al. J Vasc Interv Radiol 7:651-656,1996, Virmani R et al. J Vasc Interv Radiol 10:445-456,1999. However, only one RCT, of mediocre quality has been published on this stent in the common iliac artery (Mwipatayi BP et al. J Vasc Surg 54:1561-1570,2011, Bekken JA et al. J Vasc Surg 55:1545-1546,2012. Our hypothesis is that covered balloon-expandable stents lead to better results when compared to uncovered balloon-expandable stents. Methods/Design This is a prospective, randomized, controlled, double-blind, multi-center trial. The study population consists of human volunteers aged over 18 years, with symptomatic advanced atherosclerotic disease of the common iliac artery, defined as stenoses longer than 3 cm and occlusions. A total of 174 patients will be included. The control group will undergo

  16. Skin autofluorescence is increased in patients with carotid artery stenosis and peripheral artery disease.

    Science.gov (United States)

    Noordzij, Marjon J; Lefrandt, Joop D; Loeffen, Erik A H; Saleem, Ben R; Meerwaldt, Robbert; Lutgers, Helen L; Smit, Andries J; Zeebregts, Clark J

    2012-02-01

    Advanced glycation end products (AGEs) have a pivotal role in atherosclerosis. We evaluated skin autofluorescence (SAF), a non-invasive measurement of tissue AGE accumulation, in patients with carotid artery stenosis with and without coexisting peripheral artery occlusive disease (PAOD). SAF was measured using the AGE Reader™ in 56 patients with carotid artery stenosis and in 56 age- and sex-matched healthy controls without diabetes, renal dysfunction or known atherosclerotic disease. SAF was higher in patients with carotid artery stenosis compared to the control group: mean 2.81 versus 2.46 (P = 0.002), but especially in the younger age group of 50-60 years old: mean 2.82 versus 1.94 (P = 0.000). Patients with carotid artery stenosis and PAOD proved to have an even higher SAF than patients with carotid artery stenosis only: mean 3.28 versus 2.66 (P = 0.003). Backward linear regression analysis showed that age, smoking, diabetes mellitus, renal function and the presence of PAOD were the determinants of SAF, but carotid artery stenosis was not. SAF is increased in patients with carotid artery stenosis and PAOD. The univariate and multivariate associations of SAF with age, smoking, diabetes, renal insufficiency and PAOD suggest that increased SAF can be seen as an indicator of widespread atherosclerosis.

  17. Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease

    Directory of Open Access Journals (Sweden)

    Rosane Maria Nery

    2014-07-01

    Full Text Available Background: Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease. Objective: To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease. Methods: We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts. Results: The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months. Conclusion: Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard.

  18. Occlusion of Internal Carotid Artery in Kimura's Disease

    Directory of Open Access Journals (Sweden)

    Tomonori Tamaki

    2010-01-01

    Full Text Available We describe a unique case of Kimura's disease in which cerebral infarction was caused by occlusion of the right internal carotid artery. A 25-year-old man with Kimura's disease was admitted to our hospital because of left hemiparesis. Computed tomography and magnetic resonance imaging of the head showed infarction in the right frontal and temporal lobes. Cerebral angiography demonstrated right internal carotid artery occlusion affecting the C1 segment, with moyamoya-like collateral vessels arising from the right opthalamic artery. Kimura's disease is a chronic disease characterized by the clinical triad of slowly enlarging subcutaneous masses with lymphoid hyperplasia in the head and neck. It often occurs in young Asian men. In our patient, the pathogenesis of internal carotid artery occlusion was unknown. There have only been a few case reports in which occlusion of the internal carotid artery was associated with autoimmune disease, and no previous cases of internal carotid occlusion associated with Kimura's disease have been reported. We suspected that occlusion of this patient's internal carotid artery may be caused by the autoimmune mechanism that underlies Kimura's disease.

  19. Diabetic retinopathy: A predictor of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Fawzia El Demerdash

    2012-06-01

    Conclusion: Diabetic retinopathy is a good predictor of coronary artery disease that exceeds the conventional risk factors. Diabetics with retinopathy would benefit from early coronary angiography and diabetic retinocoronary clinics are warranted.

  20. Hepatitis C virus infection and risk of coronary artery disease

    DEFF Research Database (Denmark)

    Roed, Torsten; Lebech, Anne-Mette; Kjaer, Andreas;

    2012-01-01

    Several chronic infections have been associated with cardiovascular diseases, including Chlamydia pneumoniae, human immunodeficiency virus and viral hepatitis. This review evaluates the literature on the association between chronic hepatitis C virus (HCV) infection and the risk of coronary artery...

  1. Coronary CT angiography in coronary artery disease: Opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2016-06-01

    Full Text Available Coronary CT angiography is widely recognised as a reliable imaging modality for the diagnosis of coronary artery disease. Coronary CT angiography not only provides excellent visualisation of anatomical changes in the coronary artery with high diagnostic value in the detection of lumen stenosis or occlusion, but also offers quantitative characterisation of coronary plaque components. Furthermore, coronary CT angiography allows myocardial perfusion imaging with diagnostic value comparable to the reference standard method. Coronary CT angiography-derived haemodynamic analysis has the potential to evaluate functional significance of coronary lesions. This review article aims to provide an overview of clinical applications of coronary CT angiography in coronary artery disease.

  2. Smart Technology in Lung Disease Clinical Trials.

    Science.gov (United States)

    Geller, Nancy L; Kim, Dong-Yun; Tian, Xin

    2016-01-01

    This article describes the use of smart technology by investigators and patients to facilitate lung disease clinical trials and make them less costly and more efficient. By "smart technology" we include various electronic media, such as computer databases, the Internet, and mobile devices. We first describe the use of electronic health records for identifying potential subjects and then discuss electronic informed consent. We give several examples of using the Internet and mobile technology in clinical trials. Interventions have been delivered via the World Wide Web or via mobile devices, and both have been used to collect outcome data. We discuss examples of new electronic devices that recently have been introduced to collect health data. While use of smart technology in clinical trials is an exciting development, comparison with similar interventions applied in a conventional manner is still in its infancy. We discuss advantages and disadvantages of using this omnipresent, powerful tool in clinical trials, as well as directions for future research.

  3. Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

    Science.gov (United States)

    Schönherr, Elisabeth; Rehwald, Rafael; Nasseri, Parinaz; Luger, Anna K; Grams, Astrid E; Kerschbaum, Julia; Rehder, Peter; Petersen, Johannes; Glodny, Bernhard

    2016-01-01

    Objective The aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials. Design and setting In a retrospective cohort study, the renal arteries of 126 patients (57 women, 69 men, mean age 60±17.2 years (CI 57.7 to 63.6)) were segmented semiautomatically from high-contrast CT angiographies. Results Among the 300 renal arteries, there were three arteries with fibromuscular dysplasia and one with ostial renal artery stenosis. The first left renal artery was shorter than the right (34±11.4 mm (CI 32 to 36) vs 45.9±15 mm (CI 43.2 to 48.6); p0.05). The first left renal arteries were 1.1±0.4 mm (CI 0.9 to 1.3), and the first right renal arteries were 0.3±0.6 mm (CI 0.1 to 0.5) thinner in women than in men (p4 mm. Some 46% of the patients, or 58.7% when variants and diseases were taken into consideration, were theoretically not suitable for denervation. Conclusions Based on these precise measurements, the anatomical situation as a reason for ruling out denervation appears to be significantly more common than previously suspected. Since this can be the cause of the failure of treatment in some cases, further development of catheters or direct percutaneous approaches may improve success rates. PMID:26729385

  4. Association between nonalcoholic fatty liver disease and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Consuelo P. Vilar

    2013-06-01

    Full Text Available OBJECTIVE: Although some investigations have shown a relationship between nonalcoholic fatty liver disease (NAFLD and cardiovascular diseases, there are few studies analyzing the relationship between NAFLD and coronary artery disease (CAD. The aim of this article was to review the relationship between NAFLD and CAD and the methods of diagnosis used to assess such relationship. METHODS: A review was performed using search engines of indexed scientific material, including MEDLINE (by PubMed, Web of Science, IBECS, and LILACS, to identify articles published in Portuguese, English, and Spanish until August, 2012. The studies were eligible if they included the following data: place and year of publication, prevalence and methods used to diagnose NAFLD (ultrasound, computed tomography, nuclear magnetic resonance, or biopsy and CAD (coronary angiography, or computed tomography, and the exclusion of patients due to alcohol consumption greater than 20 g/day. RESULTS: Ten articles were selected, most of which were cross-sectional studies. The studies mostly observed the association between NAFLD and the presence and severity of CAD. CONCLUSION: The analysis of the review showed that evaluating the existence of NAFLD in patients with CAD from its subclinical form up to the symptomatic clinical form is important due to the higher risk of acute myocardial infarction and consequent increase of mortality.

  5. Peripheral arterial disease in general and diabetic population.

    Science.gov (United States)

    Rabia, K; Khoo, E M

    2007-06-01

    Peripheral arterial disease (PAD) is stenosis or occlusion of peripheral arterial vessels by atherosclerotic plaque. It may present as intermittent claudication, rest pain and impotence. PAD of the lower limbs is the third most important site of atherosclerotic disease after coronary heart disease and cerebrovascular disease. Increasing age, family history, smoking, hypertension, dyslipidemia and more decisively diabetes are significant risk factors. PAD is a clinical condition that has often been neglected, underdiagnosed, undertreated and has a serious outcome. It may lead to nonhealing wounds, gangrene and amputation of the lower limbs. Hence, early identification of patients at risk of PAD and timely referral to the vascular surgeon in severe cases is crucial.

  6. Developmental origin of age-related coronary artery disease

    Science.gov (United States)

    Wei, Ke; Díaz-Trelles, Ramon; Liu, Qiaozhen; Diez-Cuñado, Marta; Scimia, Maria-Cecilia; Cai, Wenqing; Sawada, Junko; Komatsu, Masanobu; Boyle, Joseph J.; Zhou, Bin; Ruiz-Lozano, Pilar; Mercola, Mark

    2015-01-01

    Aim Age and injury cause structural and functional changes in coronary artery smooth muscle cells (caSMCs) that influence the pathogenesis of coronary artery disease. Although paracrine signalling is widely believed to drive phenotypic changes in caSMCs, here we show that developmental origin within the fetal epicardium can have a profound effect as well. Methods and results Fluorescent dye and transgene pulse-labelling techniques in mice revealed that the majority of caSMCs are derived from Wt1+, Gata5-Cre+ cells that migrate before E12.5, whereas a minority of cells are derived from a later-emigrating, Wt1+, Gata5-Cre− population. We functionally evaluated the influence of early emigrating cells on coronary artery development and disease by Gata5-Cre excision of Rbpj, which prevents their contribution to coronary artery smooth muscle cells. Ablation of the Gata5-Cre+ population resulted in coronary arteries consisting solely of Gata5-Cre− caSMCs. These coronary arteries appeared normal into early adulthood; however, by 5–8 months of age, they became progressively fibrotic, lost the adventitial outer elastin layer, were dysfunctional and leaky, and animals showed early mortality. Conclusion Taken together, these data reveal heterogeneity in the fetal epicardium that is linked to coronary artery integrity, and that distortion of the coronaries epicardial origin predisposes to adult onset disease. PMID:26054850

  7. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

    Directory of Open Access Journals (Sweden)

    Toischer Karl

    2009-09-01

    Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

  8. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

    Science.gov (United States)

    Schmitto, Jan D; Kolat, Philipp; Ortmann, Philipp; Popov, Aron F; Coskun, Kasim O; Friedrich, Martin; Sossalla, Samuel; Toischer, Karl; Mokashi, Suyog A; Tirilomis, Theodor; Baryalei, Mersa M; Schoendube, Friedrich A

    2009-01-01

    Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE), it is still used as an adjunct to coronary artery bypass grafting (CABG). This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA), angina pectoris (CCS) and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient). In 98% left internal thoracic artery (LITA) was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA) (n = 55), on left anterior descending artery (LAD) (n = 52) and circumflex artery (RCX) (n = 7). Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%). Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5). During follow-up (24.5 ± 13.4 months), which is 96% complete (4 patients were lost caused by unknown address) 8 patients died (cardiac failure: 3

  9. Acute Limb Ischemia and Coronary Artery Disease in a Case of Kimura’s Disease

    Science.gov (United States)

    Heo, Woon; Jun, Hee Jae; Kang, Do Kyun; Min, Ho-Ki; Hwang, Youn-Ho; Kim, Ji Yong; Nam, Kyung Han

    2017-01-01

    Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion. KD is a systemic disease that affects many organs and presents with thromboembolism and vasculitis. In a patient with KD, physicians should evaluate the vascular system, including the coronary arteries. PMID:28382271

  10. Isolated supraclinoid occlusive disease of the internal carotid artery.

    Science.gov (United States)

    Lagrèze, H L; Hartmann, A; Ries, F; Wappenschmidt, J; Hanisch, E

    1987-01-01

    Isolated supraclinoid occlusive disease of the internal carotid artery is a rare cause of cerebral ischemia. The authors of the only review of this subject concluded that it is caused predominantly by factors other than atherosclerosis. We examined 6 patients with isolated supraclinoid occlusive lesions. Five of them had one or more risk factors for atherosclerosis. Thus, the isolated stenosis of that part of the internal carotid artery does not seem to represent a particular pathologic entity.

  11. Drug-eluting stents in the management of peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Marc Bosiers

    2008-06-01

    Full Text Available Marc Bosiers1, Catherine Cagiannos1, Koen Deloose1, Jürgen Verbist2, Patrick Peeters21Department of Vascular Surgery, AZ St-Blasius, Dendermonde, Belgium; 2Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, BelgiumAbstract: Since major meta-analyses of randomized controlled trials in interventional cardiology showed the potential of drug-eluting stents in decreasing restenosis and reintervention rates after coronary artery stenting, one of the next steps in the treatment of arterial occlusive disease is the transfer of the active coating technology towards peripheral arterial interventions. In this manuscript, we aim to provide a literature overview on available peripheral (lower limb, renal, and supra-aortic drug-eluting stent applications, debate the cost implications, and give recommendations for future treatment strategies.Keywords: critical limb ischemia, drug-eluting stent, below the knee, infrapopliteal, crural, limb salvage

  12. Non-congenital heart disease associated pediatric pulmonary arterial hypertension

    OpenAIRE

    Ivy, D D; Feinstein, J. A.; Humpl, T; Rosenzweig, E. B.

    2009-01-01

    Recognition of causes of pulmonary hypertension other than congenital heart disease is increasing in children. Diagnosis and treatment of any underlying cause of pulmonary hypertension is crucial for optimal management of pulmonary hypertension. This article discusses the available knowledge regarding several disorders associated with pulmonary hypertension in children: idiopathic pulmonary arterial hypertension (IPAH), pulmonary capillary hemangiomatosis, pulmonary veno-occlusive disease, he...

  13. [Coronary artery disease in patient 80 years and older].

    Science.gov (United States)

    Hanon, Olivier

    2008-09-30

    The prevalence of coronary artery disease increases with age. Its clinical presentation is even less typical and its prognosis even more severe that it occurs in frail subjects with several co-morbidities. These atypical symptoms are often associated with a delayed diagnosis and therapy. The presence of comorbidities requires a comprehensive geriatric assessment to detect the existence of "frailty". Evidence based medicine available for coronary artery disease is based on studies that involve very few subjects over 80 years and recommendations are extrapolated from data based on evidence obtained in younger populations. Basically the strategy of treatments of coronary artery disease in octogenarians remains identical to the youngest subject. However, epidemiological studies indicate an under-prescription of recommended drugs whereas this older population is likely to derive the greatest benefit because of its elevated cardiovascular risk. Cautions for use of cardio-vascular therapies are necessary in octogenarian people because of comorbidities and pharmacokinetic and pharmacodynamic changes related to aging. Globally, the therapeutic strategy of coronary artery disease should be based not on the age but on an individual analysis that takes into account the severity of coronary artery disease, the existence of comorbidities, the iatrogenic risk, the expectancy and the quality of life of the patient.

  14. High prevalence of risk factors in coronary artery disease in EUROPA gives HOPE for ACE inhibitors after PEACE

    DEFF Research Database (Denmark)

    Pedersen, S.A.; Galatius, S.; Olsen, M.H.;

    2008-01-01

    Background: Routine use of ACE inhibitors (ACE-I) as secondary preventive therapy for all patients with coronary artery disease (CAD) is challenged by the PEACE trial. Currently it is unclear to what extent ACE-I should be used in CAD populations. Purpose: To analyze the prevalence of left ventri...

  15. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFRCT: outcome and resource impacts study

    Science.gov (United States)

    Douglas, Pamela S.; Pontone, Gianluca; Hlatky, Mark A.; Patel, Manesh R.; Norgaard, Bjarne L.; Byrne, Robert A.; Curzen, Nick; Purcell, Ian; Gutberlet, Matthias; Rioufol, Gilles; Hink, Ulrich; Schuchlenz, Herwig Walter; Feuchtner, Gudrun; Gilard, Martine; Andreini, Daniele; Jensen, Jesper M.; Hadamitzky, Martin; Chiswell, Karen; Cyr, Derek; Wilk, Alan; Wang, Furong; Rogers, Campbell; De Bruyne, Bernard

    2015-01-01

    Aims In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFRCT) is unknown. Methods and results At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing (n = 287) or CTA/FFRCT (n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFRCT-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFRCT arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53–69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFRCT results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFRCT) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFRCT arms. Conclusions Computed tomographic angiography/fractional flow reserve by CTA was a feasible and safe alternative to ICA and was associated with a significantly lower rate of invasive angiography showing no obstructive CAD. PMID:26330417

  16. Chylomicrons metabolism in patients with coronary artery disease; Metabolismo de quilomicrons em pacientes portadores de doenca arterial coronaria

    Energy Technology Data Exchange (ETDEWEB)

    Brandizzi, Laura Ines Ventura

    2002-07-01

    Chylomicrons are the triglyceride-rich lipoproteins that carry dietary lipids absorbed in the intestine. In the bloodstream , chylomicron triglycerides are broken-down by lipoprotein lipase using apoliprotein (apo) CII as co factor. Fatty acids and glycerol resulting from the enzymatic action are absorbed and stored in the body tissues mainly adipose and muscle for subsequent utilizations energy source. The resulting triglycerides depleted remnants are taken-up by liver receptor such as the LDL receptor using mainly apo E as ligand. For methodological reasons, chylomicron metabolism has been unfrequently studied in subjects despite its pathophysiological importance, and this metabolism was not evaluated in the great clinical trials that established the link between atherosclerosis and lipids. In studies using oral fat load tests, it has been shown that in patients with coronary artery disease there is a trend to accumulation of post-prandial triglycerides, vitamin A or apo B-48 , suggesting that in those patients chylomicrons and their remnants are slowly removed from the circulation. A triglyceride-rich emulsion marked radioisotopic which mimics chylomicron metabolism when injected into the bloodstream has been described that can offer a more straight forward approach to evaluate chylomicrons. In coronary artery disease patients both lipolysis and remnant removal from the plasma of the chylomicron-like emulsions were found slowed-down compared with control subjects without the disease. The introduction of more practical techniques to assess chylomicron metabolism may be new mechanisms underlying atherogenesis. (author)

  17. Relationship of daily arterial blood pressure monitoring readings and arterial stiffness profile in male patients with chronic obstructive pulmonary disease combined with arterial hypertension

    Directory of Open Access Journals (Sweden)

    Karoli N.A.

    2013-06-01

    Full Text Available The aim of the study was to determine correlation between arterial blood pressure daily rhythm and daily profile of arterial stiffness in male patients with chronic obstructive pulmonary disease (COPD and arterial hypertension. Materials et methods: Prospective investigation comprised 45 male patients with COPD and arterial hypertension. Individuals of 40 years younger and 80 years elder, patients with diabetes, stroke, angina pectoris, or heart infarction, vascular diseases, and exacerbation of chronic disease, bronchial and pulmonary diseases of other etiology were excluded from the analyses. Comparison group included 47 patients with essential arterial hypertension and without chronic respiratory diseases closely similar on general parameters with patients from main clinical series. Twenty-four-hour arterial blood pressure monitoring (ABPM and daily arterial stiffness monitoring were performed using BPLab® MnSDP-2 apparatus (Petr Telegin, Russian Federation. Results: Patients with COPD combined with arterial hypertension with raised arterial stiffness measures prevail over individuals in essential hypertension group. There is pathological alteration of the ABPM circadian rhythm and raised «Pressure load» values in raised arterial stiffness group. Conclusion: We found ABPM raised parameters in patients with COPD and arterial hypertension. It confirms necessity of ABPM in daily arterial stiffness assessment in patients with COPD.

  18. Endoscopic Saphenous harvesting with an Open CO2 System (ESOS trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Campanella Antonio

    2011-11-01

    Full Text Available Abstract Background In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction. However, to date the short and the long-term benefits of the endoscopic technique remain controversial. This study provides an interesting opportunity to address this gap in the literature. Methods/Design Endoscopic Saphenous harvesting with an Open CO2 System trial includes two parallel vein harvesting arms in coronary artery bypass grafting surgery. It is an interventional, single centre, prospective, randomized, safety/efficacy, cost/effectiveness study, in adult patients with elective planned and first isolated coronary artery disease. A simple size of 100 patients for each arm will be required to achieve 80% statistical power, with a significant level of 0.05, for detecting most of the formulated hypotheses. A six-weeks leg wound complications rate was assumed to be 20% in the conventional arm and less of 4% in the endoscopic arm. Previously quoted studies suggest a first-year vein-graft failure rate of about 20% with an annual occlusion rate of 1% to 2% in the first six years, with practically no difference between the endoscopic and conventional approaches. Similarly, the results on event-free survival rates for the two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to enrol 230 patients from a single Italian cardiac surgery centre. Discussion The goal of this prospective randomized trial is to compare and to test improvement in wound healing, quality of life, safety/efficacy, cost-effectiveness, short

  19. Oral Health and Coronary Artery Disease, A Review Article

    Directory of Open Access Journals (Sweden)

    Alireza Rostami

    2016-03-01

    Full Text Available Atherosclerosis is the most common cause of myocardial infarction and ischemic stroke. Various risk factors have been identified for atherosclerosis. Recently, bacterial and viral organisms, which are involved in chronic inflammatory processes, have been also implicated in atherosclerosis development. Individuals with a prior history of periodontal diseases and/or tooth loss are considered to be at a higher risk for peripheral arterial disease, compared to those without periodontal diseases or tooth loss. Evidence suggests that periodontitis contributes to the overall burden of infection and inflammation and may lead to cardiovascular events and stroke in susceptible patients. In this article, we aimed to review the available data on the relationship between periodontal diseases and cardiovascular diseases, especially coronary artery disease. At least sixty papers were reviewed during 2014-15. Of these, 44 were included in our study.

  20. Arterial structure and function in inflammatory bowel disease.

    Science.gov (United States)

    Zanoli, Luca; Rastelli, Stefania; Inserra, Gaetano; Castellino, Pietro

    2015-10-28

    Inflammatory bowel disease (IBD) is the result of a combination of environmental, genetic and immunologic factors that trigger an uncontrolled immune response within the intestine, which results in inflammation among genetically predisposed individuals. Several studies have reported that the prevalence of classic cardiovascular risk factors is lower among subjects with IBD than in the general population, including obesity, dyslipidaemia, diabetes and hypertension. Therefore, given the risk profile of IBD subjects, the expected cardiovascular morbidity and mortality should be lower in these patients than in the general population. However, this is not the case because the standardized mortality ratio is not reduced and the risk of coronary heart disease is increased in patients with IBD. It is reasonable to hypothesize that other factors not considered in the classical stratification of cardiovascular risk may be involved in these subjects. Therefore, IBD may be a useful model with which to evaluate the effects of chronic low-grade inflammation in the development of cardiovascular diseases. Arterial stiffness is both a marker of subclinical target organ damage and a cardiovascular risk factor. In diseases characterized by chronic systemic inflammation, there is evidence that the inflammation affects arterial properties and induces both endothelial dysfunction and arterial stiffening. It has been reported that decreasing inflammation via anti tumor necrosis factor alpha therapy decreases arterial stiffness and restores endothelial function in patients with chronic inflammatory disorders. Consistent with these results, several recent studies have been conducted to determine whether arterial properties are altered among patients with IBD. In this review, we discuss the evidence pertaining to arterial structure and function and present the available data regarding arterial stiffness and endothelial function in patients with IBD.

  1. Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease

    Energy Technology Data Exchange (ETDEWEB)

    Amarteifio, E., E-mail: erick.amarteifio@med.uni-heidelberg.de [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Wormsbecher, S. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Krix, M. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Bracco Imaging Germany, Konstanz (Germany); Demirel, S. [University Hospital of Heidelberg, Department of Vascular Surgery, Heidelberg (Germany); Braun, S. [Department of Biostatistics, German Cancer Research Center, Heidelberg (Germany); Delorme, S. [Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Boeckler, D. [University Hospital of Heidelberg, Department of Vascular Surgery, Heidelberg (Germany); Kauczor, H.-U. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Weber, M.-A. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany)

    2012-11-15

    Objective: To quantify muscular micro-perfusion and arterial perfusion reserve in peripheral arterial disease (PAD) with dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion. Materials and methods: This study had local institutional review board approval and written informed consent was obtained from all subjects. We examined the dominant lower leg of 40 PAD Fontaine stage IIb patients (mean age, 65 years) and 40 healthy volunteers (mean age, 54 years) with CEUS (7 MHz; MI, 0.28) during continuous intravenous infusion of 4.8 mL microbubbles. Transient arterial occlusion at mid-thigh level simulated physical exercise. With time-CEUS-intensity curves obtained from regions of interest within calf muscles, we derived the maximum CEUS signal after occlusion (max) and its time (t{sub max}), slope to maximum (m), vascular response after occlusion (AUC{sub post}), and analysed accuracy, receiver operating characteristic (ROC) curves, and correlations with ankle-brachial index (ABI) and walking distance. Results: All parameters differed in PAD and volunteers (p < 0.014). In PAD, t{sub max} was delayed (31.2 {+-} 13.6 vs. 16.7 {+-} 8.5 s, p < 0.0001) and negatively correlated with ankle-brachial-index (r = -0.65). m was decreased in PAD (4.3 {+-} 4.6 mL/s vs. 13.1 {+-} 8.4 mL/s, p < 0.0001) and had highest diagnostic accuracy (sensitivity/specificity, 75%/93%) for detection of diminished muscular micro-perfusion in PAD (cut-off value, m < 5{approx}mL/s). Discriminant analysis and ROC curves revealed m, and AUC{sub post} as optimal parameter combination for diagnosing PAD and therefore impaired arterial perfusion reserve. Conclusions: Dynamic CEUS with transient arterial occlusion quantifies muscular micro-perfusion and arterial perfusion reserve. The technique is accurate to diagnose PAD.

  2. Atypical presentation of acute and chronic coronary artery disease in diabetics

    Institute of Scientific and Technical Information of China (English)

    Hadi; AR; Hadi; Khafaji; Jassim; M; Al; Suwaidi

    2014-01-01

    In patients with diabetes mellitus, cardiovascular disease is the principal cause of mortality and chest pain is the most frequent symptom in patients with stable and acute coronary artery disease. However, there is little knowledge concerning the pervasiveness of uncommon presentations in diabetics. The symptomatology of acute coronary syndrome, which comprises both pain and non-pain symptoms, may be affected by traditional risk factors such as age, gender, smoking, hypertension, diabetes, and dyslipidemia. Such atypical symptoms may range from silent myocardial ischemia to a wide spectrum of non-chest pain symptoms. Worldwide, few studies have highlighted this under-investigated subject, and this aspect of ischemic heart disease has also been under-evaluated in the major clinical trials. The results of these studies are highly diverse which makes definitive conclusions regarding the spectrum of atypical presentation of acute and even stable chronic coronay artery disease difficult to confirm. This may have a significant impact on the morbidity and mortality of coronary artery disease in diabetics. In this up-to-date review we will try to analyze the most recent studies on the atypical presentations in both acute and chronic ischemic heart disease which may give some emphasis to this under-investigated topic.

  3. Medical treatment of peripheral arterial disease in the elderly

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism be treated in elderly patients with peripheral arterial disease (PAD). Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all persons with PAD. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation programs and cilostazol lengthen exercise time until intermittent claudication develops. Chelation therapy should be avoided.

  4. PREVALENCE OF CORONARY ARTERY DISEASE IN PATIENTS WITH VALVULAR HEART DISEASE

    Directory of Open Access Journals (Sweden)

    Hiranya Kumar Saharia

    2016-07-01

    Full Text Available BACKGROUND Heart disease is a growing problem, particularly in developing countries. India has quoted to have 12.2% and 12% prevalence of coronary artery disease and rheumatic valvular heart disease respectively. Some older reports suggest that rheumatic fever, in addition to producing specific injuries to small coronary arterial branches may accelerate the development of coronary atherosclerosis. AIM To assess the prevalence of Coronary Artery disease in patients with Valvular Heart disease in some selected hospitals of Guwahati, Assam. SETTING AND DESIGN It was conducted in Gauhati Medical College and Hospital and Hayat Hospital, Guwahati. Explorative approach, survey design was selected for the study. MATERIALS AND METHODS Purposive sampling technique was used to select 126 patients who were diagnosed with valvular heart disease. Data was collected through a self-structured interview scheduled on prevalence of coronary artery disease. RESULTS Of the total 126 patients of valvular heart disease, 108 (85.71% cases were rheumatic valvular heart disease and 18 (14.29% were non-rheumatic valvular heart disease. Majority (56.34% of cases with CAD and RHD were in the range of 45 to 54 years. The prevalence of typical angina was significantly high among men (41.18%. Most of the rheumatic patients (72.22% did not complain about angina. Diabetes mellitus, hypertension and dyslipidaemia are significantly high among non-rheumatic group and Coronary artery disease group. In our study, the overall prevalence of significant coronary artery disease in patients with valvular heart disease was 14.28%. CONCLUSION Coronary artery disease prevalence is very high in this part of the country. Health professionals should actively participate in health promotion activities, apply the findings of the study to identify high risk individuals and prevent the occurrence of coronary artery disease.

  5. Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn's Disease

    Institute of Scientific and Technical Information of China (English)

    Wei-wei Wu; Xue-ying Jiang; Chang-wei Liu; Yong-jun Li; Rong Zeng

    2009-01-01

    Objective To investigate the dinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease(CD).Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively.Results All the cases were less than 50 years old and the most were females(8/9).Arterial occlusions occurred in either active(5/9)or inactive(4/9)stage of CD.Besides the arteries of lower extremities,other arteries could also be involved such as aorta,iliac artery,renal artery or mesentery artery.Seven cases had atherosclerotic imaging findings(4 had aortic plaques and 6 had iliac artery stenoses).Embolectomy or thromboendarterectomy were mostly performed.Four(44.4% )cases had recurrent lower limb ischemia.Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD.A thorough inspection of aorta is necessary.Embolectomy is mostly preferred.Anticoagulation treatment is highly recommended after the operation.

  6. [Impact of periodontal disease on arterial pressure in diabetic mice].

    Science.gov (United States)

    Blasco-Baque, V; Kémoun, P; Loubieres, P; Roumieux, M; Heymes, C; Serino, M; Sixou, M; Burcelin, R

    2012-06-01

    Diabetes-driven cardiovascular diseases represent a high challenge for developed countries. Periodontal disease is strictly linked to the aforementioned diseases, due to its Gram negative-driven inflammation. Thus, we investigated the effects of periodontal disease on arterial pressure during the development of diabetes in mice. To this aim, C57BL/6 female mice were colonized with pathogens of periodontal tissue (Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum) for 1month, whereas another group of mice did not undergo the colonization. Subsequently, all mice were fed a high-fat carbohydrate-free diet for 3months. Then, arterial pressure was measured in vivo and a tomodensitometric analysis of mandibles was realized as well. Our results show increased mandibular bone-loss induced by colonization with periopathogens. In addition, periodontal infection augmented glucose-intolerance and systolic and diastolic arterial pressure, parameters already known to be affected by a fat-diet. In conclusion, we show here that periodontal disease amplifies metabolic troubles and deregulates arterial pressure, emerging as a new axis of metabolic investigation.

  7. Drug-eluting balloon catheters for lower limb peripheral arterial disease: the evidence to date

    Science.gov (United States)

    Barkat, Mohamed; Torella, Francesco; Antoniou, George A

    2016-01-01

    A significant proportion of patients with severe lower limb peripheral arterial disease require revascularization. Over the past decade, an endovascular-first approach even for complex disease has gained widespread use among vascular specialists. An important limitation of percutaneous transluminal balloon angioplasty or stenting remains the occurrence of restenosis. Drug-coated balloons have emerged as an exciting technology developed to overcome the limitations of standard balloon angioplasty and stenting. Drug-eluting devices inhibit neointimal growth of vascular smooth muscle cells with the potential of preventing restenosis. This review provides a synopsis of the up-to-date evidence on the role of drug-coated balloons in the treatment of lower limb peripheral arterial disease. Bibliographic searches were conducted using MEDLINE, EMBASE, and the Cochrane Library electronic database. Eleven randomized clinical trials, two systematic reviews, and a published registry providing the best available evidence were identified. Current evidence suggests that angioplasty with drug-coated balloon is reliable, safe, and efficient in increasing patency rates and reducing target lesion revascularization and restenosis. However, it remains unknown whether these improved results can translate into beneficial clinical outcomes, as current randomized clinical trials have failed to demonstrate a significant benefit in limb salvage and mortality. Further randomized trials focusing on clinical and functional outcomes of drug-eluting balloons and on cost versus clinical benefit are required. PMID:27274265

  8. Giant aneurysm of the left anterior descending coronary artery in a pediatric patient with Behcet's disease.

    Science.gov (United States)

    Cook, Amanda L; Rouster-Stevens, Kelly; Williams, Derek A; Hines, Michael H

    2010-07-01

    Behcet's disease is a rare autoimmune vasculitis characterized by oral aphthosis, genital ulcers, and ocular and cutaneous lesions. Vascular involvement usually affects the veins more commonly than the arteries, and coronary arterial involvement is extremely rare. We report an adolescent with Behcet's disease who developed a large pseudoaneurysm of the left anterior descending coronary artery requiring a coronary arterial bypass graft.

  9. Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound

    DEFF Research Database (Denmark)

    Perko, M J; Just, S; Schroeder, T V

    1997-01-01

    To assess the predictive value of ultrasound duplex scanning in the detection of superior mesenteric artery (SMA) and celiac artery (CA) occlusive disease.......To assess the predictive value of ultrasound duplex scanning in the detection of superior mesenteric artery (SMA) and celiac artery (CA) occlusive disease....

  10. Magnetic Resonance Venous Volume Measurements in Peripheral Artery Disease (from ELIMIT).

    Science.gov (United States)

    Kamran, Hassan; Nambi, Vijay; Negi, Smita; Yang, Eric Y; Chen, Changyi; Virani, Salim S; Kougias, Panos; Lumsden, Alan B; Morrisett, Joel D; Ballantyne, Christie M; Brunner, Gerd

    2016-11-01

    The relation between the arterial and venous systems in patients with impaired lower extremity blood flow remains poorly described. The objective of this secondary analysis of the Effectiveness of Intensive Lipid Modification Medication in Preventing the Progression on Peripheral Artery Disease Trial was to determine the association between femoral vein (FV) volumes and measurements of peripheral artery disease. FV wall, lumen, and total volumes were quantified with fast spin-echo proton density-weighted magnetic resonance imaging scans in 79 patients with peripheral artery disease over 2 years. Reproducibility was excellent for FV total vessel (intraclass correlation coefficient 0.924, confidence interval 0.910 to 0.935) and lumen volumes (intraclass correlation coefficient 0.893, confidence interval 0.873 to 0.910). Baseline superficial femoral artery volumes were directly associated with FV wall (r = 0.46, p <0.0001), lumen (r = 0.42, p = 0.0001), and total volumes (r = 0.46, p <0.0001). The 2-year change in maximum walking time was inversely associated with the 24-month change in FV total volume (r = -0.45, p = 0.03). In conclusion, FV volumes can be measured reliably with fast spin-echo proton density-weighted magnetic resonance imaging, and baseline superficial femoral artery plaque burden is positively associated with FV volumes, whereas the 2-year change in FV volumes and leg function show an inverse relation.

  11. Immunohistochemical Analysis of Paraoxonases and Chemokines in Arteries of Patients with Peripheral Artery Disease

    Directory of Open Access Journals (Sweden)

    Anna Hernández-Aguilera

    2015-05-01

    Full Text Available Oxidative damage to lipids and lipoproteins is implicated in the development of atherosclerotic vascular diseases, including peripheral artery disease (PAD. The paraoxonases (PON are a group of antioxidant enzymes, termed PON1, PON2, and PON3 that protect lipoproteins and cells from peroxidation and, as such, may be involved in protection against the atherosclerosis process. PON1 inhibits the production of chemokine (C–C motif ligand 2 (CCL2 in endothelial cells incubated with oxidized lipoproteins. PON1 and CCL2 are ubiquitously distributed in tissues, and this suggests a joint localization and combined systemic effect. The aim of the present study has been to analyze the quantitative immunohistochemical localization of PON1, PON3, CCL2 and CCL2 receptors in a series of patients with severe PAD. Portions of femoral and/or popliteal arteries from 66 patients with PAD were obtained during surgical procedures for infra-inguinal limb revascularization. We used eight normal arteries from donors as controls. PON1 and PON3, CCL2 and the chemokine-binding protein 2, and Duffy antigen/chemokine receptor, were increased in PAD patients. There were no significant changes in C–C chemokine receptor type 2. Our findings suggest that paraoxonases and chemokines play an important role in the development and progression of atherosclerosis in peripheral artery disease.

  12. Drug-eluting balloon catheters for lower limb peripheral arterial disease: the evidence to date

    Directory of Open Access Journals (Sweden)

    Barkat M

    2016-05-01

    Full Text Available Mohamed Barkat,1 Francesco Torella,1 George A Antoniou2 1Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, 2Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK Abstract: A significant proportion of patients with severe lower limb peripheral arterial disease require revascularization. Over the past decade, an endovascular-first approach even for complex disease has gained widespread use among vascular specialists. An important limitation of percutaneous transluminal balloon angioplasty or stenting remains the occurrence of restenosis. Drug-coated balloons have emerged as an exciting technology developed to overcome the limitations of standard balloon angioplasty and stenting. Drug-eluting devices inhibit neointimal growth of vascular smooth muscle cells with the potential of preventing restenosis. This review provides a synopsis of the up-to-date evidence on the role of drug-coated balloons in the treatment of lower limb peripheral arterial disease. Bibliographic searches were conducted using MEDLINE, EMBASE, and the Cochrane Library electronic database. Eleven randomized clinical trials, two systematic reviews, and a published registry providing the best available evidence were identified. Current evidence suggests that angioplasty with drug-coated balloon is reliable, safe, and efficient in increasing patency rates and reducing target lesion revascularization and restenosis. However, it remains unknown whether these improved results can translate into beneficial clinical outcomes, as current randomized clinical trials have failed to demonstrate a significant benefit in limb salvage and mortality. Further randomized trials focusing on clinical and functional outcomes of drug-eluting balloons and on cost versus clinical benefit are required. Keywords: drug-eluting balloon, drug-coated balloon, angioplasty, peripheral arterial

  13. Vitamin D deficiency and coronary artery disease: a review of the evidence.

    Science.gov (United States)

    Kunadian, Vijay; Ford, Gary A; Bawamia, Bilal; Qiu, Weiliang; Manson, JoAnn E

    2014-03-01

    Coronary artery disease remains the leading cause of death in developed countries despite significant progress in primary prevention and treatment strategies. Older patients are at particularly high risk of poor outcomes following acute coronary syndrome and impaired nutrition, including low vitamin D levels, may play a role. The extraskeletal effects of vitamin D, in particular, its role in maintaining a healthy cardiovascular system are receiving increased attention. Longitudinal studies have demonstrated increased cardiovascular mortality and morbidity associated with vitamin D deficiency. Low vitamin D levels have been linked to inflammation, higher coronary artery calcium scores, impaired endothelial function and increased vascular stiffness. However, so far, few randomized controlled trials have investigated the potential benefits of vitamin D supplementation in preventing cardiovascular events, and most available trials have tested low doses of supplementation in relatively low-risk populations. Whether vitamin D supplementation will be beneficial among patients with coronary artery disease, including high risk older patients presenting with acute coronary syndrome, is unknown and warrants further investigation.

  14. Diagnosis of coronary artery disease with dobutamine-stress MRI

    NARCIS (Netherlands)

    Kuijpers, D

    2005-01-01

    Dobutamine-stress cardiovascular magnetic resonance (CMR) is a new diagnostic tool for the non-invasive detection of coronary artery disease. Technological advances in CMR have evolved this technique to an adequate alternative to the standard cardiac stress tests. Its high reproducibility and excell

  15. Brain damage in patients with manifest arterial disease

    NARCIS (Netherlands)

    Raamt, Anne Fleur van

    2006-01-01

    In this thesis we assessed whether the risk factors known to affect markers of brain damage in the general population, also effectuate brain damage in patients who already have symptomatic arterial disease. We found that elevated levels of homocysteine were related to slightly lower global cogniti

  16. The obesity paradox in patients with peripheral arterial disease

    NARCIS (Netherlands)

    W. Galal (Wael); Y.R.B.M. van Gestel (Yvette); S.E. Hoeks (Sanne); D.D. Sin; T.A. Winkel (Tamara); J.J. Bax (Jeroen); H.J.M. Verhagen (Hence); A.M.M. Awara (Adel); J. Klein (Jan); R.T. van Domburg (Ron); D. Poldermans (Don)

    2008-01-01

    textabstractBackground: Cardiac events are the predominant cause of late mortality in patients with peripheral arterial disease (PAD). In these patients, mortality decreases with increasing body mass index (BMI). COPD is identified as a cardiac risk factor, which preferentially affects underweight i

  17. Risk stratification of patients suspected of coronary artery disease

    DEFF Research Database (Denmark)

    Jensen, Jesper Møller; Voss, Mette; Hansen, Vibeke B;

    2012-01-01

    To compare the performance of five risk models (Diamond-Forrester, the updated Diamond-Forrester, Morise, Duke, and a new model designated COronary Risk SCORE (CORSCORE) in predicting significant coronary artery disease (CAD) in patients with chest pain suggestive of stable angina pectoris....

  18. Oxidation-Specific Biomarkers and Risk of Peripheral Artery Disease

    NARCIS (Netherlands)

    Bertoia, Monica L.; Pai, Jennifer K.; Lee, Jun-Hee; Taleb, Adam; Joosten, Michel M.; Mittleman, Murray A.; Yang, Xiaohong; Witztum, Joseph L.; Rimm, Eric B.; Tsimikas, Sotirios; Mukamal, Kenneth J.

    2013-01-01

    Objectives The goal of this study was to examine the prospective association between oxidation-specific biomarkers, primarily oxidized phospholipids (OxPL) on apolipoprotein B-100-containing lipoproteins (OxPL/apoB) and lipoprotein (a) [Lp(a)], and risk of peripheral artery disease (PAD). We examine

  19. IGF-I and IGFBP2 in peripheral artery disease

    DEFF Research Database (Denmark)

    Urbonaviciene, Grazina; Frystyk, Jan; Urbonavicius, Sigitas;

    2014-01-01

    -2) in the pathogenesis of CVD disorders. The aim of this study was to examine the relationship between levels of IGF-I and IGFBP-2 with all-cause and CVD mortality in a prospective study of patients with lower-extremity peripheral artery disease (PAD). METHODS AND MATERIAL: Serum IGF-I and IGFBP-2...

  20. Dietary antioxidants and peripheral arterial disease : the Rotterdam Study

    NARCIS (Netherlands)

    K. Klipstein-Grobusch (Kerstin); J.H. den Breeijen; D.E. Grobbee (Diederick); H. Boeing; J.C.M. Witteman (Jacqueline); A. Hofman (Albert)

    2001-01-01

    textabstractThis study examined cross-sectionally the association of dietary beta-carotene, vitamin C, and vitamin E with peripheral arterial disease in Rotterdam, the Netherlands (1990--1993). The 4,367 subjects from the Rotterdam Study were aged 55--94 years and had n

  1. Serum bilirubin levels, polymorphisms and risk for coronary artery disease

    OpenAIRE

    Lingenhel, Arno; Kollerits, Barbara; Johannes P. Schwaiger; Hunt, Steven C.; Gress, Richard; Hopkins, Paul N.; Schoenborn, Veit; Heid, Iris M; Kronenberg, Florian

    2008-01-01

    Serum bilirubin levels, UGT1A1 polymorphisms and risk for coronary artery disease correspondence: Corresponding author. Tel.: +43 512 9003 70560; fax: +43 512 9003 73560. (Kronenberg, Florian) (Kronenberg, Florian) Division of Genetic Epidemiology; Department of Medical Genetics, Molecular and Clinical Pharmacology; Innsbruck Medical University - AUSTRIA (Lingenhel, Arno) Division of Genetic Epidemiology; Depa...

  2. ABO Blood Group and Risk of Thromboembolic and Arterial Disease

    DEFF Research Database (Denmark)

    Vasan, Senthil K; Rostgaard, Klaus; Majeed, Ammar

    2016-01-01

    BACKGROUND: ABO blood groups have been shown to be associated with increased risks of venous thromboembolic and arterial disease. However, the reported magnitude of this association is inconsistent and is based on evidence from small-scale studies. METHODS AND RESULTS: We used the SCANDAT2 (Scand...

  3. Coronary Artery Disease: from Atherosclerosis to Cardiogenic Shock

    NARCIS (Netherlands)

    J.M. Cheng (Jin Ming)

    2015-01-01

    markdownabstract__Abstract__ The aim of this thesis is twofold: 1. to investigate the prognostic value of intracoronary imaging and blood biomarkers in patients with coronary artery disease; 2. to improve risk prediction and management of patients with cardiogenic shock from acute myocardial infarc

  4. Relationship between the arterial calcification detected in mammography and coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Topal, Ugur [Department of Radiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey)], E-mail: utopal@uludag.edu.tr; Kaderli, Aysel [Department of Cardiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey); Topal, Naile Bolca [Department of Radiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey); Ozdemir, Buelent; Yesilbursa, Dilek; Cordan, Jale [Department of Cardiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey); Ediz, Buelent [Department of Statistics, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey); Aydinlar, Ali [Department of Cardiology, Uludag University, Medical School, Goeruekle Campus, 16059 Bursa (Turkey)

    2007-09-15

    Objective: Arterial calcification is frequently encountered in mammography. The frequency of breast arterial calcification (BAC) increases with increasing age. Studies have shown that BAC is seen more frequently among the people who are under the risk of coronary artery diseases (CAD) such as diabetes and hypertension. The objective of this study is to investigate the relationship between the arterial calcification detected in mammography and the CAD. Material and methods: Screening mammography was performed in 123 women above the age of 40 years who had been examined with coronary angiography for the evaluation of CAD. The presence of BAC, number of affected vessels, and the distribution of calcification in the vessel wall were evaluated in the mammography. Subjects were questioned in terms of the cardiovasculary risk factors. The severity of CAD was evaluated according to the Gensini scoring. In addition, the number of blood vessels with stenosis of more than 50% was used as the vascular score. The correlation between Gensini and the vascular scores, and BAC was statistically evaluated using Mann-Whitney U and Kruskal-Wallis tests. Results: Eighty (65%) of 123 patients had CAD. BAC was detected in the mammography of 49 (39.8%) subjects. The ages and duration of menopause of the cases with BAC were significantly higher than those without BAC (p < 0.001). There was an almost significant correlation between the BAC and Gensini scores (p = 0.059). There was a significant increase in the frequency of BAC among subjects with more than two vessels with stenosis (p = 0.033). Conclusion: Frequency of BAC increases with increasing age. BAC is also frequently seen in subjects having severe coronary artery disease. Although increasing age may be a factor increasing the frequency of BAC, BAC may also be an indicator of CAD. Therefore, the mentioning of arterial calcification in mammography reports may be important in warning the clinician in terms of CAD.

  5. Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease

    Science.gov (United States)

    Douglas, Pamela S.; Hoffmann, Udo; Patel, Manesh R.; Mark, Daniel B.; Al-Khalidi, Hussein R.; Cavanaugh, Brendan; Cole, Jason; Dolor, Rowena J.; Fordyce, Christopher B.; Huang, Megan; Khan, Muhammad Akram; Kosinski, Andrzej S.; Krucoff, Mitchell W.; Malhotra, Vinay; Picard, Michael H.; Udelson, James E.; Velazquez, Eric J.; Yow, Eric; Cooper, Lawton S.; Lee, Kerry L.

