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Sample records for coronary artery stenosis

  1. Suture-induced right coronary artery stenosis.

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    Seltmann, Martin; Achenbach, Stephan; Muschiol, Gerd; Feyrer, Richard

    2010-01-01

    An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site. Invasive angiography confirmed the stenosis, and percutaneous intervention was successfully performed.

  2. Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis?

    NARCIS (Netherlands)

    F. Zijlstra (Felix); J.C.W. van Ommeren (Jan-Kees); J.H.C. Reiber (Johan); P.W.J.C. Serruys (Patrick)

    1987-01-01

    textabstractTo study the relationship between the quantitatively assessed coronary artery dimensions and the regional coronary flow reserve as measured by digital subtraction cineangiography, we investigated 17 coronary arteries with a single discrete proximal stenosis and 12 normal coronary

  3. Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery

    NARCIS (Netherlands)

    Mariani, MA; Boonstra, PW; Grandjean, JG; Monnink, SHJ; denHeijer, P; Crijns, HJGM

    Background: Isolated stenosis of the left anterior descending coronary artery can be treated with medication, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Recently a new treatment has been developed, which is called minimally invasive direct coronary artery

  4. Coronary Artery and Pulmonary Artery Fistula Originated from Significant Stenosis in the Left Anterior Descending Artery

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    Alper Sami Kunt

    2013-01-01

    Full Text Available Coronary artery fistula (CAF is defined as a rare anomalous connection between a coronary artery and a major vessel or a cardiac chamber. We report a case of a left anterior descending coronary (LAD stenosis and coronary artery fistula between the LAD coronary artery and the pulmonary artery (PA. CAF is often diagnosed by coronary angiogram. We describe our diagnostic approach and review the literature on the epidemiology, the pathophysiology, the diagnostic modalities, and the treatment options.

  5. Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

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    Alkan, Ozlem [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey)], E-mail: yalinozlem@hotmail.com; Kizilkilic, Osman; Yildirim, Tulin [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey); Atalay, Hakan [Department of Cardiovascular Surgery, Baskent University, Faculty of Medicine, Ankara (Turkey)

    2009-09-15

    Purpose: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors. Methods: We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS {>=} 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or {<=}25%, 25-49%, and {>=}50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded. Results: ECAS < 70% in 42 patients and ECAS {>=} 70% in 141 patients. ICAS was found in 51 patients and ICAS {>=} 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS. Conclusions: We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.

  6. Left coronary artery stenosis causing left ventricular dysfunction in two children with supravalvular aortic stenosis.

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    Yildiz, Okan; Altin, Firat H; Kaya, Mehmet; Ozyılmaz, Isa; Guzeltas, Alper; Erek, Ersin

    2015-04-01

    Congenital supravalvar aortic stenosis (SVAS) is an arteriopathy associated with Williams-Beuren syndrome (WBS) and other isolated elastin gene deletions. Cardiovascular manifestations associated with WBS are characterized by obstructive arterial lesions such as SVAS and pulmonary artery stenosis in addition to bicuspid aortic valve and mitral valve prolapse. However, coronary artery ostial stenosis may be associated with SVAS, and it increases the risk of sudden death and may complicate surgical management. In this report, we present our experience with two patients having SVAS and left coronary artery ostial stenosis with associated left ventricular dysfunction. © The Author(s) 2014.

  7. Significance of coronary artery calcification demonstrated by computed tomography in detecting coronary artery stenosis

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    Shiraki, Teruo; Akiyama, Yoko; Kita, Masahide [Iwakuni national Hospital, Yamaguchi (Japan)] [and others

    2002-02-01

    Serial 27 patients with angina attack were enrolled in this trial. Plain computed tomography (CT) of the chest and coronary angiogram were performed simultaneously. Calcification of main branch of coronary arteies (left main trunk, left anterior desending artery, left circumflex artery, right coronary artery) was judged visually. More than 50% stenosis was defined significant by quantitative coronary angiogram. Correlation between calcified lesions detected by CT and angiographic stenoses showed high specificity and negative predictive value was also high (sensitity=58%, specificity=80%, positive predictive value=27%, negative predictive value=94%, p<0.05). There was no significant correlation between patients with calcification of corornary artery and angiographic stenosis. The present study showed the low probability of significant stenosis without calcification and the high probability with multiple calcified lesions. (author)

  8. Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

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    Min Li

    2015-01-01

    Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

  9. Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting.

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    Tanaka, Akihito; Ishii, Hideki; Oshima, Hideki; Shibata, Yohei; Tatami, Yosuke; Osugi, Naohiro; Ota, Tomoyuki; Kawamura, Yoshihiro; Suzuki, Susumu; Usui, Akihiko; Murohara, Toyoaki

    2016-07-01

    Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.

  10. Fixed Coronary Artery Stenosis in Tunneled Coronary Artery Identified by Intravascular Ultrasound: A Case Report

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    Yuxiang Dai

    2014-10-01

    Full Text Available Myocardial bridging is characterized as the compression of a segment of the coronary artery during systole. Significant atherosclerosis within the bridge is almost never seen at pathologic examination because of the absence of synthetic type smooth muscle cells in the intima of the tunneled artery. To date, there have been no reports of significant atherosclerosis at the site of myocardial bridging documented by angiography or intravenous ultrasound. We report a rare case of fixed coronary artery stenosis at the site of myocardial bridging identified by intravascular ultrasound.

  11. Cerebral Lesions in Patients Undergoing Coronary Artery Bypass Grafting in Relation to Asymptomatic Carotid and Vertebral Artery Stenosis

    DEFF Research Database (Denmark)

    Wiberg, Sebastian; Schoos, Mikkel; Sillesen, Henrik

    2015-01-01

    OBJECTIVES: Carotid artery stenosis (CAS) and vertebral artery stenosis (VAS) are associated with cerebral infarction after coronary artery bypass graft surgery (CABG). It remains unclear whether this association is causal. We investigated the associations between neurologically asymptomatic CAS ...

  12. Prediction of Carotid Artery Stenosis in Candidates of Coronary Artery Bypasses Surgery by A Scoring System.

    OpenAIRE

    Sh. Shirani; Shakiba, M.; M. Soleymanzadeh

    2007-01-01

    Background and Objective: Up to 9% of coronary ar-tery bypass grafting (CABG) patients suffer from stroke after the surgery. Although post CABG stroke has multiple etiologies, stenosis of cervical carotid arteries is an important factor. Many studies have evaluated carotid artery stenosis in CABG. Carotid stenosis and its related factors and a new scoring sys-tem for selection of CABG patients for Doppler study are introduced. Materials and methods: 1721 consecutive cases of non-urgent CABG w...

  13. 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

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

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    Kosuga, Tsuneharu; Komukai, Kimiaki; Miyanaga, Satoru; Kubota, Takeyuki; Nakata, Kotaro; Suzuki, Kenichiro; Yamada, Takayuki; Yoshida, Jun; Kimura, Haruka; Yoshimura, Michihiro

    2016-05-01

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

  15. Coronary artery disease: Which degree of coronary artery stenosis is indicative of ischemia?

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    Donati, Olivio F. [Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland); Stolzmann, Paul [Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston (United States); Desbiolles, Lotus; Leschka, Sebastian [Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland); Kozerke, Sebastian [Institute for Biomedical Engineering, University and ETH Zurich (Switzerland); Plass, Andre [Clinic for Cardiovascular Surgery, University Hospital Zurich (Switzerland); Wyss, Christophe [Cardiovascular Center, Cardiology, University Hospital Zurich (Switzerland); Falk, Volkmar [Clinic for Cardiovascular Surgery, University Hospital Zurich (Switzerland); Marincek, Borut [Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland); Alkadhi, Hatem [Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston (United States); Scheffel, Hans, E-mail: hans.scheffel@usz.ch [Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston (United States)