    2015-01-01

    BACKGROUND Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. METHODS We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. RESULTS The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P = 0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P = 0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). CONCLUSIONS In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the

  6. Is misery perfusion still a predictor of stroke in symptomatic major cerebral artery disease?

    Science.gov (United States)

    Yamauchi, Hiroshi; Higashi, Tatsuya; Kagawa, Shinya; Nishii, Ryuichi; Kudo, Takashi; Sugimoto, Kanji; Okazawa, Hidehiko; Fukuyama, Hidenao

    2012-08-01

    Studies in the 1990s demonstrated that misery perfusion is a predictor of subsequent stroke in medically treated patients with symptomatic major cerebral artery disease. A recent randomized controlled trial demonstrated no benefit of bypass surgery for such patients. In this light, outcome in patients with misery perfusion has regained interest. The purpose of this study was to determine whether misery perfusion is still a predictor of subsequent stroke despite recent improvements in medical treatment for secondary prevention of stroke, and if so, whether the predictive value of misery perfusion has changed in recent years. We prospectively studied 165 non-disabled patients with symptomatic atherosclerotic internal carotid artery or middle cerebral artery occlusive diseases who underwent positron emission tomography from 1999 to 2008. Misery perfusion was defined as decreased cerebral blood flow, increased oxygen extraction fraction and decreased ratio of cerebral blood flow to blood volume in the hemisphere supplied by the diseased artery. All patients were followed up for 2 years until stroke recurrence or death. Bypass surgery was performed in 19 of 35 patients with and 16 of 130 patients without misery perfusion. The 2-year incidence of ipsilateral ischaemic stroke was six and four patients with and without misery perfusion, including two and one after surgery, respectively (P misery perfusion and 12 patients without (P misery perfusion in whole sample was 6.3 (95% confidence interval 1.7-22.4, P misery perfusion or bypass surgery did not differ. Between these periods, patients without misery perfusion demonstrated a decrease in stroke rate (from 16.2% to 0%), but patients with misery perfusion did not (26.3 and 25.0%). In symptomatic major cerebral artery disease, misery perfusion remains a predictor of subsequent stroke, although the recurrence rate was lower than the previous study. In patients without misery perfusion, the risk of stroke was reduced

  7. Advances in nanotechnology for the management of coronary artery disease.

    Science.gov (United States)

    Rhee, June-Wha; Wu, Joseph C

    2013-02-01

    Nanotechnology holds tremendous potential to advance the current treatment of coronary artery disease. Nanotechnology may assist medical therapies by providing a safe and efficacious delivery platform for a variety of drugs aimed at modulating lipid disorders, decreasing inflammation and angiogenesis within atherosclerotic plaques, and preventing plaque thrombosis. Nanotechnology may improve coronary stent applications by promoting endothelial recovery on a stent surface utilizing bio-mimetic nanofibrous scaffolds, and also by preventing in-stent restenosis using nanoparticle-based delivery of drugs that are decoupled from stents. Additionally, nanotechnology may enhance tissue-engineered graft materials for application in coronary artery bypass grafting by facilitating cellular infiltration and remodeling of a graft matrix.

  8. Vascular function and mild renal impairment in stable coronary artery disease

    NARCIS (Netherlands)

    van der Harst, P; Smilde, TDJ; Buikema, H; Voors, AA; Navis, G; van Veldhuisen, DJ; van Gilst, WH

    2006-01-01

    Objective - In patients with coronary artery disease, the concomitant presence of renal function impairment is associated with decreased survival. We aimed to assess whether in coronary artery diseased patients renal function impairment is associated with systemic vascular function, functional param

  9. Can fish oil supplementation improve endothelial function in asymptomatic offspring of patients with peripheral arterial disease?

    Directory of Open Access Journals (Sweden)

    Spark JI

    2013-07-01

    Full Text Available J Ian Spark,1 Christopher L Delaney,1 Richard B Allan,1 Melissa HL Ho,2 Michelle D Miller21Department of Vascular Surgery, Flinders Medical Centre and Flinders University, 2Department of Nutrition and Dietetics, Flinders University, Bedford Park, Adelaide, South Australia, AustraliaBackground: Peripheral arterial disease affects 10%–25% of adults aged .55 years, and while a multitude of risk factors exist, one key influence is genetics. Rather than awaiting the onset of debilitating symptoms, interventions that target high-risk individuals and prevent or delay the onset of symptoms would have widespread impact. The aim of this study is to implement a 12-week fish oil intervention (10 mL/day containing approximately 1.5 g of eicosapentaenoic acid and 1 g of docosahexaenoic acid, with the intention of improving endothelial function, inflammation, and lipid status in a high-risk population, ie, those with impaired endothelial function and a parent with symptomatic peripheral arterial disease.Methods: This is a parallel-group, double-blind, randomized controlled trial involving administration of fish oil containing either about 1.5 g of docosahexaenoic acid and 1 g of docosahexaenoic acid (intervention or about 0.15 g of eicosapentaenoic acid and about 0.1 g of docosahexaenoic acid for 12 consecutive weeks (control. The participants are 100 offspring of adults with diagnosed peripheral arterial disease who themselves have an ankle-brachial pressure index ≥0.9 but impaired endothelial function according to peripheral arterial tonometry. Measures performed at baseline and at 6 and 12 weeks include flow-mediated dilatation, C-reactive protein, absolute neutrophil and lymphocyte counts, tumor necrosis factor-α, interleukin-1ß, and interleukin-6 levels, thromboxane and prostacyclin, lipid status, and homocysteine, nitrite, and nitrate levels. Participants will be phoned fortnightly to monitor adherence and side effects, while participants will

  10. Dual antiplatelet therapy in patients with aspirin resistance following coronary artery bypass grafting: study protocol for a randomized controlled trial [NCT01159639

    Directory of Open Access Journals (Sweden)

    Gasparovic Hrvoje

    2012-08-01

    Full Text Available Abstract Background Coronary artery disease remains the dominant cause of mortality in developed countries. While platelets have been recognized to play a pivotal role in atherothrombosis, the ideal antiplatelet regime after coronary artery surgery remains elusive. The evolution of CABG has presently moved beyond technical improvements to involve modulation of pharmacologic management designed to improve patient outcomes. The aim of this trial will be to test the hypothesis that the addition of clopidogrel to patients with documented postoperative aspirin resistance will reduce the incidence of major cardiovascular events. Methods Patients scheduled for isolated coronary artery surgery will be eligible for the study. Patients in whom postoperative multiple electrode aggregometry documents aspirin resistance will be randomized into two groups. The control group will receive 300 mg of aspirin. The dual antiplatelet group will receive 75 mg of clopidogrel in addition to 300 mg of aspirin. Patients will be followed for 6 months. Major adverse cardiac and cerebrovascular events (death from any cause, myocardial infarction, stroke, hospitalization due to cardiovascular pathology as well as bleeding events will be recorded. Discussion This will be the first trial that will specifically address the issue of dual antiplatelet therapy in patients undergoing coronary artery surgery who have been found to be aspirin resistant. In the event that the addition of clopidogrel proves to be beneficial in this subset of surgical patients, this study could significantly impact their future antiplatelet management. This randomized controlled trial has been registered at the ClinicalTrials.gov website (Identifier NCT01159639.

  11. Depression and Coronary Artery Disease: The Association, Mechanisms, and Therapeutic Implications

    OpenAIRE

    Khawaja, Imran Shuja; Westermeyer, Joseph J.; Gajwani, Prashant; Feinstein, Robert E.

    2009-01-01

    We performed a comprehensive review of the literature to determine whether or not a relationship between depression and coronary artery disease exists. Our literature search supports the following: Depression and coronary artery disease have a bidirectional relationship, i.e., coronary artery disease can cause depression and depression is an independent risk factor for coronary artery disease and its complications; depression may contribute to sudden cardiac death and increase all causes of c...

  12. Remodelling of the microarchitecture of resistance arteries in cardiovascular diseases

    DEFF Research Database (Denmark)

    Bloksgaard, Maria; Brewer, Jonathan R.; Leurgans, Thomas;

    is largely unknown, and the presented project aims to investigate this. Innovative multiphoton excitation microscopy will be applied on live (vital), isolated, cannulated and pressurized arteries from parietal pericardial biopsies obtained during open cardiac surgery (coronary artery bypass grafting......, and endothelial and smooth muscle cells will be determined in relation to a range of distending pressures (50, 100, 150, 200 mmHg) and in relation to the frequently determined M:L. We present here our initial results from (pig) pericardial biopsies where we describe the microarchitecture of the tissue...... in comparison to other well-studied microvascular beds (e.g. rat mesentery). In the future we aim to compare the microarchitecture of small resistance arteries from parietal pericardial biopsies between patients with and without (treated) hypertension, diabetes and/or ischemic heart disease. 1. Buus, N.H., et...

  13. Epidemiology, classification, and modifiable risk factors of peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Nicolas W Shammas

    2007-05-01

    Full Text Available Nicolas W ShammasMidwest Cardiovascular Research Foundation, Cardiovascular Medicine, PC, Davenport, IA, USAAbstract: Peripheral arterial disease (PAD is part of a global vascular problem of diffuse atherosclerosis. PAD patients die mostly of cardiac and cerebrovascular-related events and much less frequently due to obstructive disease of the lower extremities. Aggressive risk factors modification is needed to reduce cardiac mortality in PAD patients. These include smoking cessation, reduction of blood pressure to current guidelines, aggressive low density lipoprotein lowering, losing weight, controlling diabetes and the use of oral antiplatelet drugs such as aspirin or clopidogrel. In addition to quitting smoking and exercise, cilostazol and statins have been shown to reduce claudication in patients with PAD. Patients with critical rest limb ischemia or severe progressive claudication need to be treated with revascularization to minimize the chance of limb loss, reduce symptoms, and improve quality of life.Keywords: peripheral arterial disease, epidemiology, risk factors, classification

  14. Peripheral artery disease: potential role of ACE-inhibitor therapy

    Directory of Open Access Journals (Sweden)

    Giuseppe Coppola

    2008-12-01

    Full Text Available Giuseppe Coppola, Giuseppe Romano, Egle Corrado, Rosa Maria Grisanti, Salvatore NovoDepartment of Internal Medicine, Cardiovascular and Nephro-Urological Diseases, Chair of Cardiovascular Disease, University of Palermo, Palermo, ItalyAbstract: Subjects with peripheral arterial disease (PAD of the lower limbs are at high risk for cardiovascular and cerebrovascular events and the prevalence of coronary artery disease in such patients is elevated. Recent studies have shown that regular use of cardiovascular medications, such as therapeutic and preventive agents for PAD patients, seems to be promising in reducing long-term mortality and morbidity. The angiotensin-converting-enzyme (ACE system plays an important role in the pathogenesis and progression of atherosclerosis, and ACE-inhibitors (ACE-I seem to have vasculoprotective and antiproliferative effects as well as a direct antiatherogenic effect. ACE-I also promote the degradation of bradykinin and the release of nitric oxide, a potent vasodilator; further, thay have shown important implications for vascular oxidative stress. Other studies have suggested that ACE-I may also improve endothelial dysfunction. ACE-I are useful for reducing the risk of cardiovascular events in clinical and subclinical PAD. Particularly, one agent of the class (ie, ramipril has shown in many studies to able to significantly reduce cardiovascular morbidity and mortality in patients with PAD.Keywords: atherosclerosis, peripheral arterial disease, endothelial dysfunction, ACE-inhibitors

  15. Medical History for Prognostic Risk Assessment and Diagnosis of Stable Patients with Suspected Coronary Artery Disease

    NARCIS (Netherlands)

    J.K. Min (James); A. Dunning (Allison); H. Gransar (Heidi); S. Achenbach (Stephan); F.Y. Lin (Fay); M. Al-Mallah (Mouaz); M.J. Budoff (Matthew J.); T.Q. Callister (Tracy); H.-J. Chang (Hyuk-Jae); F. Cademartiri (Filippo); E. Maffei (Erica); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); R.B. D'Agostino (Ralph); A. Delago (Augustin); J. Friedman (John); M. Hadamitzky (Martin); J. Hausleiter (Jörg); S.W. Hayes (Sean W.); P.A. Kaufmann (Philipp A.); G.L. Raff (Gilbert); L.J. Shaw (Leslee J.); L.E.J. Thomson (Louise); T.C. Villines (Todd); R.C. Cury (Ricardo); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); J. Leipsic (Jonathon); H. Marques (Hugo); D.S. Berman (Daniel S.); M. Pencina (Michael)

    2015-01-01

    textabstractObjective To develop a clinical cardiac risk algorithm for stable patients with suspected coronary artery disease based upon angina typicality and coronary artery disease risk factors. Methods Between 2004 and 2011, 14,004 adults with suspected coronary artery disease referred for cardia

  16. Anomalous origin of the right coronary artery from the pulmonary artery: an autopsied sudden death case with severe atherosclerotic disease of the left coronary artery.

    Science.gov (United States)

    Nagai, T; Mukai, T; Takahashi, S; Takada, A; Saito, K; Harada, K; Mori, S; Abe, N

    2014-03-01

    Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the "coronary steal" phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of "coronary steal" due to atherosclerotic obstructive coronary disease might have contributed to the patient's death.

  17. Coronary artery disease in Asian Indians.

    Directory of Open Access Journals (Sweden)

    Yeolekar M

    1998-01-01

    Full Text Available Coronary Heart Disease should new be considered an important public health problem in India. It is a part of the epidemiological transition characterized by changing lifestyles and a probable genetic predisposition. The interplay of factors with regards to their existence, causality and attributable weight-age needs to be understood in the context of management of an individual patient as well as strategic planning for control and prevention.

  18. Comparably improved health-related quality of life after total arterial revascularization versus conventional coronary surgery--Copenhagen arterial revascularization randomized patency and outcome trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Lund, Jens T; Lilleør, Nikolaj B

    2011-01-01

    OBJECTIVE: We compared health-related quality of life up to 11 months after coronary artery bypass grafting using total arterial revascularization versus conventional coronary surgery. METHODS: In this randomized single-center trial, 161 patients underwent total arterial revascularization using.......01). For total arterial revascularization, there were also not statistically significant improvements for 'physical component summary' (P=0.09), 'bodily pain' (P=0.07) and 'vitality' (P=0.08). CONCLUSION: Health-related quality of life up to 1 year after total arterial revascularization is equal or slightly...... of the general Danish population. On all scales of the SF-36, there was statistically significant improvement at 3 and 11 months in both groups. For 'social functioning', the improvement following total arterial revascularization was significantly higher than following conventional revascularization (P=0...

  19. Plasma viscosity increase with progression of peripheral arterial atherosclerotic disease.

    Science.gov (United States)

    Poredos, P; Zizek, B

    1996-03-01

    Increased blood and plasma viscosity has been described in patients with coronary and peripheral arterial disease. However, the relation of viscosity to the extent of arterial wall deterioration--the most important determinant of clinical manifestation and prognosis of the disease--is not well known. Therefore, the authors studied plasma viscosity as one of the major determinants of blood viscosity in patients with different stages of arterial disease of lower limbs (according to Fontaine) and its relation to the presence of some risk factors of atherosclerosis. The study encompassed four groups of subjects: 19 healthy volunteers (group A), 18 patients with intermittent claudication up to 200 m (stage II; group B), 15 patients with critical ischemia of lower limbs (stage III and IV; group C), and 16 patients with recanalization procedures on peripheral arteries. Venous blood samples were collected from an antecubital vein without stasis for the determination of plasma viscosity (with a rotational capillary microviscometer, PAAR), fibrinogen, total cholesterol, alpha-2-macroglobulin, and glucose concentrations. In patients with recanalization procedure local plasma viscosity was also determined from blood samples taken from a vein on the dorsum of the foot. Plasma viscosity was most significantly elevated in the patients with critical ischemia (1.78 mPa.sec) and was significantly higher than in the claudicants (1.68 mPa.sec), and the claudicants also had significantly higher viscosity than the controls (1.58 mPa.sec). In patients in whom a recanalization procedure was performed, no differences in systemic and local plasma viscosity were detected, neither before nor after recanalization of the diseased artery. In all groups plasma viscosity was correlated with fibrinogen concentration (r=0.70, P < 0.01) and total cholesterol concentration (r=0.24, P < 0.05), but in group C (critical ischemia) plasma viscosity was most closely linked to the concentration of alpha-2

  20. Prognostic value of changes in arterial stiffness in men with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Iana A Orlova

    2010-11-01

    Full Text Available Iana A Orlova, Eradzh Yu Nuraliev, Elena B Yarovaya, Fail T AgeevOutpatient department, Russian Cardiology Research Center, Moscow, Russian Federation Background: Men with coronary artery disease (CAD have been shown to have enhanced arterial stiffness. Arterial function may change over time according to treatment, but the prognostic value of these changes has not been investigated.Objectives: The aim of the present study was to assess whether an improvement in large artery rigidity in response to treatment, could predict a more favorable prognosis in a population of men with CAD.Methods: A total of 161 men with CAD (mean age 56.8 ± 10.9 years being treated with conventional therapy underwent brachial-ankle pulse wave velocity (PWVba measurements at baseline and after six months. Follow-up period was 3.5 years. End-points were major adverse cardiac events (MACE: acute myocardial infarction, unstable angina, coronary intervention, or cardiac death.Results: During the three-year follow-up period (since initial six-month follow-up, 30 patients experienced MACE. After six-month follow-up, PWVba had not improved (∆PWVba ≥ 0%, relative to baseline in 85 (52.8% of 161 men (Group 1, whereas it had improved (∆PWVba < 0% in the remaining 76 men (47.2% (Group 2. During follow-up, we noticed 24 cardiovascular events in Group 1 and six events in Group 2 (P < 0.001. Cox proportional hazards analyses demonstrated that independent of conventional risk factor changes, absence of PWVba decrease was a predictor of MACE (RR 3.99; 95% CI:1.81–8.78; P = 0.004. The sensitivity of ∆PWVba was 80% and its specificity was 54%.Conclusions: This study demonstrates that an improvement in arterial stiffness may be obtained after six months of conventional therapy and clearly identifies patients who have a more favorable prognosis.Keywords: arterial stiffness, coronary artery disease, prognosis

  1. Association of Peripheral Arterial and Cardiovascular Diseases in Familial Hypercholesterolemia

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Carolina [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Miname, Marcio [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Makdisse, Marcia [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Kalil, Roberto Filho [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Santos, Raul D., E-mail: rdsf@cardiol.br [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2014-08-15

    Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c). Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD). This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD), such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. The diagnosis of PAD was established by ankle-brachial index (ABI) values ≤ 0.90. This study assessed 202 patients (35% of men) with heterozygous FH (90.6% with LDL receptor mutations), mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049). Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients.

  2. Steal phenomenon through the anterior communicating artery in Moyamoya disease

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Soo Mee [Ewha Womans University, Department of Radiology, Mok-dong Hospital, College of Medicine, Seoul (Korea); Chae, Eun Jin; Kim, Min Yeong; Kim, Sang Joon; Choi, Choong Gon; Pyun, Hae Wook; Suh, Dae Chul [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea); Kim, Jae Kyun [Seoul Veterans Hospital, Department of Radiology, Seoul (Korea); Ahn, Jae Sung; Ra, Young-Shin [University of Ulsan, Asan Medical Center, Department of Neurosurgery, College of Medicine, Seoul (Korea); Kim, Jong-Uk; Hahm, Kyung Don [University of Ulsan, Asan Medical Center, Department of Anesthesiology, College of Medicine, Seoul (Korea)

    2007-01-15

    Branch occlusion of the anterior cerebral artery (ACA) is regarded as a part of Moyamoya disease. The purpose of this study is to define the ACA steal phenomenon (SP) in Moyamoya disease and to evaluate temporal changes according to the disease progression. From 139 Moyamoya patients we defined ACASP as narrowing of the ipsilateral A1-2 junction while preserving the anterior communicating artery and supplying the contralateral ACA cortical branches with the development of leptomeningeal collaterals by the ipsilateral middle cerebral artery into the hypoperfused ipsilateral ACA territory. Direction of the steal related to the stage in both hemispheres by Suzuki classification was statistically analyzed using the binomial test based on binomial distribution. Follow-ups of ACASP were evaluated in five patients. We identified ACASP in 13 (9%) patients (male:female=7:6, mean age 18 years, range: 2-58 years) of the 139 study patients. The presenting pattern was ischemic in 12 and hemorrhagic in one. The direction of SP occurred from the hemisphere in the lower to the higher stage of Suzuki classification (two-tail P value=0.0002). After revascularization surgery, ACASP disappeared or diminished. ACASP may occur in bilaterally different stages of Moyamoya disease as a transient self-adaptive process. It regresses after revascularization surgery. (orig.)

  3. Endovascular repair for a huge vertebral artery pseudoaneurysm caused by Behcet's disease

    Institute of Scientific and Technical Information of China (English)

    DONG Zhi-hui; FU Wei-guo; GUO Da-qiao; XU Xin; CHEN Bin; JIANG Jun-hao; YANG Jue; SHI Zheng-yu; WANG Yu-qi

    2006-01-01

    @@ Behcet's disease (BD), a multisystem chronic autoimmune process of unknown etiology,usually leads to arterial impairment. Isolated case reports have described BD-related arterial dissections, pseudoaneurysms or aneurysms.1-4 Recently, we successfully treated a huge vertebral artery pseudoaneurysm (VAPA) in a patient with BD by stent-grafting with preservation of the affected vertebral artery.

  4. Arterial aging and arterial disease : interplay between central hemodynamics, cardiac work, and organ flow-implications for CKD and cardiovascular disease

    NARCIS (Netherlands)

    London, Gerard; Covic, Adrian; Goldsmith, David; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Lindholm, Bengt; Martinez-Castelao, Alberto; Fliser, Danilo; Agarwal, Rajiv; Jager, Kitty J.; Dekker, Friedo W.; Blankestijn, Peter J.; Zoccali, Carmine

    2011-01-01

    Cardiovascular disease is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). All epidemiological studies have clearly shown that accelerated arterial and cardiac aging is characteristic of these populations. Arterial premat

  5. Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mara, Michal; Kubinova, Kristyna, E-mail: kristyna.kubinova@gmail.com [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Maskova, Jana [Aberdeen Royal Infirmary, Department of Radiology (United Kingdom); Horak, Petr [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Belsan, Tomas [Central Military Hospital, Department of Radiology (Czech Republic); Kuzel, David [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic)

    2012-10-15

    Purpose: To compare outcomes of two different types of occlusive therapy of uterine fibroids. Methods: Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO). Results: Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients. Conclusion: Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).

  6. Fluid Mechanics, Arterial Disease, and Gene Expression.

    Science.gov (United States)

    Tarbell, John M; Shi, Zhong-Dong; Dunn, Jessilyn; Jo, Hanjoong

    2014-01-01

    This review places modern research developments in vascular mechanobiology in the context of hemodynamic phenomena in the cardiovascular system and the discrete localization of vascular disease. The modern origins of this field are traced, beginning in the 1960s when associations between flow characteristics, particularly blood flow-induced wall shear stress, and the localization of atherosclerotic plaques were uncovered, and continuing to fluid shear stress effects on the vascular lining endothelial) cells (ECs), including their effects on EC morphology, biochemical production, and gene expression. The earliest single-gene studies and genome-wide analyses are considered. The final section moves from the ECs lining the vessel wall to the smooth muscle cells and fibroblasts within the wall that are fluid me chanically activated by interstitial flow that imposes shear stresses on their surfaces comparable with those of flowing blood on EC surfaces. Interstitial flow stimulates biochemical production and gene expression, much like blood flow on ECs.

  7. Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when to revascularize.

    Science.gov (United States)

    Torosoff, Mikhail T; Sidhu, Mandeep S; Desai, Karan P; Fein, Steven A; Boden, William E

    2015-09-01

    Patients with acute coronary syndromes and severe multivessel or left main coronary artery disease have better outcomes when prompt revascularization is performed in addition to optimal medical therapy (OMT). However, in patients with stable ischemic heart disease, randomized strategy trials have revealed equipoise between initial strategies of OMT alone and OMT plus revascularization. Conducted in diverse stable ischemic heart disease patient populations and throughout the spectrum of atherosclerotic and ischemic burden, the RITA-2, MASS II, COURAGE, BARI 2D and FAME 2 trials demonstrate that OMT alone and OMT plus revascularization yield similar outcomes with respect to mortality and myocardial infarction. What remains unclear is whether there may be one or more subsets of patients with stable ischemic heart disease in whom revascularization may be associated with a reduction in mortality or myocardial infarction, which is to be addressed in the ongoing ISCHEMIA trial.

  8. Inflammation and cortisol response in coronary artery disease.

    Science.gov (United States)

    Nijm, Johnny; Jonasson, Lena

    2009-01-01

    Atherosclerosis is characterized by chronic inflammation involving autoimmune components. The degree of inflammatory activity, as detectable both within the atherosclerotic plaque and in the circulation, is associated with plaque destabilization and atherothrombotic complications. Endogenous glucocorticoids are modulators of innate and acquired immune responses, and as such play a key role in the reciprocal interaction between neuroendocrine and immune systems. Abnormalities in hypothalamic-pituitary-adrenal axis (HPA) function have been described in several chronic inflammatory disorders, and evidence has emerged lately that HPA dysfunction may be implicated also in the pathogenesis of coronary artery disease. This review is an outline of knowledge gained so far by previous studies of glucocorticoids in coronary atherosclerosis and myocardial infarction. The results consistently point towards a dysregulated cortisol secretion that may involve a failure to contain inflammatory activity. A dysfunctional HPA axis and its possible implications for coronary artery disease progress, including the hypothetical link between stress and inflammation, are discussed.

  9. [Intermittent thrombolytic treatment. Results during severe, chronic arterial diseases].

    Science.gov (United States)

    Fiessinger, J N; Aiach, M; Lagneau, P; Cormier, J M; Housset, E

    1975-04-20

    38 patients with severe chronic arteritis of the lower limbs were treated with streptokinase intermittently. All had been refused for surgical operation. One patient died, 4 others had early interruption of treatment. Eleven of the 38 patients had efficient thrombolysis confirmed by arteriography. The facts confirm the possibility of thrombolysis during chronic arterial disease. The fact that the aggravation was recent was favourable factor in prognosis. The eleven patients improved, had severe aggravation of symptomes for less than 2 months. Thus thrombolytic treatment has a place of choice in the treatment of severe arterial disease where surgery is impossible, or dangerous, owing to the uncertain state of the vascular bed below the lesion. Efficacious, it permits reconstructive surgery in cases where it had been at first refused. The use of intermittent treatment, apart from advantages of confort and cost, seems to increase the efficacy of treatment.

  10. 波生坦治疗先天性心脏病术后肺动脉高压的前瞻性随机对照研究%Treatment of patients with bosentan in post-operation of congenital heart disease with pulmonary arterial hypertension: a double-blind, randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    张雅娟; 胡盛寿; 李守军; 郑哲; 李永青; 王旭; 王阳

    2010-01-01

    Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin-1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease, and the concentrations of endothelin-1 was correlated with severity degree of pulmonary arterial disease.Endothelin exerting vasoconstrictor and mitogenic effects by binding to two distinct receptor isoforms in the pulmonary vascular smooth muscle cells: endothelin A and B receptors. Bosentan is an orally active dual ( A and B) endothelin receptor antagonist that has been shown to improve exercise capacity, haemodynamics, and clinical worsening in many clinical trials, but have no experience in post-operation of congenital heart disease with PAH. In our country, there are lots of elder patients of congenital heart disease accompany with pulmonary arterial hypertension. And they have poor prognosis after operation because pulmonary arterial hypertension leads to right ventricular failure and sudden death. So we hope bosentan can improve clinical outcome of these patients. This time we present the results of the bosentan trial in post-operative patients still with pulmonary arterial hypertension, a randomized controlled trial designed to assess the efficacy and safety of the dual endothelin receptor antagonist bosentan in post-operative pulmonary arterial hypertension, and present the first experience of bosentan for these patients.Methods This study was a prospective clinical trial. The objects were 30 patients ( age:4 months - 6.8years,weight:5 - 15 kg) who still had pulmonary artery hypertension at one week after cardiac defects repaired. They were randomized to controlled ( n = 15 ) or to bosentan ( n = 15 ). Dosage regimen: 10 - 20 kg patients, 31. 25 mg qd ( 4 weeks ) ,31.25 mg bid ( 8 weeks);5 - 10 kg patients, 15.6 mg qd ( 4 weeks), 15.6 mg bid ( 8 weeks). Evaluate the efficacy and safety of Bosentan through

  11. Coronary artery thrombus resulting in sudden cardiac death in an infant with Kawasaki disease and giant coronary artery aneurysms

    Directory of Open Access Journals (Sweden)

    Umakumaran Ponniah

    2013-01-01

    Full Text Available We report a case of a six-month-old Hispanic male infant who had Kawasaki disease and coronary artery aneurysms on echocardiography. He died suddenly five months later in spite of aggressive medical therapy. Autopsy showed extensive coronary artery thrombosis. Giant coronary artery aneurysms need diligent follow up as they pose significant risks including risk of thrombus, myocardial infarction and sudden death.

  12. CCR2 and coronary artery disease: a woscops substudy

    Directory of Open Access Journals (Sweden)

    Gray Ian C

    2010-02-01

    Full Text Available Abstract Background Several lines of evidence support a role for CCL2 (monocyte chemotactic protein-1 and its receptor CCR2 in the development of atherosclerosis. The aim of the present study was to determine the association of the CCR2 Val64Ile polymorphism with the development of coronary artery disease in the WOSCOPS study sample set. Findings A total of 443 cases and 1003 controls from the West of Scotland Coronary Prevention Study (WOSCOPS were genotyped for the Val64Ile polymorphism in the CCR2 gene. Genotype frequencies were compared between cases and controls. The CCR2 Val64Ile polymorphism was found not to be associated with coronary events in this study population (odds ratio 1.15, 95% CI 0.82-1.61, p = 0.41. Conclusions This case-control study does not support an association of the CCR2 Val64Ile polymorphism with coronary artery disease in the WOSCOPS sample set and does not confirm a possible protective role for CCR2 Val64Ile in the development of coronary artery disease.

  13. Benefits of Heart Rate Slowing With Ivabradine in Patients With Systolic Heart Failure and Coronary Artery Disease.

    Science.gov (United States)

    Borer, Jeffrey S; Deedwania, Prakash C; Kim, Jae B; Böhm, Michael

    2016-12-15

    Heart rate (HR) is a risk factor in patients with chronic systolic heart failure (HF) that, when reduced, provides outcome benefits. It is also a target for angina pectoris prevention and a risk marker in chronic coronary artery disease without HF. HR can be reduced by drugs; however, among those used clinically, only ivabradine reduces HR directly in the sinoatrial nodal cells without other known effects on the cardiovascular system. This review provides current information regarding the safety and efficacy of HR reduction with ivabradine in clinical studies involving >36,000 patients with chronic stable coronary artery disease and >6,500 patients with systolic HF. The largest trials, Morbidity-Mortality Evaluation of the If Inhibitor Ivabradine in Patients With Coronary Disease and Left Ventricular Dysfunction and Study Assessing the Morbidity-Mortality Benefits of the If Inhibitor Ivabradine in Patients With Coronary Artery Disease, showed no effect on outcomes. The Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial, a randomized controlled trial in >6,500 patients with HF, revealed marked and significant HR-mediated reduction in cardiovascular mortality or HF hospitalizations while improving quality of life and left ventricular mechanical function after treatment with ivabradine. The adverse effects of ivabradine predominantly included bradycardia and atrial fibrillation (both uncommon) and ocular flashing scotomata (phosphenes) but otherwise were similar to placebo. In conclusion, ivabradine improves outcomes in patients with systolic HF; rates of overall adverse events are similar to placebo.

  14. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease

    DEFF Research Database (Denmark)

    Jensen, J S; Feldt-Rasmussen, B; Strandgaard, S

    2000-01-01

    Albumin excretion in urine is positively correlated with the presence of ischemic heart disease and atherosclerotic risk factors. We studied prospectively whether a slight increase of urinary albumin excretion, ie, microalbuminuria, adds to the increased risk of ischemic heart disease among...... hypertensive subjects. In 1983 and 1984, blood pressure, urinary albumin/creatinine concentration ratio, plasma total and HDL cholesterol levels, body mass index, and smoking status were obtained in a population-based sample of 2085 subjects, aged 30 to 60 years, who were free from ischemic heart disease......, diabetes mellitus, and renal or urinary tract disease. Untreated arterial hypertension or borderline hypertension was present in 204 subjects, who were followed until 1993 by the National Hospital and Death Certificate Registers with respect to development of ischemic heart disease. During 1978 person...

  15. Fifty-eight cases of ocular ischemic diseases caused by carotid artery stenosis

    Institute of Scientific and Technical Information of China (English)

    LUO Rong-jiang; LIU Shao-rui; LI Xiao-min; ZHUO Ye-hong; TIAN Zhen

    2010-01-01

    Background The blood supply to the eye comes from the retinal central vascular system of the ophthalmic artery and the ciliary vascular system. The ophthalmic artery stems from the ipsilateral internal carotid artery. If occlusion or stenosis occurs in the carotid artery, the blood perfusion to the ophthalmic artery becomes insufficient, leading to signs and symptoms of anterior and posterior ocular ischemia. The objective of this study was to evaluate the clinical characteristics and risk factors of ocular ischemic diseases caused by carotid artery stenosis.Methods This study was a retrospective review of 145 patients with carotid artery stenosis. Fifty-eight patients who had symptoms of ocular ischemic disease caused by carotid artery stenosis formed group A and the other 87 patients who only had carotid artery stenosis formed group B. We analyzed the causes and course of disease, and relative risk factors,by comparing the two groups.Results The degree of carotid artery stenosis in group A was higher than that in group B. And group A had a greater decrease of ophthalmic artery flow. Male, hypertension, hyperlipidemia, and smoking were significantly related to carotid artery stenosis. Amaurosis fugax was the most common ocular symptom in group A. The ocular ischemic diseases mainly included ischemic optic neuropathy, central/branch retinal artery occlusion, ophthalmoplegia externa, and ocular ischemic syndrome.Conclusions Carotid artery stenosis correlates with ocular ischemic diseases. Ophthalmologists must observe for ocular symptoms, which were the onset symptoms in some patients.

  16. Contemporary and optimal medical management of peripheral arterial disease.

    Science.gov (United States)

    Tattersall, Matthew C; Johnson, Heather M; Mason, Peter J

    2013-08-01

    Atherosclerotic lower extremity peripheral arterial disease (PAD) is a highly prevalent condition associated with a significant increase in risk of all-cause mortality and cardiovascular morbidity and mortality. PAD is underdiagnosed and undertreated. Treatment is focused on (1) lowering cardiovascular risk and cardiovascular disease event rates and (2) improvement in symptoms and quality of life. Multidisciplinary and intersociety guidelines guide optimal medical therapy. Substantial evidence supports implementation of tobacco cessation counseling and pharmacotherapy to help achieve tobacco abstinence, antiplatelet therapy, HMG-CoA reductase inhibitors (statins) therapy, and antihypertensive therapy for the purpose of lowering cardiovascular event rates and improving survival.

  17. Intra-arterial infusion of prostaglandin E1 in normal subjects and patients with peripheral arterial disease

    DEFF Research Database (Denmark)

    Nielsen, P E; Nielsen, S L; Holstein, P;

    1976-01-01

    Acute vasodilatation was produced by infusion of prostaglandin E1 (PGE1) in the femoral artery in 6 patients with occlusive arterial disease of the legs and in 3 normal subjects. The effect on blood flow and on blood pressure was measured at different segments of the leg with the strain gauge...

  18. Imaging popliteal artery disease in young adults with claudication: self-assessment module.

    Science.gov (United States)

    Chew, Felix S; Bui-Mansfield, Liem T

    2007-09-01

    The educational objectives of this self-assessment module on imaging popliteal artery disease in young adults with intermittent claudication are for the participant to exercise, self-assess, and improve his or her knowledge of the imaging and clinical features of popliteal artery entrapment syndrome, cystic adventitial disease,and masses associated with popliteal artery obstruction.

  19. Surgical revascularization for premature coronary artery disease in second and third decade of life.

    Science.gov (United States)

    Reddy, SriKrishna Modugula; Byrapaneni, Ramesh Babu; Rangappa, ChandraMohan; Gouni, Uday Kumar; Vakati, Chakravarthy; Suryavanshi, Satish; Kola, Prabhakar Reddy

    2017-01-01

    Coronary artery bypass grafting surgery may be needed in children and young adults for significant premature coronary artery occlusive disease. We report a case series of seven patients who underwent surgical revascularization in their second and third decade of life for significant multivessel coronary artery occlusive disease due to unusual causes.

  20. Drug delivering technology for endovascular management of infrainguinal peripheral artery disease.

    Science.gov (United States)

    Sarode, Karan; Spelber, David A; Bhatt, Deepak L; Mohammad, Atif; Prasad, Anand; Brilakis, Emmanouil S; Banerjee, Subhash

    2014-08-01

    Endovascular intervention has become a well-recognized treatment modality for peripheral artery disease; however, mid- and long-term outcomes have been plagued by limited durability. Plain balloon angioplasty and bare-metal stents have historically suffered from high restenosis rates leading to the need for frequent repeat revascularization procedures. The innovation of locally administered, drug-delivering balloons and stents has been a direct result of technological innovations directed toward prevention and treatment of this limitation. Over the last 5 years, numerous clinical trials investigating the use of drug-coated stents and drug-coated balloons indicate a significant improvement in endovascular treatment durability and outcomes. This review provides an up-to-date assessment of the current evidence for the use of drug-coated stents and drug-coated balloons in the treatment of femoropopliteal and infrapopliteal peripheral artery disease. Additionally, it provides an overview of the development of this technology, highlights landmark ongoing and completed clinical trials, examines evidence to support the use of drug-coated technologies in combination with other modalities, and examines promising new technological developments. Last, it summarizes the challenges and safety concerns that have delayed U.S. Food and Drug Administration approval of these devices.

  1. Postoperative pulmonary artery hypertension | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available n el postoperatorio de cirugia cardiaca en niños. A.3.2Name or abbreviated title of the trial where availabl...non-technical, language sildenafil in the postoperative period of cardiac surgery in children. sildenafilo e

  2. High-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide in patients with stable coronary artery disease: a prognostic study within the CLARICOR Trial

    DEFF Research Database (Denmark)

    Harutyunyan, Marina J; Mathiasen, Anders B; Winkel, Per;

    2011-01-01

    be prognostic biomarkers in patients with stable CAD. MATERIALS AND METHODS: During the 2.6-year follow-up period 270 patients among the 4264 patients with stable CAD in the CLARICOR trial suffered myocardial infarction (MI) and 377 died (187 cardiovascular deaths (CVD)). RESULTS: Serum NT...... for cardiovascular risk factors hs-CRP predicted non-CVD (HR, 1.46) and all-cause death (HR, 1.24) and NT-proBNP predicted MI (HR, 1.50), CVD (HR, 1.98), non-CVD (HR, 1.39), and all-cause death (HR, 1.62)(p cardiovascular death...... and non-cardiovascular death than hs-CRP in patients with stable CAD. Once NT-proBNP was taken into account, hs-CRP did not improve predictions....

  3. Relationship of Inflammatory Biomarkers with Severity of Peripheral Arterial Disease

    Science.gov (United States)

    Toyofuku, Takahiro; Inoue, Yoshinori

    2016-01-01

    Objective. The pentraxin family, including high-sensitivity C-reactive protein (hs-CRP), serum amyloid P (SAP), and pentraxin 3 (PTX3), has been identified as playing a key role in inflammatory reactions such as in atherosclerosis and cardiovascular disease. In this study, we examined the relationship between peripheral arterial disease (PAD) and serum levels of pentraxins. Methods. This study was undertaken via a retrospective review of PAD patients with surgical intervention for lesions of the common femoral artery. We evaluated the preoperative patient conditions, hemodynamic status, such as ankle brachial index (ABI), and clinical ischemic conditions according to Rutherford classification. Preoperatively, we collected blood samples for determining the serum levels of hs-CRP, SAP, and PTX3. Results. Twelve PAD patients with common femoral arterial lesions were treated and examined. The hemodynamic severity of PAD was not negatively correlated with hs-CRP, SAP, or PTX3. The clinical severity evaluated by Rutherford classification was significantly positively correlated with the serum level of PTX3 (p = 0.019). Conclusion. We demonstrated that PTX3 might be a better marker of PAD than hs-CRP and SAP. Furthermore, PTX3 might be a prognostic marker to evaluate the severity of PAD. PMID:27559483

  4. Low risk of coronary artery disease in patients with acromegaly.

    Science.gov (United States)

    Dos Santos Silva, Cintia Marques; Lima, G A B; Volschan, I C M; Gottlieb, I; Kasuki, L; Neto, L Vieira; Gadelha, M R

    2015-12-01

    The aims of this study are to determine the prevalence of coronary atherosclerosis in acromegalic patients and to investigate the relationship between the coronary artery calcium score (CS) and acromegaly status and clinical parameters [Framingham risk score (FRS)]. Fifty-six acromegalic patients and paired non-acromegalic volunteers were stratified according to the FRS into low-, intermediate-, and high-risk groups. CS was assessed using multidetector computed tomography. The patients were considered to have controlled or active acromegaly at the time they were submitted to evaluation. Sixty-six percent of acromegalic patients exhibited arterial hypertension, 36 % had diabetes mellitus, and 34 % had hypercholesterolemia. The median FRS and the median risk for cardiovascular event within the next 10 years were similar in the acromegalics and the controls. The median total CS and CS >75th percentile didn't differ significantly between these groups. In patients with controlled acromegaly, a low, intermediate, or high FRS risk was observed in 86, 14, and 0 %, respectively. In patients with active disease, a low, intermediate, or high FRS risk was verified in 94, 3, and 3 %, respectively, and differences between the controlled and active groups were not significant. Seventy-two percent of the patients had total CS = 0, and there were no differences between the controlled and active groups. The risk of coronary artery disease in acromegalic patients, determined according to FRS and CS, is low despite the high prevalence of metabolic abnormalities.

  5. Relationship of Inflammatory Biomarkers with Severity of Peripheral Arterial Disease

    Directory of Open Access Journals (Sweden)

    Kimihiro Igari

    2016-01-01

    Full Text Available Objective. The pentraxin family, including high-sensitivity C-reactive protein (hs-CRP, serum amyloid P (SAP, and pentraxin 3 (PTX3, has been identified as playing a key role in inflammatory reactions such as in atherosclerosis and cardiovascular disease. In this study, we examined the relationship between peripheral arterial disease (PAD and serum levels of pentraxins. Methods. This study was undertaken via a retrospective review of PAD patients with surgical intervention for lesions of the common femoral artery. We evaluated the preoperative patient conditions, hemodynamic status, such as ankle brachial index (ABI, and clinical ischemic conditions according to Rutherford classification. Preoperatively, we collected blood samples for determining the serum levels of hs-CRP, SAP, and PTX3. Results. Twelve PAD patients with common femoral arterial lesions were treated and examined. The hemodynamic severity of PAD was not negatively correlated with hs-CRP, SAP, or PTX3. The clinical severity evaluated by Rutherford classification was significantly positively correlated with the serum level of PTX3 (p=0.019. Conclusion. We demonstrated that PTX3 might be a better marker of PAD than hs-CRP and SAP. Furthermore, PTX3 might be a prognostic marker to evaluate the severity of PAD.

  6. Myocardial perfusion imaging with higenamine hydrochloride stress studies in diagnosis of coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    周维

    2013-01-01

    Objective To evaluate the stress test efficacy and safety of higenamine hydrochloride,MPI studies were performed in patients with coronary artery disease. Methods Sixty-eight patients with suspected coronary artery

  7. Retinal Arterial Occlusive Disease in a Young Patient with Cat Scratch Disease

    OpenAIRE

    Georgios Batsos; Kabanarou, Stamatina A.; Pantelis Fotiou; Alexandros Rouvas; Tina Xirou

    2013-01-01

    Purpose: To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease. Methods: A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyan...

  8. N-acetylcysteine improves arterial vascular reactivity in patients with chronic kidney disease

    DEFF Research Database (Denmark)

    Wittstock, Antje; Burkert, Magdalena; Zidek, Walter;

    2009-01-01

    Patients with stage 5 chronic kidney disease show increased cardiovascular morbidity and mortality that are partly related to impaired arterial vascular reactivity. We investigated whether intravenous administration of the antioxidant acetylcysteine improves arterial vascular reactivity in these ......Patients with stage 5 chronic kidney disease show increased cardiovascular morbidity and mortality that are partly related to impaired arterial vascular reactivity. We investigated whether intravenous administration of the antioxidant acetylcysteine improves arterial vascular reactivity...

  9. Pulmonary arterial hypertension: the burden of disease and impact on quality of life.

    Science.gov (United States)

    Delcroix, Marion; Howard, Luke

    2015-12-01

    Pulmonary arterial hypertension (PAH) is a debilitating disease that pervades all aspects of a patient's daily life. It is also increasingly acknowledged that the burden of PAH extends to older patients and carers. Until recently, the adverse effect of disease symptoms on the physical, emotional and social factors governing patient health-related quality of life (HRQoL) remained largely unrecognised. With a shift in therapeutic objectives to longer term improvements and HRQoL benefits, clinical trials now frequently include HRQoL measures as study end-points. Most HRQoL instruments used in patients with PAH are generic or non-disease-specific questionnaires and therefore may not accurately capture PAH disease burden. New PAH-specific HRQoL instruments currently undergoing validation include emPHasis-10 and Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT; Actelion Pharmaceuticals Ltd, Allschwil, Switzerland). Using various HRQoL measures, pharmacological therapies have been shown to improve HRQoL in patients with PAH. Patients also derive HRQoL benefits from nonpharmacological strategies, which include the emotional support provided by multidisciplinary care and support groups that is fundamental to patient wellbeing. Looking to the future, validated PAH-specific HRQoL instruments together with dedicated guidelines and procedures are essential to support the translation of HRQoL scores to the clinic, thus enabling a holistic treatment approach to the management of patients with PAH.

  10. Abdominal fat and risk of coronary heart disease in patients with peripheral arterial disease

    NARCIS (Netherlands)

    Brouwer, Beate G.; Visseren, Frank L. J.; Stolk, Ronald P.; van der Graaf, Yolanda

    2007-01-01

    Objective: We investigated whether the presence of concomitant coronary heart disease (CHD) in patients with peripheral arterial disease (PAD) can be explained by intra-abdominal fat accumulation and compared different measures of adiposity as predictors of CHD in patients with PAD. Research Methods

  11. The management of combined coronary artery disease and peripheral vascular disease

    NARCIS (Netherlands)

    A. Cassar (Andrew); D. Poldermans (Don); C.S. Rihal (Charanjit); B.J. Gersh (Bernard)

    2010-01-01

    textabstractCoronary artery disease (CAD) and peripheral vascular disease (PVD) remain highly prevalent in the population due to population ageing, smoking, diabetes, unhealthy lifestyles, and the epidemic of obesity, and frequently coexist. The management of combined CAD and PVD is a common challen

  12. [New insights in pathogenesis and etiology of coronary artery disease].

    Science.gov (United States)

    Erbel, R; Görge, G

    2014-01-01

    In clinical practice the non-invasive diagnosis of "coronary heart disease" is based on the clinical findings, the detection of ischemia at rest or during exercise, and elevations of cardiac enzymes. However, due to the compensatory enlargement of the vessel diameter at the beginning of plaque growth, the so-called Glagov effect, early stages of plaque development are missed by the angiography. By means of coronary angiography, changes of the coronary arteries become visible only in patients with angiographically recognizable lumen narrowing compared to the reference vessel segment. Thus, early or diffuse stages of atherosclerosis cannot be detected by ECG, stress-tests or coronary angiography. This limitation explains discrepancies, like positive troponin-test and even transmural ischemia, without angiographic visible coronary lumen narrowing. Diagnostic procedures such as intravascular ultrasound, optical coherence tomography, measurements of vasomotion and computed tomography can, in contrast, detect earlier stages of coronary artery disease and thus contribute to clarification in these patients. In addition, plaque rupture and plaque-erosion lead to acute or recurrent microembolism to distal myocardium with subsequent myocardial necrosis. In patients with formerly unexplained cardiovascular events, intravascular ultrasound, optical coherence tomography, and measurements of vasomotion help to understand the underlying pathophysiology. In the report after cardiac catheterization, the term "ruled out coronary heart disease" should be replaced by "No signs of obstructive coronary heart disease" and additional testing should be performed as necessary.

  13. Rationale and methodology of monitoring ambulatory blood pressure and arterial compliance in the Hypertension in the Very Elderly Trial

    OpenAIRE

    2006-01-01

    OBJECTIVE: This article describes the rationale and methodology for the monitoring of ambulatory blood pressure and arterial compliance in hypertensive patients aged 80 years and above. This is a side project of the Hypertension in the Very Elderly Trial. METHODS: The hypertension in the Very Elderly Trial is a multicentre, double-blind, randomized, placebo-controlled trial aiming to investigate the effect of active treatment on cardiovascular and other outcomes in hypertensive patients aged ...