    2011-10-15

    Purpose: To prospectively determine the best cut-off value of stenosis degree for low-dose computed tomography coronary angiography (CTCA) to predict the hemodynamic significance of coronary artery stenoses compared to catheter angiography (CA) using a cardiac magnetic resonance based approach as standard of reference. Materials and methods: Fifty-two patients (mean age, 64 {+-} 10 years) scheduled for CA underwent cardiac magnetic resonance (CMR) at 1.5-T and dual-source CTCA using prospective ECG-triggering the same day. Diagnostic performance of CTCA and CA to detect myocardial ischemia was evaluated with CMR as the standard of reference. The diagnostic performance and best cut-off values to predict the hemodynamic significance of coronary were determined from receiver operating characteristics analysis (ROC). Results: CA revealed >50% stenoses in 131/832 segments (15.7%) in 78/156 (50.0%) coronary arteries in 32/52 (62%) patients. CTCA revealed >50% stenoses in 148/807 (18.3%) segments, corresponding to 83/156 (53.2%) coronary arteries in 34/52 (65.4%) patients. CMR revealed ischemia in 118/832 (14.2%) myocardial segments corresponding to the territories of 60/156 (38.5%) coronary arteries in 29/52 (56%) patients. ROC analysis showed equal diagnostic performance for low-dose CTCA and CA with areas under the curve (AUC) of 0.82 and 0.83 (P = 0.64). The optimal cut-off value was determined at stenosis of >60% for the prediction of hemodynamically significant coronary stenosis by CTCA. Using this cut-off value, sensitivity, specificity, NPV and PPV to predict hemodynamic significance by CTCA were 100%, 83%, 100%, and 88% on a per-patient basis and 88%, 73%, 83% and 81% on a per-artery analysis, respectively. Conclusion: By considering coronary stenosis >60%, diagnostic performance for predicting the hemodynamic significance of coronary stenosis by CTCA is optimal and equals that of CA.

  16. A case of valvular pulmonic stenosis and an aberrant coronary artery in a Brittany spaniel.

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    Estey, Chelsie

    2011-05-01

    Valvular pulmonic stenosis and aberrancy of the right coronary artery with subsequent subvalvular stenosis was found on echocardiographic evaluation of a 9-month-old Brittany spaniel. Previous echocardiography at 4 mo of age revealed the pulmonic stenosis; however, the aberrant coronary artery only became apparent during the second evaluation.

  17. Influence of stenosis on hemodynamic parameters in the realistic left coronary artery under hyperemic conditions.

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    Kamangar, Sarfaraz; Badruddin, Irfan Anjum; Badarudin, A; Nik-Ghazali, N; Govindaraju, Kalimuthu; Salman Ahmed, N J; Yunus Khan, T M

    2017-03-01

    The current study investigates the hyperemic flow effects on heamodynamics parameters such as velocity, wall shear stress in 3D coronary artery models with and without stenosis. The hyperemic flow is used to evaluate the functional significance of stenosis in the current era. Patients CT scan data of having healthy and coronary artery disease was chosen for the reconstruction of 3D coronary artery models. The diseased 3D models of coronary artery shows a narrowing of >50% lumen area. Computational fluid dynamics was performed to simulate the hyperemic flow condition. The results showed that the recirculation zone was observed immediate to the stenosis and highest wall shear stress was observed across the stenosis. The decrease in pressure was found downstream to the stenosis as compared to the coronary artery without stenosis. Our analysis provides an insight into the distribution of wall shear stress and pressure drop, thus improving our understanding of hyperemic flow effect under both conditions.

  18. Diagnostic Efficacy of Vessel Specific Coronary Calcium Score in Detection of Coronary Artery Stenosis

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    Motevalli, Marzieh; Ghanaati, Hossein; Firouznia, Kavous; Kargar, Jalal; Aliyari Ghasabeh, Mounes; Shahriari, Mona; Jalali, Amir Hosein; Shakiba, Madjid

    2014-01-01

    Background: Coronary artery calcification which is determined quantitatively by coronary calcium scoring has been known as a sign of coronary stenosis and thus future cardiac events; hence it has been noticed on spotlight of researchers in recent years. Developing different method for early and optimal detection of coronary artery disease (CAD) is really essential as CAD are the first cause of death in population. Objectives: To evaluate predictive value of vessel specific coronary artery calcium (CAC) score in predicting obstructive coronary artery disease. Patients and Methods: In this diagnostic test study we evaluated patients with coronary computed tomography angiography (CCTA) and CAC score which had been referred to two referral radiology center in Tehran, Iran and finally we selected 2525 patients in a single and sequential pattern to create a diagnostic study. The whole-heart CAC scores and vessel specific CAC scores were calculated individually for the 4 major epicardial coronary arteries in 2 distinct group; group A ( patients with previous history of CABG) and group B (patients without history of CABG). For evaluation of obstruction tree cut off points were described: 0 > ; at least 1 segment with any kind of stenosis, ≥ 50; at least 1 segment with stenosis ≥ 50, ≥ 70; at least 1 segment with stenosis ≥ 70. Results: Mean of coronary calcium scores in terms of each coronary artery vessel increase by increasing coronary stenosis grade in group B; LAD, RCA, LCX respectively have mean CAC score 6.06, 6.21 and 5.04 in normal patients and 221.6, 226.7 and 106.6 in patients with complete stenosis. As expected these findings don't work for group A. Also By increasing calcium score cutoff in all four vessels sensitivity decreased and specificity increased but steal LAD had higher sensitivity than other vessels and LM had higher specificity. Thus using calcium score method is useful for ruling out stenosis in LAD while calcium score of LM can predict