  14. Effects of weight loss and insulin reduction on arterial stiffness in the SAVE trial

    Directory of Open Access Journals (Sweden)

    Hughes Timothy M

    2012-09-01

    Full Text Available Abstract Background Chronic arterial stiffness contributes to the negative health effects of obesity and insulin resistance, which include hypertension, stroke, and increased cardiovascular and all-cause mortality. Weight loss and improved insulin sensitivity are individually associated with improved central arterial stiffness; however, their combined effects on arterial stiffness are poorly understood. The purpose of this study was to determine how insulin levels modify the improvements in arterial stiffness seen with weight loss in overweight and obese young adults. Methods To assess the effects of weight loss and decreased fasting insulin on vascular stiffness, we studied 339 participants in the Slow the Adverse Effects of Vascular Aging (SAVE trial. At study entry, the participants were aged 20–45, normotensive, non-diabetic, and had a body-mass index of 25–39.9 kg/m2. Measures of pulse wave velocity (PWV in the central (carotid-femoral (cfPWV, peripheral (femoral-ankle (faPWV, and mixed (brachial-ankle (baPWV vascular beds were collected at baseline and 6 months. The effects of 6-month change in weight and insulin on measures of PWV were estimated using multivariate regression. Results After adjustment for baseline risk factors and change in systolic blood pressure, 6-month weight loss and 6-month change in fasting insulin independently predicted improvement in baPWV but not faPWV or cfPWV. There was a significant interaction between 6-month weight change and change in fasting insulin when predicting changes in baPWV (p baPWV. Conclusions Young adults with excess weight who both lower their insulin levels and lose weight see the greatest improvement in vascular stiffness. This improvement in vascular stiffness with weight loss and insulin declines may occur throughout the vasculature and may not be limited to individual vascular beds. Trial registration NCT00366990

  15. Association between arterial stiffness and risk of coronary artery disease in a community-based population

    Institute of Scientific and Technical Information of China (English)

    Zhang Yun; Ye Ping; Luo Leiming; Bai Yongyi; Xu Ruyi; Xiao Wenkai; Liu Dejun

    2014-01-01

    Background Arterial stiffness is well known as an important risk factor for coronary artery disease.In this study,we aimed to investigate the association between carotid-ankle pulse wave velocity (caPWV) and risk of coronary artery disease (CAD),and the interaction between pulse wave velocity (PWV) and other potential risk factors of CAD.Methods A community-based cross-sectional study was conducted for subjects living in Beijing,China.We collected 213 subjects with coronary artery disease and 1 266 subjects without CAD between September 2007 and January 2009 in a community center of Beijing.A multivariate Logistic regression analysis was carried out to assess the odds ratios of factors related to CAD.Results We found CAD subjects were more likely to have a higher body massindex (BMI),fasting glucose,uric acid,low-density lipoprotein (LDL) cholesterol,high-sensitivity Creactive protein (hs-CRP),carotic-femoral pulse wave velocity (cfPWV) and caPWV (P <0.05),and CAD subjects had a significantly lower HDL cholesterol levels (P <0.05).Moreover,the proportion of hypertension in CAD subjects was significantly higher than non-CAD subjects.The multiple Logistic regression analysis showed that hypertension,higher uric acid,hs-CRP,cfPWV and caPWV levels significantly increased the risk of CAD,with ORs (Cl) of 1.47 (1.25-1.74),1.17 (1.01-1.26),1.35 (1.10-1.67),1.15 (1.09-1.19) and 1.07 (1.01-1.15),respectively.Higher HDL cholesterol was significantly associated with reduced risk of CAD,with ORs (CI) of 0.58 (0.40-0.83).In addition,cfPWV had significant association with age,hypertension,LDL cholesterol,with Pearson's coefficients of 0.166,0.074,and 0.030,respectively.Conclusions cfPWV and caPWV are independently associated with significant CAD,and cfPWV has significant correlation with age and hypertension.cfPWV and caPWV may be used as a practical tool for predicting the risk of CAD.

  16. Coronary artery disease in patients with chronic kidney disease: a brief literature review

    Directory of Open Access Journals (Sweden)

    Mostafa Dastani

    2015-09-01

    Full Text Available Cardiovascular is the major cause of death in chronic kidney disease and end-stage renal disease. The cardiovascular mortality rate of patients with renal impairment is evaluated to be higher than general population. Coronary artery disease seems to be an important type of cardiovascular complication among patients with chronic kidney disease and end-stage renal disease before the renal replacement therapy. Due to the strong association between chronic kidney disease and the incidence of coronary artery disease, accurate screening, diagnosis, and management of cardiovascular complications would be essential in patients at different stages of renal dysfunction. Despite the need for the comprehensive knowledge about different aspects of coronary artery disease in patients with renal failure, there is not sufficient evidence regarding the pathophysiology, ideal diagnosis, and treatment strategies for coronary heart disease in population with chronic kidney disease. In this study, we briefly reviewed the existing literatures about the possible screening, diagnosis, and the treatment approaches of risk of coronary heart disease in patients with kidney dysfunction.

  17. Lysophospholipids in coronary artery and chronic ischemic heart disease

    Science.gov (United States)

    Abdel-Latif, Ahmed; Heron, Paula M.; Morris, Andrew J.; Smyth, Susan S.

    2015-01-01

    Purpose of review The bioactive lysophospholipids, lysophosphatidic acid (LPA) and sphingosine 1 phosphate (S1P) have potent effects on blood and vascular cells. This review focuses their potential contributions to the development of atherosclerosis, acute complications, such as acute myocardial infarction, and chronic ischemic cardiac damage. Recent findings Exciting recent developments have provided insight into the molecular underpinnings of LPA and S1P receptor signaling. New lines of evidence suggest roles for these pathways in the development of atherosclerosis. In experimental animal models, the production, signaling and metabolism of LPA may be influenced by environmental factors in the diet that synergize to promote the progression of atherosclerotic vascular disease. This is supported by observations of human polymorphisms in the lysophospholipid metabolizing enzyme, PPAP2B, that are associated with risk of coronary artery disease and myocardial infarction. S1P signaling protects from myocardial damage that follows acute and chronic ischemia both by direct effects on cardiomyocytes and through stem cell recruitment to ischemic tissue. Summary This review will suggest novel strategies to prevent the complications of coronary artery disease by targeting LPA production and signaling. Additionally, ways in which S1P signaling pathways may be harnessed to attenuate ischemia-induced cardiac dysfunction will be explored. PMID:26270808

  18. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Swaminathan A

    2014-07-01

    Full Text Available Aparna Swaminathan,1 Sreekanth Vemulapalli,1,2 Manesh R Patel,1,2 W Schuyler Jones1,2 1Department of Medicine, Duke University Medical Center, Durham, NC, USA; 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA Abstract: Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE amputation (LEA, although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. Keywords: peripheral artery disease, lower extremity amputation, mortality

  19. A prospective multicenter parallel-controlled trial of TIVOLI biodegradable-polymer-based sirolimus-eluting stent compared to ENDEAVOR zotarolimus-eluting stent for the treatment of coronary artery disease: 8-month angiographic and 2-year clinical follow-up results

    Institute of Scientific and Technical Information of China (English)

    XU Bo; LI Wei-min; CHEN Ji-yan; WANG Lei; WANG Yong; GE Jun-bo; LI Wei; GAO Run-lin; DOU Ke-fei; HAN Ya-ling; L(U) Shu-zheng; YANG Yue-jin; HUO Yong; WANG Le-feng; CHEN Yun-dai; WANG Hai-chang

    2011-01-01

    Background Available drug-eluting stents (DES) have achieved great success in reducing restenosis rates. Recently,investigators have demonstrated that the durable polymer carrier plays a significant role in DES-related hypersensitive reaction and delays vessel healing. TIVOLI stent is a novel sirolimus-eluting coronary stent with biodegradable coating containing sirolimus and polylactic-co-glycolic acid (PLGA) polymer. The present study sought to evaluate the effectiveness and safety of the TIVOLI biodegradable-polymer-based sirolimus-eluting stent in treating patients with coronary artery disease.Methods A prospective, multicenter clinical trial comparing TIVOLI biodegradable coated sirolimus-eluting stent with ENDEAVOR zotarolimus-eluting stent was conducted in 324 patients (TIVOLI group: 168 patients; ENDEAVOR group:156 patients) at 12 centers in China to demonstrate the non-inferiority of in-stent late loss with TIVOLI stent compared to ENDEAVOR stent in subjects with a maximum of two de novo native coronary artery lesions (lesion length ≤40 mm,reference vessel diameter 2.25-4.00 mm). The primary end point was angiographic in-stent late loss at 8-month. The secondary end points were clinical outcomes at 2 years,including major adverse cardiac events (cardiac death,myocardial infarction, or target-lesion revascularization) and stent thrombosis.Results Angiographic late lumen loss at 8 months in the TIVOLI group was superior to the ENDEAVOR group (in-stent (0.25±0.33) mm vs. (0.57±0.55) mm, diff (95% CI)-0.23 (-0.32, -0.14), P <0.0001; in-segment (0.25±-0.33) mm vs. (0.42±-0.55) mm, diff (95% CI) -0.13 (-0.23, -0.02),P=0.0083). The rate of in-stent binary restenosis at 8 months was reduced from 8.6% in the ENDEAVOR group to 2.9% in the TIVOLI group (P=0.0229). Compared to ENDEAVOR stent, TIVOLI stent resulted in a significant reduction in target-lesion revascularization (4.2% vs. 9.6%, P=0.0495) at 2 years. The two-year major adverse cardiac events (MACE

  20. Nitric Oxide Manipulation: A Therapeutic Target for Peripheral Arterial Disease?

    Directory of Open Access Journals (Sweden)

    Gareth Williams

    2012-01-01

    Full Text Available Peripheral Arterial Disease (PAD is a cause of significant morbidity and mortality in the Western world. Risk factor modification and endovascular and surgical revascularisation are the main treatment options at present. However, a significant number of patients still require major amputation. There is evidence that nitric oxide (NO and its endogenous inhibitor asymmetric dimethylarginine (ADMA play significant roles in the pathophysiology of PAD. This paper reviews experimental work implicating the ADMA-DDAH-NO pathway in PAD, focussing on both the vascular dysfunction and effects within the ischaemic muscle, and examines the potential of manipulating this pathway as a novel adjunct therapy in PAD.

  1. Robust association of the LPA locus with LDLc lowering response to statin treatment in a meta-analysis of 30,467 individuals from both randomised control trials and observational studies and association with coronary artery disease outcome during statin treatment

    Science.gov (United States)

    Donnelly, Louise A; van Zuydam, Natalie R; Zhou, Kaixin; Tavendale, Roger; Carr, Fiona; Maitland-van der Zee, Anke H; Leusink, Maarten; de Boer, Anthonius; Doevendans, Pieter A; WAsselbergs, Folkert; Morris, Andrew D; Pearson, Ewan R; Klungel, Olaf H; Doney, Alex SF; Palmer, Colin NA

    2014-01-01

    Objectives The LPA SNP rs10455872 has been associated with low density lipoprotein cholesterol (LDLc) lowering response to statins in several randomised control trials (RCTs) and is a known coronary artery disease (CAD) marker. However it is unclear what residual risk of CAD this marker may have during statin treatment. Methods Using electronic medical records linked to the GoDARTS genotyped population we identified over 8000 patients on statins in Tayside, Scotland. Results We replicated the findings of the RCTs, with the G allele of rs10455872 being associated with a 0.10mmol/l per allele poorer reduction in LDLc in response to statin treatment, and conducted a meta-analysis with previously published RCTs (P=1.46×10−29, n=30,467). We demonstrate an association between rs10455872 and CAD in statin treated individuals and have replicated this finding in the Utrecht Cardiovascular Pharmacogenetics Study (combined odds ratio 1·41, 95% CI 1.17-1.68, P=4.5×10−5, n=8822) suggesting that statin treatment does not abrogate this well-established genetic risk for CAD. Furthermore in a Cox proportional hazards model with LDLc measured time dependently we demonstrated the relationship between CAD and rs10455872 was independent of LDLc during statin treatment. Conclusion Individuals with the G allele of rs10455872, which represents approximately 1 in 7 patients, have a higher risk of CAD than the majority of the population even after treatment with statins, and therefore represent a vulnerable group requiring an alternative medication in addition to statin treatment. PMID:23903772

  2. Relationship between chronic obstructive pulmonary disease and subclinical coronary artery disease in long-term smokers

    DEFF Research Database (Denmark)

    Rasmussen, Thomas; Køber, Lars; Pedersen, Jesper Holst;

    2013-01-01

    Cardiovascular conditions are reported to be the most frequent cause of death in patients with chronic obstructive pulmonary disease (COPD). However, it remains unsettled whether severity of COPD per se is associated with coronary artery disease (CAD) independent of traditional cardiovascular risk...... factors. The aim of this study was to examine the relationship between the presence and severity of COPD and the amount of coronary artery calcium deposit, an indicator of CAD and cardiac risk, in a large population of current and former long-term smokers....

  3. Changes in the exclusion criteria in a clinical trial about arterial catheters patency

    Directory of Open Access Journals (Sweden)

    Núria Grané Mascarell

    2005-11-01

    Full Text Available Regarding a clinical trial designed to compare the functionality of arterial catheters kept with heparin vs saline solution, a slow rate of case recruiting was detected. In order to improve this rate an analysis of the reasons for non-inclusion was set up. According to the results, amendments to the protocol had to be proposed to improve case inclusion without reducing the quality of the study.Methodology: All not included catheter insertions were registered and analysed regarding the reason of non-inclusion.Results: The more frequent reasons for non including a case in the study were the insertion of the catheter in other ward or department, the issues related with the informed consent (IC and the need of more than 5 attempts to insert the catheter. The remaining reasons were related to hematological issues as well as competition with other trials.Conclusions: The main reasons for not including cases in the trial were subject to be changed by including amendments to the protocol, without affecting neither the trial quality nor the proposed goals. So, four amendments were proposed to the local ethical commission, two of which were accepted and subsequently notified to the Spanish Drug Agency. The phase of cases inclusion is now ending with less delay had the amendments not been presented.

  4. Arterial stiffness & Sri Lankan chronic kidney disease of unknown origin

    Science.gov (United States)

    Gifford, Fiona; Kimmitt, Robert; Herath, Chula; Webb, David J.; Melville, Vanessa; Siribaddana, Sisira; Eddleston, Michael; Dhaun, Neeraj

    2016-09-01

    Chronic kidney disease (CKD) is common and independently associated with cardiovascular disease (CVD). Arterial stiffness contributes to CVD risk in CKD. In many developing countries a considerable proportion of CKD remains unexplained, termed CKDu. We assessed arterial stiffness in subjects with Sri Lankan CKDu, in matched controls without CKD and in those with defined CKD. Aortic blood pressure (BP), pulse wave velocity (PWV) and augmentation index (AIx) were assessed in 130 subjects (50 with CKDu, 45 with CKD and 35 without CKD) using the validated TensioMed™ Arteriograph monitor. Brachial and aortic BP was lower in controls than in CKDu and CKD subjects but no different between CKDu and CKD. Controls had a lower PWV compared to subjects with CKDu and CKD. Despite equivalent BP and renal dysfunction, CKDu subjects had a lower PWV than those with CKD (8.7 ± 1.5 vs. 9.9 ± 2.2 m/s, p groups (controls vs. CKDu vs. CKD: 6.7 ± 0.9 vs. 8.7 ± 1.5 vs. 10.4 ± 1.5 m/s, p < 0.001 for all). Sri Lankan CKDu is associated with less arterial stiffening than defined causes of CKD. Whether this translates to lower cardiovascular morbidity and mortality long term is unclear and should be the focus of future studies.

  5. Relation of anthropometric variables to coronary artery disease risk factors

    Directory of Open Access Journals (Sweden)

    Virendra C Patil

    2011-01-01

    Full Text Available Background and Objectives: Anthropometric variables and their relation to conventional coronary artery disease (CAD risk factors in railway employees have been inadequately studied in India. This cross-sectional survey was carried out in the Solapur division of the Central railway in the year 2004, to assess the anthropometric variables in railway employees and their relation to conventional CAD risk factors. Materials and Methods: A total of 995 railway employees, with 872 males and 123 females participated in this cross-sectional study. All subjects underwent anthropometric measurements, fasting lipid profile, and blood sugar level. Various anthropometric indices were calculated for body mass index (BMI, waist circumference (WC, waist-to-hip ratio (WHR, waist-to-height ratio (WHtR, and abdominal volume index (AVI. Statistical analysis was done by EPI Info 6 statistical software. Results: Compared to all other obesity indices, WHtR was most prevalent in both genders. High WHtR was present in 699 (80.16% males and 103 (83.73% females. Age ≥45 years, high systolic BP, high diastolic BP, low HDL, high triglyceride, and diabetes mellitus were positively correlated with high BMI, high WC, high WHR, high WHtR, and high AVI. High BMI, high WC, high WHR, high WHtR, and high AVI were negatively associated with physical inactivity. Conclusions: Over all, anthropometric variables in both genders were significantly deranged in subjects with coronary risk factors. Compared to all other anthropometric variables, WHtR was statistically significantly associated with a majority of coronary artery risk factors. Hence we recommend inclusion of WHtR as a parameter of obesity to predict coronary artery disease risk factor along with WC, WHR, and BMI in epidemiologic studies.

  6. Matrix metalloproteinase gene polymorphisms in patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Vanessa L.N. Dalepiane

    2007-01-01

    Full Text Available Matrix metalloproteinases (MMPs play an important role in the pathogenesis of atherosclerosis, the pathology underlying the majority of coronary artery disease (CAD. In this study we tested the hypothesis that polymorphic variation in the MMP genes influences the risk of developing atherosclerosis. We analyzed functional polymorphisms in the promoter of the MMP-1, MMP-3, MMP-9 and MMP-12 genes in 183 Brazilian Caucasian individuals submitted to coronary angiography, of which 67 (37% had normal coronary arteries (control group and 116 (63% had CAD (CAD patient group. The -1607 1G/2G MMP-1, -1171 5A/6A MMP-3, -1562 C/T MMP-9, -82 A/G MMP-12 polymorphisms were analyzed by PCR followed by restriction digestion. No significant differences were observed in allele frequencies between the CAD patients and controls. Haplotype analysis showed no differences between the CAD patients and controls. There was a significant difference in the severity of CAD, as assessed by the number of diseased vessels, in MMP-1 1G/1G homozygous individuals and in those homozygous for the 6A allele of the MMP-3 polymorphism. However, multivariate analysis showed that diabetes mellitus was the only variable independently associated with CAD severity. Our findings indicated that MMP polymorphisms have no significant impact on the risk and severity of CAD.

  7. Lack of MEF2A mutations in coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Weng, Li; Kavaslar, Nihan; Ustaszewska, Anna; Doelle, Heather; Schackwitz, Wendy; Hebert, Sybil; Cohen, Jonathan; McPherson, Ruth; Pennacchio, Len A.

    2004-12-01

    Mutations in MEF2A have been implicated in an autosomal dominant form of coronary artery disease (adCAD1). In this study we sought to determine whether severe mutations in MEF2A might also explain sporadic cases of coronary artery disease (CAD). To do this, we resequenced the coding sequence and splice sites of MEF2A in {approx}300 patients with premature CAD and failed to find causative mutations in the CAD cohort. However, we did identify the 21 base pair (bp) MEF2A coding sequence deletion originally implicated in adCAD1 in one of 300 elderly control subjects without CAD. Further screening of an additional {approx}1,500 non-CAD patients revealed two more subjects with the MEF2A 21 bp deletion. Genotyping of 19 family members of the three probands with the 21 bp deletion in MEF2A revealed that the mutation did not co-segregate with early CAD. These studies demonstrate that MEF2A mutations are not a common cause of CAD and cast serious doubt on the role of the MEF2A 21 bp deletion in adCAD1.

  8. Coronary artery disease and its association with Vitamin D deficiency

    Directory of Open Access Journals (Sweden)

    Ramesh Aggarwal

    2016-01-01

    Full Text Available Coronary artery disease (CAD has become the latest scourge of humankind and referred to in this article as CAD, is the end result of the accumulation of atheromatous plaques within the walls of coronary arteries that supply the myocardium, a process also known as atherosclerosis and manifests mostly in the form of chronic stable angina or acute coronary syndrome. Vitamin D has attracted considerable interest recently due to its role in a number of extraskeletal disease processes including multiple sclerosis, malignancies, diabetes mellitus, and CAD. It is also known as sunshine vitamin due to its production in the body following exposure to ultraviolet rays, and it is a unique vitamin as it acts like a hormone with its receptor present in a wide range of tissues including endothelium, which is the important mediator of atherosclerosis and subsequent CAD. A large number of studies conducted in the past have provided the basic scientific framework and this article attempts to explore the role of Vitamin D deficiency in the pathogenesis of CAD and stresses the need for further research to fill up gap in our knowledge.

  9. Effects of Resistance Exercise Applied Early After Coronary Artery Bypass Grafting: a Randomized Controlled Trial

    Science.gov (United States)

    Ximenes, Nayana Nazaré Pessoa Sousa; Borges, Daniel Lago; Lima, Reijane Oliveira; Silva, Mayara Gabrielle Barbosa e; da Silva, Luan Nascimento; Costa, Marina de Albuquerque Gonçalves; Baldez, Thiago Eduardo Pereira; Nina, Vinícius José da Silva

    2015-01-01

    OBJECTIVE To evaluate the effects of resistance exercise applied early after coronary artery bypass grafting. METHODS It is a randomized controlled trial with 34 patients undergoing coronary artery bypass grafting between August 2013 and May 2014. Patients were randomized into two groups by simple draw: a control group (n=17), who received conventional physical therapy and an intervention group (n=17), who received, additionally, resistance exercise. Pulmonary function and functional capacity were evaluated in preoperative period and hospital discharge by spirometry and the six-minute walk test. For statistical analysis, we used the following tests: Shapiro-Wilk, Mann-Whitney, Student's t and Fisher's exact. Variables with P<0.05 were considered significant. RESULTS Groups were homogeneous in terms of demographic, clinical and surgical variables. Resistance exercise exerted no effect on pulmonary function of intervention group compared to control group. However, intervention group maintained functional capacity at hospital discharge measured by percentage of predict distance in 6MWT (54.122.7% vs. 52.515.5%, P=0.42), while control group had a significant decrease (59.211.1% vs. 50.69.9%, P<0.016). CONCLUSION Our results indicate that resistance exercise, applied early, may promote maintenance of functional capacity on coronary artery bypass grafting patients, having no impact on pulmonary function when compared to conventional physical therapy. PMID:26934401

  10. The HubBLe trial: haemorrhoidal artery ligation (HAL versus rubber band ligation (RBL for haemorrhoids

    Directory of Open Access Journals (Sweden)

    Tiernan Jim

    2012-10-01

    Full Text Available Abstract Background Haemorrhoids (piles are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse, the best option for treatment depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option. There are substantial data in the literature concerning efficacy and safety of 'rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. Methods/design The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III haemorrhoids. Design: A multi-centre, parallel group randomised controlled trial. Outcomes: The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms

  11. [Vascular rehabilitation in patients with peripheral arterial disease].

    Science.gov (United States)

    de Holanda, Ana; Aubourg, Marion; Dubus-Bausière, Valérie; Eveno, Dominique; Abraham, Pierre

    2013-06-01

    Lower limb peripheral arterial disease (PAD) is a frequent debilitating disease associated with a high morbidity and mortality rate. The benefit of rehabilitation in PAD patients has been largely demonstrated, both for patients that undergo amputation, and for patients with claudication. In these latter patients, rehabilitation programs rely on a variety of additional techniques or tools, among which: stretching, specific muscle proprioception, walking and a variety of other physical activities, exercise or situations adapted to community life, lower limb and respiratory physiotherapy, patient's education, support for smoking cessation and healthy nutrition, social support, etc. Whether rehabilitation is performed in specialised integrated structures or performed on a home-based basis, various clinicians are involved. Despite evidence-based proof of efficacy, rehabilitation of PAD patients with claudication is still under-used.

  12. The relationship between obesity and coronary artery disease.

    Science.gov (United States)

    Jahangir, Eiman; De Schutter, Alban; Lavie, Carl J

    2014-10-01

    Obesity continues to be a growing issue in the United States, with an estimated prevalence of 72 million people. There are major health implications associated with obesity, including its relationship with hypertension, diabetes mellitus type 2, metabolic syndrome, and dyslipidemia, all independent risk factors for coronary artery disease (CAD). Despite the increased risk of developing CAD, in recent years an "obesity paradox" has been described in which moderately obese individuals with established cardiovascular disease, including CAD, appear to have mortality similar to their normal-weight counterparts. This review examines the relationship between obesity and CAD, including the increased risk of hypertension, diabetes mellitus, metabolic syndrome, and dyslipidemia, along with a discussion of the obesity paradox and the benefits of weight reduction.

  13. Genome-Wide Association Study of Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Naomi Ogawa

    2010-01-01

    Full Text Available Coronary artery disease (CAD is a multifactorial disease with environmental and genetic determinants. The genetic determinants of CAD have previously been explored by the candidate gene approach. Recently, the data from the International HapMap Project and the development of dense genotyping chips have enabled us to perform genome-wide association studies (GWAS on a large number of subjects without bias towards any particular candidate genes. In 2007, three chip-based GWAS simultaneously revealed the significant association between common variants on chromosome 9p21 and CAD. This association was replicated among other ethnic groups and also in a meta-analysis. Further investigations have detected several other candidate loci associated with CAD. The chip-based GWAS approach has identified novel and unbiased genetic determinants of CAD and these insights provide the important direction to better understand the pathogenesis of CAD and to develop new and improved preventive measures and treatments for CAD.

  14. MR-based coronary artery blood velocity measurements in patients without coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Schiemann, M.; Esmaeili, A.; Vogl, T.J. [Johann Wolfgang Goethe-University, Institute of Diagnostic and Interventional Radiology University Hospital, Frankfurt am Main (Germany); Bakhtiary, F.; Moritz, A. [University HospitalJohann Wolfgang Goethe-University, Department of Thoracic and Cardiovascular Surgery, Frankfurt am Main (Germany); Hietschold, V. [University Hospital Carl Gustav Carus Technical University Dresden, Institute of Diagnostic Radiology, Dresden (Germany); Koch, A.; Abolmaali, N.D. [Johann Wolfgang Goethe-University, Institute of Diagnostic and Interventional Radiology University Hospital, Frankfurt am Main (Germany); University Hospital Carl Gustav Carus Techinical University Dresden, ZIK OncoRay - Molecular Imaging, Dresden (Germany); Ackermann, H. [Johann Wolfgang Goethe University, Department for Biomathematics, Frankfurt am Main (Germany)

    2006-05-15

    To evaluate the feasibility of MR-based coronary blood velocity measurements (MRvenc) in patients without coronary artery disease (CAD). Eighty-three patients with angiographically excluded CAD received MRvenc of the proximal segments of both coronary arteries (CAs). Using a retrospectively ECG-gated breath-hold phase-contrast FLASH sequence with high temporal resolution, flow data were technically acquirable in 137/166 (83%) CAs. Quantification and analysis of blood velocities in systole and diastole of both CAs were performed. Biphasic velocity profiles were found in 83/100 CAs. Median systolic and diastolic velocities differed significantly in LCA (19 cm/s, 24 cm/s; P<0.0001) and RCAs (14 cm/s, 16 cm/s; P<0.01). The diastolic/systolic velocity ratio was calculated in LCAs and RCAs with a median of 1.3 and 1.1, respectively. The velocity profiles of the remaining CAs were monophasic (17 CAs) or revealed severe alterations of the physiologic velocity profile with reduced flow undulations and steady velocities (37 CAs). Optimized clinical MRvenc is feasible to quantify blood velocities in the CAs. Potential indications are (1) non-invasive monitoring of patients after aortic valve reconstruction as well as (2) detection of asymptomatic CAD patients. (orig.)

  15. Peripheral arterial disease: A high risk – but neglected – disease population

    Directory of Open Access Journals (Sweden)

    Lip Gregory YH

    2005-06-01

    Full Text Available Abstract Peripheral arterial disease (PAD is a common, progressive manifestation of atherothrombotic vascular disease, which should be managed no different to cardiac disease. Indeed, there is growing evidence that PAD patients are a high risk group, although still relatively under-detected and under treated. This is despite the fact that PAD patients are an increased mortality rate comparable to those with pre-existing or established cardiovascular disease [myocardial infarction, stroke]. With a holistic approach to atherothrombotic vascular disease, our management of PAD can only get better.

  16. Association of arterial stiffness with coronary flow reserve in revascularized coronary artery disease patients

    Institute of Scientific and Technical Information of China (English)

    Vlassis Tritakis; Stavros Tzortzis; Ignatios Ikonomidis; Kleanthi Dima; Georgios Pavlidis; Paraskevi Trivilou; Ioannis Paraskevaidis; Giorgos Katsimaglis; John Parissis; John Lekakis

    2016-01-01

    AIM: To investigate the association of arterial wave reflection with coronary flow reserve(CFR) in coronary artery disease(CAD) patients after successful revascularization.METHODS: We assessed 70 patients with angiographically documented CAD who had undergone recent successful revascularization. We measured(1) reactive hyperemia index(RHI) using fingertip peripheral arterial tonometry(RH-PAT Endo-PAT);(2) carotid to femoral pulse wave velocity(PWVc-Complior);(3) augmentation index(AIx), the diastolic area(DAI%) and diastolic reflection area(DRA) of the central aortic pulse wave(Arteriograph);(4) CFR using Doppler echocardiography; and(5) blood levels of lipoprotein-phospholipase A2(LpPLA2).RESULTS: After adjustment for age, sex, blood pressure parameter, lipidemic, diabetic and smoking status, we found that coronary flow reserve was independently related to AIx(b =-0.38, r = 0.009), DAI(b = 0.36, P = 0.014), DRA(b = 0.39, P = 0.005) and RT(b =-0.29,P = 0.026). Additionally, patients with CFR < 2.5 had higher PWVc(11.6 ± 2.3 vs 10.2 ± 1.4 m/s, P = 0.019), SBPc(139.1 ± 17.8 vs 125.2 ± 19.1 mm Hg, P = 0.026), AIx(38.2% ± 14.8% vs 29.4% ± 15.1%, P = 0.011) and lower RHI(1.26 ± 0.28 vs 1.50 ± 0.46, P = 0.012), DAI(44.3% ± 7.9% vs 53.9% ± 6.7%, P = 0.008), DRA(42.2 ± 9.6 vs 51.6 ± 11.4, P = 0.012) and Lp PLA2(268.1 ± 91.9 vs 199.5 ± 78.4 ng/m L, P = 0.002) compared with those with CFR ≥ 2.5. Elevated Lp PLA2 was related with reduced CFR(r =-0.33, P = 0.001), RHI(r =-0.37, P < 0.001) and DRA(r =-0.35, P = 0.001) as well as increased PWVc(r = 0.34, P = 0.012) and AIx(r = 0.34, P = 0.001). CONCLUSION: Abnormal arterial wave reflections are related with impaired coronary flow reserve despite successful revascularization in CAD patients. There is a common inflammatory link between impaired aortic wall properties, endothelial dysfunction and coronary flow impairment in CAD.

  17. Cost-utility of enoxaparin compared with unfractionated heparin in unstable coronary artery disease

    Directory of Open Access Journals (Sweden)

    Milne Ruairidh

    2001-10-01

    Full Text Available Abstract Background Low molecular weight heparins hold several advantages over unfractionated heparin including convenience of administration. Enoxaparin is one such heparin licensed in the UK for use in unstable coronary artery disease (unstable stable angina and non-Q wave myocardial infarction. In these patients, two large randomised controlled trials and their meta-analysis showed small benefits for enoxaparin over unfractionated heparin at 30–43 days and potentially at one year. We found no relevant published full economic evaluations, only cost studies, one of which was conducted in the UK. The other studies, from the US, Canada and France, are difficult to interpret since their resource use and costs may not reflect UK practice. Methods We aimed to compare the benefits and costs of short-term treatment (two to eight days with enoxaparin and unfractionated heparin in unstable coronary artery disease. We used published data sources to estimate the incremental cost per quality adjusted life year (QALY, adopting a NHS perspective and using 1998 prices. Results The base case was a 0.013 QALY gain and net cost saving of £317 per person treated with enoxaparin instead of unfractionated heparin. All but one sensitivity analysis showed net savings and QALY gains, the exception (the worst case being a cost per QALY of £3,305. Best cases were a £495 saving and 0.013 QALY gain, or a £317 saving and 0.014 QALY gain per person. Conclusions Enoxaparin appears cost saving compared with unfractionated heparin in patients with unstable coronary artery disease. However, cost implications depend on local revascularisation practice.

  18. DISCOVER: Dutch Iliac Stent trial: COVERed balloon-expandable versus uncovered balloon-expandable stents in the common iliac artery: Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    J.A. Bekken (Joost); J.A. Vos (Jan Albert); R.A. Aarts (Ruud); J.-P.P.M. de Vries (Jean-Paul); B. Fioole (Bram)

    2012-01-01

    textabstractBackground: Iliac artery atherosclerotic disease may cause intermittent claudication and critical limb ischemia. It can lead to serious complications such as infection, amputation and even death. Revascularization relieves symptoms and prevents these complications. Historically, open sur

  19. Radiologic evaluation of coronary artery disease in adults with congenital heart disease.

    Science.gov (United States)

    Valenzuela, David M; Ordovas, Karen G

    2016-01-01

    Improved surgical and medical therapy have prolonged survival in patients with congenital heart disease (CHD) such that general medical conditions like coronary artery disease (CAD) are now the main determinants of mortality. A summary of the association of CAD with CHD, as well as a discussion of the radiologic evaluation of the coronary arteries in adults with CHD is described herein. Cross sectional imaging to evaluate CAD in adults with CHD should follow the same appropriateness criteria as gender and aged matched patients without CHD. Coronary CT imaging may be particularly valuable in evaluating the coronary arteries in this patient population as invasive coronary angiography may prove challenging secondary to complicated or unconventional anatomy of the coronary arteries. Further, typical methods for evaluating CAD such as stress or echocardiography may be impractical in adults with CHD. Finally, delineating the anatomic relationship of the coronary arteries and their relationship with the sternum, chest wall, conduits, grafts, and valves is highly recommended in patients with CHD prior to reintervention to avoid iatrogenic complications.

  20. Multi-parametric ultrasound criteria for internal carotid artery disease - comparison with CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Barlinn, Kristian; Kepplinger, Jessica; Siepmann, Timo; Pallesen, Lars-Peder; Bodechtel, Ulf; Reichmann, Heinz; Puetz, Volker [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neurology, Dresden (Germany); Floegel, Thomas [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neurology, Dresden (Germany); Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neuroradiology, Dresden (Germany); Kitzler, Hagen H. [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neuroradiology, Dresden (Germany); Alexandrov, Andrei V. [The University of Tennessee Health Science Center, Department of Neurology, Memphis, TN (United States)

    2016-09-15

    The German Society of Ultrasound in Medicine (known by its acronym DEGUM) recently proposed a novel multi-parametric ultrasound approach for comprehensive and accurate assessment of extracranial internal carotid artery (ICA) steno-occlusive disease. We determined the agreement between duplex ultrasonography (DUS) interpreted by the DEGUM criteria and CT angiography (CTA) for grading of extracranial ICA steno-occlusive disease. Consecutive patients with acute cerebral ischemia underwent DUS and CTA. Internal carotid artery stenosis was graded according to the DEGUM-recommended criteria for DUS. Independent readers manually performed North American Symptomatic Carotid Endarterectomy Trial-type measurements on axial CTA source images. Both modalities were compared using Spearman's correlation and Bland-Altman analyses. A total of 303 acute cerebral ischemia patients (mean age, 72 ± 12 years; 58 % men; median baseline National Institutes of Health Stroke Scale score, 4 [interquartile range 7]) provided 593 DUS and CTA vessel pairs for comparison. There was a positive correlation between DUS and CTA (r{sub s} = 0.783, p < 0.001) with mean difference in degree of stenosis measurement of 3.57 %. Bland-Altman analysis further revealed widely varying differences (95 % limits of agreement -29.26 to 22.84) between the two modalities. Although the novel DEGUM criteria showed overall good agreement between DUS and CTA across all stenosis ranges, potential for wide incongruence with CTA underscores the need for local laboratory validation to avoid false screening results. (orig.)

  1. Clinical trials in luminal Crohn's disease: a historical perspective.

    Science.gov (United States)

    Hindryckx, Pieter; Baert, Filip; Hart, Ailsa; Armuzzi, Alessandro; Panès, Julian; Peyrin-Biroulet, Laurent

    2014-11-01

    It goes back to 1932 when Dr. Burrill Bernard Crohn and co-workers published their landmark paper, describing regional ileitis as a disease entity. However, clinical trial research has been developing rather slowly in luminal Crohn's disease. It took until the early seventies before the first randomized clinical trial was set up by the National Co-operative Crohn's Disease Study (NCCDS) group. Although the efforts of this group triggered a first wave of clinical trials in Crohn's disease, the lack of guidelines for conducting a clinical trial in this research area resulted in a variety of study designs and much criticism. Besides having a rather small sample size and a short follow-up time, they were often characterized by vague and subjective assessment of disease activity and treatment response. Following the advent of a new and very potent drug class in the late nineties, the anti-TNF agents, investigators started to re-think their study protocols and the first guidelines were set up by the regulatory authorities. Over the last 15years, clinical trials in luminal Crohn's disease have been evolving significantly. Inclusion criteria have been shifting from clinical scores such as Crohn's Disease Activity Index (CDAI) to more objective disease activity parameters such as biomarkers (C-reactive protein and faecal calprotectin) and endoscopic lesions. Primary endpoints have been developing from clinical response to corticosteroid-free remission and more ambitious end-points such as mucosal healing. In this paper, we will give a historical overview on clinical trials in luminal Crohn's disease, before and within the biologic era, and provide insight into how they have shaped our current understanding of trial designs in Crohn's disease.

  2. Coronary artery disease: new insights and their implications for radiology

    Energy Technology Data Exchange (ETDEWEB)

    Dewey, Marc; Kivelitz, Dietmar; Taupitz, Matthias; Wagner, Susanne; Hamm, Bernd [Department of Radiology, Charite Medical School, Freie Universitaet und Humboldt-Universitaet zu Berlin, Schumannstrasse 20/21, P.O. Box 10098, 10117, Berlin (Germany); Borges, Adrian C.; Baumann, Gert [Division of Cardiology, Angiology and Pneumology, Medical Department and Outpatient Centre, Charite Medical School, Berlin (Germany)

    2004-06-01

    Coronary artery disease (CAD) diminishes local, regional, or global blood supply to the heart and is most commonly caused by coronary atherosclerosis. New insights into the etiology of atherosclerosis suggest that CAD is an inflammatory disorder that responds well to modulation rather than an unchangeable chronic process. Since 75% of all acute coronary syndromes result from rupture of atherosclerotic plaques, factors causing rupture have a crucial role. Magnetic resonance imaging and CT have the potential to visualize the composition of coronary artery plaques and thus to identify plaques at risk. Considering the new insights into stunning and hibernation, myocardial late enhancement on MRI might provide pivotal information for therapeutic decision making among lysis therapy, catheter intervention, and bypass surgery. Exercise electrocardiography without or with right precordial leads, stress echocardiography, and stress scintigraphy are simple clinical procedures to identify CAD with high sensitivities of 67, 92, 76, and 88%, respectively. The MRI and CT have to be compared with these good results. Nevertheless, we are expecting that MRI and CT will replace the conventional diagnostic modalities, gain a central role in diagnosing patients with suspected CAD, and prove to be cost-effective in this regard. (orig.)

  3. Obesity and coronary artery disease: evaluation and treatment.

    Science.gov (United States)

    Garcia-Labbé, David; Ruka, Emmeline; Bertrand, Olivier F; Voisine, Pierre; Costerousse, Olivier; Poirier, Paul

    2015-02-01

    With the increasing prevalence of obesity, clinicians are now facing a growing population of patients with specific features of clinical presentation, diagnostic challenges, and interventional, medical, and surgical management. After briefly discussing the effect of obesity on atherosclerotic burden in this review, we will focus on strategies clinicians might use to ensure better outcomes when performing revascularization in obese and severely obese patients. These patients tend to present comorbidities at a younger age, and their anthropometric features might limit the use of traditional cardiovascular risk stratification approaches for ischemic disease. Alternative techniques have emerged, especially in nuclear medicine. Positron emission tomography-computed tomography might be the diagnostic imaging technique of choice. When revascularization is considered, features associated with obesity must be considered to guide therapeutic strategies. In percutaneous coronary intervention, a radial approach should be favoured, and adequate antiplatelet therapy with new and more potent agents should be initiated. Weight-based anticoagulation should be contemplated if needed, with the use of drug-eluting stents. An "off-pump" approach for coronary artery bypass grafting might be preferable to the use of cardiopulmonary bypass. For patients who undergo bilateral internal thoracic artery grafting, harvesting using skeletonization might prevent deep sternal wound infections. In contrast to percutaneous coronary intervention, lower surgical bleeding has been observed when lean body mass is used for perioperative heparin dose determination.

  4. Oxidative Stress Genes, Antioxidants and Coronary Artery Disease in Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Tibaut, Miha; Petrovič, Daniel

    2016-01-01

    The worldwide increasing prevalence of obesity and sedentary lifestyle is the main cause of the rising incidence of T2DM. Due to chronic macrovascular and microvascular complications, T2DM represent a huge socioeconomic burden in the world. Oxidative stress is a key pathogenic mechanism implicated in diabetic coronary artery disease (CAD). Polymorphisms of oxidative stress genes are known to influence oxidative stress levels and are therefore thought to impact CAD pathogenesis. Identifying higher risk groups would be rational, since it would allow better sample selection and thus better results in antioxidant trials. In this review, we summarize the evidence of oxidative stress gene polymorphisms related to the pathogenesis of CAD. Moreover, we provide a review of antioxidants tested in subjects with CAD.

  5. JNKs, insulin resistance and inflammation: A possible link between NAFLD and coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Giovanni Tarantino; Armando Caputi

    2011-01-01

    The incidence of obesity has dramatically increased in recent years. Consequently, obesity and associated disorders such as nonalcoholic fatty liver disease constitute a serious problem. Therefore, the contribution of adipose tissue to metabolic homeostasis has become a focus of interest. In this review, we discuss the latest discoveries that support the role of lipids in nonalcoholic fatty liver disease. We describe the common mechanisms (c-Jun amino-terminal kinases, endoplasmic reticulum stress, unfolded protein response, ceramide, low-grade chronic inflammation) by which lipids and their derivatives impair insulin responsiveness and contribute to inflammatory liver and promote plaque instability in the arterial wall. Presenting the molecular mechanism of lipid activation of pro-inflammatory pathways, we attempt to find a link between nonalcoholic fatty liver disease, metabolic syndrome and cardiovascular diseases. Describing the common mechanisms by which lipid derivatives, through modulation of macrophage function, promote plaque instability in the arterial wall, impair insulin responsiveness and contribute to inflammatory liver and discussing the molecular mechanism of lipid activation of pro-inflammatory pathways, the key roles played by the proliferator-activated receptor and liver X receptor α, nuclear receptors-lipid sensors that link lipid metabolism and inflammation, should be emphasized. Further studies are warranted of anti-inflammatory drugs such as aspirin, anti-interleukin-6 receptors, immune-modulators (calcineurin inhibitors), substances enhancing the expression of heat shock proteins (which protect cells from endoplasmic reticulum stress-induced apoptosis), and anti- c-Jun amino-terminal kinases in well-designed trials to try to minimize the high impact of these illnesses, and the different expressions of the diseases, on the whole population.

  6. Association between depression and development of coronary artery disease: pathophysiologic and diagnostic implications

    Directory of Open Access Journals (Sweden)

    Sakamoto

    2011-03-01

    Full Text Available Carlos V Serrano Jr1, Karina Tiemi Setani2, Erica Sakamoto2, Anna Maria Andrei3, Renério Fraguas41Heart Institute (InCor, 2Medical School, University of São Paulo, Brazil; 3Albert Einstein Hospital, São Paulo, Brazil; 4Department and Institute of Psychiatry, Medical School, University of São Paulo, BrazilAbstract: Depression and coronary artery disease (CAD are both extremely prevalent diseases. In addition, compromised quality of life and life expectancy are characteristics of both situations. There are several conditions that aggravate depression and facilitate the development of CAD, as well as provoke a worse prognosis in patients with already established CAD: inferior adherence to medical orientations (medications and life style modifications, greater platelet activation and aggregation, endothelial dysfunction, and impaired autonomic dysfunction (lowered heart rate variability. Recent literature has shown that depression alone is becoming an independent risk factor for cardiac events both in primary and secondary prevention. As the diagnosis of depression in patients with heart disease is difficult, due to similarities of symptoms, the health professional should perform a careful evaluation to differentiate the clinical signs of depression from those related with general heart diseases. After a myocardial infarction, depression is an independent risk factor for mortality. Successful therapy of depression has been shown to improve patients’ quality of life and cardiovascular outcome. However, multicentric clinical trials are needed to support this inference. A practical liaison between qualified professionals is necessary for the better management of depressed patients with excess risk in developing CAD. Accordingly, pathophysiological and clinical implications between depression and CAD are discussed in this article.Keywords: depression, coronary artery disease, behavioral disorders, prognosis

  7. Association factor analysis between osteoporosis with cerebral artery disease: The STROBE study.

    Science.gov (United States)

    Jin, Eun-Sun; Jeong, Je Hoon; Lee, Bora; Im, Soo Bin

    2017-03-01

    The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified cerebral artery

  8. The effects of direct renin inhibitor, aliskiren, on arterial hypertension, chronic kidney disease and cardiovascular disease: optimal pharmacotherapy.

    Science.gov (United States)

    Morishita, Yoshiyuki; Kusano, Eiji

    2013-03-01

    The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of progression of arterial hypertension, chronic kidney disease (CKD) and cardiovascular disease (CVD). Previous studies suggested that a direct renin inhibitor, aliskiren, may be effective for blood pressure lowering, renoprotection and cardiovascular protection. This review focuses on the effects of aliskiren for arterial hypertension, CKD and CVD.

  9. Endovascular treatment strategies for supra-aortic arterial occlusive disease.

    Science.gov (United States)

    Peeters, P; Verbist, J; Deloose, K; Bosiers, M

    2005-06-01

    Because of the focal nature of stenoses or occlusions in the supra-aortic vasculature, the high blood-pressures in this area and the very low morbidity rates related to percutaneous therapy have largely replaced surgical revascularization as the initial treatment of choice for patients with supra-aortic arterial occlusive disease. The initial technical success and durability of percutaneous angioplasty (PTA) and stenting in these lesions is excellent. Nevertheless several factors can make PTA and stenting a complex procedure that requires advanced endovascular skills for a successful outcome. Profound knowledge of surgical reconstruction techniques or extra-anatomic bypasses remains mandatory, as it is occasionally required for failure of endovascular techniques or if contraindications exist.

  10. Contemporary evaluation and management of lower extremity peripheral artery disease.

    Science.gov (United States)

    Foley, T Raymond; Armstrong, Ehrin J; Waldo, Stephen W

    2016-09-15

    Peripheral artery disease (PAD) includes atherosclerosis of the aorta and lower extremities. Affecting a large segment of the population, PAD is associated with impaired functional capacity and reduced quality of life as well as an increased risk of stroke, myocardial infarction and cardiovascular death. The evaluation of PAD begins with the physical examination, incorporating non-invasive testing such as ankle-brachial indices to confirm the diagnosis. Therapeutic interventions are aimed at alleviating symptoms while preserving limb integrity and reducing overall cardiovascular risk. With this in mind, risk factor modification with exercise and medical therapy are the mainstays of treatment for many patients with PAD. Persistent symptoms or non-healing wounds should prompt more aggressive therapies with endovascular or surgical revascularisation. The following manuscript provides a comprehensive review on the contemporary evaluation and management of PAD.

  11. Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry.

    Directory of Open Access Journals (Sweden)

    Laurent Fauchier

    Full Text Available Few data are available regarding the use of antithrombotic strategies in coronary artery disease patients with atrial fibrillation (AF in everyday practice. We sought to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease.CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary artery disease, defined as prior (≥12 months myocardial infarction, revascularization procedure, coronary stenosis >50%, or chest pain associated with evidence of myocardial ischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available for analysis at baseline; of these 2,229 (6.7% had a history of AF. Median (interquartile range CHA2DS2-VASc score was 4 (3, 5. Oral anticoagulation alone was used in 25.7%, antiplatelet therapy alone in 52.8% (single 41.8%, dual 11.0%, and both in 21.5%. OAC use was independently associated with permanent AF (p<0.001, CHA2DS2-VASc score (p=0.006, pacemaker (p<0.001, stroke (p=0.04, absence of angina (p=0.004, decreased left ventricular ejection fraction (p<0.001, increased waist circumference (p=0.005, and longer history of coronary artery disease (p=0.008. History of percutaneous coronary intervention (p=0.004 and no/partial reimbursement for cardiovascular medication (p=0.01, p<0.001, respectively were associated with reduced oral anticoagulant use.In this contemporary cohort of patients with stable coronary artery disease and AF, most of whom are theoretical candidates for anticoagulation, oral anticoagulants were used in only 47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received both antiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelines in these patients.ISRCTN registry of clinical trials: ISRCTN43070564.

  12. The relationship between rheumatoid factor levels and coronary artery lesion complexity and severity in patients with stable coronary artery disease

    Science.gov (United States)

    Avcı, Anıl; Açar, Göksel; Fidan, Serdar; Öcal, Lütfi; Bulut, Mustafa; Tellice, Muhammed; Akçakoyun, Mustafa; Pala, Selçuk; Esen, Ali Metin

    2015-01-01

    Introduction The relation between serum rheumatoid factor levels and the extent, severity, and complexity of coronary artery disease has not been adequately studied. Aim Therefore, we assessed the relationship between the severity of coronary artery disease assessed by SYNTAX score and serum rheumatoid factor levels in patients with stable coronary artery disease. Material and methods We enrolled 268 consecutive patients who underwent coronary angiography. Patients with acute coronary syndrome and chronic immune disorders were excluded. Baseline serum rheumatoid factor levels were measured and the SYNTAX score was calculated from the study population. Results Patients were divided into two groups. Group 1 was defined as low SYNTAX score 22. Serum rheumatoid factor levels were significantly higher in the intermediate and high-SYNTAX score group than in the low-SYNTAX score group (16.4 ±9 IU/mlvs. 11.36 ±5 IU/ml, p < 0.001). Also, there was a significant correlation between rheumatoid factor and CRP levels with the SYNTAX score r = 0.411; p < 0.001 and r = 0.275; p < 0.001, respectively. On multivariate linear regression analysis, rheumatoid factor (β = 0.101, p < 0.001) was an independent risk factor for intermediate and high SYNTAX score in patients with stable coronary artery disease. In receiver operator characteristic curve analysis, optimal cut-off value of rheumatoid factor to predict high SYNTAX score was found to be 10.5 IU/ml, with 69% sensitivity and 61% specificity. Conclusions The rheumatoid factor level was independently associated with the extent, complexity, and severity of coronary artery disease assessed by SYNTAX score in patients with stable coronary artery diseases. PMID:25848367

  13. [Exrercise tolerance in patients with coronary artery disease after coronary artery stenting].

    Science.gov (United States)

    Tseluyko, V; Kreyndel, K; Vashakidze, Z

    2014-01-01

    The aim of the research is to investigate the impact of coronary stenting on exercise tolerance after 4-8 week and after 12-15 months. The study involved total 90 patients with coronary artery disease, who underwent coronary stenting. All patients underwent clinical examination, including an assessment of their condition, the frequency of angina attacks, echocardioscopy, resting ECG was recorded in all the patients in the standard 12 -lead veloergometry. Statistical processing was performed using Statistica 6.0 for Windows, the method of Wald - Wolfowitz . Data are presented as arithmetic means and error average M ± m. We used a statistical method of calculation - the median ranks (with the median calculated by the usual rules of statistics - the arithmetic mean of the central members of the ordered series). Significant differences were assessed by t-test . The level of significance was considered significant when p <0,05. According to the monitoring data of patients have a significant increase in exercise tolerance: threshold power increased by 63% and in 12-15 months by 58 % compared with the original. The duration of the test conducted after stenting increased by almost 2 -fold. In addition, significantly reduced the proportion of patients whose test results were evaluated as positive. Stenting of the coronary arteries after 4-8 weeks promotes the significant increase in exercise tolerance that persists after 12-15 months. The factors of associated with insufficient increase in exercise tolerance after stenting according veloergometry are: female gender, diabetes, smoking cessation further contributes to the increase in the threshold of physical activity.

  14. PREVALENCE OF PERIPHERAL ARTERIAL DISEASE IN TYPE - 2 DIABETES MELLITUS AND ITS CORRELATION WITH CORONARY ARTERY DISEASE USING ANKLE - BRACHIAL INDEX

    Directory of Open Access Journals (Sweden)

    Basawaraj

    2015-02-01

    Full Text Available OBJECTIVES: Peripheral vascular disease is one of the macrovascular complications of diabetes mellitus. The purpose of this study was to examine the peripheral arterial disease (PAD complicating type 2 diabetes, in particular the influence of PAD on the risk of coronary artery disease. METHODS: Randomly selected T2DM pat ients admitted to Basaweshwara Teaching and General Hospital were included. In addition to a detailed history and physical examination, anthropometric parameters like body mass index was measured. Relevant laboratory investigations were performed. Modified Rose questionnaire was used to diagnose coronary artery disease (CAD. Colour Doppler examination of the arteries of the lower limbs was performed. A cut off of 7% were significant predictors of PAD. Older age, higher HbA1c levels microalbuminuria and deranged lipid profile were found to be significant predictors of CAD. CONCLUSION: We found evidence of PAD in 16% of type 2 dia betics using ankle brachial index. The prevalence of CAD was higher in patients with PAD. So there is definite and strong correlation between PAD and CAD. Thus the early diagnosis of PAD should alert the clinician to a high probability of underlying CAD. KEYWORDS: D i abetes mellitus; Coronary artery disease; Peripheral artery disease; Ankle - brachial index.

  15. 39. Predictors of coronary artery disease in young Saudi patients

    Directory of Open Access Journals (Sweden)

    G. ALbarqy

    2016-07-01

    Full Text Available Coronary artery disease (CAD is defined as obstruction of the lumen of the coronary artery due to formation of atherosclerotic plaque. This eventually leads to reduced blood supply to the heart. It could lead to high morbidity and mortality. Risk factors for CAD are divided into modifiable or non-modifiable. Modifiable such as diabetes, hypertension, hyperlipidemia, obesity, smoking while non-modifiable risks are family history, age, and gender according to previous studies.The aim of this study is to identify the predictors and the prevalence of coronary disease risk factors among young Saudi patients.This study reviewed 1061 patients referred to the cardiac catheterization lab in King Abdulaziz Cardiac Center in Riyadh between the year 2010 and 2013. Included patients were males and females aged 18-45 years who underwent coronary angiography for various clinical indications.The results were divided into two groups; Group A aged 35 years. Male gender in Gp.A 143 (16.1% vs. Gp.B 747 (83.9% p-value = 0.500. Smoking Gp.A 84 (15.8% vs. Gp.B 446 (84.2% p = 0.680. Obesity Gp.A 43 (14.1% vs. Gp.B 262 (85.9% p = 0.234. Family history Gp.A 24 (23.1% vs. 80 (76.9% p = 0.069. Hyperlipidemia Gp.A 40 (12.9% vs. Gp.B 271 (87.1% p = 0.045. Hypertension Gp.A 20 (8.2% vs. Gp 233 (91.8% p = 35 years we found that HTN and Diabetes were statistically significant risk factors. Therefore, a modification of lifestyle habits is recommended.

  16. Effects of different therapies on coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    吕树铮; 刘文娴; 宋现涛; 陈韵岱; 柳弘; 陈立颖; 卢艳玲; 陈欣; 田锐; 张金荣

    2003-01-01

    Objective To analyse the effects of different therapies on coronary artery disease (CAD).Methods A total of 1055 patients who suffered from CAD diagnoised by coronary angiograpy were divided into three groups, namely pure drug therapy, percutanious coronary intervention (PCI) and coronary artery bypass graft (CABG) groups. Follow up was carried out from March to May in 2001, and the major adverse cardiac events (MACEs) including death, no-lethal myocardial infarction (MI) and revascularization were observed. In long-term observation, angina reoccured, and their improvement was evaluated. The short-term period was defined as the duration of 30 days after discharge, and the long term period was defined as the duration from 30 days after discharge.Results In the long-term period, the recurrences of angina both in PCI group and CABG group were lower than pure drug group (P 0.018, 0.002 respectively). No differences about long-term endpoint events were observed among these three groups (P>0.05). Forty-two patients suffering from left main coronary disease were intervened by the three therapies, and there was no death or MI both in PCI and CABG groups, three patients died and suffered from AMI in pure drug therapy group (P=0.015). In the short-term period, mortality in CABG group (5.77%) was higher than those in the other two groups (1.91% for PCI, and 1.40% for medical therapy, P=0.002), and no obvious difference observed in the latter two groups. No significance was concluded about the recent MI among this three groups (P=0.357). There were no differences on revascularization in these three groups.Conclusions Percutanious coronary interventions can not only reduce the attack of angina but also improve the life quality of patients, however it can not improve the long-term existance but left main CAD.

  17. Arterial spin labeling in patients with chic cerebral artery steno-occlusive disease - Correlation with {sup 15}O-PET

    Energy Technology Data Exchange (ETDEWEB)

    Kamano, Hironori; Yoshiura, Takashi; Hiwatashi, Akio; Abe, Koichiro; Yamashita, Koji; Honda, Hiroshi [Dept. of Clinical Radiology, Graduate School of Medical Sciences, Kyushu Univ., Fukuoka (Japan)], e-mail: tsu@radiol.med.kyushu-u.ac.jp; Togao, Osamu [Dept. of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu Univ., Fukuoka (Japan)

    2013-02-15

    Background: Heterogeneity of arterial transit time due to cerebral artery steno-occlusive lesions hampers accurate regional cerebral blood flow measurement by arterial spin labeling (ASL). Purpose: To assess the feasibility of regional cerebral blood flow measurement by ASL with multiple-delay time sampling in patients with steno-occlusive diseases by comparing with positron emission tomography (PET), and to determine whether regional arterial transit time measured by this ASL technique is correlated with regional mean transit time, a PET index of perfusion pressure. Material and Methods: Sixteen patients with steno-occlusive diseases received both ASL and {sup 15}O-PET. The mean regional cerebral blood flow measured by ASL and PET, regional arterial transit time by ASL, and regional mean transit time by PET were obtained by a region-of-interest analysis. Correlation between regional cerebral blood flow by ASL and that by PET, and correlation between regional arterial transit time by ASL and regional mean transit time by PET were tested using Pearson's correlation coefficient for both absolute and relative values. A multivariate regression analysis was performed to test whether regional arterial transit time by ASL was a significant contributor in modeling regional mean transit time by PET after controlling the effect of regional cerebral blood flow by ASL. Results: A significant positive correlation was found between regional cerebral blood flow by ASL and that by PET for both absolute (r = 0.520, P < 0.0001) and relative (r = 0.691, P < 0.0001) values. A significant positive correlation was found between regional arterial transit time by ASL and regional mean transit time by PET both for absolute (r = 0.369, P = 0.0002) and relative (r = 0.443, P < 0.0001) values. The regression analysis revealed that regional arterial transit time by ASL was a significant contributor in modeling regional mean transit time by PET after controlling regional cerebral blood flow by

  18. Cardiac symptoms before sudden cardiac death caused by coronary artery disease

    DEFF Research Database (Denmark)

    Jabbari, Reza; Risgaard, Bjarke; Holst, Anders G;

    2013-01-01

    The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD).......The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD)....

  19. Radiotherapy-induced concomitant coronary artery stenosis and mitral valve disease.

    Science.gov (United States)

    Akboga, Mehmet Kadri; Akyel, Ahmet; Sahinarslan, Asife; Cengel, Atiye

    2014-04-01

    Radiotherapy is extensively used in the treatment of Hodgkin's disease. One of its untoward effects is on heart. Coronary arteries and heart valves can be adversely affected from radiotherapy. However, co-existence of both conditions is very rare. In this report, we present a patient with Hodgkin's disease who developed both coronary artery stenosis and severe mitral valve regurgitation after radiotherapy.

  20. Classification of peripheral occlusive arterial diseases based on symptoms, signs and distal blood pressure measurements

    DEFF Research Database (Denmark)

    Tønnesen, K H; Noer, Ivan; Paaske, William

    1980-01-01

    Systolic blood pressures at toe and ankle were measured in 459 consecutive patients with occlusive arterial disease. Fifty-eight per cent had intermittent claudication with arterial disease of all degrees of severity. Seventeen per cent complained of rest pain having toe systolic pressures below 30...

  1. The renal arterial resistive index and stage of chronic kidney disease in patients with renal allograft

    DEFF Research Database (Denmark)

    Winther, Stine O; Thiesson, Helle C; Poulsen, Lene N;

    2012-01-01

    The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft.......The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft....

  2. Control of drug treatment of chronic coronary artery disease: possibilities of a regional registry

    Directory of Open Access Journals (Sweden)

    Rachkova S.A.

    2016-03-01

    Full Text Available The article describes the results of the Register of hypertension, coronary artery disease, chronic heart failure (Register of AH, CAD, HF in the Ivanovo region in 2015. The frequency of prescribing of the main groups of drugs in patients with coronary artery disease was estimated.

  3. Cost-effectiveness of new cardiac and vascular rehabilitation strategies for patients with coronary artery disease

    NARCIS (Netherlands)

    S. Spronk (Sandra); J.L.H.R. Bosch (Ruud); C. Ryjewski (Connie); J. Rosenblum (Judy); G.C. Kaandorp (Guido); J.V. White (John); M.G.M. Hunink (Myriam)

    2008-01-01

    textabstractObjective: Peripheral arterial disease (PAD) often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (

  4. Kawasaki disease and the emerging coronary artery disease epidemic in India: is there a correlation?

    Science.gov (United States)

    Singh, Surjit; Aulakh, Roosy; Kawasaki, Tomisaku

    2014-04-01

    Although Kawasaki disease (KD) is now being increasingly reported from India, the vast majority of children with KD are still not being diagnosed and treated. A recent study from Chandigarh has shown that the incidence of KD is at least 4.54/100,000 children below 15 y of age. Extrapolations of this figure suggest that a minimum of 17,417 new cases of KD would be occurring every year in our country. A significant proportion of these children may develop coronary artery abnormalities. These children would then be at risk of developing myocardial ischemia as young adults. It is authors' contention that (undiagnosed) KD in childhood may be contributing to the growing pool of coronary artery disease (CAD) in India. Similarly, a missed diagnosis of KD in childhood should be considered as a possibility while evaluating adults with CAD, especially when there are no overt risk factors and no family history of the disease.

  5. Iskemia pada Jari Tangan Penderita Diabetes Melitus: Suatu Keadaan Peripheral Arterial Disease

    Directory of Open Access Journals (Sweden)

    Eva Decroli

    2015-05-01

    Full Text Available Abstrak Pendahuluan: Peripheral Arterial Disease (PAD adalah penyumbatan pada arteri perifer akibat proses atherosklerosis atau proses inflamasi yang menyebabkan lumen arteri menyempit (stenosis, atau pembentukantrombus. Tempat tersering terjadinya PAD adalah daerah tungkai bawah dan jarang ditemukan pada jari tangan.Metode: Laporan kasus. Hasil: Telah dilaporkan suatu kasus iskemia jari tangan yang jarang ditemui di klinik, merupakan suatu PAD. Pembahasan: Selain adanya faktor risiko konvensional seperti diabetes melitus dan keganasan untuk terjadinya trombosis, juga didapatkan suatu kelainan herediter berupa defisiensi antikoagulan yaitu defisiensi protein S, sekalipun protein C dalam batas normal yang secara bersama-sama diduga mempermudah terjadinya trombosis pada arteri perifer. Kata kunci: Diabetes, Iskemia, Peripheral arterial disease, Protein S, Trombosis Abstract Introduction: Peripheral Arterial Disease (PAD is occlusion in peripheral artery caused by atherosclerosis or inflammation process that make stenosis in artery, or thrombus formation. High incidence of PAD occur in lower extremity, and rarely in hand and finger. Method: Case report. Result: Has been reported hand ischaemia that rarely found in hand and finger. Discussion: Despite conventional risk factor for thrombosis like diabetes mellitus and malignancy, hereditary disorder of anticoagulant factor deficiency played the same role, like protein S deficiency,eventhough protein C in normal limit. These risk factors made thrombosis at peripheral arteri easier to occur.Keywords:  Diabetes, Ischaemia, Peripheral arterial disease, Protein S, Thrombosis

  6. Genetic epidemiology of coronary artery disease: an Asian Indian perspective

    Indian Academy of Sciences (India)

    Shanker Jayashree; Maitra Arindam; Kakkar V. Vijay

    2015-09-01

    Coronary artery disease (CAD) has emerged as a major cause of morbidity and mortality worldwide. Recent findings on the role of genetic factors in the aetiopathology of CAD have implicated novel genes and variants in addition to those involved in lipid and lipoprotein metabolism. However, our present knowledge is limited due to lack of clarity on their exact identity and the quantum of impact on disease susceptibility, and incident risk. It is a matter of great interest to understand the role of genetic factors in ethnic populations that have a strong underlying predisposition to CAD such as the South Asian populations, particularly among Asian Indians living in India and abroad. Although, a number of isolated studies do implicate certain gene polymorphisms towards enhanced disease susceptibility, the available data remains scanty and inconclusive as they have not been validated in large, prospective cohorts. The present review aims to consolidate the available literature on the genetics of CAD in Asian Indians and seeks to provide insights on the concerns that need to be addressed in future studies to generate information having clinical value.

  7. Coronary artery disease: the other half of the heaven

    Energy Technology Data Exchange (ETDEWEB)

    Milan, E. [PET Center, Nuclear Medicine Unit, S. Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso (Italy)

    2005-03-01

    Coronary artery disease (CAD) is the leading cause of death in both men and women in the United States as well as in the most of the industrialized world. Emerging data have displayed important sex-based differences in CAD: its pathophysiology, clinical presentation, diagnostic strategies, response to therapies, and adverse outcomes. Although the incidence of CAD has doubled among women in the past decade, and the rate of women referred to diagnostic testing and revascularization has increased, this disease in female population is still identified less often, at a later stage and treated less aggressively than in men. Significant advances have been made in scintigraphic myocardial perfusion imaging for detection of ischemia, determination of prognosis, assessment of variability and evaluation on the efficacy of revascularization. With the introduction of technetium-99m perfusion agents, gated single emission computed tomography and attenuation correction, myocardial perfusion imaging in women has achieved as high sensitivity and specificity for the detection of CAD as that observed in men and can be considered an adequate noninvasive test to follow-up women with heart disease.

  8. Alcohol consumption and risk of peripheral arterial disease: the Rotterdam study

    NARCIS (Netherlands)

    R. Vliegenthart (Rozemarijn); J.M. Geleijnse (Marianne); W.T. Meijer (Wouter); F.J.A. van Rooij (Frank); D.E. Grobbee (Diederick); J.C.M. Witteman (Jacqueline); A. Hofman (Albert)

    2002-01-01

    textabstractModerate alcohol consumption is associated with a reduced risk of cardiovascular disease. Data on alcohol consumption and atherosclerosis are scarce. To determine the association between alcohol consumption and risk of peripheral arterial disease, the authors carried ou

  9. Ivabradine, coronary artery disease, and heart failure: beyond rhythm control

    Directory of Open Access Journals (Sweden)

    Scicchitano P

    2014-06-01

    Full Text Available Pietro Scicchitano,1 Francesca Cortese,1 Gabriella Ricci,1 Santa Carbonara,1 Michele Moncelli,1 Massimo Iacoviello,1 Annagrazia Cecere,1 Michele Gesualdo,1 Annapaola Zito,1 Pasquale Caldarola,2 Domenico Scrutinio,3 Rocco Lagioia,3 Graziano Riccioni,4 Marco Matteo Ciccone1 1Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy; 2Section of Cardiovascular Diseases, Policlinic, San Paolo Hospital, Bari, Italy; 3Section of Cardiovascular Diseases, Fondazione Maugeri, Cassano Murge, Italy; 4Intensive Cardiology Care Unit, San Camillo de Lellis Hospital, Manfredonia, Foggia, Italy Abstract: Elevated heart rate could negatively influence cardiovascular risk in the general population. It can induce and promote the atherosclerotic process by means of several mechanisms involving endothelial shear stress and biochemical activities. Furthermore, elevated heart rate can directly increase heart ischemic conditions because of its skill in unbalancing demand/supply of oxygen and decreasing the diastolic period. Thus, many pharmacological treatments have been proposed in order to reduce heart rate and ameliorate the cardiovascular risk profile of individuals, especially those suffering from coronary artery diseases (CAD and chronic heart failure (CHF. Ivabradine is the first pure heart rate reductive drug approved and currently used in humans, created in order to selectively reduce sinus node function and to overcome the many side effects of similar pharmacological tools (ie, β-blockers or calcium channel antagonists. The aim of our review is to evaluate the role and the safety of this molecule on CAD and CHF therapeutic strategies. Keywords: chronic heart failure, heart rate reduction, cardiac ischemic disease, heart-rate lowering drugs, funny current

  10. Sustained postoperative anaemia is associated with an impaired outcome after coronary artery bypass graft surgery : insights from the IMAGINE trial

    NARCIS (Netherlands)

    Westenbrink, B. Daan; Kleijn, Lennaert; de Boer, Rudolf A.; Tijssen, Jan G.; Warnica, Wayne J.; Baillot, Richard; Rouleau, Jean L.; van Gilst, Wiek H.

    2011-01-01

    Objective To investigate the association between sustained postoperative anaemia and outcome after coronary artery bypass graft (CABG) surgery. Design Retrospective analysis of the IMAGINE trial, which tested the effect of the ACE inhibitor quinapril on cardiovascular events after CABG. Setting Thor

  11. No benefit of intraoperative whole blood sequestration and autotransfusion during coronary artery bypass grafting : results of a randomized clinical trial

    NARCIS (Netherlands)

    Ramnath, A N; Naber, H R; de Boer, A; Leusink, J A

    2003-01-01

    OBJECTIVES: In a randomized clinical trial of patients undergoing elective coronary artery bypass grafting, we evaluated the effect of intraoperative whole blood sequestration and autotransfusion on postoperative blood loss and the use of allogeneic blood products. METHODS: Male patients were includ

  12. Computerized analysis of coronary artery disease: Performance evaluation of segmentation and tracking of coronary arteries in CT angiograms

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Chuan, E-mail: chuan@umich.edu; Chan, Heang-Ping; Chughtai, Aamer; Kuriakose, Jean; Agarwal, Prachi; Kazerooni, Ella A.; Hadjiiski, Lubomir M.; Patel, Smita; Wei, Jun [Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109 (United States)

    2014-08-15

    Purpose: The authors are developing a computer-aided detection system to assist radiologists in analysis of coronary artery disease in coronary CT angiograms (cCTA). This study evaluated the accuracy of the authors’ coronary artery segmentation and tracking method which are the essential steps to define the search space for the detection of atherosclerotic plaques. Methods: The heart region in cCTA is segmented and the vascular structures are enhanced using the authors’ multiscale coronary artery response (MSCAR) method that performed 3D multiscale filtering and analysis of the eigenvalues of Hessian matrices. Starting from seed points at the origins of the left and right coronary arteries, a 3D rolling balloon region growing (RBG) method that adapts to the local vessel size segmented and tracked each of the coronary arteries and identifies the branches along the tracked vessels. The branches are queued and subsequently tracked until the queue is exhausted. With Institutional Review Board approval, 62 cCTA were collected retrospectively from the authors’ patient files. Three experienced cardiothoracic radiologists manually tracked and marked center points of the coronary arteries as reference standard following the 17-segment model that includes clinically significant coronary arteries. Two radiologists visually examined the computer-segmented vessels and marked the mistakenly tracked veins and noisy structures as false positives (FPs). For the 62 cases, the radiologists marked a total of 10191 center points on 865 visible coronary artery segments. Results: The computer-segmented vessels overlapped with 83.6% (8520/10191) of the center points. Relative to the 865 radiologist-marked segments, the sensitivity reached 91.9% (795/865) if a true positive is defined as a computer-segmented vessel that overlapped with at least 10% of the reference center points marked on the segment. When the overlap threshold is increased to 50% and 100%, the sensitivities were 86

  13. Evaluation of Cognitive Schemas Based on the Presence of Anxiety Disorder among Coronary Artery Disease Patients

    Directory of Open Access Journals (Sweden)

    Huri ASLAN

    2012-11-01

    Full Text Available Objective: The relationship between psychological factors and cardiac diseases has been concerned for a long but our knowledge about the cognitive profiles which could be important etiological factor in cardiac disease and comorbid psychiatric disorders is limited. In this study, we aimed to compare the cognitive profiles of coronary artery disease patients with or without comorbid anxiety disorder. Method: A total of 35 coronary artery disease patients with anxiety disorder and 20 coronary artery disease patients without comorbid anxiety disorders were enrolled into the study. Beck Anxiety Inventory and the Young Schema Questionnaire-Short Form 3 were applied to each participant. Results: Disconnection, rejection, impaired autonomy self-manifestation, extreme vigilance, unrelenting standards, other-directedness, and impaired limits schema domain scores were significantly higher in coronary artery disease patients with anxiety disorder comorbidity compared to coronary artery disease patients without anxiety disorder. Conclusion: Our study has revealed significant differences in cognitive profiles of coronary artery disease patients with comorbidity of anxiety disorders. These findings show the importance of cognitive profiles which were observed in coronary artery disease patients with anxiety disorders. Schema-focused approach might be useful in the treatment of such patients. Further studies with schema-focused therapy approaches are needed to illustrate the issue.

  14. Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

    This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

  15. Value of left ventricular ejection fraction during exercise in predicting the extent of coronary artery disease.

    Science.gov (United States)

    DePace, N L; Iskandrian, A S; Hakki, A H; Kane, S A; Segal, B L

    1983-04-01

    To determine the relation between left ventricular performance during exercise and the extent of coronary artery disease, the results of exercise radionuclide ventriculography were analyzed in 65 patients who also underwent cardiac catheterization. A scoring system was used to quantitate the extent of coronary artery disease. This system takes into account the number and site of stenoses of the major coronary vessels and their secondary branches. The conventional method of interpreting the coronary angiograms indicated that 26 patients had significant coronary artery disease (defined as 70% or more narrowing of luminal diameter) of one vessel, 21 had multivessel disease and 18 had no significant coronary artery disease. Although the exercise left ventricular ejection fraction was significantly higher in patients with no coronary artery disease than in patients with one or multivessel disease (probability [p] less than 0.001), there was considerable overlap among the three groups. With the scoring system, a good correlation was found between the coronary artery disease score and the exercise left ventricular ejection fraction (r = -0.70; p less than 0.001). If the exercise heart rate was 130 beats/min or greater or the age of the patient was 50 years or less, an even better correlation was found (r = -0.73 and r = -0.82, respectively). The exercise ejection fraction (but not the change in ejection fraction, end-diastolic volume and end-systolic volume from rest to exercise) correlated with the extent of coronary artery disease. The exercise ejection fraction is the most important exercise variable that correlates with the extent of coronary artery disease when the latter is assessed quantitatively by a scoring system rather than the conventional method of reporting coronary angiograms. Young age and greater exercise heart rate strengthened the correlation. The change in ejection fraction from rest to exercise is useful in the diagnosis of coronary artery disease

  16. Progenitor cell release plus exercise to improve functional performance in peripheral artery disease: the PROPEL Study.

    Science.gov (United States)

    Domanchuk, Kathryn; Ferrucci, Luigi; Guralnik, Jack M; Criqui, Michael H; Tian, Lu; Liu, Kiang; Losordo, Douglas; Stein, James; Green, David; Kibbe, Melina; Zhao, Lihui; Annex, Brian; Perlman, Harris; Lloyd-Jones, Donald; Pearce, William; Taylor, Doris; McDermott, Mary M

    2013-11-01

    Functional impairment, functional decline, and mobility loss are major public health problems in people with lower extremity peripheral artery disease (PAD). Few medical therapies significantly improve walking performance in PAD. We describe methods for the PROgenitor cell release Plus Exercise to improve functionaL performance in PAD (PROPEL) Study, a randomized controlled clinical trial designed to determine whether granulocyte-macrophage colony stimulating factor (GM-CSF) combined with supervised treadmill walking exercise improves six-minute walk distance more than GM-CSF alone, more than supervised treadmill exercise alone, and more than placebo plus attention control in participants with PAD, respectively. PROPEL Study participants are randomized to one of four arms in a 2 by 2 factorial design. The four study arms are GM-CSF plus supervised treadmill exercise, GM-CSF plus attention control, placebo plus supervised exercise therapy, or placebo plus attention control. The primary outcome is change in six-minute walk distance at 12-week follow-up. Secondary outcomes include change in brachial artery flow-mediated dilation (FMD), change in maximal treadmill walking time, and change in circulating CD34+ cells at 12-week follow-up. Outcomes are also measured at six-week and six-month follow-up. Results of the PROPEL Study will have important implications for understanding mechanisms of improving walking performance and preventing mobility loss in the large and growing number of men and women with PAD.

  17. Inflammation is strongly associated with lupus anticoagulant positivity, indepentent of know autoimmune disease and recent venous or arterial thrombosis

    DEFF Research Database (Denmark)

    Just, Søren Andreas; Nybo, Mads; Laustrup, Helle;

    2014-01-01

    Inflammation is strongly associated with lupus anticoagulant positivity, indepentent of know autoimmune disease and recent venous or arterial thrombosis......Inflammation is strongly associated with lupus anticoagulant positivity, indepentent of know autoimmune disease and recent venous or arterial thrombosis...

  18. [Perioperative myocardial ischemia in patients with peripheral arterial occlusive diseases].

    Science.gov (United States)

    Rapp, H J; Buselmeier, P; Gasteiger, P; Hoberg, E; Striebel, J P

    1990-04-01

    Patients with peripheral vascular disease (PVD) often have coronary artery disease (CAD) which means an increased risk during anesthesia. The prevalence of CAD is nearly 50% among such patients. Owing to claudication, diagnostic stress tests can rarely be performed in PVD patients. In order to evaluate the frequency of transient perioperative myocardial ischemia, Holter monitoring was performed in 30 consecutive PVD patients with ASA II-III and AVK scale (Fontaine) II-IV who were undergoing femoropopliteal bypass surgery. Patients who had left bundle branch block and left ventricular hypertrophy or were taking digitalis medication were excluded from Holter monitoring. The ST-segment analysis of the frequency modulated recordings (n = 19) revealed episodes of myocardial ischemia in 26% of the patients. Most (75%) of the episodes occurred preoperatively, and 25%, during or after the anesthesia or during preparation for it. Risk factors for CAD were more often found in patients with ST segment alterations than in patients without ST segment deviations, even though the preoperative antianginal medication administered was comparable in the two subgroups. It is concluded that in a considerable subset of PVD patients silent myocardial ischemia occurs, which can be related to the different perioperative intervals by means of ST segment analyses of Holter recordings. The ST segment may allow a better insight into the cardiac state of PVD patients. Further studies are necessary in larger populations to test our suspicion.

  19. Leptospirosis and Peripheral Artery Occlusive Disease: A Nationwide Cohort Analysis.

    Science.gov (United States)

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-03-01

    Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44-1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58-1.95).The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population.

  20. Coronary arterial disease after electroconvulsive therapy: a case report

    Directory of Open Access Journals (Sweden)

    Nataly Pimentel Rodrigues

    2015-06-01

    Full Text Available Objectives Unipolar depression (UPD is a leading cause of global burden of diseases, particularly among the elderly, whose treatment may be challenging. In such cases, ECT is often recommended due to its safety and efficacy. This report presents a case of a 67-year-old male inpatient that developed a rare cardiac complication during ECT. Methods Clinical case report with patient’s consent and bibliographic review. Results A 67-year-old male inpatient with recurrent severe psychotic depression was hospitalized and ECT was indicated after failure of the pharmacological treatment. A comprehensive clinical pre-evaluation revealed only nonspecific ST-segment changes in electrocardiogram. During the 7th ECT session, it was observed transitory ST-segment depression followed by a discrete increase of plasma troponin I. Severe tri-vessel coronary artery stenosis was found and a percutaneous coronary angioplasty was performed, with satisfactory psychiatric and cardiac outcomes. Conclusions Unipolar depression (UPD and cardiovascular disease are often coexistent conditions, especially among the elderly. In the current case, myocardial ischemia was detected lately during ECT therapy and its treatment allowed the UPD treatment to be completed adequately.

  1. Coronary artery disease in Alström syndrome.

    Science.gov (United States)

    Jatti, Kumar; Paisey, Richard; More, Ranjit

    2012-01-01

    Alström syndrome (ALMS) is a rare autosomal recessive condition, caused by mutations in the ALMS1 gene located on the short arm of chromosome 2. This gene codes for a protein linked with the centrosome, whose precise function is unknown. This condition was first described by Alström in 1959. ALMS is a multisystem condition that is characterised by childhood onset of blindness secondary to rod-cone retinal degeneration and dilated cardiomyopathy with heart failure, which often presents in infanthood and may recur later in life. Metabolic abnormalities including hypertriglyceridemia, liver steatosis, insulin resistance and type 2 diabetes mellitus are common, often occurring in association with obesity. Other abnormalities include endocrinological disturbances, such as thyroid disorder, growth hormone deficiency, hypogonadism and, in women, hyperandrogenism. This syndrome is also associated with sensorineural hearing loss, renal failure secondary to glomerulo-fibrosis, and fibrotic lung disease. Multiorgan fibrotic infiltration is the common feature in all cases. Considering the history of diabetes, hypertension, dyslipidemia, obesity and renal dysfunction in ALMS, it would be expected that this group of patients could develop coronary artery disease (CAD). But such cases have not been reported so far. We report a case of premature onset of CAD in one of the longest surviving patient with ALMS.

  2. Pulmonary arterial hypertension associated with congenital heart disease

    Directory of Open Access Journals (Sweden)

    Michele D'Alto

    2012-12-01

    Full Text Available Pulmonary arterial hypertension (PAH is a common complication of congenital heart disease (CHD, with most cases occurring in patients with congenital cardiac shunts. In patients with an uncorrected left-to-right shunt, increased pulmonary pressure leads to vascular remodelling and dysfunction, resulting in a progressive rise in pulmonary vascular resistance and increased pressures in the right heart. Eventually, reversal of the shunt may arise, with the development of Eisenmenger's syndrome, the most advanced form of PAH-CHD. The prevalence of PAH-CHD has fallen in developed countries over recent years and the number of patients surviving into adulthood has increased markedly. Today, the majority of PAH-CHD patients seen in clinical practice are adults, and many of these individuals have complex disease or received a late diagnosis of their defect. While there have been advances in the management and therapy in recent years, PAH-CHD is a heterogeneous condition and some subgroups, such as those with Down's syndrome, present particular challenges. This article gives an overview of the demographics, pathophysiology and treatment of PAH-CHD and focuses on individuals with Down's syndrome as an important and challenging patient group.

  3. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Science.gov (United States)

    Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler

    2014-01-01

    Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192

  4. Heart rate reduction in coronary artery disease and heart failure.

    Science.gov (United States)

    Ferrari, Roberto; Fox, Kim

    2016-08-01

    Elevated heart rate is known to induce myocardial ischaemia in patients with coronary artery disease (CAD), and heart rate reduction is a recognized strategy to prevent ischaemic episodes. In addition, clinical evidence shows that slowing the heart rate reduces the symptoms of angina by improving microcirculation and coronary flow. Elevated heart rate is an established risk factor for cardiovascular events in patients with CAD and in those with chronic heart failure (HF). Accordingly, reducing heart rate improves prognosis in patients with HF, as demonstrated in SHIFT. By contrast, data from SIGNIFY indicate that heart rate is not a modifiable risk factor in patients with CAD who do not also have HF. Heart rate is also an important determinant of cardiac arrhythmias; low heart rate can be associated with atrial fibrillation, and high heart rate after exercise can be associated with sudden cardiac death. In this Review, we critically assess these clinical findings, and propose hypotheses for the variable effect of heart rate reduction in cardiovascular disease.

  5. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease.

    Directory of Open Access Journals (Sweden)

    Chi-Lun Huang

    Full Text Available OBJECTIVE: The clinical implication of the coronary artery calcium score (CS is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. METHODS AND RESULTS: Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03. During the follow-up period (21±11 months, 29 (35% patients underwent amputation, and 24 (29% patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18-12.72, p = 0.03 and a 5.16-fold (95% CI 1.13-21.61, p = 0.04 higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. CONCLUSION: Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

  6. Inherited Retinal Degenerative Disease Clinical Trial Network. Addendum

    Science.gov (United States)

    2010-10-01

    gene therapy program with Oxford Biomedica to bring gene therapy for juvenile macular degeneration (Stargardt’s disease). This phase I clinical trial...working with Oxford Biomedica and a separate project with academic investigators on gene therapy for Usher lb syndrome (deaf-blindness due to a gene... Biomedica collaboration will begin no later than 04 2011. 3. NNRI has held multiple clinical investigator meetings to define clinical trial outcomes for

  7. Therapeutic arteriogenesis in peripheral arterial disease: combining intervention and passive training.

    Science.gov (United States)

    Bondke Persson, A; Buschmann, E-E; Lindhorst, R; Troidl, K; Langhoff, R; Schulte, K-L; Buschmann, I

    2011-05-01

    The prevalence of peripheral arterial disease (PAD) is on the rise in an aging population, significantly affecting quality of life, morbidity and mortality. Besides medical treatment and surgical or interventional revascularization, supervised exercise programs are a primary treatment modality for PAD. Training may significantly increase pain-free walking time (+ 180 %) while avoiding the associated complications of (repeated) invasive revascularization. Training effects rely on an improvement of risk factor management, muscle function, economy of movement, hemorheology, vascular growth and collateral vessel growth. Exercise training upregulates pulsatile fluid shear stress on the vascular endothelium, prompting an improvement of endothelial function (eNOS, NO) and an outgrowth of preexistent collaterals (arteriogenesis) to functional conductance arteries outside the ischemic area at risk. However, the necessary intense minimum training intervals compromise patient compliance, and the impaired functional status of many PAD patients limits active exercise training. Strategies are necessary to a) increase training compliance, b) make the benefits of exercise training available to patients unable to exercise actively and c) therapeutically enhance the adaptive growth of biological bypasses (arteriogenesis). A modified form of “passive exercise training” derived from enhanced external counterpulsation (low-pressure ECP) which was originally developed for the therapy of heart failure, may prove to be an option for this group of patients. Therefore, this review article suggests a tailored combination therapy, consisting of a facilitating revascularization procedure to restore arterial inflow, succeeded by supervised exercise training, which has yielded promising therapeutic results in clinical trials. Further studies, using appropriate imaging methods and controls, are under way to (a) establish the efficacy of low-pressure EECP in PAD patients and (b) to directly

  8. The application of disease management to clinical trial designs.

    Science.gov (United States)

    Puterman, Jared; Alter, David A

    2009-08-01

    The utilization of disease management (DM) as a minimum standard of care is believed to facilitate pronounced benefits in overall patient outcome and cost management. Randomized clinical trials remain the gold standard evaluative tool in clinical medicine. However, the extent to which contemporary cardiovascular clinical trials incorporate DM components into their treatment or control arms is unknown. Our study is the first to evaluate the extent to which clinical trials incorporate DM as a minimum standard of care for both the intervention and control groups. In total, 386 clinical trials published in 3 leading medical journals between 2003 and 2006 were evaluated. For each study, elements related to DM care, as defined using the American Heart Association Taxonomy, were abstracted and characterized. Our results demonstrate that while the application of DM has increased over time, only 3.4% of the clinical trials examined incorporated all 8 DM elements (and only 11% of such trials incorporated 4 DM elements). A significant association was found between study year and the inclusion of more than 3 elements of DM (chi(2) = 10.10 (3); p = 0.018). In addition, associations were found between study objective and DM criteria, as well as between cohort type and domains described. Our study serves as a baseline reference for the tracking of DM within, and its application to, randomized clinical trials. Moreover, our results underscore the need for broader implementation and evaluation of DM as a minimum care standard within clinical trial research.

  9. [Management of coronary artery disease in diabetic patients with lower limb critical ischaemia: assessment of operational risk, drug therapy and indications for interventions].

    Science.gov (United States)

    Dedov, I I; Kalashnikov, V Iu; Terekhin, S A; Melkozerov, K V

    2012-01-01

    Despite obvious progress in management of diabetes mellitus, the DM-related complications rate remains inadmissibly high. Macroangiopathy is known to rank first amongst complications of diabetes mellitus, and coronary artery disease remains to be the major cause of death. Analysed herein are peculiarities of the clinical course in diabetic patients presenting with coronary artery disease and lower limb critical ischaemia, followed by discussing the issues concerning drug therapy, preoperative examination, and methods of diagnosis in this cohort of patients prior to vascular operations, assessment of the preoperative risk, indications for coronarography and myocardial revascularization. Also presented are the results of the main clinical trials dedicated to preoperative myocardial revascularization, including those in diabetic patients with limb critical ischaemia, and finally highlighting current importance of optimizing approaches to managing and working out algorithms of treatment policy for diabetic patients with a combination of coronary artery disease, diabetes mellitus, and critical limb ischaemia.

  10. Iskemia pada Jari Tangan Penderita Diabetes Melitus: Suatu Keadaan Peripheral Arterial Disease

    OpenAIRE

    Eva Decroli

    2015-01-01

    Abstrak Pendahuluan: Peripheral Arterial Disease (PAD) adalah penyumbatan pada arteri perifer akibat proses atherosklerosis atau proses inflamasi yang menyebabkan lumen arteri menyempit (stenosis), atau pembentukantrombus. Tempat tersering terjadinya PAD adalah daerah tungkai bawah dan jarang ditemukan pada jari tangan.Metode: Laporan kasus. Hasil: Telah dilaporkan suatu kasus iskemia jari tangan yang jarang ditemui di klinik, merupakan suatu PAD. Pembahasan: Selain adanya faktor risiko konve...

  11. Paraplegia after aortic and superior mesenteric artery stenting for occlusive disease.

    Science.gov (United States)

    Hans, Sachinder S; Ngo, William; McAllister, Michael

    2014-02-01

    Paraplegia after endovascular therapy for aortic and visceral artery occlusive disease is an extremely uncommon occurrence. Two cases of paraplegia after placement of an aortic covered stent for infrarenal aortic stenosis and a superior mesenteric artery stent for chronic visceral ischemia are presented. In both patients, embolization of the arterial supply to the spinal cord was the presumed cause. One patient had a slight recovery after intense physical therapy and rehabilitation. The second patient did not have any recovery from her paraplegia.

  12. A modified regimen of extracorporeal cardiac shock wave therapy for treatment of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Wang Yu

    2012-08-01

    Full Text Available Abstract Background Cardiac shock wave therapy (CSWT improves cardiac function in patients with severe coronary artery disease (CAD. We aimed to evaluate the clinical outcomes of a new CSWT treatment regimen. Methods The 55 patients with severe CAD were randomly divided into 3 treatment groups. The control group (n = 14 received only medical therapy. In group A ( n = 20, CSWT was performed 3 times within 3 months. In group B ( n = 21, patients underwent 3 CSWT sessions/week, and 9 treatment sessions were completed within 1 month. Primary outcome measurement was 6-minute walk test (6MWT. Other measurements were also evaluated. Results The 6MWT, CCS grading of angina, dosage of nitroglycerin, NYHA classification, and SAQ scores were improved in group A and B compared to control group. Conclusions A CSWT protocol with 1 month treatment duration showed similar therapeutic efficacy compared to a protocol of 3 months duration. Clinical trial registry We have registered on ClinicalTrials.gov, the protocol ID is CSWT IN CHINA.

  13. “Obesity paradox” in coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Ibrahim; Akin; Christoph; A; Nienaber

    2015-01-01

    Obesity used to be among the more neglected public health problems, but has unfolded as a growing medical and socioeconomic burden of epidemic proportions. Morbid obesity is linked to traditional cardiovascular risk factors like, hypertension, hyperlipidemia and diabetes, and suspected to incur increased morbidity and mortality in the Western and even third world populations. This patient cohort is also at greater risk to develop coronary artery disease. Recent population-based registries revealed that 43% and 24% of all cases of coronary revascularization were carried out in overweight and obese patients, respectively. However, despite evidence of a positive correlation between obesity and increased cardiovascular morbidity, some authors have described a better clinical outcome in overweight and obese patients, a phenomenon they coined "obesity paradoxon". Thus, there is an ongoing debate in light of conflicting data and the possibility of confounding bias causing misconception and challenging the "obesity paradox". In this review article we present the current evidence and throughly discuss the validity of the "obesity paradoxon" in a variety of clinical settings.

  14. Changing demographics of pulmonary arterial hypertension in congenital heart disease

    Directory of Open Access Journals (Sweden)

    B.J.M. Mulder

    2010-12-01

    Full Text Available Pulmonary arterial hypertension (PAH is a serious complication of congenital heart disease (CHD. Without early surgical repair, around one-third of paediatric CHD patients develop significant PAH. Recent data from the Netherlands suggest that >4% of adult CHD patients have PAH, with higher rates in those with septal defects. A spectrum of cardiac defects is associated with PAH-CHD, although most cases develop as a consequence of large systemic-to-pulmonary shunts. Eisenmenger's syndrome, characterised by reversed pulmonary-to-systemic (right-to-left shunt, represents the most advanced form of PAH-CHD and affects as many as 50% of those with PAH and left-to-right shunts. It is associated with the poorest outcome among patients with PAH-CHD. 40 yrs ago, ∼50% of children with CHD requiring intervention died within the first year, and <15% survived to adulthood. Subsequent advances in paediatric cardiology have seen most patients with CHD survive to adulthood, with resulting shifts in the demographics of CHD and PAH-CHD. The number of adults presenting with CHD is increasing and, although mortality is decreasing, morbidity is increasing as older patients are at increased risk of arrhythmia, heart failure, valve regurgitation and PAH. Data show that probability of PAH increases with age in patients with cardiac defects.

  15. Clinical Application of Vascular Regenerative Therapy for Peripheral Artery Disease

    Directory of Open Access Journals (Sweden)

    Hiroshi Suzuki

    2013-01-01

    Full Text Available Prognosis of peripheral artery disease (PAD, especially critical limb ischemia, is very poor despite the development of endovascular therapy and bypass surgery. Many patients result in leg amputation and, therefore, vascular regenerative therapy is expected in this field. Gene therapy using vascular endothelial growth factor is the first step of vascular regenerative therapy, but did not confirm effectiveness in a large-scale randomized comparative study. Based on animal experiments, bone marrow mononuclear cells (MNCs, peripheral blood MNCs were used as the cell source for regenerative therapy. Those cells were confirmed to be effective to decrease rest pain and ulcer size, but its effect was not fully satisfied. Mesenchymal stem cells (MSCs are expected as an effective cell source for vascular regeneration and clinical studies are ongoing, because the cells are able to differentiate into various cell types and produce a significant amount of vascular growth factors. Of vascular regeneration therapy, peripheral MNCs and bone marrow MNCs were recognized as advanced medical technology but do not attain to the standard therapy. However, clinical use of MSCs have already started, and induced pluripotent stem cells are surely promising tool for vascular regeneration therapy although further basic studies are required for clinical application.

  16. Signal and image processing for early detection of coronary artery diseases: A review

    Science.gov (United States)

    Mobssite, Youness; Samir, B. Belhaouari; Mohamad Hani, Ahmed Fadzil B.

    2012-09-01

    Today biomedical signals and image based detection are a basic step to diagnose heart diseases, in particular, coronary artery diseases. The goal of this work is to provide non-invasive early detection of Coronary Artery Diseases relying on analyzing images and ECG signals as a combined approach to extract features, further classify and quantify the severity of DCAD by using B-splines method. In an aim of creating a prototype of screening biomedical imaging for coronary arteries to help cardiologists to decide the kind of treatment needed to reduce or control the risk of heart attack.

  17. Balloon Angioplasty and Drug Eluting Stenting for Treatment of Peripheral Arterial Occlusive Disease

    Directory of Open Access Journals (Sweden)

    Akın İzgi

    2010-08-01

    Full Text Available Peripheral arterial disease is one of the manifestations of systemic atherosclerosis. In the last decade, remarkable technological advances, especially in the stent area, have shifted revascularization strategies from traditional open surgical approaches toward less morbide percutaneous endovascular treatments. However, even with new designed nitinol bare stents, restenosis remains as the major obstacle of this procedures. More recently, drug eluting stent platforms have been used to treat atherosclerotic peripheral arterial disease. In this article, we reviewed new studies relevant to drug eluting stents for lower extremity peripheral arterial occlusive disease.

  18. [Efficacy of metformin as initial therapy in patients with coronary artery disease and diabetes type 2].

    Science.gov (United States)

    Lavrenko, A V; Kutsenko, L A; Solokhina, I L; Rasin, M S; Kaĭdashev, I P

    2011-01-01

    The use of metformin during the first month of treatment of patients with coronary artery disease and diabetes type 2 led to the decrease of insulin resistance and reduced activity of systemic inflammation (significant decrease in the concentrations of IL-1, IL-6, IL-8 and TNF-alpha). Reduced activity of systemic inflammation had a beneficial effect on the course of coronary artery disease (significant decrease in the functional class of stable angina). Type 2 diabetes appears to be quite successfully modifiable risk factor for coronary artery disease by the adequate controls.

  19. Osteoprotegerin and coronary artery disease in type 2 diabetic patients with microalbuminuria

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Nybo, Mads; Hansen, Peter R

    2011-01-01

    Plasma osteoprotegerin (P-OPG) is an independent predictor of cardiovascular disease in diabetic and other populations. OPG is a bone-related glycopeptide produced by vascular smooth muscle cells and increased P-OPG may reflect arterial damage. We investigated the correlation between P-OPG and co......-OPG and coronary artery disease (CAD) in asymptomatic type 2 diabetic patients with microalbuminuria.......Plasma osteoprotegerin (P-OPG) is an independent predictor of cardiovascular disease in diabetic and other populations. OPG is a bone-related glycopeptide produced by vascular smooth muscle cells and increased P-OPG may reflect arterial damage. We investigated the correlation between P...

  20. Concise Review: Stem Cell Trials Using Companion Animal Disease Models.

    Science.gov (United States)

    Hoffman, Andrew M; Dow, Steven W

    2016-07-01

    Studies to evaluate the therapeutic potential of stem cells in humans would benefit from more realistic animal models. In veterinary medicine, companion animals naturally develop many diseases that resemble human conditions, therefore, representing a novel source of preclinical models. To understand how companion animal disease models are being studied for this purpose, we reviewed the literature between 2008 and 2015 for reports on stem cell therapies in dogs and cats, excluding laboratory animals, induced disease models, cancer, and case reports. Disease models included osteoarthritis, intervertebral disc degeneration, dilated cardiomyopathy, inflammatory bowel diseases, Crohn's fistulas, meningoencephalomyelitis (multiple sclerosis-like), keratoconjunctivitis sicca (Sjogren's syndrome-like), atopic dermatitis, and chronic (end-stage) kidney disease. Stem cells evaluated in these studies included mesenchymal stem-stromal cells (MSC, 17/19 trials), olfactory ensheathing cells (OEC, 1 trial), or neural lineage cells derived from bone marrow MSC (1 trial), and 16/19 studies were performed in dogs. The MSC studies (13/17) used adipose tissue-derived MSC from either allogeneic (8/13) or autologous (5/13) sources. The majority of studies were open label, uncontrolled studies. Endpoints and protocols were feasible, and the stem cell therapies were reportedly safe and elicited beneficial patient responses in all but two of the trials. In conclusion, companion animals with naturally occurring diseases analogous to human conditions can be recruited into clinical trials and provide realistic insight into feasibility, safety, and biologic activity of novel stem cell therapies. However, improvements in the rigor of manufacturing, study design, and regulatory compliance will be needed to better utilize these models. Stem Cells 2016;34:1709-1729.

  1. A systematic review of the effects of hemophilia and von Willebrand disease on arterial trombosis

    NARCIS (Netherlands)

    Biere-Rafi, Sara; Zwiers, M.; Peters, Marjolein; Van Der Meer, Jan; Rosendaal, Frits R; Buller, Harry R; Kamphuisen, Pieter W

    2009-01-01

    Background: Patients with hemophilia and von Willebrand disease (VWD) may be protected against arterial thrombosis, through a hy-pocoagulable state or atherosclerosis. We performed a systematic review to assess the association between these clotting disorders, arterial thrombosis and the prevalence

  2. The rationale for heart team decision-making for patients with stable, complex coronary artery disease

    NARCIS (Netherlands)

    S.J. Head (Stuart); S. Kaul (Sanjay); M. Mack (Michael); P.W.J.C. Serruys (Patrick); D.P. Taggart (David); D.R. Holmes (David); M.B. Leon (Martin); J. Marco (Jean); A.J.J.C. Bogers (Ad); A.P. Kappetein (Arie Pieter)

    2013-01-01

    textabstractStable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy

  3. Multimodality cardiac image analysis for the assessment of coronary artery disease

    NARCIS (Netherlands)

    Gupta, Vikas

    2013-01-01

    Coronary artery disease(CAD) is one of the leading causes of mortality and morbidity worldwide. Clinically, it refers to atherosclerotic changes in the coronary arteries and is usually assessed with a stress electrocardiogram and conventional coronary angiography(CCA). CCA, however, is an invasive t

  4. Diagnostic pathway of integrated SPECT/CT for coronary artery disease

    NARCIS (Netherlands)

    Slart, Riemer H. J. A.; Tio, Rene A.; Zijlstra, Felix; Dierckx, Rudi A.

    2009-01-01

    Treatment strategy in patients with suspected coronary artery disease (CAD) is driven by symptomatology in combination with diagnostic evaluation of the extent and/or severity of atherosclerosis in the coronary arteries and ischemia in the myocardium, i.e., the anatomic and functional correlates of

  5. Cystatin C Is Not Causally Related to Coronary Artery Disease.

    Directory of Open Access Journals (Sweden)

    Patrik Svensson-Färbom

    Full Text Available Strong and independent associations between plasma concentration of cystatin C and risk of cardiovascular disease (CVD suggests causal involvement of cystatin C.The aim of our study was to assess whether there is a causal relationship between plasma concentration of cystatin C and risk of coronary artery disease (CAD using a Mendelian Randomization approach.We estimated the strength of association of plasma cystatin C on CAD risk and the strength of association of the strongest GWAS derived cystatin C SNP (rs13038305 on plasma cystatin C in the population-based Malmö Diet and Cancer Study (MDC and thereafter the association between rs13038305 and CAD in the MDC (3200 cases of CAD and 24418 controls and CARDIOGRAM (22233 cases of CAD and 64762 controls.Each standard deviation (SD increment of plasma cystatin C was associated with increased risk of CAD (OR = 1.20, 95% CI 1.07-1.34 after full adjustment. Each copy of the major allele of rs13038305 was associated with 0.34 SD higher plasma concentration of cystatin C (P98% to detect a significant relationship between rs13038305 and CAD in MDC and CARDIOGRAM pooled. The odds ratio for CAD (per copy of the major rs13038305 allele was 1.00 (0.94-1.07; P = 0.92 in MDC, 0.99 (0.96-1.03; P = 0.84 in CARDIOGRAM and 1.00 (0.97-1.03; P = 0.83 in MDC and CARDIOGRAM pooled.Genetic elevation of plasma cystatin C is not related to altered risk of CAD, suggesting that there is no causal relationship between plasma cystatin C and CAD. Rather, the association between cystatin C and CAD appears to be due to the association of eGFR and CAD.

  6. Genetics of coronary artery disease and myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Xuming Dai; Szymon Wiernek; James P Evans; Marschall S Runge

    2016-01-01

    Atherosclerotic coronary artery disease(CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction(MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MIassociated genetic variants identified using candidate gene approaches and genome-wide association studies(GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI.

  7. Congenital coronary artery fistulas: dual-source CT findings from consecutive 6624 patients with suspected or confirmed coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    YUN Hong; ZENG Meng-su; YANG Shan; JIN Hang; YANG Xue

    2011-01-01

    Background Coronary artery fistulas (CAFs) are rare congenital abnormality often unintentionally found in patients with coronary artery disease.Clinical diagnosis of CAFs is difficult due to symptomless or lack of specific symptoms.Dual-source computed tomography (DSCT) might be a useful diagnostic tool for CAFs.The study aimed to retrospectively summarize the imaging features of CAFs delineated at DSCT in 48 CAF patients detected from consecutive 6624 patients with suspected or confirmed coronary artery disease in our institution.Methods Forty-eight patients underwent DSCT angiography by using retrospective electrocardiographic (ECG) gating after infusion of 70 ml of intravenous contrast material during breath hold.Maximum intensity projection (MIP),curved planar reconstruction (CPR),and volume rendering technique (VR) were obtained.Anomalous termination of coronary artery in each subject was evaluated by two radiologists (with more than 10 years experience with cardiovascular imaging),and disagreement between diagnosis readers was settled by a consensus reading.Ten of 48 patients also underwent traditional coronary angiography (CAG) simultaneously.Results In each CAF case,DSCT angiography clearly demonstrated the origin,the termination,the size of abnormal vessel and its course in relation to surrounding great vessels.CAF arising from right coronary artery was the most common type,left circumflex was the least one involved among three coronaries,and pulmonary artery was the most common drainage site.Aneurismal fistulous tract,coronary atherosclerosis,myocardial bridging and anomalous origin of coronary artery were also detected in this group.The demonstration of drainage sites in CAG was consistent with DSCT angiography in 9 patients,and judgment on one anomalous connection in CAG was inconsistent with that in DSCT angiography.Conclusions DSCT angiography could provide accurate delineation of anomalous communications,size and numbers of fistulas in patients with

  8. EXCEL Clinical Trial

    Science.gov (United States)

    2016-07-13

    Chronic Coronary Occlusion; Unprotected Left Main Coronary Artery Disease; Stent Thrombosis; Vascular Disease; Myocardial Ischemia; Coronary Artery Stenosis; Coronary Disease; Coronary Artery Disease; Coronary Restenosis

  9. Endothelial dysfunction, carotid artery plaque burden, and conventional exercise-induced myocardial ischemia as predictors of coronary artery disease prognosis

    Directory of Open Access Journals (Sweden)

    Ishihara Masayuki

    2008-12-01

    Full Text Available Abstract Background While both flow-mediated vasodilation (FMD in the brachial artery (BA, which measures endothelium-dependent vasodilatation, and intima-media thickness (IMT in the carotid artery are correlated with the prognosis of coronary artery disease (CAD, it is not clear which modality is a better predictor of CAD. Furthermore, it has not been fully determined whether either of these modalities is superior to conventional ST-segment depression on exercise stress electrocardiogram (ECG as a predictor. Thus, the goal of the present study was to compare the predictive value of FMD, IMT, and stress ECG for CAD prognosis. Methods and Results A total of 103 consecutive patients (62 ± 9 years old, 79 men with clinically suspected CAD had FMD and nitroglycerin-induced dilation (NTG-D in the BA, carotid artery IMT measurement using high-resolution ultrasound, and exercise treadmill testing. The 73 CAD patients and 30 normal coronary patients were followed for 50 ± 15 months. Fifteen patients had coronary events during this period (1 cardiac death, 2 non-fatal myocardial infarctions, 3 acute heart failures, and 9 unstable anginas. On Kaplan-Meier analysis, only FMD and stress ECG were significant predictors for cardiac events. Conclusion Brachial endothelial function as reflected by FMD and conventional exercise stress testing has comparable prognostic value, whereas carotid artery plaque burden appears to be less powerful for predicting future cardiac events.

  10. [Comparative assessment of immediate outcomes of surgical treatment of patients with coronary artery disease and lesion of the brachiocephalic arteries].

    Science.gov (United States)

    Drozhzhin, E V; Ibragimov, O R; Koval'chuk, D N; Efanov, Iu M; Zor'kin, A A; Ibragimova, E A; Urvantseva, I A

    2014-01-01

    From 2000 to 2011, a total of 52 patients with combined atherosclerotic lesions of the coronary and brachiocephalic arteries were subjected to a single-stage operation. Depending on the type of operative intervention, all patients were subdivided into two groups: Group One comprising 13 patients who underwent coronary artery bypass grafting (CABG) in a combination with simultaneous stenting of the internal carotid artery, and Group Two consisting of 39 patients subjected to CABG with simultaneous carotid endarterectomy. Assessing the intraoperative parameters revealed that in Group One patients the average duration of operations was significantly lower (179.6±6.4 minutes versus 273.2±5.6 minutes in Group Two, partery with the development of intestinal gangrene and peritonitis. In the structure of hospital complications cardiac insufficiency was prevalent (23.1% and 59.0% for Groups One and Group Two patients, respectively, pcoronary and brachiocephalic arteries makes it possible to increase the overall survival rate in patients suffering this disease and to decrease the incidence rate of ischaemic impairments of the coronary and cerebral circulation. The hybrid method of treatment on arteries of various vascular basins may be an alternative to carotid endarterectomy and CABG, especially in patients running high surgical risk.

  11. The Importance of Patency in Patients with Critical Limb Ischemia undergoing Endovascular Revascularization for Infrapopliteal Arterial Disease

    Directory of Open Access Journals (Sweden)

    Frederic eBaumann

    2015-01-01

    Full Text Available Critical limb ischemia (CLI represents the most severe form of peripheral arterial disease (PAD and frequently occurs in medically frail patients. CLI patients frequently exhibit multi-segmental PAD commonly including the tibial arterial segment. Endovascular therapy has been established as first-line revascularization strategy for most CLI patients. Restenosis was reported to occur in up to more than two thirds of CLI patients undergoing angioplasty of complex tibial arterial obstructions. Nevertheless, favourable clinical outcomes were observed for infrapopopliteal angioplasty when compared with bypass surgery despite higher patency rates for the latter. Based on these observations, infrapopliteal patency was considered to be only of secondary importance upon clinical outcomes in CLI patients. In contrast to these earlier observations, however, recent findings from two randomized clinical trials indicate that infrapopliteal patency does impact on clinical outcomes in CLI patients. Purpose of the present manuscript is to provide a critical reappraisal of the present literature on the clinical importance of tibial arterial patency in CLI patients undergoing endovascular revascularization and to discuss utility and limitations of currently available anti-restenosis technologies.

  12. German guideline on the diagnosis and treatment of peripheral artery disease - a comprehensive update 2016.

    Science.gov (United States)

    Lawall, Holger; Huppert, Peter; Espinola-Klein, Christine; Zemmrich, Claudia Silke; Ruemenapf, Gerhard

    2017-03-01

    The prevalence of peripheral artery disease (PAD) is increasing worldwide and is strongly age-related, affecting about 20 % of Germans over 70 years of age. Recent advances in endovascular and surgical techniques as well as clinical study results on comparative treatment methods strengthened the need for a comprehensive review of the published evidence for diagnosis, management, and prevention of PAD. The interdisciplinary guideline exclusively covers distal aorta and atherosclerotic lower extremity artery disease. A systematic literature review and formal consensus finding process, including delegated members of 22 medical societies and two patient self-support organisations were conducted and supervised by the Association of Scientific Medical Societies in Germany, AWMF. Three levels of recommendation were defined, A = "is recommended/indicated", B = "should be considered", C = "may be considered", means agreement of expert opinions due to lack of evidence. Altogether 294 articles, including 34 systematic reviews and 98 RCTs have been analysed. The key diagnostic tools and treatment basics have been defined. In patients with intermittent claudication endovascular and/or surgical techniques are treatment options depending on appropriate individual morphology and patient preference. In critical limb ischaemia, revascularisation without delay by means of the most appropriate technique is key. If possible and reasonable, endovascular procedures should be applied first. The TASC classification is no longer recommended as the base of therapeutic decision process due to advances in endovascular techniques and new crural therapeutic options. Limited new data on rehabilitation and follow-up therapies have been integrated. The article summarises major new aspects of PAD treatment from the updated German Guidelines for Diagnosis and Treatment of PAD. Limited scientific evidence still calls for randomised clinical trials to close the present gap of evidence.

  13. Periodontitis as a Risk Factor in Non-Diabetic Patients with Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Vida Nesar Hoseini

    2010-11-01

    Full Text Available Coronary Artery Disease (CAD is responsible for much mortality across the w orld, especially in our country .The conventional risk factors for atherosclerosis are well understood, but they can account for only about 50 to 70% of atherosclerotic events in the general population. The aim of this study was to investigate relationships between prevalent Coronary Artery Disease (CAD and clinical periodontal disease in patients with angiographic ally proven coronary artery disease. 152 consecutive patients w ith angiographically proven coronary artery disease will be included in this study, who received a complete periodontal examination during visit. Patients with normal coronary, average plaque index (1.6±1.02 Index of bleeding (1.51±0.92, mean adhesion level (3.57±1.18. But patients with coronary artery disease, the mean plaque index (2.46±0.62 Index of bleeding (1.86±0.92, mean adhesion level (4.13±1.45. These differences are statistically significant. (p<0.05 In this study, average depth of probe entrance on the surface of teeth has had little relation w ith cardiovascular disease (p = 0.051. According to the results of this study, in peoples over 40 years, who had coronary artery disease proved by coronary angiography, gingival inflammation (periodentitis has a significant relation as a risk factor.

  14. Elastin organization in pig and cardiovascular disease patients' pericardial resistance arteries

    DEFF Research Database (Denmark)

    Bloksgaard, Maria; Leurgans, Thomas; Nissen, Inger;

    2015-01-01

    coronary artery bypass grafting or cardiac valve replacement surgeries, can serve as a source of resistance arteries for structural research in cardiovascular disease patients. We applied two-photon excitation fluorescence microscopy to study the parietal pericardium and isolated pericardial resistance...... arteries with a focus on the collagen and elastin components of the extracellular matrix. Initial findings in pig tissue were confirmed in patient biopsies. The microarchitecture of the internal elastic lamina in both the pig and patient pericardial resistance arteries (studied at a transmural pressure...

  15. Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch

    Directory of Open Access Journals (Sweden)

    Luís Alberto Oliveira Dallan

    2013-06-01

    Full Text Available Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.

  16. Coronary artery problems and disease in adults with congenital heart disease: how to evaluate, how to prevent, how to treat.

    Science.gov (United States)

    Cataldo, S; Stuart, A G

    2014-10-01

    There are a wide variety of coronary artery anomalies and disease in adults with congenital heart disease (CHD). In fact, the increasing burden of acquired coronary artery disease (CAD) has to be considered in addition to congenital abnormalities of the coronary arteries, isolated or associated to other congenital diseases. This is largely a consequence of the increasing number of patients reaching older age. Due to complex underlying cardiac anatomy, previous surgery and comorbidities, treatment can be challenging. Individualized and multidisciplinary management involving congenital heart cardiologists, cardiac surgeons, coronary interventionists and imaging specialists is essential. This review gives an overview of coronary artery involvement in adults with CHD, summarizes the current literature and focuses on prevention, diagnosis and treatment. The potential role of cardiovascular risk factors for CAD is also discussed.

  17. Incidence of coronary artery disease in siblings of patients with premature coronary artery disease: 10 years of follow-up.

    Science.gov (United States)

    Vaidya, Dhananjay; Yanek, Lisa R; Moy, Taryn F; Pearson, Thomas A; Becker, Lewis C; Becker, Diane M

    2007-11-01

    Although family history of premature coronary artery disease (CAD) confers increased risk of CAD, the magnitude of this increase beyond that expected from the risk factors incorporated in the Framingham Risk Equation (FRE) remains unknown. We prospectively determined the accuracy of the FRE 10-year incident CAD events prediction in initially healthy siblings of patients with documented premature CAD. We recruited 784 siblings (30 to 59 years) of 449 patients hospitalized with CAD FRE (12% vs 20%, p FRE (p = 0.34). Thus, there was a significant 66.6% excess risk in men, and a nonsignificant 12.7% excess risk in women beyond the risk predicted by the FRE for total CAD events. The FRE and its known classic risk factor profile failed to accurately predict total incident 10-year CAD events in individuals with a sibling history of premature CAD, most particularly in men. In conclusion, in families with a history of premature CAD, the excess risk observed cannot be attributed to traditional risk factors, suggesting a major role for as yet undetermined genetic and other susceptibility factors.

  18. Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients.

    Science.gov (United States)

    Seyahi, Emire; Melikoglu, Melike; Akman, Canan; Hamuryudan, Vedat; Ozer, Harun; Hatemi, Gulen; Yurdakul, Sebahattin; Tuzun, Hasan; Oz, Buge; Yazici, Hasan

    2012-01-01

    Pulmonary artery aneurysms (PAAs) are well known causes of mortality and morbidity in Behçet disease (BD). However, pulmonary artery involvement in BD is not limited to PAA; the other main type of pulmonary artery involvement is pulmonary artery thrombus (PAT), with or without associated PAA. In addition, other types of lung disease like nodules and cavities in the lung parenchyma are frequently associated with pulmonary artery involvement, and can be misinterpreted as being due to infection. We surveyed the clinical, radiologic, and laboratory characteristics and outcome of 47 BD patients with pulmonary artery involvement and the associated findings, all seen and followed at a single dedicated tertiary care center.We identified 47 (41 male, 6 female) patients in whom pulmonary artery involvement was diagnosed, who were registered in the multidisciplinary clinic at Cerrahpasa Medical Faculty between January 2000 and December 2007. Mean age at diagnosis was 29 ± 8 years, and mean disease duration to the onset of pulmonary artery involvement was 3.6 ± 4.8 years. Hemoptysis was the most common presenting symptom (79%) followed by cough, fever, dyspnea, and pleuritic chest pain. Thirty-four of 47 patients (72%) presented with PAA, including 8 with associated PAT. The remaining 13 patients (28%) had isolated PAT. Patients with isolated PAT in general have clinical features similar to patients with PAA. However, hemoptysis was less frequent and voluminous in patients with isolated PAT. Most (91%) of the patients had active disease outside the lungs when they presented with pulmonary artery involvement.Forty (85%) patients had nodules and 6 (13%) had cavities when first seen. Peripheral venous thrombosis was present in 36 of 47 (77%) patients, and intracardiac thrombi in 12 of the 36 (33%) patients. Nodules, cavities, and intracardiac thrombi were mainly present in the acute stages of pulmonary artery involvement.Pulmonary artery involvement is usually multiple, and

  19. Coronary revascularization in ischemic heart disease: lessons from observational studies and randomized clinical trials

    NARCIS (Netherlands)

    N.F. Mercado (Nestor)

    2003-01-01

    textabstractThis thesis presents an overview of clinical trials and observational studies on coronary revascularization and evaluates the results obtained with revascularization in different subsets of patients treated with percutaneous coronary intervention or coronary artery bypass graft surgery.

  20. Multislice computed tomography angiography in the diagnosis of coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Zhong-Hua Sun; Yan Cao; Hua-Feng Li

    2011-01-01

    Multislice Cr angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease.Rapid improvements in multislice CT scanners over the last decade have allowed this technique to become a potentially effective alternative to invasive coronary angiography in patients with suspected coronary artery disease.High diagnostic value has been achieved with multisfice CT angiography with use of 64-and more slice CT scanners.In addition,multislice CT angiography shows accurate detection and analysis of coronary calcium,characterization of coronary plaques,as well as prediction of the disease progression and major cardiac events.Thus,patients can benefit from multislice CT angiography that provides a rapid and accurate diagnosis while avoiding unnecessary invasive coronary angiography procedures.The aim of this article is present an overview of the clinical applications of multislice CT angiography in coronary artery disease with a focus on the diagnostic accuracy of coronary artery disease;prognostic value of coronary artery disease with regard to the prediction of major cardiac events; detection and quantification of coronary calcium and characterization of coronary plaques.Limitations of multislice Cr angiography in coronary artery disease are also briefly discussed,and future directions are highlighted.

  1. Clinical utility of digital dobutamine stress echocardiography in the noninvasive evaluation of coronary artery disease.

    Science.gov (United States)

    Madu, E C; Ahmar, W; Arthur, J; Fraker, T D

    1994-05-23

    Exercise electrocardiography is an established mode of evaluation for patients with suspected coronary artery disease. It also provides prognostic information and guides therapeutic management in patients with established disease. However, some patients are unable to exercise because of orthopedic problems, neurologic diseases, peripheral vascular disease, or deconditioning. In the past, these patients have been referred for angiography to help assess their disease. Recently, however, new techniques to assess myocardial perfusion and/or function, including stress echocardiography, have been used in the noninvasive assessment of coronary artery disease in this group of patients. Echocardiography has been used in combination with different drugs, including dobutamine, dipyridamole, and adenosine. Dobutamine is probably the single most studied drug for stress echocardiography. Dobutamine stress echocardiography is a safe, feasible, and valuable technique for evaluating coronary artery disease.

  2. Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

    Institute of Scientific and Technical Information of China (English)

    Li-Qun Chi; Jian-Qun Zhang; Qing-Yu Kong; Wei Xiao; Lin Liang; Xin-Liang Chen

    2015-01-01

    Background:It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD).Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization.In this study,short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD.Methods:From January 2012 to April 2014,221 cases of CABG were performed by the same surgeon in our unit.Among these cases,38 cases of CE + CABG were performed,which was about 17.2% (38/221) of the cohort.All these patients were divided into two groups:CE + CABG group (Group A) and CABG alone group (Group B).All clinical data were compared between the two groups,and postoperative complications and in-hospital mortality were analyzed.The categorical and continuous variables were analyzed by Chi-square test and Student's t-test respectively.Results:Diabetes mellitus,hypertension,hyperlipidemia,and peripheral vascular disease were more common in group A.In this cohort,a total of 50 vessels were endarterectomized.Among them,CE was performed on left anterior descending artery in 11 cases,on right coronary artery in 29 cases,on diagonal artery in 3 cases,on intermediate artery in 2 cases,on obtuse marginal artery in 5 cases.There was no hospital mortality in both groups.The intro-aortic balloon pump was required in 3 cases in Group A (3/38),which was more often than that in Group B (3/183).At the time of follow-up,coronary computed tomography angiogram showed all the grafts with CE were patent (50/50).There is no cardio-related mortality in both groups.All these patients were free from coronary re-intervention.Conclusions:Coronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.

  3. Urinary proteomic diagnosis of coronary artery disease: identification and clinical validation in 623 individuals

    DEFF Research Database (Denmark)

    Delles, Christian; Schiffer, Eric; von Zur Muhlen, Constantin

    2010-01-01

    We studied the urinary proteome in a total of 623 individuals with and without coronary artery disease (CAD) in order to characterize multiple biomarkers that enable prediction of the presence of CAD....

  4. 78. Environmental air pollution: A new emerging factor for coronary artery disease

    Directory of Open Access Journals (Sweden)

    S.A. Meo

    2016-07-01

    Conclusion: Environmental pollution exert detrimental effects on the heart. The researchers and physicians must consider the environmental pollution as an emerging factor in the development of coronary artery disease.

  5. Association between chronic kidney dysfunction and the complexity of coronary artery disease in elderly patients

    Institute of Scientific and Technical Information of China (English)

    颜利求

    2013-01-01

    Objective To investigate the association between chronic kidney dysfunction and the complexity of coronary artery disease in elderly patients.Methods A prospective study was conducted on 1380 consecutive patients

  6. Cost and patency rate targets for the development of endovascular devices to treat femoropopliteal arterial disease

    NARCIS (Netherlands)

    G.S. Muradin (Galied); M.G.M. Hunink (Myriam)

    2001-01-01

    textabstractPURPOSE: To determine the criteria that would make use of an endovascular device cost-effective compared with bypass surgery and percutaneous transluminal angioplasty in the treatment of femoropopliteal arterial disease. MATERIALS AND METHODS: A decision mod

  7. Refractory angina pectoris in end-stage coronary artery disease : Evolving therapeutic concepts

    NARCIS (Netherlands)

    Schoebel, FC; Frazier, OH; Jessurun, GAJ; DeJongste, MJL; Kadipasaoglu, KA; Jax, TW; Heintzen, MP; Cooley, DA; Strauer, BE; Leschke, M

    1997-01-01

    Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortoco

  8. Comparable three months' outcome of total arterial revascularization versus conventional coronary surgery: Copenhagen Arterial Revascularization Randomized Patency and Outcome trial

    DEFF Research Database (Denmark)

    Damgaard, S.; Lund, J.T.; Lilleor, N.B.;

    2008-01-01

    .9 in the conventional group (P = .004). Three months' follow-up for the arterial versus conventional groups showed the following: deaths: 1 (0.6%) versus 0; stroke: 3 (1.9%) versus 3 (1.8%); myocardial infarction: 6 (3.7%) versus 4 (2.4%); sternal wound reoperation: 4 (2.5%) versus 0 (P = .054); arm and leg wound...

  9. Short term effects of exercise training on exercise capacity and quality of life in patients with pulmonary arterial hypertension: protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Gain Kevin

    2011-05-01

    Full Text Available Abstract Background Advances in the understanding and management of pulmonary arterial hypertension have enabled earlier diagnosis and improved prognosis. However, despite best available therapy, symptoms of exertional dyspnoea and fatigue are commonly reported and result in a reduced capacity to perform daily activities and impaired quality of life. Exercise training has demonstrated efficacy in individuals with other respiratory and cardiovascular diseases. Historically, however, exercise training has not been utilised as a form of therapy in pulmonary arterial hypertension due to the perceived risk of sudden cardiac death and the theoretical possibility that exercise would lead to worsening pulmonary vascular haemodynamics and deterioration in right heart function. Now, with the advances in pharmaceutical management, determining the safety and benefits of exercise training in this population has become more relevant. Only three studies of supervised exercise training in pulmonary arterial hypertension have been published. These studies demonstrated improvements in exercise capacity and quality of life, in the absence of adverse events or clinical deterioration. However, these studies have not utilised an outpatient-based, whole body exercise training program, the most common format for exercise programs within Australia. It is uncertain whether this form of training is beneficial and capable of producing sustained benefits in exercise capacity and quality of life in this population. Design/Methods This randomised controlled trial will determine whether a 12 week, outpatient-based, supervised, whole body exercise training program, followed by a home-based exercise program, is safe and improves exercise capacity and quality of life in individuals with pulmonary arterial hypertension. This study aims to recruit 34 subjects who will be randomly allocated to the exercise group (supervised exercise training 3 times a week for 12 weeks, followed by

  10. Genetic variants associated with celiac disease and the risk for coronary artery disease.

    Science.gov (United States)

    Jansen, Henning; Willenborg, Christina; Schlesinger, Sabrina; Ferrario, Paola G; König, Inke R; Erdmann, Jeanette; Samani, Nilesh J; Lieb, Wolfgang; Schunkert, Heribert

    2015-10-01

    Epidemiological evidence suggests that patients with celiac disease are at increased risk for coronary artery disease (CAD). Genetic-epidemiological analyses identified many single nucleotide polymorphisms (SNPs) associated with celiac disease. If there is a causal relation between celiac disease and CAD, one might expect that risk alleles primarily associated with celiac disease also increase the risk of CAD. In this study we identified from literature 41 SNPs that have been previously described to be genome-wide associated with celiac disease (p DIsease Genome-wide Replication and Meta-analysis (CARDIoGRAM) dataset, a meta-analysis comprising genome-wide SNP association data from 22,233 CAD cases and 64,762 controls. 24 out of 41 (58.5 %) risk alleles for celiac disease displayed a positive association with CAD (CAD-OR range 1.001-1.081). The remaining risk alleles for celiac disease (n = 16) revealed CAD-ORs of ≤1.0 (range 0.951-1.0). The proportion of CAD associated alleles was greater but did not differ significantly from the proportion of 50 % expected by chance (p = 0.069). One SNP (rs653178 at the SH2B3/ATXN2 locus) displayed study-wise statistically significant association with CAD with directionality consistent effects on celiac disease and CAD. However, the effect of this locus is most likely driven by pleiotropic effects on multiple other diseases. In conclusion, this genetically based approach provided no convincing evidence that SNPs associated with celiac disease contribute to the risk of CAD. Hence, common non-genetic factors may play a more important role explaining the coincidence of these two complex disease conditions.

  11. Impact of chronic kidney disease on use of evidence-based therapy in stable coronary artery disease: a prospective analysis of 22,272 patients.

    Directory of Open Access Journals (Sweden)

    Paul R Kalra

    in lower eGRF categories. Surprisingly the reverse was seen for angiotensin-receptor blockers. Further evaluation is required to fully understand these associations. The CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease Registry is registered in the ISRCTN registry of clinical trials with the number ISRCTN43070564. http://www.controlled-trials.com/ISRCTN43070564.

  12. Improved myocardial perfusion after transmyocardial laser revascularization in a patient with microvascular coronary artery disease

    Directory of Open Access Journals (Sweden)

    Peyman Mesbah Oskui

    2014-03-01

    Full Text Available We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her symptoms dramatically improved. This case suggests that combination of ranolazine and transmyocardial revascularization can be applied to patients with microvascular coronary artery disease.

  13. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography

    DEFF Research Database (Denmark)

    Jensen, Jesper Møller; Medina, Hector; Nørgaard, Bjarne Linde;

    2012-01-01

    BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac...... increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P...

  14. Fractional flow reserve-guided PCI for stable coronary artery disease

    DEFF Research Database (Denmark)

    De Bruyne, Bernard; Fearon, William F; Pijls, Nico H J

    2014-01-01

    BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy. METHODS: In 1220 patients with stable coronary artery disease, we......-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; Pratio, 0.23; 95% CI, 0.14 to 0.38; P

  15. Mammographically detected breast arterial calcifications: Indicators for arteriosclerotic diseases?

    Energy Technology Data Exchange (ETDEWEB)

    Taskin, Fuesun [Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin (Turkey)]. E-mail: fusuntaskin@yahoo.com; Akdilli, Alev [Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin (Turkey); Karaman, Can [Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin (Turkey); Unsal, Alparslan [Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin (Turkey); Koeseoglu, Kutsi [Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin (Turkey); Ergin, Filiz [Adnan Menderes University, Faculty of Medicine, Department of Public Health, Aydin (Turkey)

    2006-11-15

    Purpose: To determine the prevalence of breast arterial calcifications (BAC) detected on mammography and search for conditions that may influence their existence. Materials and methods: The mammograms of 6156 consecutive patients were reevaluated for the presence of BAC. Four hundred eighty-five women having BAC were enrolled in the patient group. Additionally, randomly selected 500 women, without BAC constituted the control group. Hospital records of the participants were reviewed for parity, menopausal status, oral contraceptive agent (OCA) usage, hormone replacement therapy (HRT) usage, presence of diabetes, hypertension, hyperlipidemia, albuminuria and history of myocardial infarction (MI). Results: Prevalence of BAC was 7.9% on mammograms. Ninety-four women were aged between 40 and 49 years, 165 were aged between 50 and 59 years and 226 were over 60 years among BAC positive 485 women. A significant relationship was found for the frequency of BAC versus age and HRT usage in all age groups (p < 0.05). Similarly, significant relationships were also found for the frequency of BAC versus OCA usage, HRT usage, hyperlipidemia and diabetes in age group of 40-49 and in age group of 50-59, and for the frequency of BAC versus albuminuria in age group of 40-49, BAC versus history of myocardial infarction in age group of 59-59 and over 60 years (p < 0.05). The correlations were not significant for the relationships of BAC with OCA usage, hyperlipidemia, diabetes and albuminuria in women over 60 years (p > 0.05). Conclusion: Most benign findings like BAC are not routinely reported during mammographic evaluation. Our study showed that, presence of BAC on mammography was strongly related to advancing age. However, these findings may signify a systemic risk and can be used as precautious indicators for undocumented systemic diseases, especially in premenopausal women.

  16. Androgenetic alopecia and risk of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Lata Sharma

    2013-01-01

    Full Text Available Background: Androgenetic alopecia (AGA or male pattern baldness (MPB has been found to be associated with the risk of coronary artery disease (CAD. The well-known risk factors are family history of CAD, hypertension, increased body mass index (BMI, central obesity, hyperglycemia, and dyslipidemia. The newer risk factors are serum lipoprotein-a (SL-a, serum homocysteine (SH, and serum adiponectin (SA. Aim : Identifying individuals at risk of CAD at an early age might help in preventing CAD and save life. Hence, a comparative study of CAD risk factors was planned in 100 males of AGA between the age of 25 and 40 years with equal number of age- and sex-matched controls. Materials and Methods : Patients of AGA grade II or more of Hamilton and Norwood (HN Scale and controls were examined clinically and advised blood test. The reports were available for fasting blood sugar (FBS, serum total serum cholesterol (SC in 64 cases, 64 controls; lipoproteins (high, low, very low density, HDL, LDL, VLDL, serum triglycerides (ST in 63 cases, 63 controls; SL-a in 63 cases, 74 controls; SH in 56 cases, 74 controls; and SA in 62 cases, 74 controls. Results : In these cases family history (FH of AGA and CAD was significantly high. The blood pressure (BP was also found to be significantly high in the cases. The difference of mean serum HDL, LDL, VLDL, ST, SH, and SL-a in cases and controls were statistically significant and with increasing grade of AGA, the risk factors also increased. Conclusion : Patients with AGA appear to be at an increased risk of developing CAD, therefore, clinical evaluation of cases with AGA of grade II and above may be of help in preventing CAD in future.

  17. The Relation Between Aortic Pulse Pressure and Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Ali Metin Esen

    2011-08-01

    Full Text Available Objective: Pulse pressure (PP is a significant marker of cardiovascular morbidity.We investigated the relation between aortic PP and the presence and extent of coronary artery disease (CAD in patients undergoing diagnostic coronary angiography (CAG.Patients and Method: The study group consisted of 550 patients (363 men, 187 women.We evaluated patients in two different groups, PP < 60 mmHg and ≥ 60 mmHg.Results: In univariate analysis gender and presence of hyperlipidemia showed no statistically significant differences between both groups. However, the ratio of patients having diabetes mellitus, hypertension or smoking were significantly higher in ≥ 60 mmHg PP group. The mean age was 55.2 ±11.9 in < 60 mmHg PP group and 61.3±9.3 in the other group (p<0.01. Although systolic blood pressure level was higher in ≥ 60 mmHg PP group (160.4±21.1 vs. 126.4±13.5, p< 0.001, diastolic blood pressure level showed no significant differences between both groups (78.3±13.5 vs. 80.3±10.2, p= 0.32. In the <60 mmHg PP group, the ratio of normal CAG was significantly higher, and also, the critically CAD rate was lower than the other group. In multivariate analysis, smoking [odds ratios (OR 2.344, 95% confidence intervals (CI, 1.416-3.879], male gender (OR 5.858, 95% CI, 3.425-10.019 and PP ≥60 mmHg (OR 25.788, 95% CI, 14.001-47.498 were evaluated as an independent indicators of CAD.Conclusions: In our study, we demonstrate that, aortic PP ≥60 mmHg is related to the risk of critically CAD as an independent factor.

  18. ACE Inhibition and Endothelial Function: Main Findings of PERFECT, a Sub-Study of the EUROPA Trial

    NARCIS (Netherlands)

    Bots, M.L.; Remme, W.J.; Lüscher, T.F.; Fox, K.M.; Bertrand, M.; Ferrari, R.; Simoons, M.L.; Grobbee, D.E.; EUROPA-PERFECT Investigators

    2007-01-01

    Background: ACE inhibition results in secondary prevention of coronary artery disease (CAD) through different mechanisms including improvement of endothelial dysfunction. The Perindopril-Function of the Endothelium in Coronary artery disease Trial (PERFECT) evaluated whether long-term administratio

  19. Femoral artery pressure measurement to predict the outcome of arterial surgery in patients with multilevel disease

    DEFF Research Database (Denmark)

    Faris, I; Tønnesen, K H; Agerskov, K;

    1982-01-01

    Direct measurement of the femoral artery pressure before operation has been used to predict the postoperative change in ankle and toe pressure in 102 limbs (83 patients) that underwent aortoiliac surgery for the treatment of atherosclerotic occlusion or stenosis affecting both the aortoiliac...... and femoral artery segments. Rest pain or gangrene was present in 74 limbs. In 26 other limbs simultaneous aortoiliac and femoral artery reconstructions were performed. The changes in both toe and ankle pressures could be confidently predicted from the preoperative data. A predicted toe pressure of lower than...... 25 mm Hg was associated with a high probability that amputation would be required. The chances of an amputation were less than 3% if a toe pressure higher than 40 mm Hg was predicted. If the predicted ankle pressure index was lower than 0.56, there was a 90% chance that intermittent claudication...

  20. Myocardial ischemia, carotid, and peripheral arterial disease and their interrelationship in type 2 diabetes patients

    DEFF Research Database (Denmark)

    Poulsen, Mikael K; Henriksen, Jan Erik; Dahl, Jordi;

    2009-01-01

    for the first time and age-matched nondiabetic reference subjects (n = 40) were screened for myocardial ischemia, carotid, and peripheral arterial disease by means of myocardial perfusion scintigraphy, carotid artery ultrasonography, and peripheral ankle and toe systolic blood pressure measurements. RESULTS......: In the T2DM patients, the prevalence of myocardial ischemia, carotid, and peripheral arterial disease was 30%, 42%, and 15%, respectively, almost three times higher than in the reference subjects (P = 0.007, P = 0.001, and P = 0.09, respectively). T2DM patients with myocardial ischemia, carotid...

  1. Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials

    Directory of Open Access Journals (Sweden)

    Mitrakrishnan Chrishan Shivanthan

    2014-01-01

    Full Text Available The efficacy of magnesium sulphate in chronic obstructive pulmonary disease (COPD was assessed by conducting a systematic review of published randomized clinical trials through extensive searches in MEDLINE and SCOPUS with no date limits, as well as manual review of journals. Outcome measures varied depending on route(s of administration of magnesium sulphate and medications co-administered. Risk of bias was evaluated and quality of evidence was graded. Four (4 randomized trials were included. All trials had a moderate risk of bias and were of average methodological quality. Magnesium sulphate given intravenously did not seem to have an immediate bronchodilatory effect; however it appears to potentiate the bronchodilatory effect of inhaled beta-2 agonists. Increase in peak expiratory flow rate (PEFR at 30 and 45 min was greater in those who received magnesium sulphate compared to placebo (P = 0.03, although the mean percentage change in PEFR was just 24%, without significant differences in dyspnoea scores, hospital admission rates, or emergency department readmission rates compared to placebo. Nebulized magnesium sulphate with salbutamol versus nebulized salbutamol with saline placebo showed no significant differences is forced expiratory volume in 1 s (FEV 1 measured at 90 min after adjustment for baseline FEV 1 (P = 0.34 or differences in the need for hospital admission. Combined inhalational and intravenous magnesium sulphate versus intravenous saline placebo and nebulized ipratropium bromide were comparable in terms of hospital admission, intubation and death, but the ipratropium bromide group showed better bronchodilator effect and improvement in arterial blood gas parameters. Overall, trial evidence for trial evidence for magnesium sulphate in acute exacerbation of COPD is poor, and further well-designed trials are needed.

  2. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study) : an interim analysis of a randomised controlled trial

    NARCIS (Netherlands)

    Ederle, Joerg; Dobson, Joanna; Featherstone, Roland L.; Bonati, Leo H.; van der Worp, H. Bart; de Borst, Gert J.; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumaira; Lyrer, Philippe A.; Hendriks, Johanna M.; McCollum, Charles; Nederkoorn, Paul J.; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Bradbury, A.; Brown, M. M.; Clifton, A.; Gaines, P.; Collins, R.; Molynewc, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Chu, P.; Clark, D.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Fell, G.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Saunder, A.; Than, P. G.; Gett, S.; Leggett, D.; McGahan, T.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Stanley, B.; Allard, B.; Atkinson, N.; Cambell, W.; Davies, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; d'Archambeau, O.; Hendriks, J. M. H.; Van Schil, P.; Bosiers, M.; Deloose, K.; van Buggenhout, E.; De Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verhelst, R.; DeJaegher, L.; Peeters, A.; Verbist, J.; Blair, J-F; Caron, J. L.; Daneault, N.; Giroux, M-F; Guilbert, F.; Lanthier, S.; Lebrun, L-H; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Weill, A.; Hill, M.; Hu, W.; Hudion, M.; Morrish, W.; Sutherland, G.; Wong, J.; Alback, A.; Harno, H.; Ijas, P.; Kaste, M.; Lepantalo, M.; Mustanoja, S.; Paananen, T.; Porras, M.; Putaala, J.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; Skalej, M.; Brennan, P.; Kelly, C.; Leahy, A.; Moroney, J.; Thornton, J.; Koelemay, M. J. W.; Nederkoorn, P. J.; Reekers, J. A. A.; Roos, Y. B. W. E. M.; Hendriks, J. M.; Koudstaal, P. J.; Pattynama, P. M. T.; van der Lugt, A.; van Dijk, L. C.; van Sambeek, M. R. H. M.; van Urk, H.; Verhagen, H. J. M.; Bruininckx, C. M. A.; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H.; Wever, J.; de Beer, F. C.; van den Berg, J. S. P.; van Hasselt, B. A. A. M.; Zeilstra, D. J.; Boiten, J.; van Otterloo, J. C. A. de Mol; de Vries, A. C.; Nieholt, G. J. Lycklama A.; van der Kallen, B. F. W.; Blankensteijn, J. D.; De Leeuw, F. E.; Kool, L. J. Schultze; van der Vliet, J. A.; de Borst, G. J.; de Kort, G. A. P.; Kapelle, L. J.; Lo, T. H.; Mali, W. P. Th M.; Moll, F.; van der Worp, H. Bart; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sorensen, K.; Skjelland, M.; Tennoe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Jedrzejewska, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; Obach, V.; Riambau, V.; San Roman, L.; Branera, J.; Canovas, D.; Estela, Jordi; Gimenez Gaibar, A.; Perendreu, J.; Bjorses, K.; Gottsater, A.; Ivancev, K.; Maetzsch, T.; Sonesson, B.; Berg, B.; Delle, M.; Formgren, J.; Gillgren, P.; Kall, T-B; Konrad, P.; Nyman, N.; Takolander, R.; Andersson, T.; Malmstedt, J.; Soderman, M.; Wahlgren, C.; Wahlgren, N.; Binaghi, S.; Hirt, L.; Michel, P.; Ruchat, P.; Bonati, L. H.; Engelter, S. T.; Fluri, F.; Guerke, L.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E-W; Stierli, P.; Wasner, M.; Wetzel, S.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Murith, N.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Adam, D.; Bell, J.; Bradbury, A. W.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; D'Souza, S.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, A.; Enevoldson, T. P.; Gilling-Smith, G.; Gould, D. A.; Harris, P. L.; McWilliams, R. G.; Nasser, H-C; White, R.; Prakash, K. G.; Serracino-Inglott, F.; Subramanian, G.; Symth, J. V.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dolman, P.; Dyker, A.; Ford, G.; Golkar, A.; Jackson, R.; Jayakrishnan, V.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Rose, J.; Stansby, G.; Wyatt, M.; Baker, T.; Baldwin, N.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Beard, J.; Cleveland, T.; Dodd, D.; Gaines, P.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Venables, G.; Belli, A.; Clifton, A.; Cloud, G.; Halliday, A.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Thompson, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Malik, I.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Brookes, J.; Brown, M. M.; Jaeger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Wong, J.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.; Rogers, P.

    2010-01-01

    Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid

  3. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2010-03-20

    Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.

  4. Women and Coronary Artery Disease. Part I: Basic Considerations

    Directory of Open Access Journals (Sweden)

    Seyed-Hesameddin Abbasi

    2011-09-01

    Full Text Available Women die of cardiovascular disorders even more than a combination of breast cancer, stroke, chronic obstructive pulmonary disease, and lung cancer. Recent data show that while 1 out of 2.6 women die of coronary artery disease (CAD, only 1 out of 4.6 die from cancer. Whereas some studies show an increase in the age-adjusted mortality of CAD in both women and men, some other studies report an increase in mortality amongst young women. There is a significant decrease in sudden cardiac death in men without significant change in women, and more women die of CAD before their arrival at the emergency room of hospitals than do men. It is, therefore, regrettable that many women and their physicians are not sufficiently aware of the problem and this unawareness is believed to be a major culprit for the existing gender disparities and inaction on the part of women as regards risk modification. What is more, the bulk of our knowledge, preventive measures, diagnostic strategies, and treatment plans are on the basis of studies conducted chiefly in men, when powerful evidence-based gender-specific recommendations call for efforts to enroll more women in order to reach a desirable level of sex representation.Given the significance of CAD assessment in women, it is essential that an acceptable risk score system be devised to estimate the risk of coronary events. The Framingham Risk Score, which has been used for this purpose for a long time, is no longer suitable for women and the Reynolds Risk Score seems to be a more appropriate tool.Finally, from a pathophysiological point of view, endothelial and microvascular dysfunctions are the most salient contributors to the development of CAD in women by comparison with men and they give rise to non-obstructive CAD. Lamentably, most of the relevant studies conducted hitherto have focused predominantly on men; any attempt to redress the balance would be of great value in the endeavors to decrease the risk in women.

  5. Presence of anomalous coronary seen on angiogram is not associated with increased risk of significant coronary artery disease.

    Science.gov (United States)

    Suryanarayana, Prakash; Kollampare, Shubha; Riaz, Irbaz Bin; Lee, Justin; Husnain, Muhammad; Luni, Faraz Khan; Movahed, Mohammad Reza

    2014-12-01

    It is unclear if anomalous coronary arteries are at higher risk for atherosclerosis. The link between anomalous coronary artery and early coronary artery disease has been suggested. The aim of this study is to determine whether the coronary artery anomaly predisposes to development of significant coronary disease. Using retrospective chart review, patients with documented anomalous coronary arteries recognized during coronary angiography between years 2000 to 2007 were analyzed. Prevalence of significant atherosclerotic coronary artery disease (defined as more than 50% luminal narrowing) was compared between normal and anomalous coronaries. A total of 147 patients with anomalous coronary arteries were found. Right coronary artery was the most common anomalous artery 128 of 148 (86.5%) in our dataset. There was no difference in the occurrence of atherosclerosis between anomalous and nonanomalous coronaries. Significant atherosclerosis was present in 59 of the 148 anomalous coronary arteries (37.8%), and 112 of the 293 nonanomalous coronary arteries (38.2%, p = 0.9). On the basis of our study, there is no evidence that anomalous coronary arteries predispose to significant coronary artery disease in comparison to normal coronary arteries.

  6. A focus on the prognosis and management of ischemic heart disease in patients without evidence of obstructive coronary artery disease.

    Science.gov (United States)

    Scalone, Giancarla; Niccoli, Giampaolo

    2015-01-01

    Ischemic heart disease without evidence of obstructive coronary artery disease is a common phenotype comprising different coronary syndromes with either stable or unstable clinical presentation. In this context, the clinical outcome and management appear extremely variable, due to different etiologies. Of note, coronary microvascular dysfunction is the pathogenetic mechanism linking different clinical scenarios in most of the cases. Hence, in this article, we aim to provide a systematic approach of reviewing the prognosis and management of angina or myocardial infarction without evidence of obstructive coronary artery disease. Moreover, we will propose a new scheme of classification by distinguishing between angina with normal coronary artery and myocardial infarction with normal coronary artery in order to facilitate clinicians to perform a proper management workflow.

  7. Meta-analysis of randomized trials comparing the effectiveness of on-pump and off-pump coronary artery bypass

    Institute of Scientific and Technical Information of China (English)

    CHEN Yong-bing; SHU Jian; YANG Wen-tao; SHI Li; GUO Xu-feng; WANG Fei-ge; QIAN Yong-yue

    2012-01-01

    Background The growing enthusiasm for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is emerging,but the role of off-pump coronary artery bypass (OPCAB) in clinical practice remains controversial.The purpose of this study was to assess differences in the incidences of stroke,atrial fibrillation (AF),and myocardial infarction (MI) between OPCAB and conventional coronary artery bypass grafting (CCABG) by meta-analyses of randomized clinical trials.Methods A literature search for the period before March 2010 supplemented with manual bibliographic review was performed for all Chinese or English publications in Medline,the Science Citation Index Expanded,the Cochrane Central Register of Controlled Trials (CENTRAL) and CBMdisc.A systematic overview (meta-analyses) of randomized clinical trials was conducted to evaluate the differences between OPCAB and CCABG in the incidences of stroke,AF,and MI.The meta-analysis was performed using RevMan 5 software.Results Forty-three randomized clinical trials were selected for meta-analysis after screening a total of 356 references,with 8104 patients in the OPCAB group and 8724 cases in the CCABG group.The meta-analyses of these trials showed no significant difference between OPCAB and CCABG in the incidences of stroke (odds ratio (OR)=0.80,95% confidence interval (CI)=0.52-1.22,P=0.30) and MI (OR=0.73,95%CI=0.52-1.02,P=0.06).However,we found a significantly reduced risk of AF (OR=0.65,95%CI =0.52-0.82,P=0.0002)in off-pump patients.Conclusions Our meta-analyses suggest that OPCAB reduces the risk of postoperative AF compared with CCABG,but there is no significant difference in the incidences of stroke and MI between OPCAB and CCABG.

  8. Characteristics of randomised trials on diseases in the digestive system registered in ClinicalTrials.gov: a retrospective analysis

    DEFF Research Database (Denmark)

    Wildt, Signe; Krag, Aleksander; Gluud, Liselotte

    2011-01-01

    Objectives To evaluate the adequacy of reporting of protocols for randomised trials on diseases of the digestive system registered in http://ClinicalTrials.gov and the consistency between primary outcomes, secondary outcomes and sample size specified in http://ClinicalTrials.gov and published...

  9. Superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis in treating moyamoya disease: surgical techniques, indications and midterm follow-up results

    Institute of Scientific and Technical Information of China (English)

    XU Bin; SONG Dong-lei; MAO Ying; GU Yu-xiang; XU Hong; LIAO Yu-jun; LIU Chuang-hong; ZHOU Liang-fu

    2012-01-01

    Background Surgical interventions for moyamoya disease include direct and indirect revascularizations.This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass combined with an indirect revascularization procedure,encephalo-duro-myo-synangiosis,in the treatment of moyamoya disease.Methods From October 2005 to November 2009,we performed this combined revascularization procedure in 111 patients with different types and stages of moyamoya disease.The superficial temporal artery,middle meningeal artery and the deep temporal artery were evaluated for individualized surgical planning in these cases.The integrity of the deep temporal artery and the middle meningeal artery network,and the pre-existing spontaneous anastomoses of the distal branches of the external carotid artery with the cortical arteries were well preserved.The mean follow-up time was 72.5 months,all clinical and radiological data were retrospectively reviewed.Results A total of 198 stomas were performed in 122 hemispheres,all remaining patent until the last follow-up.The encephalo-duro-myo-synangiosis resulted in extensive anastomoses of the deep temporal artery (100%),the middle meningeal artery (90.9%),and the sphenopalatine artery (39.8%) with the cortical arteries,respectitvely.The superficial temporal artery,deep temporal artery,and the middle meningeal artery were significantly thickened in 88 patients as determined by digital subtraction angiography at follow-up.The relative cerebral blood flow increased significantly within one week after the operation.At 6 months post the operation,the relative cerebral blood flow was further increased by 15.5% from the gradual formation of anastomoses as a result of indirect revascularization.Transient ischemic attacks were effectively reduced or totally arrested.The neurological deficits significantly improved in 37 patients,with the National Institutes of Health Stroke Scale scores lowered by 2

  10. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

    OpenAIRE

    Ederle, J; Dobson, J.; Featherstone, RL; Bonati, LH; van der Worp, HB; de Borst, GJ; lo, TH; Gaines, P.; Dorman, PJ; Macdonald, S; Lyrer, PA; Hendriks, JM; McCollum, C; Nederkoorn, PJ; Brown, MM

    2010-01-01

    Summary Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were ra...

  11. Doppler examination of the periorbital arteries adds valuable hemodynamic information in carotid artery disease

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T; Steenberg, H J;

    1987-01-01

    The periorbital flow direction and internal carotid artery (ICA) angiogram were compared to the ICA pressure gradient across the stenosis and the distal ICA pressure in 51 patients subjected to carotid endarterectomy. All 17 patients with inverted periorbital flow had stenoses exceeding 50%. The ...

  12. Relationships between use of statins and arterial stiffness in normotensive and hypertensive patients with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-guang; CHEN Bing-wei; L(U) Na-qiang; CHENG Yan-mei; DANG Ai-min

    2013-01-01

    Background Statins improve arterial stiffness in patients with coronary artery disease (CAD).Hypertension is a predominant contributor of arterial stiffening.However,the influence of hypertension on the effect of statins for improving arterial stiffness in CAD patients has seldom been investigated.Therefore,in this study,we investigated the relationships between statin use and arterial stiffness in normotensive and hypertensive CAD patients.Methods Brachial-ankle pulse wave velocity (ba-PWV) was measured in 437 patients,including 220 hypertensive CAD patients (121 used statins,99 did not) and 217 normotensive CAD patients (105 used statins,112 did not).The normotensive and hypertensive CAD patients were matched according to age,sex,and body mass index (BMI).Results In the normotensive and hypertensive CAD patients,lipid profiles were significantly improved in the statin group compared with the non-statin group.No significant differences in the administered statins (i.e.,atorvastatin,simvastatin,rosuvastatin,and pravastatin) and statin therapy duration were found between normotensive and hypertensive CAD patients (all P>0.05).No significant correlation of ba-PWV and statin therapy duration was found in all CAD patients,normotensive CAD patients,or hypertensive CAD patients (all P>0.05).ba-PWV in the statin group was significantly lower than that in the non-statin group in normotensive CAD patients ((1331.68±167.52) cm/s vs.(1468.61±244.54) cm/s,P=0.002) but not in hypertensive CAD patients (P>0.05).In multiple linear regression analyses,statin therapy was significantly associated with ba-PWV after adjusting for confounding variables in normotensive CAD patients (P=0.018) but not in hypertensive CAD patients (P>0.05).Conclusions Statins may significantly improve arterial stiffness in CAD patients,and hypertension may probably influence the effectiveness of statin therapy in improving arterial stiffness in this population.Further studies are required to

  13. Up-front combination therapy in pulmonary arterial hypertension: from clinical trials to 'real world' observational studies.

    Science.gov (United States)

    Grignola, Juan C

    2014-05-15

    Combination therapy in pulmonary arterial hypertension is widely used in daily clinical practice. There is a wide variation among reference centers, with respect to not only when and how combination therapy should be initiated, but also what constitutes the most effective multidrug regimen. Presently, no combination therapy has proven to be more effective than the other. However, add-on therapy, in case of unsatisfactory improvements after initiation of specific monotherapy, seems to have more evidence of effectiveness than up-front therapy at the diagnosis. Data from national pulmonary arterial hypertension registries provide valuable information on practice patterns on diagnosis and treatment in 'real world'. In the study of Bergot et al. the current use of epoprostenol in newly diagnosed patients with severe idiopathic, heritable or anorexigen-use associated pulmonary arterial hypertension enrolled in the French pulmonary hypertension registry was investigated. Up-front combination of epoprostenol and oral pulmonary arterial hypertension tended to be more beneficial compared with epoprostenol alone. New drug trials with well-defined morbidity and mortality end-points are likely to help not only identify novel agents that may help in the treatment of pulmonary arterial hypertension but also determine the most useful combination strategies to maximize efficacy of existing drugs.

  14. Combination treatment of rosuvastatin or atorvastatin, with regular exercise improves arterial wall stiffness in patients with coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Kensuke Toyama

    Full Text Available OBJECTIVE: Statin- and exercise-therapy are both clinically beneficial by preventing cardiovascular events in patients with coronary artery disease (CAD. However, there is no information on the vascular effects of the combination of statins and exercise on arterial wall stiffness in CAD patients. METHODS: The present study is a sub-analysis of PRESET study that determined the effects of 20-week treatment with statins (rosuvastatin, n=14, atorvastatin, n=14 combined with regular exercise on arterial wall stiffness assessed by measurement of brachial and ankle pulse wave velocity (baPWV in CAD patients. RESULTS: The combination of statins and regular exercise significantly improved exercise capacity, lipid profile, including low- and high-density lipoprotein cholesterol, and high-sensitivity C-reactive protein (hs-CRP, baPWV (baseline: 1747 ± 355, at 20 weeks of treatment: 1627 ± 271 cm/s, p=0.008, and basophil count (baseline: 42 ± 32, 20 weeks: 26 ± 15 cells/µL, p=0.007, but had no effect on blood pressure (baseline: 125 ± 22, 20 weeks: 121 ± 16 mmHg. Changes in baPWV correlated significantly with changes in basophil count (r=0.488, p=0.008, but not with age, lipids profile, exercise capacity, or hs-CRP. CONCLUSION: In CAD patients, the combination treatment with statins and exercise resulted in significant amelioration of arterial wall stiffness, at least in part, through reduction of circulating basophils.

  15. Life Style Interventions in the Prevention of Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Sridhar Dwivedi

    2015-06-01

    Full Text Available Lifestyle diseases particularly coronary artery disease (CAD has been noted to be the most important   cause of the morbidity and mortality all over the world.  India is currently passing through this epidemic so much  so that it would be taking a heavy toll of Indian youth and economy to the tune of some 1.6 trillion $ during 2015-2030 . The main causative factors for CAD identified as coronary risk factors are: smoking / tobacco, physical inactivity, faulty diet, hypertension, diabetes, high level of cholesterol and stress. As most of these risk factors are lifestyle related attempt to modify them by appropriate interventions form the cornerstone of prevention of CAD epidemic.  Studies done by Dean Ornish and several others prompted us to plan an interventional case control study in 640 patients of established CAD. These cases were given power point presentation regarding healthy lifestyle on one to one basis and followed up at three and six months. Primary outcomes variable were change in smoking /tobacco habits, physical activity, obesity, dietary habits, control of hypertension, diabetes and lipid profile.  At the end of intervention it was possible to bring down the tobacco consumption, improve physical activity, better control of hypertension ( p< 0.03 , reduction in obesity ( p= 0. 0005 and raising HDL cholesterol ( p 0.05 significantly in test group.  Taking cue from above study a five step innovative strategy was developed for effective implementation of healthy life style in coronary patients attending Cardiac Clinic at HAH Centenary Hospital, Jamia Hamdard. This strategy  included sensitizing patients to  locally developed visuals , posters and pamphlets at  registration desk , concurrent counseling by attending doctor  at the end of clinical examination ,  and showing patients  and their  family the features of atherosclerosis during  carotid  ultrasound assessment . These points were again reinforced at follow up

  16. Arterial pulse wave velocity, inflammatory markers, pathological GH and IGF states, cardiovascular and cerebrovascular disease

    Directory of Open Access Journals (Sweden)

    Michael R Graham

    2008-12-01

    Full Text Available Michael R Graham1, Peter Evans2, Bruce Davies1, Julien S Baker11Health and Exercise Science Research Unit, Faculty of Health Sport and Science, University of Glamorgan, Pontypridd, Wales, United Kingdom; 2Royal Gwent Hospital, Newport, Gwent, United KingdomAbstract: Blood pressure (BP measurements provide information regarding risk factors associated with cardiovascular disease, but only in a specific artery. Arterial stiffness (AS can be determined by measurement of arterial pulse wave velocity (APWV. Separate from any role as a surrogate marker, AS is an important determinant of pulse pressure, left ventricular function and coronary artery perfusion pressure. Proximal elastic arteries and peripheral muscular arteries respond differently to aging and to medication. Endogenous human growth hormone (hGH, secreted by the anterior pituitary, peaks during early adulthood, declining at 14% per decade. Levels of insulin-like growth factor-I (IGF-I are at their peak during late adolescence and decline throughout adulthood, mirror imaging GH. Arterial endothelial dysfunction, an accepted cause of increased APWV in GH deficiency (GHD is reversed by recombinant human (rh GH therapy, favorably influencing the risk for atherogenesis. APWV is a noninvasive method for measuring atherosclerotic and hypertensive vascular changes increases with age and atherosclerosis leading to increased systolic blood pressure and increased left ventricular hypertrophy. Aerobic exercise training increases arterial compliance and reduces systolic blood pressure. Whole body arterial compliance is lowered in strength-trained individuals. Homocysteine and C-reactive protein are two infl ammatory markers directly linked with arterial endothelial dysfunction. Reviews of GH in the somatopause have not been favorable and side effects of treatment have marred its use except in classical GHD. Is it possible that we should be assessing the combined effects of therapy with rhGH and rh

  17. Association between non-alcoholic fatty liver disease and coronary artery disease severity

    Institute of Scientific and Technical Information of China (English)

    SUN Ling; L(U) Shu-zheng

    2011-01-01

    Background Both non-alcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) are closely associated with many metabolic disorders. Invasive coronary angiography (CAG) is a common approach as an intervention for CAD.However, the association between angiographic severity of coronary artery and NAFLD remains controversial. This study aimed to evaluate the relationship between NAFLD and CAD.Methods Totally 542 consecutive patients who planned to undergo CAG due to a suspected CAD were enrolled.Abdominal computed tomography (CT) was performed before angiography to detect NAFLD. CAD was defined as stenosis of at least 50% in at least one major coronary artery. The severity of CAD was assessed by the number of vessels affected and the vessel score multiplied by the severity score (Gensini score). Significant stenosis was defined as 70% or greater reduction in lumen diameter. A probability value of P <0.05 was considered statistically significant.Results Of 542 patients studied, 248 (45.8%) were found to have NAFLD by abdominal CT, and 382 patients (88%)were found to have significant CAD by CAG. Age, diabetes mellitus, waist circumference, body mass index, and obesity were associated with NAFLD. According to the results of Logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG (odds ratio (OR), 95% confidence interval (CI): 7.585(4.617-12.461); P <0.001). NAFLD was significantly more common in patients as CAD severity increased (P<0.001).Conclusions The presence of NAFLD is associated with high severity of CAD, requiring that patients with abdominal obesity be also investigated for NAFLD. Patients with NAFLD should be closely followed up for the presence and severity of CAD.

  18. Traditional risk factors are predictive on segmental localization of coronary artery disease.

    Science.gov (United States)

    Tacoy, Gulten; Balcioglu, Akif Serhat; Akinci, Sinan; Erdem, Güliz; Kocaman, Sinan Altan; Timurkaynak, Timur; Cengel, Atiye

    2008-01-01

    The aim of this study was to investigate the relationship between established risk factors and segmental localization of coronary artery disease. A total of 2760 patients who underwent coronary angiography were enrolled into the study. Coronary angiographic segmental evaluation was performed according to the scheme of American Heart Association. Patients were classified into 2 groups (group 1: normal coronary artery segments, group 2: coronary artery segments with coronary artery disease). Smoking was highly related with left main coronary artery disease (odds ratio = 7.5; P = .005). Diabetes mellitus and male sex increased the risk of atherosclerosis in all coronary vasculature (odds ratio = 2.7-2.2; P < .001-P < .001). Hypertension was correlated with distal coronary artery (odds ratio = 1.4; P < .001) and family history with distal circumflex lesions (odds ratio = 4.5; P = .005) High triglyceride levels were associated with right coronary artery lesions (odds ratio = 1.00; P =.03). The effect of advanced age was small (odds ratio = 1.08; P < .001). Risk factors may be predictive for segmental localization.

  19. Coronary arterial complications after percutaneous coronary intervention in Behçet’s disease

    Directory of Open Access Journals (Sweden)

    Kinoshita T

    2013-02-01

    Full Text Available Toshio Kinoshita,1 Shinichiro Fujimoto,1 Yukio Ishikawa,2 Hitomi Yuzawa,1 Shunji Fukunaga,1 Mikihito Toda,3 Kenji Wagatsuma,3 Yoshikiyo Akasaka,2 Toshiharu Ishii,2 Takanori Ikeda11Department of Cardiovascular Medicine, 2Department of Pathology, 3Division of Interventional Cardiology, Toho University Faculty of Medicine, Ohta City, Tokyo, JapanAbstract: Behçet’s disease is a multisystemic vascular inflammatory disease, but concurrent cardiac diseases, such as acute myocardial infarction, are rare. Several complications may arise after coronary intervention for coronary lesions that interfere with treatment, and the incidence of coronary arterial complications due to invasive therapy remains unclear. Further, the long-term outcomes in patients with Behçet’s disease after stenting for acute myocardial infarction have not been described. The present report describes a 35-year-old Japanese man with Behçet’s disease who developed acute myocardial infarction. A coronary aneurysm developed at the stenting site of the left anterior descending coronary artery, along with stenosis in the left anterior descending segment proximal to the site. Although invasive therapy was considered, medication including immunosuppressants was selected because of the high risk of vascular complications after invasive therapy. The coronary artery disease has remained asymptomatic for the 4 years since the patient started medication. This case underscores the importance of considering the incidence of coronary arterial complications and of conservative treatment when possible.Keywords: Behçet’s disease, myocardial infarction, coronary arterial complications, percutaneous coronary intervention, immunosuppressants

  20. Relationship between Peripheral Artery Disease and Cardiac Function in Elderly Patients with Ischemic Heart Disease

    Directory of Open Access Journals (Sweden)

    Moatasem S Amer*, Heba M Tawfik*, Manar MA Maamoun*, Ayman M Abd Elmoteleb

    2013-04-01

    Full Text Available Background: There is high prevalence of combined peripheral and coronary artery disease (CAD related to atherosclerosis with associated increase in morbidity and mortality . Objectives:The aim of our study was to find an association between ankle brachial index (ABI and cardiac function in elderly patients with CAD using ejection fraction (EF.Method: A Case control study. The case group included 100 elderly patients who had peripheral artery disease ( PAD divided into 2 groups according to age ( 60- 70 and > 70 years. The control group included 100 elderly subjects who didn't have PAD which were divided also into 2 groups according to age . Both groups have CAD and underwent coronary angiography (CA showing significant CAD lesions. Echocardiography were done to all patients showing cardiac function. Results: EF was lowest in cases > 70 years (46.84 ± 9.82 and was highest in controls > 70 years (53.02 ± 5.53 which is statistically significant (P- Value 0.009. Also EF is correlated with ABI. Conclusion: There is a significant positive relationship between ABI and EF.

  1. Peripheral arterial obliterative disease. Cost of illness in France.

    Science.gov (United States)

    Montron, A; Guignard, E; Pelc, A; Comte, S

    1998-01-01

    The main purpose of this study, carried out in 1995, was to determine, using available sources, the cost of peripheral arterial obliterative disease (PAOD) in France over a 1-year period. This cost-of-illness study was based on a retrospective analysis of the available literature and databases. It involved a description of epidemiological data and a cost estimate of the different medical resources consumed over 1 year. For this latter purpose, a payer perspective was chosen. Data were extracted from national representative surveys and databases with respect to morbidity and mortality [from the National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale; INSERM) and the National Sickness Insurance Fund for Salaried People (Caisse Nationale d'Assurance Maladie des Travailleurs Salariés; CNAMTS)], consultations, examination tests and drug prescriptions [from the French Medical Audit conducted by Intercontinental Medical Statistics (IMS)], hospitalisations [from the Statistical Unit of the Department of Health-Service des Statistiques, des Etudes et des Systemes d'Information (SESI) and the National Public Research Centre in Health Economics (Centre de Recherche d'Etude et de Documentation en Economie de la Santé; CREDES)] and related health expenditure from CNAMTS. In France, the prevalence of stage II PAOD (Leriche and Fontaine classification) in 1992 was estimated to be 675,000; 53% of these patients had undergone vascular or bypass surgery. The total annual cost of healthcare (including consultations, drugs, laboratory tests, hospitalisation and hydrotherapy) for the management of patients with PAOD ranged from 3.9 billion French francs (F) to F4.6 billion (1995 values), depending on the type of hospital considered. 50% of this cost was related to hospitalisations and 75% was covered by the CNAMTS. Although this study was only a partial evaluation and did not take into account indirect costs or nonmedical direct

  2. SAFARI - RANDOMISED TRIAL ON COMPLEX THERAPY OF ARTERIAL HYPERTENSION AND DISLIPIDEMY. THE MAIN RESULTS

    Directory of Open Access Journals (Sweden)

    S. Y. Martsevich

    2016-01-01

    Full Text Available Aim. To evaluate possibility of complex pharmaceutical effect simultaneously on 2 risk factors – arterial hypertension (HT and hypercholesterolemia (HH in patients with high risk of cardiovascular complications (CVC.Material and methods. 101 patients with HT of 1-2 stage, HH and high risk of CVC (SCORE>5 were included in the study. Patients were randomized in 2 groups: active therapy group (ATG and control group (CG. ATG patients were actively treated for HT and HH control. The long-acting nifedipine (Nifecard XL, LEK 30 mg once daily (OD was prescribed as start antihypertensive drug. Hydrochlorothiazide 12,5 mg/day OD and bisiprolol 5 mg OD was added if antihypertensive effect was insufficient. Atorvastatin (Tulip, LEK 20-40 mg OD was prescribed for HH control. Management of CG patients was performed by doctors of out-patient clinics. The study duration was 12 weeks.Results. Systolic and diastolic blood pressure (BP levels in ATG patients were lower than these in CG patients. Target BP level was reached in 88,4% of ATG patients and only in 48,9% of CG patients. Cholesterol of low density lipoprotein (CH LPLD level was also lower in ATG patients than this in CG patients. Target CH LPLD level was reached in 37,2 % of ATG patients and in 8,3 % of CG patients. Relative risk of CVC was significantly lower in ATG patients than this in CG patients.Conclusion. SAFARI trial shows that effective pharmaceutical simultaneous control of 2 key risk factors, HT and HH, results in risk reduction of CVC.

  3. Gabapentin May Relieve Post-Coronary Artery Bypass Graft Pain: A Double Blind Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    MSoltanzadeh

    2011-09-01

    Full Text Available Background: One of the most common complaints after coronary artery bypass graft (CABG is post-operative pain. Gabapentin is an anticonvulsant and antineuralgic agent. Objective: To evaluate the analgesic effect of preemptive gabapentin on post-operative pain and morphine consumption after cardiac surgery. Methods: A double-blind randomized clinical trial was conducted on 60 male candidates for CABG. The patients were divided into two groups—the gabapentin (n=30 and the control group (n=30. The test group received 800 mg gabapentin orally two hours before the surgery followed by 400 mg of the drug two hours post-extubation. The control group received placebo instead. Then severity of pain was recorded according to an 11-point visual analog pain scale. The amount of morphine consumed, its side effects and hemodynamic changes were also recorded during and at 2, 6, 12, 18 and 24 hours after extubation. Results: The mean±SD cumulative morphine consumption at the first 24 hours after extubation in gabapentin group was 0.9±1.5 mg while it was 1.5±4 mg for the control group. Therefore, gabapentin group consumed 38% less than the control group (P=0.01. The pain scores during rest and coughing at 2, 6, and 12 hours after extubation were also significantly lower in the gabapentin group compared with the control group (P=0.02. The mean±SD mechanical ventilation time was 5.4±1.7 hours for gabapentin group and 1.6±4.4 hours for the control group (P=0.035. The other variables including hemodynamic changes (HR, SBP and DBP, and incidence of nausea, vomiting and respiratory depression showed no significant difference between the studied groups within 24 hours after extubation. Conclusion: Oral pre-medication with gabapentin before CABG significantly reduces post-operative pain and morphine consumption in adult cardiac surgery.

  4. Supplementation of iron in pulmonary hypertension: Rationale and design of a phase II clinical trial in idiopathic pulmonary arterial hypertension.

    Science.gov (United States)

    Howard, Luke S G E; Watson, Geoffrey M J; Wharton, John; Rhodes, Christopher J; Chan, Kakit; Khengar, Rajeshree; Robbins, Peter A; Kiely, David G; Condliffe, Robin; Elliott, Charlie A; Pepke-Zaba, Joanna; Sheares, Karen; Morrell, Nicholas W; Davies, Rachel; Ashby, Deborah; Gibbs, J Simon R; Wilkins, Martin R

    2013-01-01

    Our aim is to assess the safety and potential clinical benefit of intravenous iron (Ferinject) infusion in iron deficient patients with idiopathic pulmonary arterial hypertension (IPAH). Iron deficiency in the absence of anemia (1) is common in patients with IPAH; (2) is associated with inappropriately raised levels of hepcidin, the key regulator of iron homeostasis; and (3) correlates with disease severity and worse clinical outcomes. Oral iron absorption may be impeded by reduced absorption due to elevated hepcidin levels. The safety and benefits of parenteral iron replacement in IPAH are unknown. Supplementation of Iron in Pulmonary Hypertension (SIPHON) is a Phase II, multicenter, double-blind, randomized, placebo-controlled, crossover clinical trial of iron in IPAH. At least 60 patients will be randomized to intravenous ferric carboxymaltose (Ferinject) or saline placebo with a crossover point after 12 weeks of treatment. The primary outcome will be the change in resting pulmonary vascular resistance from baseline at 12 weeks, measured by cardiac catheterization. Secondary measures include resting and exercise hemodynamics and exercise performance from serial bicycle incremental and endurance cardiopulmonary exercise tests. Other secondary measurements include serum iron indices, 6-Minute Walk Distance, WHO functional class, quality of life score, N-terminal pro-brain natriuretic peptide (NT-proBNP), and cardiac anatomy and function from cardiac magnetic resonance. We propose that intravenous iron replacement will improve hemodynamics and clinical outcomes in IPAH. If the data supports a potentially useful therapeutic effect and suggest this drug is safe, the study will be used to power a Phase III study to address efficacy.

  5. Effects of ozone therapy on haemostatic and oxidative stress index in coronary artery disease.

    Science.gov (United States)

    Martínez-Sánchez, Gregorio; Delgado-Roche, Livan; Díaz-Batista, Arquímides; Pérez-Davison, Gema; Re, Lamberto

    2012-09-15

    Coronary artery disease (CAD) is the most common cause of sudden death, and death of people over 20 years of age. Because ozone therapy can activate the antioxidant system and improve blood circulation and oxygen delivery to tissue, the aim of this study was to investigate the therapeutic efficacy of ozone in patients with CAD, treated with antithrombotic therapy, Aspirin and policosanol. A randomized controlled clinical trial was performed with 53 patients divided into two groups: one (n=27) treated with antithrombotic therapy and other (n=26) treated with antithrombotic therapy plus rectal insufflation of O(3). A parallel group (n=50) age and gender matched was used as reference for the experimental variables. The efficacy of the treatments was evaluated by comparing hemostatic indexes and biochemical markers of oxidative stress in both groups after 20 day of treatment. Ozone treatment significantly (Ptherapy only group, without modifying bleeding time. Combination antithrombotic therapy+O(3) improved the antioxidant status of patients reducing biomarkers of protein and lipid oxidation, enhancing total antioxidant status and modulating the level of superoxide dismutase and catalase with a 57% and 32% reduction in superoxide dismutase and catalase activities respectively, moving the redox environment to a status of low production of O(2)(•-) with an increase in H(2)O(2) detoxification. No side effects were observed. These results show that medical ozone treatment could be a complementary therapy in the treatment of CAD and its complications.

  6. Shared decision making in patients with stable coronary artery disease: PCI choice.

    Directory of Open Access Journals (Sweden)

    Megan Coylewright

    Full Text Available BACKGROUND: Percutaneous coronary intervention (PCI and optimal medical therapy (OMT are comparable, alternative therapies for many patients with stable angina; however, patients may have misconceptions regarding the impact of PCI on risk of death and myocardial infarction (MI in stable coronary artery disease (CAD. METHODS AND RESULTS: We designed and developed a patient-centered decision aid (PCI Choice to promote shared decision making for patients with stable CAD. The estimated benefits and risks of PCI+OMT as compared to OMT were displayed in a decision aid using pictographs with natural frequencies and text. We engaged patients, clinicians, health service researchers, and designers with over 20 successive iterations of the decision aid, which were field tested during real-world clinical encounters involving clinicians and patients. The decision aid is intended to facilitate knowledge transfer, deliberation based on patient values and preferences, and shared decision making. CONCLUSIONS: We describe the methods and outcomes of the design and development of a decision aid (PCI Choice to promote shared decision making between clinicians and patients regarding the choice of PCI+OMT vs. OMT for treatment of stable CAD. We will evaluate the impact of PCI Choice on patient knowledge, decisional conflict, participation in decision-making, and treatment choice in an upcoming randomized trial.

  7. [Peripheral artery disease as supplemental diagnosis in coronary heart disease--influence on diagnostics, treatment and prognosis].

    Science.gov (United States)

    Espinola-Klein, C; Savvidis, S; Kopp, H

    2014-01-01

    Peripheral arterial disease (PAD) increases cardiovascular event rate in patients with coronary artery disease (CAD). Therefore PAD should be considered in patients with CAD with regard to diagnostic and therapeutic strategies. PAD may difficult diagnostic tests in CAD patients. Patients with PAD and CAD may be limited in stress testing by decreased leg perfusion. In addition, arterial puncture can be more difficult in sclerotic femoral arteries. Cardiovascular risk factors should be treated carefully in all manifestations of atherosclerosis. Target values from current guidelines are similar for PAD and CAD. Inhibitors of platelet aggregation are indication in both CAD and PAD. Exercise not only improves walking distance in patients with intermittent claudication but also improves cardiovascular prognosis in patients with atherosclerosis.

  8. Venous and arterial thrombosis: Two aspects of the same disease?

    Directory of Open Access Journals (Sweden)

    Paolo Prandoni

    2009-01-01

    Full Text Available Paolo PrandoniDepartment of Cardiothoracic and Vascular Sciences, Thromboembolism Unit, University Hospital of Padua Padua, ItalyAbstract: An increasing body of evidence suggests the likelihood of a link between venous and arterial thrombosis. The two vascular complications share several risk factors, such as age, obesity, diabetes mellitus, blood hypertension, hypertriglyceridemia, and metabolic syndrome. Moreover, there are many examples of conditions accounting for both venous and arterial thrombosis, such as the antiphospholipid antibody syndrome, hyperhomocysteinemia, malignancies, infections, and the use of hormonal treatment. Finally, several recent studies have consistently shown that patients with venous thromboembolism are at a higher risk of arterial thrombotic complications than matched control individuals. We, therefore, speculate the two vascular complications are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.Keywords: venous thromboembolism, deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, atherosclerosis

  9. Diseases of the thoracic aorta and pulmonary arteries

    NARCIS (Netherlands)

    Salgado, R.; Habets, J.; Budde, R. P J; Leiner, T.

    2015-01-01

    Many acute and chronic clinical entities can affect the great thoracic arteries. As clinical findings are often unreliable, (mostly) noninvasive imaging plays a crucial role both in the initial assessment of critically ill patients, and in the follow-up of chronic conditions. Imaging also forms an i

  10. Level selection in leg amputation for arterial occlusive disease

    DEFF Research Database (Denmark)

    Holstein, P

    1982-01-01

    In 102 leg amputations for arterial occlusion including 84 below-knee (BK), 16 above-knee (AD) and 2 through-knee (TK) amputations, the amputation level was determined by means of clinical criteria. The healing results and the selection of levels were then compared with sealed preoperative measur...

  11. Increased arterial inflammation in individuals with stage 3 chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); MacNabb, Megan H.; Emami, Hamed; Abdelbaky, Amr; Lavender, Zachary R. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Singh, Parmanand [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); New York Presbyterian Hospital, Weill Cornell Medical College, Division of Cardiology, New York, NY (United States); Di Carli, Marcelo; Taqueti, Viviany; Foster, Courtney [Brigham and Women' s Hospital and Harvard Medical School, Division of Radiology, Department of Medicine, Boston, MA (United States); Mann, Jessica; Comley, Robert A.; Weber, Chek Ing Kiu [F. Hoffmann-La Roche Ltd., Basel (Switzerland); Tawakol, Ahmed [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Massachusetts General Hospital and Harvard Medical School, Cardiology Division, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States)

    2016-02-15

    While it is well known that patients with chronic kidney disease (CKD) are at increased risk for the development and progression of atherosclerosis, it is not known whether arterial inflammation is increased in mild CKD. The aim of this study was to compare arterial inflammation using {sup 18}F-FDG PET/CT in patients with CKD and in matched controls. This retrospective study included 128 patients undergoing FDG PET/CT imaging for clinical indications, comprising 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history. CKD was defined according to guidelines using a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake on PET. Background FDG uptake (venous, subcutaneous fat and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. The impact of CKD on arterial inflammation and CAC was then assessed. Arterial inflammation was higher in patients with CKD than in matched controls (standardized uptake value, SUV: 2.41 ± 0.49 vs. 2.16 ± 0.43; p = 0.002). Arterial SUV correlated inversely with eGFR (r = -0.299, p = 0.001). Venous SUV was also significantly elevated in patients with CKD, while subcutaneous fat and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in patients with CKD compared to controls after correcting for muscle and fat background, and also remained significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC). Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is independent of presence of subclinical atherosclerosis. Current risk stratification tools may underestimate the presence of atherosclerosis in patients with CKD and thereby the risk of

  12. GATA2 is associated with familial early-onset coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Jessica J Connelly

    2006-08-01

    Full Text Available The transcription factor GATA2 plays an essential role in the establishment and maintenance of adult hematopoiesis. It is expressed in hematopoietic stem cells, as well as the cells that make up the aortic vasculature, namely aortic endothelial cells and smooth muscle cells. We have shown that GATA2 expression is predictive of location within the thoracic aorta; location is suggested to be a surrogate for disease susceptibility. The GATA2 gene maps beneath the Chromosome 3q linkage peak from our family-based sample set (GENECARD study of early-onset coronary artery disease. Given these observations, we investigated the relationship of several known and novel polymorphisms within GATA2 to coronary artery disease. We identified five single nucleotide polymorphisms that were significantly associated with early-onset coronary artery disease in GENECARD. These results were validated by identifying significant association of two of these single nucleotide polymorphisms in an independent case-control sample set that was phenotypically similar to the GENECARD families. These observations identify GATA2 as a novel susceptibility gene for coronary artery disease and suggest that the study of this transcription factor and its downstream targets may uncover a regulatory network important for coronary artery disease inheritance.

  13. Raynaud's phenomenon in arterial obstructive disease of the hand demonstrated by locally provoked cooling

    DEFF Research Database (Denmark)

    Nielsen, Steen Levin; Nobin, B A; Hirai, M;

    1978-01-01

    Finger systolic blood pressure (FSP) was measured by cuff technique before and after local cooling in three groups of patients (Raynaud's disease (7), subclavian stenoses, (5), thrombo-angiitis obliterans (15)), and in 15 normals. The response to finger cooling registered as a decrease in FSP...... indicates an increase of digital arterial tone. In all three groups, digital arterial tone increased more than in normals during finger cooling. Patients with Raynaud's disease showed a pathological increase in arterial tone at 23.5 degrees C with closure of the digital arteries at a mean temperature of 18.......5 degrees C. The temperature eliciting these phenomena in patients with thrombo-angiitis obliterans was about 7 degrees C lower (16.5 and 11.0 degrees C, respectively). Accordingly, cold sensitivity and Raynaud's phenomena in the two groups may have a different pathophysiological mechanism, namely...

  14. Peripheral artery disease: a cause of refractory hypertension after renal transplantation.

    Science.gov (United States)

    Dourado, Raquel; Gonçalves, Pedro de Araújo; Almeida, Manuel; Weigert, André; Bruges, Margarida; Gaspar, Augusta; Negrão, Acácio Pita; Machado, Domingos; Clemente, Belarmino; Teles, Rui; Machado, Francisco Pereira; Silva, Aniceto

    2008-03-01

    The authors report the case of a 44-year-old man, with a history of hypertension, smoking, peripheral artery disease and chronic renal failure. After renal transplantation, the patient developed persistent high blood pressure, despite optimal medical therapy. When angiotensin-converting enzyme (ACE) inhibitor therapy was begun, he developed acute anuric renal failure, which was reversed after interruption of the ACE inhibitor. After the initial clinical evaluation, the patient was referred for renal angiography, which revealed critical stenosis of the proximal left common iliac artery, just above the renal graft artery anastomosis. The patient underwent successful angioplasty and stenting of the lesion, with complete normalization of blood pressure.

  15. Assessment of coronary artery disease using coronary computed tomography angiography and biochemical markers

    Institute of Scientific and Technical Information of China (English)

    Gitsios; Gitsioudis; Hugo; A; Katus; Grigorios; Korosoglou

    2014-01-01

    Chronic inflammatory mechanisms in the arterial wall lead to atherosclerosis,and include endothelial cell damage,inflammation,apoptosis,lipoprotein deposition,calcification and fibrosis.Cardiac computed tomography angiography(CCTA)has been shown to be a promising tool for non-invasive assessment of theses specific compositional and structural changes in coronary arteries.This review focuses on the technical background of CCTA-based quantitative plaque characterization.Furthermore,we discuss the available evidence for CCTA-based plaque characterization and the potential role of CCTA for risk stratification of patients with coronary artery disease.

  16. Intra-arterial infusion of Solcoseryl: a clinical trial of a method of treatment for pre-gangrene of the lower limb.

    Science.gov (United States)

    Charlesworth, D; Harris, P L; Palmer, M K

    1975-05-01

    A randomized double blind trial of the drug Solcoseryl given by intra-arterial infusion was carried out on 57 patients with pre-gangrene of the lower limb. A sequential analysis was carried out and the trial stopped when the results showed a statistically significant result in favour of the active drug.

  17. A randomized, controlled, multicenter trial to evaluate the safety and efficacy of Zotarolimus- vs. Paclitaxel-eluting stents in de novo occlusive lesions in coronary arteries

    DEFF Research Database (Denmark)

    Chevalier, Bernard; Dimario, Carlo; Neumann, Franz-Josef;

    2013-01-01

    The ZOMAXX I trial tested the noninferiority of a zotarolimus-eluting coronary stent (ZoMaxx(™) ) when compared with a paclitaxel-eluting coronary stent (Taxus(™) Express(2™) ) in a randomized trial of percutaneous intervention for de novo coronary artery stenosis. Angiographic analysis at the pr...

  18. Plasma YKL-40 in relation to the degree of coronary artery disease in patients with stable ischemic heart disease

    DEFF Research Database (Denmark)

    Mathiasen, Anders B; Harutjunjan, Marina; Jørgensen, Erik;

    2011-01-01

    YKL-40 is a glycoprotein secreted by macrophages and neutrophils in tissues with inflammation. Plasma YKL-40 is increased in patients with coronary artery disease (CAD) and associated with cardiovascular and all-cause mortality. Furthermore, plasma YKL-40 seems related to the number of diseased...

  19. Diabetes mellitus and chronic kidney disease amplify accumulation of tissue advanced glycation end products in patients with peripheral artery disease

    NARCIS (Netherlands)

    Lefrandt, J.D.; De Vos, L.C.; Mulder, D.J.; Dullaart, R.P.F.; Lutgers, H.L.; Lambers Heerspink, H.J.; Smit, A.J.; Kamphuisen, P.W.; Zeebregts, C.J.

    2013-01-01

    Backgrounds and aims: Diabetes mellitus (DM) and chronic kidney disease (CKD) are important risk factors for peripheral artery disease (PAD) and associated with a severely increased cardiovascular (CV) risk in these patients. DM increases production of AGEs and CKD decreases their clearance, while c

  20. Alzheimer’s disease multiple intervention trial (ADMIT: study protocol for a randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Callahan Christopher M

    2012-06-01

    Full Text Available Abstract Background Given the current lack of disease-modifying therapies, it is important to explore new models of longitudinal care for older adults with dementia that focus on improving quality of life and delaying functional decline. In a previous clinical trial, we demonstrated that collaborative care for Alzheimer’s disease reduces patients’ neuropsychiatric symptoms as well as caregiver stress. However, these improvements in quality of life were not associated with delays in subjects’ functional decline. Trial design Parallel randomized controlled clinical trial with 1:1 allocation. Participants A total of 180 community-dwelling patients aged ≥45 years who are diagnosed with possible or probable Alzheimer’s disease; subjects must also have a caregiver willing to participate in the study and be willing to accept home visits. Subjects and their caregivers are enrolled from the primary care and geriatric medicine practices of an urban public health system serving Indianapolis, Indiana, USA. Interventions All patients receive best practices primary care including collaborative care by a dementia care manager over two years; this best practices primary care program represents the local adaptation and implementation of our prior collaborative care intervention in the urban public health system. Intervention patients also receive in-home occupational therapy delivered in twenty-four sessions over two years in addition to best practices primary care. The focus of the occupational therapy intervention is delaying functional decline and helping both subjects and caregivers adapt to functional impairments. The in-home sessions are tailored to the specific needs and goals of each patient-caregiver dyad; these needs are expected to change over the course of the study. Objective To determine whether best practices primary care plus home-based occupational therapy delays functional decline among patients with Alzheimer’s disease compared

  1. Retinal Arterial Occlusive Diseasein a Young Patient with Cat Scratch Disease

    Directory of Open Access Journals (Sweden)

    Georgios Batsos

    2013-08-01

    Full Text Available Purpose: To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease. Methods: A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyanine angiography did not reveal choroidal involvement. Laboratory analysis showed rising IgG titers for Bartonellahenselae. Results: Cat scratch disease was diagnosed, and a 4-week course of doxycycline was initiated. The patient responded well to the antibiotics. Both retinitis and arterial occlusion were resolved, the visual field was regained and the patient reported elimination of her symptoms. Conclusions: Cat scratch disease should be considered in the differential diagnosis in young patients with retinal occlusive disease.

  2. YKL-40 a new biomarker in patients with acute coronary syndrome or stable coronary artery disease

    DEFF Research Database (Denmark)

    Wang, Y.Z.; Ripa, R.S.; Johansen, J.S.;

    2008-01-01

    Background. YKL-40 is involved in remodelling and angiogenesis in non-cardiac inflammatory diseases. Aim was to quantitate plasma YKL-40 in patients with ST-elevation myocardial infarction (STEMI) or stable chronic coronary artery disease (CAD), and YKL-40 gene activation in human myocardium....... Methods and results. We included 73 patients: I) 20 patients with STEMI; II) 28 patients with stable CAD; III) 15 CAD patients referred for coronary by-pass surgery. YKL-40 mRNA expression was measured in myocardium subtended by stenotic or occluded arteries and areas with no apparent disease; and IV) 10...

  3. Interventional therapy of coronary artery disease in China:retrospective and perspective

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2008-01-01

    @@ Coronary artery disease is the most common cardiovascular disease and constitutes the major cause of death in China.The interventional treatment of coronary artery disease has developed rapidly during the last decade,with the number of percutaneous coronary intervention (PCI) procedures being around 147 300 in the year of 2007.The number is expected to be elevated greatly in the coming years because of great improvement in national health care system and interventional expertise.This article reviews the current status of coronary intervention in China.

  4. Clinical features and coronary backgrounds of coexistent peripheral vascular disease in Japanese coronary artery disease patients.

    Science.gov (United States)

    Seino, Y; Takita, T; Tanaka, K; Takano, T; Hayakawa, H; Okumura, H

    1991-11-01

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

  5. The Investigation of Serum Vaspin Level in Atherosclerotic Coronary Artery Disease

    OpenAIRE

    Kobat, Mehmet Ali; Celik,Ahmet; Balin, Mehmet; Altas, Yakup; Baydas, Adil; Bulut, Musa; Aydin, Suleyman; DAGLI, Necati; YAVUZKIR, Mustafa Ferzeyn; Ilhan, Selcuk

    2012-01-01

    Background It was speculated that fatty tissue originated adipocytokines may play role in pathogenesis of atherosclerosis. These adipocytokines may alter vascular homeostasis by effecting endothelial cells, arterial smooth muscle cells and macrophages. Vaspin is a newly described member of adipocytokines family. We aimed to investigate whether plasma vaspin level has any predictive value in coronary artery disease (CAD). Methods Forty patients who have at least single vessel ≥ 70 % stenosis d...

  6. Radonexposure with the treatment of rheumatic diseases - randomized controlled trials

    Energy Technology Data Exchange (ETDEWEB)

    Falkenbach, A. [Krankenanstalt Gasteiner Heilstollen, Bad Gastein-Boeckstein (Austria)]|[Forschungsinstitut Gastein, Bad Gastein (Austria); Kovac, J.; Brandmaier, P. [Krankenanstalt Gasteiner Heilstollen, Bad Gastein-Boeckstein (Austria); Soto, J. [Dept. of Medical Physics, Univ. of Cantabria (Spain)

    2001-07-01

    The objective was to investigate whether there is evidence for the effectiveness of radon therapy in the treatment of rheumatic diseases. Method: Medline and MedKur databases were searched for randomised controlled clinical trials. Radon therapy centres and experts in the field were contacted, proceedings were hand-searched and bibliographies were checked for references of potential impact. Four clinical trials evaluating the effect of radon in patients suffering from rheumatic diseases with no or only a small number of drop-outs met the inclusion criteria. In patients with degenerative disease of the spine and large joints, two trials [1,2] reported less pain on pressure of painful paraspinal muscle points after a series of radon baths at a concentration of 0.8 kBq/L and 3 kBq/L, respectively. The alleviation of pain was most pronounced in the weeks following the treatment period. [3]. At six months follow-up serial immersion in combined radon and CO{sub 2} baths reduced pain and functional restrictions in patients with rheumatoid arthritis (n=60) more effectively than bathing in CO{sub 2} only. [4] In 130 patients with ankylosing spondylitis a complex rehabilitation program at a health resort (group 1 and 2) showed greater and longer-lasting differences to a control group staying at home (group 3), if speleotherapeutic radon exposure (group 1) was added (as compared to an added sauna treatment, group 2). Conclusion: The four trials meeting the inclusion criteria showed beneficial effects of radon therapy compared to interventions without radon exposure. Up to nine months after the treatment period significantly better results were observed, if radon therapy is added. (orig.)

  7. Total Adiponectin and Risk of Symptomatic Lower Extremity Peripheral Artery Disease in Men

    NARCIS (Netherlands)

    Joosten, Michel M.; Joshipura, Kaumudi J.; Pai, Jennifer K.; Bertoia, Monica L.; Rimm, Eric B.; Mittleman, Murray A.; Mukamal, Kenneth J.

    2013-01-01

    Objective-Lower concentrations of adiponectin have been linked to subsequent risk of coronary heart disease in healthy individuals. Whether similar relationships exist for the development of systemic atherosclerosis, such as peripheral artery disease (PAD), is uncertain. We investigated the associat

  8. Vitamin D deficiency may be an independent risk factor for arterial disease

    NARCIS (Netherlands)

    K.M. van de Luijtgaarden (Koen); M.T. Voûte (Michiel); S.E. Hoeks (Sanne); E.J. Bakker (Erik Jan); M. Chonchol (Michel); R.J. Stolker (Robert); E.V. Rouwet (Ellen); H.J.M. Verhagen (Hence)

    2012-01-01

    textabstractObjectives: The aim of this study was to assess the vitamin D status in patients with occlusive or aneurysmatic arterial disease in relation to clinical cardiovascular risk profiles and markers of atherosclerotic disease. Methods: We included 490 patients with symptomatic peripheral arte

  9. Marital Discord and Coronary Artery Disease: A Comparison of Behaviorally Defined Discrete Groups

    Science.gov (United States)

    Smith, Timothy W.; Uchino, Bert N.; Berg, Cynthia A.; Florsheim, Paul

    2012-01-01

    Objective: Marital difficulties can confer risk of coronary heart disease, as in a study of outwardly healthy couples (T. W. Smith et al., 2011) where behavioral ratings of low affiliation and high control during marital disagreements were associated with asymptomatic coronary artery disease (CAD). However, taxometric studies suggest that marital…

  10. Open and Closed Endotracheal Suctioning and Arterial Blood Gas Values: A Single-Blind Crossover Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Azam Faraji

    2015-01-01

    Full Text Available Aim. This study was aimed at comparing the effects of the open and closed suctioning techniques on the arterial blood gas values in patients undergoing open-heart surgery. Methods. In a clinical trial, we recruited 42 patients after open-heart surgery in an educational hospital. Each patient randomly underwent both open and closed suctioning. ABGs, PaO2, SaO2, PaCO2, were analyzed before and one, five, and fifteen minutes after each suctioning episode. Results. At first the pressure of oxygen in arterial blood increased; however, this increase in the open technique was greater than that of the closed system (P<0.001. The pressure of oxygen decreased five and fifteen minutes after both suctioning techniques (P<0.05. The trends of carbon dioxide variations after the open and closed techniques were upward and downward, respectively. Moreover, the decrease in the level of oxygen saturation five and fifteen minutes after the open suctioning was greater than that of the closed suctioning technique (P<0.05.  Conclusion. Arterial blood gas disturbances in the closed suctioning technique were less than those of the open technique. Therefore, to eliminate the unwanted effects of endotracheal suctioning on the arterial blood gases, the closed suctioning technique is recommended.

  11. Dermatoglyphs in Coronary Artery Disease Among Ningxia Population of North China

    Science.gov (United States)

    Lu, Hong; Qian, Wenli; Geng, Zhi; Sheng, Youjing; Yu, Haochen; Ma, Zhanbing

    2015-01-01

    Background Coronary artery disease (CAD) is an enormous health problem in the world. Dermatoglyphs are cutaneous ridges on the fingers, palms, and soles, formed by genetic regulation and control during early intrauterine life. The Dermatoglyphic traits do not change significantly as the growth of the age. They may be the phenotypic characters of individual genes and represent the predisposition to certain diseases. Aims and Objectives The study was carried out to document characteristic dermatoglyphic patterns in coronary artery disease which could be useful in early diagnosis of the disease. Materials and Methods Dermatoglyphic study of 258 male (129 coronary artery disease cases and 129 normal subjects) of Ningxia China were studied in the present cross-sectional study. It involved the digital patterns, ATD angles, A-B ridge counts on the hands. Chi-square test, t-test were used for the statistical analysis in this study. Results The overall frequency of whorls was higher followed by loop and arch in both two groups. It was observed that there was significant difference of digital frequency of whorls and ulnar loops in patients in both hands as compared to controls (p≤0.01). The mean value of finger ridge counts, total ridge counts were similar between two groups. The A-B ridge counts were significantly higher in coronary artery disease compared with controls on the right palm (p≤0.01). However, the mean ATD angle values were significantly higher in cases than those of in normal on both hands (pdermatoglyphic patterns of coronary artery disease. Dermatoglyphics may have an important role in early diagnosis of coronary artery disease in future. PMID:26816877

  12. A PROSPECTIVE STUDY OF PULMONARY ARTERIAL HYPERTENSION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASES

    Directory of Open Access Journals (Sweden)

    Saptanaga Kumar

    2015-04-01

    Full Text Available BACKGROUND : Chronic obstructive pulmonary disease (COPD is a heterogeneous, multisystem disease with complexities that extend far beyond airway obstruction. OBJECTIVES : The purpose of this prospective study is to determine pulmonary arterial hypertension in chronic obstructi ve pulmonary disease non - invasively. METHODS : In this descriptive, prospective, observational, cross sectional study, all patients who presented to the department of Medicine and Respiratory medicine, during this study period of 12 months from January 2013 - December 2014 in Chennai were included. RESULTS : Total number of males in the study is 90(90%, females in the study is 10 (10%. Number of patients in the age group 25 - 35years was 06 (6%, 36 - 45years was 38(38%, 46 - 55 years was 30(30, number of patie nts in 56 - 65 years was 14 (14 and number of patients in the age group 66 - 75 years was 12(12. total number of males smoking in the study is 55(61.11% and total number of non - smokers were 35(38.88, total number of female smoking in the study is 1(10% an d total number of non - smokers were 9(90%. Pulmonary arterial systolic pressure in present study, Mild pulmonary arterial hypertension was seen in 26(26%, Moderate pulmonary arterial hypertension was seen in 54(54%, Severe pulmonary arterial hypertension was seen in 20(20%. CONCLUSION : This study shows the prevalence of pulmonary arterial hypertension in COPD patients.

  13. Association of Aortic Calcification on Plain Chest Radiography with Obstructive Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Yeong Han; Chang, Jeong Ho [Dept. of Diagnostic Radiology, Daegu Catholic University Hospital, Daegu (Korea, Republic of); Park, Jong Sam [Dept. of Radiologic Tecnology, Daegu Health College, Daegu (Korea, Republic of)

    2009-03-15

    This study was conducted to determine an association between aortic calcification viewed on plain chest radiography and obstructive coronary artery disease. Retrospective review of all chest radiography obtained from consecutive patients undergoing coronary angiography. Chest PA images were reviewed by technical radiologist and radiologist. Considering the presence of aortic arch calcification, images were compared with the results of coronary angiography. In addition, the size of aortic arch calcification were divided into two groups - the smaller and the larger than 10 mm. Among the total 846 patients, the number of the patients with obstructive coronary artery disease is total 417 (88.3%) in males and 312 (83.4%) in females. Considering the presence of aortic arch calcification, the positive predictive value of relation between aortic arch calcification and obstructive coronary artery disease was 91.4% and the relative risk of the group with aortic arch calcification to the opposite group was 1.10. According to the size of aortic arch calcification and obstructive coronary artery disease, the positive predictive value was 91.9% and the relative risk between two groups was 1.04. This study shows that aortic calcification was closely associated with obstructive coronary artery disease. If the aortic calcification is notified on plain chest radiography, we strongly recommend to consult with doctor.

  14. National survey of pediatric hospitalizations due to Kawasaki disease and coronary artery aneurysms in the USA.

    Science.gov (United States)

    Okubo, Yusuke; Nochioka, Kotaro; Sakakibara, Hiroshi; Testa, Marcia; Sundel, Robert P

    2017-02-01

    Several studies revealed the epidemiology of Kawasaki disease-related hospitalizations among children in the USA and other countries. However, disparities of developing coronary artery aneurysms by race/ethnicity, patient socioeconomic status, and geographic locations remain unknown in the USA. Hospital discharge record data of patients with Kawasaki disease aged 19 years or younger were obtained from the 2003, 2006, 2009, and 2012 Kid's Inpatient Database. The data were weighted to estimate the annual hospitalization rates with respect to age, gender, and race/ethnicity in the USA. Multivariable logistic regression was conducted to ascertain the factors associated with the development of coronary artery aneurysms. Total annual hospitalization rates of Kawasaki disease showed a decreasing trend, ranging from 6.54 per 100,000 children in 2003 to 6.11 per 100,000 children in 2012 (p Kawasaki disease ranged from 2.25 to 3.20%. Factor associated with the development of coronary artery aneurysms was hospitals in West (OR 2.15, 95% CI 1.42-3.26). Race/ethnicity, health insurance status, and household income were not associated with the development of coronary artery aneurysms. Total hospitalization rates of Kawasaki disease showed a decreasing trend. Children admitted to hospitals in West region were more likely to develop coronary artery aneurysms.

  15. Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry

    OpenAIRE

    Fauchier, Laurent; Greenlaw, Nicola; Ferrari, Roberto; Ford, Ian; Fox, Kim M; Tardif, Jean-Claude; Tendera, Michal; Steg, Ph. Gabriel

    2015-01-01

    Background:\\ud \\ud Few data are available regarding the use of antithrombotic strategies in coronary artery disease patients with atrial fibrillation (AF) in everyday practice. We sought to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease.\\ud \\ud Methods and Findings:\\ud \\ud CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary artery disease, defined as pr...

  16. Assessment of coronary artery lesions in children with Kawasaki disease: evaluation of MSCT in comparison with 2-D echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Xing, Yanlin; Wang, Hong; Yu, Xianyi; Chen, Rui [Shengjing Hospital of China Medical University, Department of Pediatrics, Shenyang (China); Hou, Yang [Shengjing Hospital of China Medical University, Department of Radiology, Shenyang (China)

    2009-11-15

    Transthoracic two-dimensional echocardiography is an effective method for detecting coronary arterial injury in Kawasaki disease. However, its accuracy in the diagnosis of coronary arterial lesions is limited. To investigate the value of multislice spiral CT for coronary angiography for observing the coronary arterial injury caused by infantile Kawasaki disease. Coronary angiography, using a 64-slice spiral CT scanner, and 2-D echocardiography were performed in 48 children with Kawasaki disease in whom the position, internal diameter, and length of each coronary artery were measured. MSCT showed coronary artery injury in 15 of the 48 children. Among these 15 children, 20 coronary artery branches showed complications, including the left coronary artery branches in 15 (31.2%) and the right coronary artery branches in 5 (10.4%). Complications in the left coronary artery branches included dilation in 12 (25.0%) and stenosis, calcification and the combination of the two in one each, and the right coronary artery branches showed dilation; two branches also showed beaded changes. MSCT also showed dilation in the left anterior descending arteries in two children. These children showed no abnormality on 2-D echocardiography. MSCT is a valuable examination method for detecting coronary artery injury in Kawasaki disease. (orig.)

  17. Evaluation of restenosis, renal function and blood pressure after the renal artery stenting in patients with atherosclerosis renovascular disease

    Institute of Scientific and Technical Information of China (English)

    王焱

    2006-01-01

    Objective To evaluate the restenosis, renal function and blood pressure after renal artery stenting in patients with atherosclerosis renovascular disease. Methods Percutaneous renal artery stent (PTRAS) was performed in 135 patients with single or bilateral renal artery stenosis (≥70%). Clinical data of above patients were studied during follow-up period. Results A total of 147

  18. Signature of circulating microRNAs as potential biomarkers in vulnerable coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Jingyi Ren

    Full Text Available AIMS: MicroRNAs (miRNAs play important roles in the pathogenesis of cardiovascular diseases. Circulating miRNAs were recently identified as biomarkers for various physiological and pathological conditions. In this study, we aimed to identify the circulating miRNA fingerprint of vulnerable coronary artery disease (CAD and explore its potential as a novel biomarker for this disease. METHODS AND RESULTS: The Taqman low-density miRNA array and coexpression network analyses were used to identify distinct miRNA expression profiles in the plasma of patients with typical unstable angina (UA and angiographically documented CAD (UA group, n = 13 compared to individuals with non-cardiac chest pain (control group, n = 13. Significantly elevated expression levels of miR-106b/25 cluster, miR-17/92a cluster, miR-21/590-5p family, miR-126*, and miR-451 were observed in UA patients compared to controls. These findings were validated by real-time PCR in another 45 UA patients, 31 stable angina patients, and 37 controls. In addition, miR-106b, miR-25, miR-92a, miR-21, miR-590-5p, miR-126* and miR-451 were upregulated in microparticles (MPs isolated from the plasma of UA patients (n = 5 compared to controls (n = 5. Using flow cytometry and immunolabeling, we further found that Annexin V(+ MPs were increased in the plasma samples of UA patients compared to controls, and the majority of the increased MPs in plasma were shown to be Annexin V(+ CD31(+ MPs. The findings suggest that Annexin V(+ CD31(+ MPs may contribute to the elevated expression of the selected miRNAs in the circulation of patients with vulnerable CAD. CONCLUSION: The circulating miRNA signature, consisting of the miR-106b/25 cluster, miR-17/92a cluster, miR-21/590-5p family, miR-126* and miR-451, may be used as a novel biomarker for vulnerable CAD. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR-OCH-12002349.

  19. Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction

    Science.gov (United States)

    Maddox, Thomas M.; Stanislawski, Maggie A.; Grunwald, Gary K.; Bradley, Steven M.; Ho, P. Michael; Tsai, Thomas T.; Patel, Manesh R.; Sandhu, Amneet; Valle, Javier; Magid, David J.; Leon, Benjamin; Bhatt, Deepak L.; Fihn, Stephan D.; Rumsfeld, John S.

    2016-01-01

    IMPORTANCE Little is known about cardiac adverse events among patients with nonobstructive coronary artery disease (CAD). OBJECTIVE To compare myocardial infarction (MI) and mortality rates between patients with nonobstructive CAD, obstructive CAD, and no apparent CAD in a national cohort. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of all US veterans undergoing elective coronary angiography for CAD between October 2007 and September 2012 in the Veterans Affairs health care system. Patients with prior CAD events were excluded. EXPOSURES Angiographic CAD extent, defined by degree (no apparent CAD: no stenosis >20%; nonobstructive CAD: ≥1 stenosis ≥20% but no stenosis ≥70%; obstructive CAD: any stenosis ≥70% or left main [LM] stenosis ≥50%) and distribution (1,2, or 3 vessel). MAIN OUTCOMES AND MEASURES The primary outcome was 1-year hospitalization for nonfatal MI after the index angiography. Secondary outcomes included 1-year all-cause mortality and combined 1-year MI and mortality. RESULTS Among37 674 patients, 8384 patients (22.3%) had nonobstructive CAD and 20 899 patients (55.4%) had obstructive CAD. Within 1 year, 845 patients died and 385 were rehospitalized for MI. Among patients with no apparent CAD, the 1-year MI rate was 0.11% (n = 8, 95% CI, 0.10%–0.20%) and increased progressively by 1-vessel nonobstructive CAD, 0.24% (n = 10, 95% CI, 0.10%–0.40%); 2-vessel nonobstructive CAD, 0.56% (n = 13, 95% CI, 0.30%–1.00%); 3-vessel nonobstructive CAD, 0.59% (n = 6, 95% CI, 0.30%–1.30%); 1-vessel obstructive CAD, 1.18% (n = 101, 95% CI, 1.00%–1.40%); 2-vessel obstructive CAD, 2.18% (n = 110, 95% CI, 1.80%–2.60%); and 3-vessel or LM obstructive CAD, 2.47% (n = 137, 95% CI, 2.10%–2.90%). After adjustment, 1-year MI rates increased with increasing CAD extent. Relative to patients with no apparent CAD, patients with 1-vessel nonobstructive CAD had a hazard ratio (HR) for 1-year MI of 2.0 (95% CI, 0.8–5.1); 2-vessel

  20. Diagnosis of Coronary Heart Diseases Using Gene Expression Profiling; Stable Coronary Artery Disease, Cardiac Ischemia with and without Myocardial Necrosis.

    Science.gov (United States)

    Kazmi, Nabila; Gaunt, Tom R

    2016-01-01

    Cardiovascular disease (including coronary artery disease and myocardial infarction) is one of the leading causes of death in Europe, and is influenced by both environmental and genetic factors. With the recent advances in genomic tools and technologies there is potential to predict and diagnose heart disease using molecular data from analysis of blood cells. We analyzed gene expression data from blood samples taken from normal people (n = 21), non-significant coronary artery disease (n = 93), patients with unstable angina (n = 16), stable coronary artery disease (n = 14) and myocardial infarction (MI; n = 207). We used a feature selection approach to identify a set of gene expression variables which successfully differentiate different cardiovascular diseases. The initial features were discovered by fitting a linear model for each probe set across all arrays of normal individuals and patients with myocardial infarction. Three different feature optimisation algorithms were devised which identified two discriminating sets of genes, one using MI and normal controls (total genes = 6) and another one using MI and unstable angina patients (total genes = 7). In all our classification approaches we used a non-parametric k-nearest neighbour (KNN) classification method (k = 3). The results proved the diagnostic robustness of the final feature sets in discriminating patients with myocardial infarction from healthy controls. Interestingly it also showed efficacy in discriminating myocardial infarction patients from patients with clinical symptoms of cardiac ischemia but no myocardial necrosis or stable coronary artery disease, despite the influence of batch effects and different microarray gene chips and platforms.

  1. ISCHEMIA in chronic kidney disease: improving the representation of patients with chronic kidney disease in cardiovascular trials.

    Science.gov (United States)

    Wyatt, Christina M; Shineski, Matthew; Chertow, Glenn M; Bangalore, Sripal

    2016-06-01

    Despite the high cardiovascular risk associated with chronic kidney disease, a recent systematic review confirmed that patients with kidney disease remain underrepresented in cardiovascular trials. Two ongoing trials are assessing the risk:benefit of aggressive evaluation and intervention for ischemic heart disease in patients with advanced chronic kidney disease.

  2. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease.

    Science.gov (United States)

    Shirai, Kazuyuki; Lansky, Alexandra J; Mehran, Roxana; Dangas, George D; Costantini, Costantino O; Fahy, Martin; Slack, Steven; Mintz, Gary S; Stone, Gregg W; Leon, Martin B

    2004-04-15

    The purpose of this study was to compare the clinical outcomes of stenting and minimally invasive coronary artery bypass grafting (MIDCAB) in patients with proximal left anterior descending (LAD) coronary artery disease. The Patency, Outcome, Economics of Minimally invasive direct coronary bypass (POEM) study demonstrated that MIDCAB had similar safety and long-term efficacy for LAD revascularization compared with conventional coronary artery bypass grafting. Although LAD stenting is superior to conventional balloon angioplasty, whether it is comparable to MIDCAB is not known. We identified a matched population of 429 consecutive patients with 1-vessel disease who underwent elective proximal LAD stenting and compared their clinical outcomes with those of the 152 patients in the MIDCAB group of the POEM study. The in-hospital event rate was similar in both groups, except for a shorter length of hospital stay with LAD stenting compared with MIDCAB (2.68 vs 4.07 days, p <0.0001). At 6-month follow-up, the incidence of death and Q-wave myocardial infarction or that of cerebrovascular accident was not significantly different between these 2 groups. However, target vessel revascularization was significantly higher with LAD stenting than MIDCAB (13.3% vs 6.6%, p = 0.045). In the subgroup of patients without diabetes, all clinical events were similar in both groups, and the benefit of a shorter hospital stay associated with stenting was maintained. Compared with MIDCAB, LAD stenting is associated with higher repeat revascularization rates but offers the advantage of shorter hospitalization. For nondiabetics with proximal LAD disease, stenting may be the revascularization strategy of choice.

  3. Decreased plasma urotensin Ⅱ levels inversely correlate with extent and severity of coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To determine the plasma urolensin Ⅱ(UⅡ) levels in various types of coronary heart disease and to clarify how the plasma UⅡ levels correlate with the clinical presentation, extent and severity of coronary artery atherosclerosis (CAD). Methods: One hundred and three aged patients undergoing elective diagnostic coronary angiography for proven or clinical suspected coronary heart disease were enrolled in this study. The extent and severity of coronary artery disease were evaluated by vessel score and Gensini score, respectively. Plasma UⅡ levels were measured by radioimmunoassay. Results: The plasma UⅡ levels in the patients with modest to severe coronary stenosis (3.03±0.34 pg/ml, 1.83±0.67 pg/ml) were significantly lower than that in subjects with normal coronary artery (4.80±1.11 pg/ml, P<0.001). The plasma UⅡ levels in patients with coronary heart disease were also significantly lower than that in patients with insignificant coronary stenosis (P < 0.001). Compared to patients with stable angina pectoris, plasma UⅡ levels in patients with acute coronary syndrome were significantly decreased (1.89±0.51 pg/ml vs 2.42±0.77 pg/ml, P< 0.001). Plasma UⅡ levels were found to be negatively correlated with the severity of coronary artery stenosis (r = -0.488, P<0.001), as well as the vessel score (r = -0.408, P<0.05) in the patients with CAD. Conclusion: Significant inverse correlations exist between the plasma UⅡ levels, and the extent and severity of coronary artery stenosis. These findings suggest that plasma UⅡ contribute to the development and progression of coronary artery stenosis, and may be a novel marker to predict clinical types, as well as the extent and severity of coronary artery disease in the patients.

  4. Current Status of Interventional Radiology Treatment of Infrapopliteal Arterial Disease

    Energy Technology Data Exchange (ETDEWEB)

    Rand, T., E-mail: thomas.rand@wienkav.at [General Hospital Hietzing, Department of Radiology (Austria); Uberoi, R. [John Radcliffe Hospital, Department of Radiology (United Kingdom)

    2013-06-15

    Treatment of infrapopliteal arteries has developed to a standard technique during the past two decades. With the introduction of innovative devices, a variety of techniques has been created and is still under investigation. Treatment options range from plain balloon angioplasty (POBA), all sorts of stent applications, such as bare metal, balloon expanding, self-expanding, coated and drug-eluting stents, and bio-absorbable stents, to latest developments, such as drug-eluting balloons. Regarding the scientific background, several prospective, randomized studies with relevant numbers of patients have been (or will be) published that are Level I evidence. In contrast to older studies, which primarily were based mostly on numeric parameters, such as diameters or residual stenoses, more recent study concepts focus increasingly on clinical features, such as amputation rate improvement or changes of clinical stages and quality of life standards. Although it is still not decided, which of the individual techniques might be the best one, we can definitely conclude that whatever treatment of infrapopliteal arteries will be used it is of substantial benefit for the patient. Therefore, the goal of this review is to give an overview about the current developments and techniques for the treatment of infrapopliteal arteries, to present clinical and technical results, to weigh individual techniques, and to discuss the recent developments.

  5. Reductions in disease activity in the AMPLE trial: clinical response by baseline disease duration

    Science.gov (United States)

    Schiff, Michael; Weinblatt, Michael E; Valente, Robert; Citera, Gustavo; Maldonado, Michael; Massarotti, Elena; Yazici, Yusuf; Fleischmann, Roy

    2016-01-01

    Objectives To evaluate clinical response by baseline disease duration using 2-year data from the AMPLE trial. Methods Patients were randomised to subcutaneous abatacept 125 mg weekly or adalimumab 40 mg bi-weekly, with background methotrexate. As part of a post hoc analysis, the achievement of validated definitions of remission (Clinical Disease Activity Index (CDAI) ≤2.8, Simplified Disease Activity Index (SDAI) ≤3.3, Routine Assessment of Patient Index Data 3 (RAPID3) ≤3.0, Boolean score ≤1), low disease activity (CDAI 6 months). Disease Activity Score 28 (C-reactive protein) 6 months) across multiple clinical measures. Conclusions Abatacept or adalimumab with background methotrexate were associated with similar onset and sustainability of response over 2 years. Patients treated early or later in the disease course achieved comparable clinical responses. Trial registration number NCT00929864, Post-results. PMID:27110385

  6. Selection of treatment for patients with carotid artery disease: medication, carotid endarterectomy, or carotid artery stenting.

    Science.gov (United States)

    Bosiers, Marc; Peeters, Patrick; Deloose, Koen; Verbist, Jürgen; Sprouse, Richard L

    2005-01-01

    Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case. This algorithm was then employed to determine therapy in 308 consecutive patients presenting to a single institution during one calendar year. Ninety-five (30.8%) patients presented with an asymptomatic carotid stenosis of more than 80% and 213 (69.2%) with a symptomatic stenosis of more than 50%. According to our algorithm, 59 (62.1%) of the 95 asymptomatic patients received CAS, 20 (21.1%) received CEA, and 16 (16.8%) received medical therapy. All symptomatic patients underwent intervention; 153 (71.8%) were treated with CAS and 60 (28.2%) with CEA. Combined 30-day stroke and death rates after CAS were 1.7% in asymptomatic patients and 2.6% in symptomatic patients. After CEA, these rates were 0% and 3.3%, respectively. Careful selection of treatment modality according to predetermined criteria can result in improved outcomes.

  7. Critical appraisal of paclitaxel balloon angioplasty for femoral–popliteal arterial disease

    Directory of Open Access Journals (Sweden)

    Herten M

    2016-08-01

    Full Text Available Monika Herten,1 Giovanni B Torsello,1,2 Eva Schönefeld,3 Stefan Stahlhoff2 1Department of Vascular and Endovascular Surgery, University Hospital Münster, 2Department of Vascular Surgery, St Franziskus Hospital, Münster, 3Institute for Education and Student Affairs, University Hospital Münster, Münster, Germany Abstract: Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1 medical journals (ie, MEDLINE, 2 international registers for clinical studies (ie, www.clinicaltrials.gov, and 3 abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel –DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been

  8. Amantadine for dyskinesias in Parkinson's disease: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Hideyuki Sawada

    Full Text Available BACKGROUND: Dyskinesias are some of the major motor complications that impair quality of life for patients with Parkinson's disease. The purpose of the present study was to investigate the efficacy of amantadine in Parkinson's disease patients suffering from dyskinesias. METHODS: In this multi-center, double-blind, randomized, placebo-controlled, cross-over trial, 36 patients with Parkinson's disease and dyskinesias were randomized, and 62 interventions, which included amantadine (300 mg/day or placebo treatment for 27 days, were analyzed. At 15 days after washout, the treatments were crossed over. The primary outcome measure was the changes in the Rush Dyskinesia Rating Scale (RDRS during each treatment period. The secondary outcome measures were changes in the Unified Parkinson's Disease Rating Scale part IVa (UPDRS-IVa, dyskinesias, part IVb (motor fluctuations, and part III (motor function. RESULTS: RDRS improved in 64% and 16% of patients treated with amantadine or placebo, respectively, with significant differences between treatments. The adjusted odds-ratio for improvement by amantadine was 6.7 (95% confidence interval, 1.4 to 31.5. UPDRS-IVa was improved to a significantly greater degree in amantadine-treated patients [mean (SD of 1.83 (1.56] compared with placebo-treated patients [0.03 (1.51]. However, there were no significant effects on UPDRS-IVb or III scores. CONCLUSIONS: Results from the present study demonstrated that amantadine exhibited efficacious effects against dyskinesias in 60-70% of patients. TRIAL REGISTRATION: UMIN Clinical Trial Registry UMIN000000780.

  9. Off-pump Coronary Endarterectomy and Bypass Grafting in Patients With Diffuse Coronary Artery Disease

    Institute of Scientific and Technical Information of China (English)

    Chen Xin; Xu Ming; Jiang Yinshuo; Sui Kaihu; Qiu Zhibing; Wang Liming; Liu Peisheng

    2006-01-01

    Objectives To summarize our preliminary experience on off-pump coronary endarterectomy and bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3-year period, 53 patients (41 male) with diffuse coronary artery disease underwent off-pump coronary endarterectomy and bypass grafting at our institution.Patients' age ranged from 55 to 79 years. Prior to surgery, 70% of patients were in CCS angina class 2 (n=5) or 3 (n=32), and nearly half of them (26/53) had history of myocardial infarction. Most patients (n=50) had triple vessel lesions, with left main stem involvement in 9. Their left ventricular ejection fraction ranged from 26% to 65% (mean 52%). At the end of operation, a flow-meter was routinely applied to measure the perfusion flow of each postendarterectomy graft. Results In total, 70 endarterectomies were performed in 53 patients, including 38 in left anterior descending artery (LAD), 8 in circumflex artery and 24 in right coronary artery. Four operations were emergency or urgent in nature. Five patients received on-lay venous patch after endarterectomy in LAD, followed by left internal mammary artery (LIMA) grafting on the patch. The graft conduits included 53 LIMAs and 2 radial arteries,and saphenous veins in others. Mean number of grafts per patient was 3.75. The overall index of completeness of revascularization reached 1.03±0.07. There was no death in this group of patients during their post-operative hospital stay (mean duration = 9 days).Intra-operatively, 63 (90%) out of the 70 grafts after coronary endarterectomy showed satisfactory flow. Two patients had perioperative myocardial infarctions but neither experienced significant hemodynamic deteriations. Conclusions Off-pump coronary endarterectomy with bypass grafting is technically feasible and can be performed safely in patients with diffuse coronary artery disease. This strategy may help to improve the completeness of myocardial revascularization.

  10. Dutch randomized trial comparing standard catheter-directed thrombolysis versus Ultrasound-accElerated Thrombolysis for thromboembolic infrainguinal disease (DUET: design and rationale

    Directory of Open Access Journals (Sweden)

    Fioole Bram

    2011-01-01

    Full Text Available Abstract Background The use of thrombolytic therapy in the treatment of thrombosed infrainguinal native arteries and bypass grafts has increased over the years. Main limitation of this treatment modality, however, is the occurrence of bleeding complications. Low intensity ultrasound (US has been shown to accelerate enzymatic thrombolysis, thereby reducing therapy time. So far, no randomized trials have investigated the application of US-accelerated thrombolysis in the treatment of thrombosed infra-inguinal native arteries or bypass grafts. The DUET study (Dutch randomized trial comparing standard catheter-directed thrombolysis versus Ultrasound-accElerated Thrombolysis for thrombo-embolic infrainguinal disease is designed to assess whether US-accelerated thrombolysis will reduce therapy time significantly compared with standard catheter-directed thrombolysis. Methods/design Sixty adult patients with recently (between 1 and 7 weeks thrombosed infrainguinal native arteries or bypass grafts with acute limb ischemia class I or IIa, according to the Rutherford classification for acute ischemia, will be randomly allocated to either standard thrombolysis (group A or US-accelerated thrombolysis (group B. Patients will be recruited from 5 teaching hospitals in the Netherlands during a 2-year period. The primary endpoint is the duration of catheter-directed thrombolysis needed for uninterrupted flow in the thrombosed infrainguinal native artery or bypass graft, with outflow through at least 1 crural artery. Discussion The DUET study is a randomized controlled trial that will provide evidence of whether US-accelerated thrombolysis will significantly reduce therapy time in patients with recently thrombosed infrainguinal native arteries or bypass grafts, without an increase in complications. Trial registration Current Controlled Trials ISRCTN72676102

  11. Medical treatment in carotid artery intervention

    NARCIS (Netherlands)

    Kolkert, J. L.; Meerwaldt, R.; Lefrandt, Johan; Geelkerken, R. H.; Zeebregts, C. J.

    2011-01-01

    Medical treatment has a pivotal role in the treatment of patients with occlusive carotid artery disease. Large trials have provided the justification for operative treatment besides medical treatment in patients with recent significant carotid artery stenosis two decades ago. Since then, medical the

  12. Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nielsen, Lene H; Bøtker, Hans Erik; Sørensen, Henrik T

    2016-01-01

    AIMS: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity. METHODS AND RESULTS: This cohort study i......, and comorbidity. CONCLUSION: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.......AIMS: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity. METHODS AND RESULTS: This cohort study...

  13. Antiplatelet therapy for stable coronary artery disease in atrial fibrillation patients taking an oral anticoagulant

    DEFF Research Database (Denmark)

    Lamberts, Morten; Gislason, Gunnar H.; Lip, Gregory Y. H.

    2014-01-01

    Background The optimal long-term antithrombotic treatment of patients with coexisting atrial fibrillation and stable coronary artery disease is unresolved, and commonly, a single antiplatelet agent is added to oral anticoagulation. We investigated the effectiveness and safety of adding antiplatelet...... or thromboembolism, whereas risk of bleeding is increased significantly. The common practice of adding antiplatelet therapy to oral VKA anticoagulation in patients with atrial fibrillation and stable coronary artery disease warrants reassessment........23-1.82]) or clopidogrel (hazard ratio, 1.84 [95% confidence interval, 1.11-3.06]) was added to VKA. Conclusions In atrial fibrillation patients with stable coronary artery disease, the addition of antiplatelet therapy to VKA therapy is not associated with a reduction in risk of recurrent coronary events...

  14. The impact of peripheral arterial disease: A proposal for a new classification.

    Science.gov (United States)

    Vaquero Morillo, Fernando

    2016-05-01

    Clasically, intermittent claudication, an intermediate stage in peripheral arterial disease, has been considered as a benign condition when considering only the muscular pain on walking. In this paper our aim is to attract attention about the effects linked to ischemic pain and the oxidative injury resulting from episodes of ischemia/reperfusion. Throughout this process alterations in calcium homeostasis as well as uncontrolled generation of reactive oxygen species, in association with the mitochondrial dysfunction and inflammatory phenomena, could lead to accelerate atherosclerosis, with an increased cardiovascular risk stated by means of a reduced ankle-brachial index. Taking this idea into account we propose a possible new classification for the management of the peripheral arterial disease, combining the Fontaine and Rutherford classifications and thinking about the described systemic effects in order to change the traditional management of peripheral arterial disease.

  15. Increased risk of venous thromboembolism and arterial cardiovascular events in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper;

    2012-01-01

    This focused review describes the current knowledge of the association between inflammatory bowel disease (IBD) and cardiovascular disease. Atherosclerosis is a chronic inflammatory disease, and as well as venous thromboembolism this disease shares inflammatory mechanisms with IBD. Patients...... with IBD have a high risk of venous thromboembolism especially during IBD flare-ups. Their risk of arterial cardiovascular disease may also be increased. The risk of cardiovascular disease in patients with IBD warrants clinical attention, and it is possible that the risk can be modified by applying anti...

  16. Chlamydia pneumoniae in the atherosclerotic plaques of coronary artery disease patients.

    Directory of Open Access Journals (Sweden)

    Morteza Izadi

    2013-12-01

    Full Text Available An association between Chlamydia pneumoniae (C. pneumoniae and cardiovascular disease has been demonstrated. In this study, we aimed to study this potential relationship in 105 Iranian patients. Coronary artery specimens from 105 Iranian patients undergoing CABG were analyzed by PCR method for C. pneumoniae. Serological evaluation for C. pneumoniae IgG and IgM was performed using ELISA. 53 specimens from mamillary artery were also investigated. C. pneumoniae PCR test result was positive for 23 (21.9% of patients with coronary artery atherosclerosis, but none of the specimens from the mamillary artery was positive for C. pneumoniae when it was evaluated by the PCR (P<0.001. Coronary artery disease patients with and without a history of unstable angina or myocardial infarction were comparable in C. pneumoniae PCR test positive rates (P=0.618. Relevance of IgG and IgM positivity were also studied by correlating it to the study parameters, but no difference was found. CRP was significantly higher in the IgM positive group (P<0.001. A significant proportion of coronary atherosclerotic plaques are infected with C. pneumoniae while no infection was found in the normal mamillary artery specimens. No association was found between acute coronary syndromes and serological and PCR positivity. Further prospective randomized controlled studies with large patient population are needed to confirm our findings.

  17. Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter

    Energy Technology Data Exchange (ETDEWEB)

    Massmann, Alexander, E-mail: Alexander.Massmann@uks.eu; Katoh, Marcus [Saarland University Hospital, Department of Diagnostic and Interventional Radiology (Germany); Shayesteh-Kheslat, Roushanak [Saarland University Hospital, Department of General Surgery, Visceral, Vascular, and Pediatric Surgery (Germany); Buecker, Arno [Saarland University Hospital, Department of Diagnostic and Interventional Radiology (Germany)

    2012-10-15

    Purpose: To retrospectively examine the technical feasibility and safety of directional atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Methods: Five patients (one woman, four men, age range 51-81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease-related symptoms during the last 2-6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery (n = 4) and in-stent occlusion of the superficial femoral artery (n = 1). Subsequently, all patients were treated by atherectomy with the SilverHawk (ev3 Endovascular, USA) device. Results: The mean diameter of treated vessels was 5.1 {+-} 1.0 mm. The length of the occlusion ranged 2-14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. Conclusion: The recanalization of infrainguinal arterial vessel occlusions by atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.

  18. The relationship between aortic calcification volume and obstructive coronary artery disease: comparison with coronary calcification volume

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Seok; Kim, Jeong Ho; Park, Chul Hi; Park, Seon Young; Choe, Soo Jin; Hwang, Hee Young; Kim, Hyung Sik [Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2007-12-15

    We compared the diagnostic performance of aortic calcification volume with that of coronary artery calcification volume at CT in diagnosing obstructive coronary artery disease (OCAD). A total of 308 patients (M: F 141: 167) underwent coronary CT angiography using a 64-slice MDCT. We measured the calcification volume (mm{sup 3}) of coronary artery (CAC), thoracic aorta (TAC), abdominal aorta (AAC), and whole aorta (AC) at unenhanced CT. OCAD was defined as the significant stenosis ({>=} 50%) in any coronary artery at CT angiography. The diagnostic performance for OCAD was evaluated by calculating the area under the receiver operating characteristic (ROC) curve. Among the 308 patients studied, 45 patients were diagnosed with OCAD. The mean volumes of TAC, AAC, AC, and CAC were 518.8 mm{sup 3}, 551.5 mm{sup 3}, 1069.9 mm{sup 3}, 57.6 mm{sup 3} respectively. The areas under the ROC curve of TAC, AAC, AC, and CAC for OCAD were 0.766 (0.694 < 95% confidence interval < 0.838), 0.837 (0.784 < 95% confidence interval < 0.892), 0.814 (0.755 < 95% confidence interval < 0.873), 0.871 (0.812 < 95% confidence interval < 0.930), respectively. The volume of aortic calcification as well as coronary artery calcification is associated with obstructive coronary artery disease.

  19. CIRCADIAN ARTERIAL TENSION PROFILE IN THE PATIENTS WITH BRONCHIAL ASTHMA AND COMORBID HYPERTENSIVE DISEASE

    Directory of Open Access Journals (Sweden)

    T. N. Zaripova

    2016-01-01

    Full Text Available The aim of research is to study the state of circadian arterial tension profile in the patients with bronchial asthma and hypertensive disease as comorbid disease. Materials and methods. The research has been performed at 76 patients with bronchial asthma and hypertensive disease as comorbid disease (the main group and 52 patients with hypertensive disease as the comparison group. The groups were comparable with respect to the gender and age sign. Investigation was performed in the period of clinical remission. The main method used in this research was the investigation of day arterial tension profile in the time of its monitoring. Results. It has been revealed the presence of frequent and expressed change from the side of the studied indexes, especially in the patients with comorbid pathology, which were characterized by more frequent and more significant disorders from the side of diastolic blood pressure, especially at night in combination with more considerable and more rapid rise in early morning hours. The day arterial tension profile was characterized either with insufficient decline of arterial pressure at night or, opposite, with its sharp decrease. Specified disorders were increased as far as heaving of main and comorbid diseases, presence of disorders from the side of lipid exchange were not related to the phase of bronchial asthma (remission, exacerbation and level of its flow control. 

  20. Influence of Baseline Characteristics, Operative Conduct and Postoperative Course on 30-day Outcomes of Coronary Artery Bypass Grafting among Patients with Left Ventricular Dysfunction: Results from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

    Science.gov (United States)

    Wrobel, Krzysztof; Stevens, Susanna R.; Jones, Robert H.; Selzman, Craig H.; Lamy, Andre; Beaver, Thomas M.; Djokovic, Ljubomir T.; Wang, Nan; Velazquez, Eric J.; Sopko, George; Kron, Irving L.; DiMaio, J. Michael; Michler, Robert E.; Lee, Kerry L.; Yii, Michael; Leng, Chua Yeow; Zembala, Marian; Rouleau, Jean L.; Daly, Richard C.; Al-Khalidi, Hussein R.

    2015-01-01

    Background Patients with severe left ventricular (LV) dysfunction, ischemic heart failure and coronary artery disease (CAD) suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision-making regarding whether to proceed to surgery difficult in such patients. To better inform such decision-making, we analyzed the STICH CABG population for detailed information on perioperative risk and outcomes. Methods and Results In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction (LVEF) ≤ 35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy or CABG with surgical ventricular reconstruction (SVR). Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients who received surgery, and 346 of them (roughly, one-quarter) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). LV size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions CABG can be performed with relatively low 30-day mortality in patients with LV dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality. Clinical Trial

  1. Birth weight and coronary artery disease. The effect of gender and diabetes

    OpenAIRE

    Maria Banci, Patrizia Saccucci, Alessandro Dofcaci, Ilaria Sansoni, Andrea Magrini, Egidio Bottini, Fulvia Gloria-Bottini

    2009-01-01

    Background: The developmental origin theory of coronary heart disease proposes that undernutrition in utero permanently changes body functions and metabolism leading to an increased risk of coronary artery diseases (CAD) in adult life. Some studies support this theory but others suggest that birth weight (BW) is not a major risk factor for cardiovascular diseases. Gender differences concerning the association between BW and risk factors for CAD have been reported in some studies but not in ot...

  2. Comparison of dobutamine and exercise using technetium-99m sestamibi imaging for the evaluation of coronary artery disease.

    Science.gov (United States)

    Herman, S D; LaBresh, K A; Santos-Ocampo, C D; Garber, C E; Barbour, M M; Messinger, D E; Cloutier, D J; Ahlberg, A W; Heller, G V

    1994-01-15

    Studies using dobutamine thallium-201 myocardial perfusion imaging have suggested a high sensitivity and specificity for the detection of coronary artery disease. However, few data are available comparing dobutamine with exercise stress for the detection and localization of perfusion defects. This study compared the effects of dobutamine and exercise stress using technetium-99m sestamibi single-photon emission computed tomographic imaging in the same patients in a prospective crossover trial. Twenty-four patients with a high likelihood of coronary artery disease underwent tomographic myocardial imaging at rest, after symptom-limited treadmill exercise, and after intravenous dobutamine (maximum 30 micrograms/kg/min). Tomograms of the left ventricle were divided into 20 segments and were interpreted without knowledge of patient identity or stress protocol. Dobutamine was well tolerated by all patients. Segment-by-segment concordance between exercise and dobutamine images was highly significant (kappa = 0.56, p < 0.0001). Global first-order agreement (normal vs abnormal) between exercise and dobutamine studies was 96% (kappa = 0.65, p = 0.02); global second-order agreement (normal vs fixed vs ischemic defect) was 88% (kappa = 0.45, p = 0.02). Regional first- and second-order agreement were 96 and 93%, respectively (p < 0.001 for both). Twenty patients underwent coronary angiography. Comparisons between exercise and angiography and between dobutamine and angiography were similar for both global agreement (95 vs 100%, p = NS) and regional agreement (77 vs 72%, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

  3. [Adjuvant and individual application of lumbar sympathectomy at patient with arterial disease in lower limb].

    Science.gov (United States)

    Govedarski, V; Petrov, I; Zahariev, T; Nachev, G

    2010-01-01

    The first lumbar sympathectomy for treatment of arterial occlusive disease of the lower extremity was performed in 1924 by Julio Diez of Buenos Aires. The standart anatomy textbooks indicate, as a rule that the lumbar sympathetic trunk contains four or five ganglia. The overall anatomic denervation is important for achievement of an adequate sympathectomy of a given segment of an extremity. Criteria and indications for complete sympathetic block are still not clear. Exceptionally important for the improvement of the reology of the lower limbs is the option for a direct increase of the collaterals' debit which could be achieved by extensive profundoplasty. As an addition to the arterial reconstructions, the sympathectomy increases the passability of small vessel anastomosis and the recovery of traumatized arteries. Unilateral or bilateral lumbar sympathectomy is performed by retroperitonal access. From 01.01.2008 till 01.11.2008 in our clinic were performed 117 isolated and after arterial reconstruction lumbar sympathectomies.

  4. Association between serum uric acid level and the severity of coronary artery disease in patients with obstructive coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Yu Jie; Han Jiangli; Mao Jieming; Guo Lijun; Gao Wei

    2014-01-01

    Background Many studies have shown that the serum uric acid (SUA) level is one of the cardiovascular risk factors.The aim of the study is to evaluate the relationship between SUA levels and the severity of coronary artery disease (CAD) assessed by angiography and the Syntax score in patients with obstructive CAD.Methods Participants who visited our hospital for a coronary angiography,from December 2007 to September 2012,were eligible for this analysis.SUA and other blood parameters after at least 12-hour fast were determined.First,the patients were divided into tertiles according to their Syntax scores (low Syntax score group:Syntax score ≤10.0; moderate Syntax score group:10.0 <Syntax score ≤18.0; high Syntax score group:Syntax score >18.0).Second,to clarify the association between SUA levels and major adverse cardiovascular events (MACEs),all patients were divided into two subgroups on the basis of SUA levels.The cutoff value of SUA was defined by diagnostic criteria of hyperuricemia.Patients were separated into normal SUA group (n=251,with SUA <416 μmol/L for men and SUA <357 μmol/L for women) and high SUA group (n=96,with SUA ≥416 μmol/L for men and SUA ≥357 tμmol/L for women).All participants were followed for a mean of 22.0 months (1-75 months,interquartile range:28 months) for major adverse cardiovascular events (MACEs),including all-cause death,recurrent nonfatal myocardial infarction (re-MI) and recurrent percutaneous coronary intervention (re-PCI).Results A total of 347 patients were registered for the study.The SUA levels in the high Syntax score group were significantly higher than that of the moderate Syntax score group and the low Syntax score group ((392.3±81.6) μmol/L vs.(329.9±71.0) μmol/L,P <0.001; (392.3±81.6) μmol/L vs.(311.4±64.7) μmol/L,P <0.001).The SUA level was positively correlated not only with the Syntax score (r=0.421,P <0.001; 95% CI:0.333-0.512),but also with the number of diseased vessels (t=0

  5. Effect of a tart cherry juice supplement on arterial stiffness and inflammation in healthy adults: a randomised controlled trial.

    Science.gov (United States)

    Lynn, Anthony; Mathew, Shilpa; Moore, Chris T; Russell, Jean; Robinson, Emma; Soumpasi, Vithleem; Barker, Margo E

    2014-06-01

    Tart cherries are a particularly rich source of anthocyanins. Evidence indicates that dietary intake of anthocyanins is inversely associated with arterial stiffness. We conducted an open-label randomised placebo controlled study to determine whether a tart cherry juice concentrate (Cherry Active) reduced arterial stiffness, inflammation and risk markers for cardiovascular disease in 47 healthy adults (30-50 years). Participants consumed 30 ml of cherry concentrate diluted to a volume of 250 ml with water or the same volume of an energy matched control drink daily for six weeks. Measurements were taken at baseline and at the end of the intervention. There was no effect of the intervention on arterial stiffness (P = 0.218), c-reactive protein (P = 0.220), systolic blood pressure (P = 0.163), diastolic blood pressure (P = 0.121), total cholesterol (P = 0.342) and high density lipoprotein cholesterol (P = 0.127). At the end of the intervention, plasma antioxidant capacity (measured as the ferric reducing ability of plasma (FRAP)) was significantly higher in the intervention group than the control group (P = 0.012). We conclude that a tart cherry juice concentrate rich in anthocyanins has no effect on arterial stiffness, c-reactive protein and risk markers for cardiovascular disease, but evokes a minor increase in antioxidant status in healthy adults.

  6. A logistic regression model of Coronary Artery Disease among Male Patients in Punjab

    Directory of Open Access Journals (Sweden)

    Sohail Chand

    2005-07-01

    Full Text Available This is a cross-sectional retrospective study of 308 male patients, who were presented first time for coronary angiography at the Punjab Institute of Cardiology. The mean age was 50.97 + 9.9 among male patients. As the response variable coronary artery disease (CAD was a binary variable, logistic regression model was fitted to predict the Coronary Artery Disease with the help of significant risk factors. Age, Chest pain, Diabetes Mellitus, Smoking and Lipids are resulted as significant risk factors associated with CAD among male population.

  7. Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis C

    DEFF Research Database (Denmark)

    Roed, Torsten; Kristoffersen, Ulrik Sloth; Knudsen, Andreas

    2014-01-01

    % confidence interval [CI] 0.9-2.7) and smoked more (53% versus 38%, PR 1.4; 95% CI 0.9-2.1). The two groups had similar body mass index (mean 25.0 versus 25.7 kg/m(2)), whereas those with chronic hepatitis C had less dyslipidemia (including significantly lower low-density lipoprotein and cholesterol...... of several coronary artery disease risk markers. These results may be important when evaluating the appropriateness of screening for coronary artery disease and its risk factors in chronic hepatitis C....

  8. Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease

    DEFF Research Database (Denmark)

    Kühl, J Tobias; Hove, Jens D; Kristensen, Thomas S;

    2017-01-01

    OBJECTIVES: To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. DESIGN: The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using...... in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population....

  9. Current Role of Ivabradine in Stable Coronary Artery Disease Without Heart Failure.

    Science.gov (United States)

    Porres-Aguilar, Mateo; Muñoz, Oscar C; Abbas, Aamer

    2016-02-01

    Increase in heart rate represents a significant contribution in the pathophysiology of coronary artery disease and heart failure, by promoting atherosclerotic process and endothelial dysfunction. Thus, it negatively influences cardiovascular risk in the general population. The aim of this review is to analyze the current, controversial, and future role of ivabradine as an anti-anginal agent in the setting of coronary artery disease without heart failure. Ivabradine represents a selective heart rate-lowering agent that increased diastolic perfusion time and improving energetics in the ischemic myocardium.

  10. Obesity and the challenges of noninvasive imaging for the detection of coronary artery disease.

    Science.gov (United States)

    Lim, Siok P; Arasaratnam, Punitha; Chow, Benjamin J; Beanlands, Rob S; Hessian, Renée C

    2015-02-01

    Obesity is a significant health problem that could potentially lead to increased cardiovascular risk. Noninvasive imaging plays an important role in the evaluation of cardiovascular symptoms and risk of these patients. Selection of the appropriate test in the diagnosis of obstructive coronary artery disease in this unique population is important. In this article, we focus on the strengths, limitations, and recommendations of the various noninvasive cardiac imaging modalities available in the detection of obstructive coronary artery disease. We have suggested an algorithm to help direct investigation. Ultimately, patient management should be individualized based on clinical judgement, test availability, and local expertise.

  11. Echocardiography in Diagnosis and Prevention of the Coronary Artery Lesions in Kawasaki Disease

    Institute of Scientific and Technical Information of China (English)

    Pan Baoquan; Xu Zongyi; Zheng Manlei; Feng Zhekang

    2000-01-01

    @@Kawasaki disease (muco-cutaneous lymph node syndrome, MCLS) was first reported by Kawasaki in 1967. It was characteried by nonvascular polymorphous rash, fever, ulcer in oral mucosa, edema of hands of feet, cervix lymphadenopathy and desquamations in peripheral extremities. Because of unknown pathogens, no lab examination was available as a single easily recognized diagnostic marker; the diagnosis is based on clinical features. The main complication of Kawasaki disease is coronary artery (CA) lesion; the prognosis is determined by the degree of pathological change of the coronary artery[1.2].

  12. Analysis of relationship between severity of coronary artery disease and coronary artery disease risk factors%冠状动脉病变程度与冠心病危险因素的相关分析

    Institute of Scientific and Technical Information of China (English)

    刘恒宾

    2014-01-01

    目的:探讨冠心病患者冠状动脉病变的严重程度与冠心病危险因素的关系。方法选择冠心病患者116例为冠心病组,选择冠状动脉样硬化狭窄程度<50%的患者66例为对照组。分析冠状动脉狭窄程度与冠心病危险因素的关系。结果多因素分析结果显示,LVEF、Ccr与冠状动脉粥样硬化程度呈负相关,而hs-CRP与冠状动脉粥样硬化程度呈正相关(P<0.05或P<0.01)。结论冠状动脉狭窄程度与LVEF、Ccr呈负相关,与hs-CRP呈正相关。%Objective To analyze relationship between severity of coronary artery disease and coronary artery disease risk factors. Methods 116 cases with coronary artery disease were selected as group of coronary artery disease, and 66 cases with coronary artery sclerosis stenosis degree < 50% were selected as control group. Relationship between severity of coronary artery disease and coronary artery disease risk factors was analyzed. Results Multifactor analysis results showed LVEF and Ccr were negative correlation with severity of coronary artery disease,and hs-CRP was positive correlation with severity of coronary artery disease(P < 0.05 orP < 0.01). Conclusion LVEF and Ccr are negative correlation with severity of coronary artery disease,and hs-CRP is positive correlation with severity of coronary artery disease.

  13. Effect of age on left ventricular function during exercise in patients with coronary artery disease.

    Science.gov (United States)

    Hakki, A H; DePace, N L; Iskandrian, A S

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p = not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p = 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p = not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  14. Effect of age on left ventricular function during exercise in patients with coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Hakki, A.H.; DePace, N.L.; Iskandrian, A.S.

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p . not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p . 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p . not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  15. Classification of coronary artery tissues using optical coherence tomography imaging in Kawasaki disease

    Science.gov (United States)

    Abdolmanafi, Atefeh; Prasad, Arpan Suravi; Duong, Luc; Dahdah, Nagib

    2016-03-01

    Intravascular imaging modalities, such as Optical Coherence Tomography (OCT) allow nowadays improving diagnosis, treatment, follow-up, and even prevention of coronary artery disease in the adult. OCT has been recently used in children following Kawasaki disease (KD), the most prevalent acquired coronary artery disease during childhood with devastating complications. The assessment of coronary artery layers with OCT and early detection of coronary sequelae secondary to KD is a promising tool for preventing myocardial infarction in this population. More importantly, OCT is promising for tissue quantification of the inner vessel wall, including neo intima luminal myofibroblast proliferation, calcification, and fibrous scar deposits. The goal of this study is to classify the coronary artery layers of OCT imaging obtained from a series of KD patients. Our approach is focused on developing a robust Random Forest classifier built on the idea of randomly selecting a subset of features at each node and based on second- and higher-order statistical texture analysis which estimates the gray-level spatial distribution of images by specifying the local features of each pixel and extracting the statistics from their distribution. The average classification accuracy for intima and media are 76.36% and 73.72% respectively. Random forest classifier with texture analysis promises for classification of coronary artery tissue.

  16. Community engagement in diverse populations for Alzheimer disease prevention trials.

    Science.gov (United States)

    Romero, Heather R; Welsh-Bohmer, Kathleen A; Gwyther, Lisa P; Edmonds, Henry L; Plassman, Brenda L; Germain, Cassandra M; McCart, Michelle; Hayden, Kathleen M; Pieper, Carl; Roses, Allen D

    2014-01-01

    The recruitment of asymptomatic volunteers has been identified as a critical factor that is delaying the development and validation of preventive therapies for Alzheimer disease (AD). Typical recruitment strategies involve the use of convenience samples or soliciting participation of older adults with a family history of AD from clinics and outreach efforts. However, high-risk groups, such as ethnic/racial minorities, are traditionally less likely to be recruited for AD prevention studies, thus limiting the ability to generalize findings for a significant proportion of the aging population. A community-engagement approach was used to create a registry of 2311 research-ready, healthy adult volunteers who reflect the ethnically diverse local community. Furthermore, the registry's actual commitment to research was examined, through demonstrated participation rates in a clinical study. The approach had varying levels of success in establishing a large, diverse pool of individuals who are interested in participating in pharmacological prevention trials and meet the criteria for primary prevention research trials designed to delay the onset of AD. Our efforts suggest that entry criteria for the clinical trials need to be carefully considered to be inclusive of African Americans, and that sustained effort is needed to engage African Americans in pharmacological prevention approaches.

  17. CLINICAL STUDY OF CORONARY ARTERY DISEASE IN WOMEN WITH SPECIAL REFERENCE TO RISK FACTORS

    Directory of Open Access Journals (Sweden)

    Anand Betdur

    2016-07-01

    Full Text Available AIM To study the clinical profile of coronary artery disease in women and to identify the influence of the risk factors. METHODS We conducted a prospective observational study in Vydehi Institute of Medical Science and Research Centre (VIMS & RC, Bengaluru during the period June 2012 to Dec 2013. Patients admitted with history suggestive of coronary artery disease were evaluated clinically and investigated for risk factors. Prognosis with regards to morbidity and mortality following the standard treatment protocol was documented. RESULTS Out of 100 cases of coronary artery disease (CAD, 32 had Acute Myocardial infarction (AMI, 23 with Unstable Angina and 45 patients had Stable Angina. Nearly half of the patients had the traditional risk factors, namely hypertension (HTN, diabetes mellitus (DM, hyperlipidaemia and obesity. Chest pain was the most common symptom. Mortality was 14% which was observed predominantly in post-menopausal women who presented after 24 hours of the onset of symptoms. CONCLUSION Coronary artery disease is no longer a disease of men. Men and women share the same traditional risk factors like HTN, DM, Obesity, and Hyperlipidaemia. Increased incidence of complications and mortality occurred in those who presented after 24 hours of the symptoms. Our study highlights the importance of early recognition of CAD and initiation of thrombolytic therapy, to reduce significant morbidity and mortality.

  18. Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

    Institute of Scientific and Technical Information of China (English)

    Pedro; Valdivielso; José; Ramírez-Bollero; Carmen; Pérez-López

    2014-01-01

    Peripheral arterial disease, manifested as intermittent claudication or critical ischaemia, or identified by an ankle/brachial index < 0.9, is present in at least one in every four patients with type 2 diabetes mellitus.Several reasons exist for peripheral arterial disease indiabetes. In addition to hyperglycaemia, smoking and hypertension, the dyslipidaemia that accompanies type2 diabetes and is characterised by increased triglyceride levels and reduced high-density lipoprotein cholesterol concentrations also seems to contribute to this association. Recent years have witnessed an increased interest in postprandial lipidaemia, as a result of various prospective studies showing that non-fasting triglycerides predict the onset of arteriosclerotic cardiovascular disease better than fasting measurements do. Additionally,the use of certain specific postprandial particle markers,such as apolipoprotein B-48, makes it easier and more simple to approach the postprandial phenomenon. Despite this, only a few studies have evaluated the role of postprandial triglycerides in the development of peripheral arterial disease and type 2 diabetes. The purpose of this review is to examine the epidemiology and risk factors of peripheral arterial disease in type 2 diabetes, focusing on the role of postprandial triglycerides and particles.

  19. Clinical and angiographic features of coronary artery disease after chest irradiation

    Energy Technology Data Exchange (ETDEWEB)

    McEniery, P.T.; Dorosti, K.; Schiavone, W.A.; Pedrick, T.J.; Sheldon, W.C.

    1987-11-01

    Coronary artery disease (CAD) developed in 15 patients at a mean of 16 years (range 3 to 29) after chest irradiation. The mean dose of radiation was 42 +/- 7 grays; irradiation was performed for Hodgkin's disease in 9 patients, lymphoma in 2, breast carcinoma in 3 and cystic hygroma in 1 patient. Mean age was 48 years (range 26 to 63) at diagnosis of CAD; 4 patients were younger than 35 years. Nine were women. Ten presented with angina, 3 with acute myocardial infarction, 1 patient with syncope and 1 with dyspnea. Twelve had no more than 2 risk factors of atherosclerosis. At coronary angiography, 8 had at least 50% diameter narrowing of the left main coronary artery and 4 had severe ostial stenosis of the right coronary artery. Eight patients also had valvular heart disease, 4 pericardial disease and 4 complete heart block. Mean left ventricular ejection fraction was 67 +/- 11% (range 53 to 80%). Nine had undergone coronary artery bypass grafting, but surgery was difficult or impossible in 3 because of severe mediastinal and pericardial fibrosis. Radiation-associated CAD is characterized by a high incidence of left main and right ostial coronary disease and often occurs in women with relatively few conventional risk factors for CAD.

  20. Imaging of Small Animal Peripheral Artery Disease Models: Recent Advancements and Translational Potential

    Directory of Open Access Journals (Sweden)

    Jenny B. Lin

    2015-05-01

    Full Text Available Peripheral artery disease (PAD is a broad disorder encompassing multiple forms of arterial disease outside of the heart. As such, PAD development is a multifactorial process with a variety of manifestations. For example, aneurysms are pathological expansions of an artery that can lead to rupture, while ischemic atherosclerosis reduces blood flow, increasing the risk of claudication, poor wound healing, limb amputation, and stroke. Current PAD treatment is often ineffective or associated with serious risks, largely because these disorders are commonly undiagnosed or misdiagnosed. Active areas of research are focused on detecting and characterizing deleterious arterial changes at early stages using non-invasive imaging strategies, such as ultrasound, as well as emerging technologies like photoacoustic imaging. Earlier disease detection and characterization could improve interventional strategies, leading to better prognosis in PAD patients. While rodents are being used to investigate PAD pathophysiology, imaging of these animal models has been underutilized. This review focuses on structural and molecular information and disease progression revealed by recent imaging efforts of aortic, cerebral, and peripheral vascular disease models in mice, rats, and rabbits. Effective translation to humans involves better understanding of underlying PAD pathophysiology to develop novel therapeutics and apply non-invasive imaging techniques in the clinic.

  1. Clinical and angiographic features of coronary artery disease after chest irradiation.

    Science.gov (United States)

    McEniery, P T; Dorosti, K; Schiavone, W A; Pedrick, T J; Sheldon, W C

    1987-11-01

    Coronary artery disease (CAD) developed in 15 patients at a mean of 16 years (range 3 to 29) after chest irradiation. The mean dose of radiation was 42 +/- 7 grays; irradiation was performed for Hodgkin's disease in 9 patients, lymphoma in 2, breast carcinoma in 3 and cystic hygroma in 1 patient. Mean age was 48 years (range 26 to 63) at diagnosis of CAD; 4 patients were younger than 35 years. Nine were women. Ten presented with angina, 3 with acute myocardial infarction, 1 patient with syncope and 1 with dyspnea. Twelve had no more than 2 risk factors of atherosclerosis. At coronary angiography, 8 had at least 50% diameter narrowing of the left main coronary artery and 4 had severe ostial stenosis of the right coronary artery. Eight patients also had valvular heart disease, 4 pericardial disease and 4 complete heart block. Mean left ventricular ejection fraction was 67 +/- 11% (range 53 to 80%). Nine had undergone coronary artery bypass grafting, but surgery was difficult or impossible in 3 because of severe mediastinal and pericardial fibrosis. Radiation-associated CAD is characterized by a high incidence of left main and right ostial coronary disease and often occurs in women with relatively few conventional risk factors for CAD.

  2. Effects of statin treatment in patients with coronary artery disease and chronic kidney disease.

    Science.gov (United States)

    Kaneko, Hidehiro; Yajima, Junji; Oikawa, Yuji; Tanaka, Shingo; Fukamachi, Daisuke; Suzuki, Shinya; Sagara, Koichi; Otsuka, Takayuki; Matsuno, Shunsuke; Funada, Ryuichi; Kano, Hiroto; Uejima, Tokuhisa; Koike, Akira; Nagashima, Kazuyuki; Kirigaya, Hajime; Sawada, Hitoshi; Aizawa, Tadanori; Yamashita, Takeshi

    2014-01-01

    Statins reduce cardiovascular morbidity and mortality from coronary artery disease (CAD). However, the effects of statin therapy in patients with CAD and chronic kidney disease (CKD) remain unclear. Within a single hospital-based cohort in the Shinken Database 2004-2010 comprising all patients (n = 15,227) who visited the Cardiovascular Institute, we followed patients with CKD and CAD after percutaneous coronary intervention (PCI). A major adverse cardiovascular and cerebrovascular event (MACCE) was defined by composite end points, including death, myocardial infarction, cerebral infarction, cerebral hemorrhage, and target lesion revascularization. A total of 391 patients were included in this study (median follow-up time 905 ± 679 days). Of these, 209 patients used statins. Patients with statin therapy were younger than those without. Obesity and dyslipidemia were more common, and the glomerular filtration rate (GFR) was significantly higher, in patients undergoing statin treatment. MACCE and cardiac death tended to be less common, and all-cause death was significantly less common, in patients taking statins. Multivariate analysis showed that low estimated GFR, poor left ventricular ejection fraction, and the absence of statin therapy were independent predictors for all-cause death of CKD patients after PCI. Statin therapy was associated with reduced all-cause mortality in patients with CKD and CAD after PCI.

  3. Peripheral artery disease is a coronary heart disease risk equivalent among both men and women

    DEFF Research Database (Denmark)

    Subherwal, Sumeet; Patel, Manesh R; Kober, Lars;

    2015-01-01

    AIMS: Lower extremity peripheral artery disease (PAD) has been proposed as a 'coronary heart disease (CHD) risk equivalent'. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender. METHODS: Using nationwide Danish...... the other groups. During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD + MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.......62-1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI 1.61-1.75, respectively). The greater long-term risks of PAD were seen for both women and men. CONCLUSIONS: Both women and men with incident PAD have greater long-term risks of total...

  4. Novel risk factors for premature peripheral arterial occlusive disease in non-diabetic patients: a case-control study.

    Directory of Open Access Journals (Sweden)

    Annie M Bérard

    Full Text Available BACKGROUND: This study aimed to determine the prevalence of genetic and environmental vascular risk factors in non diabetic patients with premature peripheral arterial disease, either peripheral arterial occlusive disease or thromboangiitis obliterans, the two main entities of peripheral arterial disease, and to established whether some of them are specifically associated with one or another of the premature peripheral arterial disease subgroups. METHODS AND RESULTS: This study included 113 non diabetic patients with premature peripheral arterial disease (diagnosis <45-year old presenting either a peripheral arterial occlusive disease (N = 64 or a thromboangiitis obliterans (N = 49, and 241 controls matched for age and gender. Both patient groups demonstrated common traits including cigarette smoking, low physical activity, decreased levels of HDL-cholesterol, apolipoprotein A-I, pyridoxal 5'-phosphate (active form of B6 vitamin and zinc. Premature peripheral arterial occlusive disease was characterized by the presence of a family history of peripheral arterial and carotid artery diseases (OR 2.3 and 5.8 respectively, 95% CI, high lipoprotein (a levels above 300 mg/L (OR 2.3, 95% CI, the presence of the factor V Leiden (OR 5.1, 95% CI and the glycoprotein Ia(807T,837T,873A allele (OR 2.3, 95% CI. In thromboangiitis obliterans group, more patients were regular consumers of cannabis (OR 3.5, 95% CI and higher levels in plasma copper has been shown (OR 6.5, 95% CI. CONCLUSIONS: According to our results from a non exhaustive list of study parameters, we might hypothesize for 1 a genetic basis for premature peripheral arterial occlusive disease development and 2 the prevalence of environmental factors in the development of thromboangiitis obliterans (tobacco and cannabis. Moreover, for the first time, we demonstrated that the 807T/837T/873A allele of platelet glycoprotein Ia may confer an additional risk for development of peripheral

  5. Alternative Physical Therapy Protocol Using a Cycle Ergometer During Hospital Rehabilitation of Coronary Artery Bypass Grafting: a Clinical Trial

    Science.gov (United States)

    Trevisan, Margarete Diprat; Lopes, Diene Gomes Colvara; de Mello, Renato Gorga Bandeira; Macagnan, Fabrício Edler; Kessler, Adriana

    2015-01-01

    OBJECTIVE To compare the efficacy of a cycle ergometer-based exercise program to a standard protocol on the increment of the maximum distance walked during the six-minute walk test in the postoperative rehabilitation of patients submitted to coronary artery bypass grafting. METHODS A controlled clinical trial pilot, blinded to the outcome, enrolled subjects who underwent coronary artery bypass grafting in a hospital from Southern Brazil. Subjects were designated for the standard physical rehabilitation protocol or to an alternative cycle ergometer-based protocol through simple random sampling. The primary outcome was the difference in the maximum distance walked in the six-minute walk test before and after the allocated intervention. RESULTS Twenty-four patients were included in the analysis, 10 in the standard protocol and 14 in the alternative protocol group. There was an increment in the maximum distance walked in both groups, and borderline superiority in the intervention group comparing to the control group (312.2 vs. 249.7; P=0.06). CONCLUSION There was an increase in the maximum distance walked in the alternative protocol compared to the standard protocol. Thus, it is postulated that the use of a cycle ergometer can be included in physical rehabilitation in the hospital phase of postoperative coronary artery bypass grafting. However, randomized studies with larger sample size should be conducted to assess the significance of these findings. PMID:26934400

  6. ROLE OF CELECOXIB IN BENIGN BREAST DISEASE: RANDOMISED CONTROL TRIAL

    Directory of Open Access Journals (Sweden)

    Soumen Das

    2012-06-01

    Full Text Available Benign Breast Disease (BBD, commonest cause of morbidity in females due to breast diseases, still offers therapeutic challenge. Several drug therapies (with Evening Primrose Oil, Danazol etc have been tried, but none made gold standard. Reports on effect of Cox-2 inhibitors are scarce. This randomized control trial aims at determination of effect of Cox- inhibitors (Celecoxib in BBD in comparison to Evening Primrose Oil (EPO . Celecoxib showed better reduction in lump size (in 80% than EPO group (in 50%. Pain reduction was excellent in COX -2 groups as compared to EPO group. Recurrence rate was also lower in Celecoxib group at 10 weeks. Side effects were almost nil in both the groups. Celecoxib is better than EPO in the management of BBD. Short course therapy with COX-2 inhibitors gives good pain relief, greater reduction in lump size, low recurrence with minimum side effects.

  7. Coronary artery disease in type 2 diabetes mellitus:Recent treatment strategies and future perspectives

    Institute of Scientific and Technical Information of China (English)

    Ryo; Naito; Takatoshi; Kasai

    2015-01-01

    Patients with type 2 diabetes mellitus(T2DM) are at a higher risk of developing coronary artery disease(CAD) than are non-T2 DM patients. Moreover, the clinical outcomes in CAD with T2 DM are poor despite improvements in medications and other interventions. Coronary artery bypass grafting is superior to percutaneous coronary intervention in treating multivessel coronary artery disease in diabetic patients. However, selecting a revascularization strategy depends not only on the lesion complexity but also on the patient’s medical history and comorbidities. Additionally, comprehensive risk management with medical and non-pharmacological therapies is important, as is confirmation regarding whether the risk-management strategies are being appropriately achieved. Furthermore, non-pharmacological interventions using exercise and diet during the earlier stages of glucose metabolism abnormalities, such as impaired glucose tolerance, might be beneficial in preventing the development or progression of T2 DM and in reducing the occurrence of cardiovascular events.

  8. Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease

    Institute of Scientific and Technical Information of China (English)

    胡盛寿; 王小启; 宋云虎; 吕锋

    2003-01-01

    Objective To compare graft patency in off-pump and conventional coronary artery bypass grafting by using the transit time flow meter in the treatment of triple vessel coronary artery disease. Methods Between June 2000 and April 2001, 60 patients with triple vessel coronary artery disease underwent coronary artery bypass grafting. They were divided into two groups: off-pump and conventional coronary artery bypass. All completed grafts were tested intraoperatively using Transit Time Flow Measurement (TTFM). Preoperative and postoperative variables of the two groups were also compared. Results There were no significant differences in sex, age, weight, acute or remote myocardial infarction, hypertension, diabetes and type of bypass grafts between the two groups. The number of bypass grafts and the assisted respiratory time of the off-pump coronary artery bypass grafting (OPCAB) group were significantly less than those of the conventional coronary artery bypass grafting (CCABG) group. The flow and pulsatile index (PI) of the left anterior descending artery bypass grafts and the right coronary artery bypass grafts were not significantly different between the OPCAB and CCABG groups. The flow of OM in the CCABG group with the multiple anastomosis site of sequential grafts was higher than that in the OPCAB group. Diffused narrow coronary artery bypass grafts in both groups had less flow.Conclusion No signficant differences in graft patency were observed in patients with triple vessel coronary artery disease who had undergone OPCAB or CCABG.

  9. Carotid artery disease and low cerebral perfusion pressure

    DEFF Research Database (Denmark)

    Schroeder, T; Utzon, N P; Aabech, J

    1990-01-01

    Direct internal carotid artery blood pressure measurements in patients undergoing carotid endarterectomy identified 49 patients, among 239 consecutive cases (21%), who had a reduction in perfusion pressure of 20% or more. The clinical history, objective findings and angiographic data were compared...... with those of a control group of a further 49 patients selected from the remaining patients operated on over the same period. The two groups were compared for short- and long-term outcome of surgery. We were unable to delineate a symptomatic neurological profile that identified patients with low perfusion...... pressures. Surgery in patients with low perfusion pressures seemed to be associated with an increased complication rate (12% versus 4%), although this was not statistically significant. Definite postoperative improvements in persisting neurological deficits were observed only in one patient. Long...

  10. The dietary fatty acids of patients with coronary artery disease and controls in Curacao - Implications for primary and secondary prevention

    NARCIS (Netherlands)

    Brouwer, DAJ; vanderDijs, FPL; Leerink, CB; Steward, HN; Kroon, TAJ; Suverkropp, GHJ; Romer, JWP; vanDoormaal, JJ; Muskiet, FAJ

    1997-01-01

    Patients with coronary artery disease are advised to augment their dietary linoleic acid intakes at the expense of saturated fatty acids. We investigated whether the dietary linoleic acid intake of 57 patients with coronary artery disease (47 males, 10 females; ages 61 +/- 10 years) in Curacao is hi

  11. Serial measurements of high-sensitivity cardiac troponin T after exercise stress test in stable coronary artery disease

    DEFF Research Database (Denmark)

    Axelsson, Anna; Ruwald, Martin Huth; Dalsgaard, Morten;

    2013-01-01

    The aim was to assess serial measurements of high-sensitivity cardiac troponin T (hs-cTNT) post-exercise in patients with stable coronary artery disease (CAD).......The aim was to assess serial measurements of high-sensitivity cardiac troponin T (hs-cTNT) post-exercise in patients with stable coronary artery disease (CAD)....

  12. ASSESSMENT OF AWARENESS LEVEL OF OWN DISEASE IN PATIENTS WITH STABLE ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    G. F. Andreeva

    2005-01-01

    Full Text Available Arterial hypertension (AH is the most frequent risk factor of cardiovascular diseases and related mortality in all developed countries. Altough therapy with antihypertensive drugs significantly reduces this risk, patients with stable mild hypertension have poor compliance with the treatment. The reasons and levels of inadequacy of antihypertensive therapy in this group of patients are well-known.Aim. To evaluate the awareness level of own disease, adequacy of therapy only in those patients with stable mild arterial hypertension, who are complied with recommendations of physicians concerning AH treatment and changing of mode of life. It was also planned to reveal possible grounds for inadequate secondary prevention of cardiovascular disease.Materials and methods. 76 patiens with stable mild arterial hypertension were included into study. They didn’t have any serious concomitant diseases and were complied with the recommendations of physicians concerning secondary prevention of cardiovascular disease. Questionnaire of State Research Center for Preventive Medicine “Assessment of awareness level of own disease in patients with stable arterial hypertension” was used in the study.Results. It was revealed, that the majority of patients, invoved in the study, were nonsmokers and regularly took antihypertensive drugs. 70% of questioned patients reached the target arterial blood pressure levels, while patients with arterial hypertension in general Russia population received regular and efficient treatment in less than 30-20%. Drugs treatment of questioned patients almost didn’t differ from that, which received patients in out-patient clinics of Moscow: in both cases ACE inhibitors were preferred. Only 29% of questioned patients knew their lipid levels in blood and none of the patients took drugs, reducing levels of lipids in blood. Half of the patients, that took part in our study, had increased level of body mass index.Conclusions. Inadequate

  13. Selective uterine artery embolization: a new therapeutic approach in a patient with low-risk gestational trophoblastic disease.

    Science.gov (United States)

    Carlini, Laura; Villa, Antonella; Busci, Luisa; Trezzi, Gaetano; Agazzi, Roberto; Frigerio, Luigi

    2006-07-01

    We report a case of persistent gestational trophoblastic disease (GTD) in which a selective uterine artery embolization instead of invasive surgery achieved both the control of pelvic hemorrhage and of disease.

  14. Role of Metals and Aspects of Socioeconomic Status (SES) in Peripheral Arterial Disease in the US Population

    Science.gov (United States)

    Atherosclerosis and atherothrombosis are serious pathological changes and are responsible for various disease conditions such as peripheral arterial disease (PAD). The prevalence of PAD, commonly assessed by Ankle–Brachial Index (ABI), is over 10% in the US population over...

  15. Pathogenesis of coronary artery disease: focus on genetic risk factors and identification of genetic variants

    Directory of Open Access Journals (Sweden)

    Sayols-Baixeras S

    2014-01-01

    Full Text Available Sergi Sayols-Baixeras, Carla Lluís-Ganella, Gavin Lucas, Roberto ElosuaCardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, SpainAbstract: Coronary artery disease (CAD is the leading cause of death and disability worldwide, and its prevalence is expected to increase in the coming years. CAD events are caused by the interplay of genetic and environmental factors, the effects of which are mainly mediated through cardiovascular risk factors. The techniques used to study the genetic basis of these diseases have evolved from linkage studies to candidate gene studies and genome-wide association studies. Linkage studies have been able to identify genetic variants associated with monogenic diseases, whereas genome-wide association studies have been more successful in determining genetic variants associated with complex diseases. Currently, genome-wide association studies have identified approximately 40 loci that explain 6% of the heritability of CAD. The application of this knowledge to clinical practice is challenging, but can be achieved using various strategies, such as genetic variants to identify new therapeutic targets, personal genetic information to improve disease risk prediction, and pharmacogenomics. The main aim of this narrative review is to provide a general overview of our current understanding of the genetics of coronary artery disease and its potential clinical utility.Keywords: coronary artery disease, pathogenesis, genetic risk factors, genetic variants

  16. Circulating endothelial cells in coronary artery disease and acute coronary syndrome

    NARCIS (Netherlands)

    Schmidt, David E; Manca, Marco; Höfer, Imo E

    2015-01-01

    Circulating endothelial cells (CECs) have been put forward as a promising biomarker for diagnosis and prognosis of coronary artery disease and acute coronary syndromes. This review entails current insights into the physiology and pathobiology of CECs, including their relationship with circulating en

  17. Clinical classification in pediatric pulmonary arterial hypertension associated with congenital heart disease

    NARCIS (Netherlands)

    Zijlstra, Willemijn M H; Douwes, Johannes M; Ploegstra, Mark-Jan; Krishnan, Usha; Roofthooft, Marcel; Hillege, Hans L; Ivy, D Dunbar; Rosenzweig, Erika B; Berger, Rolf M F

    2016-01-01

    Congenital heart disease (CHD) is a frequent cause of pediatric pulmonary arterial hypertension (PAH), with diverse etiology and outcome. We aimed to describe phenotypic heterogeneity in pediatric PAH associated with CHD (PAH-CHD), assess the applicability of the Nice CHD classification, and explore

  18. Common variants associated with plasma triglycerides and risk for coronary artery disease

    NARCIS (Netherlands)

    Do, Ron; Willer, Cristen J; Schmidt, Ellen M; Sengupta, Sebanti; Gao, Chi; Peloso, Gina M; Gustafsson, Stefan; Kanoni, Stavroula; Ganna, Andrea; Chen, Jin; Buchkovich, Martin L; Mora, Samia; Beckmann, Jacques S; Bragg-Gresham, Jennifer L; Chang, Hsing-Yi; Demirkan, Ayşe; Den Hertog, Heleen M; Donnelly, Louise A; Ehret, Georg B; Esko, Tõnu; Feitosa, Mary F; Ferreira, Teresa; Fischer, Krista; Fontanillas, Pierre; Fraser, Ross M; Freitag, Daniel F; Gurdasani, Deepti; Heikkilä, Kauko; Hyppönen, Elina; Isaacs, Aaron; Jackson, Anne U; Johansson, Asa; Johnson, Toby; Kaakinen, Marika; Kettunen, Johannes; Kleber, Marcus E; Li, Xiaohui; Luan, Jian'an; Lyytikäinen, Leo-Pekka; Magnusson, Patrik K E; Mangino, Massimo; Mihailov, Evelin; Montasser, May E; Müller-Nurasyid, Martina; Nolte, Ilja M; O'Connell, Jeffrey R; Palmer, Cameron D; Perola, Markus; Petersen, Ann-Kristin; Sanna, Serena; Saxena, Richa; Service, Susan K; Shah, Sonia; Shungin, Dmitry; Sidore, Carlo; Song, Ci; Strawbridge, Rona J; Surakka, Ida; Tanaka, Toshiko; Teslovich, Tanya M; Thorleifsson, Gudmar; Van den Herik, Evita G; Voight, Benjamin F; Volcik, Kelly A; Waite, Lindsay L; Wong, Andrew; Wu, Ying; Zhang, Weihua; Absher, Devin; Asiki, Gershim; Barroso, Inês; Been, Latonya F; Bolton, Jennifer L; Bonnycastle, Lori L; Brambilla, Paolo; Burnett, Mary S; Cesana, Giancarlo; Dimitriou, Maria; Doney, Alex S F; Döring, Angela; Elliott, Paul; Epstein, Stephen E; Eyjolfsson, Gudmundur Ingi; Gigante, Bruna; Goodarzi, Mark O; Grallert, Harald; Gravito, Martha L; Groves, Christopher J; Hallmans, Göran; Hartikainen, Anna-Liisa; Hayward, Caroline; Hernandez, Dena; Hicks, Andrew A; Holm, Hilma; Hung, Yi-Jen; Illig, Thomas; Jones, Michelle R; Kaleebu, Pontiano; Kastelein, John J P; Khaw, Kay-Tee; Kim, Eric; Klopp, Norman; Komulainen, Pirjo; Kumari, Meena; Langenberg, Claudia; Lehtimäki, Terho; Lin, Shih-Yi; Lindström, Jaana; Loos, Ruth J F; Mach, François; McArdle, Wendy L; Meisinger, Christa; Mitchell, Braxton D; Müller, Gabrielle; Nagaraja, Ramaiah; Narisu, Narisu; Nieminen, Tuomo V M; Nsubuga, Rebecca N; Olafsson, Isleifur; Ong, Ken K; Palotie, Aarno; Papamarkou, Theodore; Pomilla, Cristina; Pouta, Anneli; Rader, Daniel J; Reilly, Muredach P; Ridker, Paul M; Rivadeneira, Fernando; Rudan, Igor; Ruokonen, Aimo; Samani, Nilesh; Scharnagl, Hubert; Seeley, Janet; Silander, Kaisa; Stančáková, Alena; Stirrups, Kathleen; Swift, Amy J; Tiret, Laurence; Uitterlinden, Andre G; van Pelt, L Joost; Vedantam, Sailaja; Wainwright, Nicholas; Wijmenga, Cisca; Wild, Sarah H; Willemsen, Gonneke; Wilsgaard, Tom; Wilson, James F; Young, Elizabeth H; Zhao, Jing Hua; Adair, Linda S; Arveiler, Dominique; Assimes, Themistocles L; Bandinelli, Stefania; Bennett, Franklyn; Bochud, Murielle; Boehm, Bernhard O; Boomsma, Dorret I; Borecki, Ingrid B; Bornstein, Stefan R; Bovet, Pascal; Burnier, Michel; Campbell, Harry; Chakravarti, Aravinda; Chambers, John C; Chen, Yii-Der Ida; Collins, Francis S; Cooper, Richard S; Danesh, John; Dedoussis, George; de Faire, Ulf; Feranil, Alan B; Ferrières, Jean; Ferrucci, Luigi; Freimer, Nelson B; Gieger, Christian; Groop, Leif C; Gudnason, Vilmundur; Gyllensten, Ulf; Hamsten, Anders; Harris, Tamara B; Hingorani, Aroon; Hirschhorn, Joel N; Hofman, Albert; Hovingh, G Kees; Hsiung, Chao Agnes; Humphries, Steve E; Hunt, Steven C; Hveem, Kristian; Iribarren, Carlos; Järvelin, Marjo-Riitta; Jula, Antti; Kähönen, Mika; Kaprio, Jaakko; Kesäniemi, Antero; Kivimaki, Mika; Kooner, Jaspal S; Koudstaal, Peter J; Krauss, Ronald M; Kuh, Diana; Kuusisto, Johanna; Kyvik, Kirsten O; Laakso, Markku; Lakka, Timo A; Lind, Lars; Lindgren, Cecilia M; Martin, Nicholas G; März, Winfried; McCarthy, Mark I; McKenzie, Colin A; Meneton, Pierre; Metspalu, Andres; Moilanen, Leena; Morris, Andrew D; Munroe, Patricia B; Njølstad, Inger; Pedersen, Nancy L; Power, Chris; Pramstaller, Peter P; Price, Jackie F; Psaty, Bruce M; Quertermous, Thomas; Rauramaa, Rainer; Saleheen, Danish; Salomaa, Veikko; Sanghera, Dharambir K; Saramies, Jouko; Schwarz, Peter E H; Sheu, Wayne H-H; Shuldiner, Alan R; Siegbahn, Agneta; Spector, Tim D; Stefansson, Kari; Strachan, David P; Tayo, Bamidele O; Tremoli, Elena; Tuomilehto, Jaakko; Uusitupa, Matti; van Duijn, Cornelia M; Vollenweider, Peter; Wallentin, Lars; Wareham, Nicholas J; Whitfield, John B; Wolffenbuttel, Bruce H R; Altshuler, David; Ordovas, Jose M; Boerwinkle, Eric; Palmer, Colin N A; Thorsteinsdottir, Unnur; Chasman, Daniel I; Rotter, Jerome I; Franks, Paul W; Ripatti, Samuli; Cupples, L Adrienne; Sandhu, Manjinder S; Rich, Stephen S; Boehnke, Michael; Deloukas, Panos; Mohlke, Karen L; Ingelsson, Erik; Abecasis, Goncalo R; Daly, Mark J; Neale, Benjamin M; Kathiresan, Sekar

    2013-01-01

    Triglycerides are transported in plasma by specific triglyceride-rich lipoproteins; in epidemiological studies, increased triglyceride levels correlate with higher risk for coronary artery disease (CAD). However, it is unclear whether this association reflects causal processes. We used 185 common va

  19. High-density lipoproteins and coronary artery disease: a single-center cohort study

    NARCIS (Netherlands)

    Schaffer, A.; Verdoia, M.; Barbieri, L.; Aprami, T.M.; Suryapranata, H.; Marino, P.; Luca, G.D.

    2014-01-01

    Our goal was to estimate the role of high-density lipoprotein cholesterol (HDL-C) in predicting the prevalence and extent of coronary artery disease (CAD) in 3280 patients undergoing coronary angiography. Predictors of lower HDL levels (<32 mg/dL) were male gender (P < .001), diabetes mellitus

  20. Etiology of End-Stage Renal Disease and Arterial Stiffness among Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Balsam El Ghoul

    2017-01-01

    Full Text Available Background. Prior studies have demonstrated that conventional and emerging CV risk factors are associated with worsening arterial stiffness among end-stage renal disease (ESRD patients on hemodialysis. The present cross-sectional study evaluates the association between the etiology of ESRD and arterial stiffness among a cohort of hemodialysis patients. Methods. Etiology of ESRD was identified from patients’ medical records and classified as either vascular renal disease, diabetic nephropathy, nondiabetic glomerulopathy, tubular interstitial nephropathy, hereditary nephropathy, or ESRD of unconfirmed etiology. Results. A total of 82 subjects were enrolled. cfPWV was independently associated with the composite of either diabetic nephropathy or vascular renal disease (p=0.022, pulse pressure (p=0.001, and a history of CV events (p=0.025, but not history of hypertension or diabetes mellitus alone. The median cfPWVs in diabetic nephropathy and vascular renal disease were comparable and significantly higher than median cfPWVs in other etiologies of ESRD. Conclusion. The study suggests that the etiology of ESRD is independently associated with arterial stiffness among hemodialysis patients. Furthermore, arterial stiffness was higher among patients who developed renal sequelae of either diabetes mellitus or hypertension as compared with those who have a history of either diabetes mellitus or hypertension alone.

  1. Morphologic,mechanical and functional sonographic parameters of arteries in autosomal dominant polycystic kidney disease

    Institute of Scientific and Technical Information of China (English)

    戎殳

    2006-01-01

    Objective To investigate whether the risk factors of cardiovascular disease exist in early stage of ADPKD patients with normal renal function. Methods Morphologic , mechanical and functional sonographic parameters of arteries were examined by high-frequency ultrasonography in 32 hypertensive and 28 normotensive ADPKD patients with preserved renal function, 25 patients with es-

  2. The relationship between sex hormones and extent of coronary artery disease in postmenopausal women

    Institute of Scientific and Technical Information of China (English)

    Odgerel Tumur; HAN Jiang-li; YANG Chi-sun; MAO Jie-ming

    2007-01-01

    @@ The prevalence of coronary artery disease (CAD) in women increases with menopause. Results from the studies on the role of endogenous sex hormones on CAD in postmenopausal women are conflicting.1,2 The present study evaluated the relationship between endogenous sex hormones and extent of CAD in postmenopausal women and the associations of sex hormones with CAD risk factors.

  3. Large-Scale Gene-Centric Analysis Identifies Novel Variants for Coronary Artery Disease

    NARCIS (Netherlands)

    Butterworth, Adam S.; Braund, Peter S.; Farrall, Martin; Hardwick, Robert J.; Saleheen, Danish; Peden, John F.; Soranzo, Nicole; Chambers, John C.; Sivapalaratnam, Suthesh; Kleber, Marcus E.; Keating, Brendan; Qasim, Atif; Klopp, Norman; Erdmann, Jeanette; Assimes, Themistocles L.; Ball, Stephen G.; Balmforth, Anthony J.; Barnes, Timothy A.; Basart, Hanneke; Baumert, Jens; Bezzina, Connie R.; Boerwinkle, Eric; Boehm, Bernhard O.; Brocheton, Jessy; Bugert, Peter; Cambien, Francois; Clarke, Robert; Codd, Veryan; Collins, Rory; Couper, David; Cupples, L. Adrienne; de Jong, Jonas S.; Diemert, Patrick; Ejebe, Kenechi; Elbers, Clara C.; Elliott, Paul; Fornage, Myriam; Franzosi, Maria-Grazia; Frossard, Philippe; Garner, Stephen; Goel, Anuj; Goodall, Alison H.; Hengstenberg, Christian; Hunt, Sarah E.; Kastelein, John J. P.; Klungel, Olaf H.; Klueter, Harald; Koch, Kerstin; Koenig, Inke R.; Kooner, Angad S.; Laaksonen, Reijo; Lathrop, Mark; Li, Mingyao; Liu, Kiang; McPherson, Ruth; Musameh, Muntaser D.; Musani, Solomon; Nelson, Christopher P.; O'Donnell, Christopher J.; Ongen, Halit; Papanicolaou, George; Peters, Annette; Peters, Bas J. M.; Potter, Simon; Psaty, Bruce M.; Qu, Liming; Rader, Daniel J.; Rasheed, Asif; Rice, Catherine; Scott, James; Seedorf, Udo; Sehmi, Joban S.; Sotoodehnia, Nona; Stark, Klaus; Stephens, Jonathan; van der Schoot, C. Ellen; van der Schouw, Yvonne T.; Thorsteinsdottir, Unnur; Tomaszewski, Maciej; van der Harst, Pim; Vasan, Ramachandran S.; Wilde, Arthur A. M.; Willenborg, Christina; Winkelmann, Bernhard R.; Zaidi, Moazzam; Zhang, Weihua; Ziegler, Andreas; de Bakker, Paul I. W.; Koenig, Wolfgang; Maerz, Winfried; Trip, Mieke D.; Reilly, Muredach P.; Kathiresan, Sekar; Schunkert, Heribert; Hamsten, Anders; Hall, Alistair S.; Kooner, Jaspal S.; Thompson, Simon G.; Thompson, John R.; Deloukas, Panos; Ouwehand, Willem H.; Watkins, Hugh; Danesh, John; Samani, Nilesh J.

    2011-01-01

    Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. W

  4. Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training

    DEFF Research Database (Denmark)

    Pedersen, Lene Rørholm; Olsen, Rasmus Huan; Frederiksen, Marianne;

    2013-01-01

    Coronary artery disease (CAD) is accountable for more than 7 million deaths each year according to the World Health Organization (WHO). In a European population 80% of patients diagnosed with CAD are overweight and 31% are obese. Physical inactivity and overweight are major risk factors in CAD, t...

  5. Bioresorbable drug-eluting magnesium-alloy scaffold for treatment of coronary artery disease

    NARCIS (Netherlands)

    C.A.M. Campos (Carlos); T. Muramatsu (Takashi); A. Iqbal (Anwarul); Y.-J. Zhang (Ya-Jun); Y. Onuma (Yoshinobu); H.M. Garcia-Garcia (Hector); M. Haude; P.A. Lemos Neto (Pedro); B. Warnack (Boris); P.W.J.C. Serruys (Patrick)

    2013-01-01

    textabstractThe introduction of metallic drug-eluting stents has reduced the risk of restenosis and widened the indications of percutaneous coronary intervention in treatment of coronary artery disease. However, this medical device can induce hypersensitive reaction that interferes with the endothel

  6. Osteoprotegerin is higher in peripheral arterial disease regardless of glycaemic status.

    LENUS (Irish Health Repository)

    O'Sullivan, Eoin P

    2010-12-01

    Peripheral arterial disease (PAD) and type 2 diabetes mellitus (DM) are both associated with excessive vascular calcification and elevated levels of inflammatory markers IL-6 and hsCRP. The recently identified Osteoprotegerin(OPG)\\/RANKL\\/TRAIL pathway has been implicated in vascular calcification, but data on levels in PAD and effect of co-existent DM are lacking.

  7. Associations Between Conventional Cardiovascular Risk Factors and Risk of Peripheral Artery Disease in Men

    NARCIS (Netherlands)

    Joosten, Michel M.; Pai, Jennifer K.; Bertoia, Monica L.; Rimm, Eric B.; Spiegelman, Donna; Mittleman, Murray A.; Mukamal, Kenneth J.

    2012-01-01

    Context Previous studies have examined the associations of individual clinical risk factors with risk of peripheral artery disease (PAD), but the combined effects of these risk factors are largely unknown. Objective To estimate the degree to which the 4 conventional cardiovascular risk factors of sm

  8. CTA Quantification and Multi-modal Visualization for Assessing Coronary Artery Disease

    NARCIS (Netherlands)

    H.A. Kirisli (Hortense)

    2013-01-01

    textabstractIn cardiovascular disease, relating a coronary stenosis to a cardiac perfusion defect is of importance for selecting and planning the proper treatment. However, this is challenging owing to the high anatomical variability of the coronary arteries between patients. Anatomical and function

  9. Apolipoprotein-E polymorphism and response to pravastatin in men with coronary artery disease (REGRESS)

    NARCIS (Netherlands)

    A.H. Maitland-van de Zee; J.W. Jukema; A.H. Zwinderman; D.M. Hallman; A. de Boer; J.J.P. Kastelein; P. de Knijff

    2006-01-01

    Objectve - The influence of ApoE polymorphism on the efficacy of statins in lowering plasma lipids and lipoproteins and improving angiographic parameters was assessed. Methods: ApoE genotypes were studied in a group (n = 815) of well-characterised male coronary artery disease (CAD) patients who part

  10. Clinical outcome of patients with familial hypercholesterolemia and coronary artery disease undergoing partial ileal bypass surgery

    Directory of Open Access Journals (Sweden)

    Jaqueline Scholz Issa

    2000-07-01

    Full Text Available Familial hypercholesterolemia is characterized by high serum levels of total cholesterol and LDL-cholesterol. It may be homozygous or heterozygous. In homozygous patients, LDL-cholesterol levels range from 500 to 1000mg/dL and coronary artery disease is precocious, usually manifesting itself between the 2nd and 3rd decades of life. The diagnosis is often made by the presence of xanthoma tuberosum and tendinous xanthomas that appear between the 1st and 2nd decades of life. The use of high doses of statins or even unusual procedures (apheresis, partial ileal bypass surgery, liver transplantation, gene therapy, or both, is necessary for increasing survival and improving quality of life, because a reduction in cholesterol levels is essential for stabilizing the coronary artery disease and reducing xanthomas. We report our experience with 3 patients with xanthomatous familial hypercholesterolemia and coronary artery disease, who underwent partial ileal bypass surgery. Their follow-up over the years (approximately 8 years showed a mean 30% reduction in total cholesterol, with a significant reduction in the xanthomas and stabilization of the coronary artery disease.

  11. Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

    NARCIS (Netherlands)

    Amoroso, G; Van Boven, AJ; Crijns, HJGM

    2001-01-01

    Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

  12. Association of Skin Autofluorescence Levels With Kidney Function Decline in Patients With Peripheral Artery Disease

    NARCIS (Netherlands)

    Schutte, Elise; de Vos, Lisanne C; Lutgers, Helen L; Lambers Heerspink, Hiddo J; Wolffenbuttel, Bruce H R; Vart, Priya; Zeebregts, Clark J; Gansevoort, Ron T; Lefrandt, Joop D

    2016-01-01

    OBJECTIVE: Skin autofluorescence (SAF), a measure of advanced glycation end product accumulation, is associated with kidney function. We investigated the association of SAF with rate of kidney function decline in a cohort of patients with peripheral artery disease. APPROACH AND RESULTS: We performed

  13. Large-scale gene-centric analysis identifies novel variants for coronary artery disease

    NARCIS (Netherlands)

    Butterworth, A.S.; Braund, P.S.; Hardwick, R.J.; Saleheen, D.; Peden, J.F.; Soranzo, N.; Chambers, J.C.; Kleber, M.E.; Keating, B.; Qasim, A.; Klopp, N.; Erdmann, J.; Basart, H.; Baumert, J.H.; Bezzina, C.R.; Boehm, B.O.; Brocheton, J.; Bugert, P.; Cambien, F.; Collins, R.; Couper, D.; Jong, J.S. de; Diemert, P.; Ejebe, K.; Elbers, C.C.; Elliott, P.; Fornage, M.; Frossard, P.; Garner, S.; Hunt, S.E.; Kastelein, J.J.; Klungel, O.H.; Kluter, H.; Koch, K.; Konig, I.R.; Kooner, A.S.; Liu, K.; McPherson, R.; Musameh, M.D.; Musani, S.; Papanicolaou, G.; Peters, A.; Peters, B.J.; Potter, S.; Psaty, B.M.; Rasheed, A.; Scott, J.; Seedorf, U.; Sehmi, J.S.; Sotoodehnia, N.; Stark, K.; Stephens, J.; Schoot, C.E. van der; Schouw, Y.T. van der; Harst, P. van der; Vasan, R.S.; Wilde, A.A.; Willenborg, C.; Winkelmann, B.R.; Zaidi, M.; Zhang, W.; Ziegler, A.; Koenig, W.; Matz, W.; Trip, M.D.; Reilly, M.P.; Kathiresan, S.; Schunkert, H.; Hamsten, A.; Hall, A.S.; Kooner, J.S.; Thompson, S.G.; Thompson, J.R.; Watkins, H.; Danesh, J.; Barnes, T.; Rafelt, S.; Codd, V.; Bruinsma, N.; Dekker, L.R.; Henriques, J.P.; Koch, K.T.; Winter, R.J. de; Alings, M.; Allaart, C.F.; Gorgels, A.P.; Verheugt, F.W.A.; Mueller, M.; Meisinger, C.; DerOhannessian, S.; Mehta, N.N.; Ferguson, J.; Hakonarson, H.; Matthai, W.; Wilensky, R.; Hopewell, J.C.; Parish, S.; Linksted, P.; Notman, J.; Gonzalez, H.; Young, A.; Ostley, T.; Munday, A.; Goodwin, N.; Verdon, V.; Shah, S.; Edwards, C.; Mathews, C.; Gunter, R.; Benham, J.; Davies, C.; Cobb, M.; Cobb, L.; Crowther, J.; Richards, A.; Silver, M.; Tochlin, S.; Mozley, S.; Clark, S.; Radley, M.; Kourellias, K.; Olsson, P.; Barlera, S.; Tognoni, G.; Rust, S.; Assmann, G.; Heath, S.; Zelenika, D.; Gut, I.; Green, F.; Farrall, M.; Peden, J.; Goel, A.; Ongen, H.; Franzosi, M.G.; Lathrop, M.; Clarke, R.; Aly, A.; Anner, K.; Bjorklund, K.; Blomgren, G.; Cederschiold, B.; Danell-Toverud, K.; Eriksson, P.; Grundstedt, U.; Heinonen, M.; Hellenius, M.L.; Hooft, F. van 't; Husman, K.; Lagercrantz, J.; Larsson, A.; Larsson, M.; Mossfeldt, M.; Malarstig, A.; Olsson, G.; Sabater-Lleal, M.; Sennblad,