  19. Simulation of Blood Flow Coronary Artery with Consecutive Stenosis and Coronary-Coronary Bypass

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    Omid Arjmandi-Tash

    2011-08-01

    Full Text Available Introduction: In this research the behavior of coronary arteries has been studied with symmetric and asymmetric consecutive stenosis, and grafted vessels. Methods: The incompressible Navier-Stokes and energy equations were discretized with second-order upwind method. Assumptions such as Newtonian fluid, wall rigidity and steady-flow were used. Results: All the calculations showed the same results with Newtonians and non-Newtonian fluids. It was found that the possibility of stenosis be reduced by increasing the graft angle. However, there exists further stenosis possibility. Among the three graft angles 20, 30 ̊ and 40, the 30 ̊ was found to be the reliable ones. Conclusion: Based on these findings, it can be deduced that there would be a high risk of further atherosclerosis when the first stenose has the maximum percentage.

  20. Incidental visceral and renal artery stenosis in patients undergoing coronary angiography.

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    Bageacu, S; Cerisier, A; Isaaz, K; Nourissat, A; Barral, X; Favre, J-P

    2011-03-01

    The study aimed to examine the association between incidentally discovered mesenteric artery stenosis, renal artery stenosis (RAS) and coronary artery disease in patients undergoing coronary angiography. We performed a prospective analysis of consecutive patients undergoing routine cardiac catheterisation. Abdominal aortograms in lateral and antero-posterior view were obtained to assess arterial stenosis of the coeliac axis, superior mesenteric artery and renal arteries. Significant arterial stenosis was defined as a narrowing of at least 50% compared with the normal artery. Demographic data and cardiovascular risk factors were analysed. The prevalence of visceral artery stenosis (VAS) was 63/450 (14%) including 48/450 (10.6%) cases of coeliac axis stenosis and 15/450 (3.3%) cases of superior mesenteric artery stenosis. Female sex (p = 0.01), older age (p = 0.03) and the presence of coronary artery disease (p = 0.05) were significant predictors for the presence of VAS in univariate analysis. The determinants for VAS in multivariate analysis were female sex and three-vessel coronary artery disease, while two- and three-vessel coronary artery disease was significant for RAS. Screening for VAS and RAS in female patients older than 60 years with more than two diseased coronary segments could have a high diagnostic value. Copyright © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  1. Prediction of Carotid Artery Stenosis in Candidates of Coronary Artery Bypasses Surgery by A Scoring System.

    Directory of Open Access Journals (Sweden)

    Sh. Shirani

    2007-05-01

    Full Text Available Background and Objective: Up to 9% of coronary ar-tery bypass grafting (CABG patients suffer from stroke after the surgery. Although post CABG stroke has multiple etiologies, stenosis of cervical carotid arteries is an important factor. Many studies have evaluated carotid artery stenosis in CABG. Carotid stenosis and its related factors and a new scoring sys-tem for selection of CABG patients for Doppler study are introduced. Materials and methods: 1721 consecutive cases of non-urgent CABG were evaluated for presence of significant carotid stenosis (> 50% stenosis. The asso-ciation of age, sex, hypertension, smoking, diabetes, dislipidemia and left main coronary stenosis with ca-rotid stenosis was evaluated. For introducing a scor-ing method, absence of each related factor was scored by 1 and its presence by 2. The score range for each patient was from 5 (none of related factors up to 10 (all of related factors. Results: 7% of patients suffered from significant stenosis. Female gender, age more than 55 years old, hypertension, diabetes, and stenosis of left main coronary artery were the related risk factors in uni-variate analysis. A step type analysis revealed patients with score 5 have 98.3% negative predictive value (NPV for significant stenosis with 96.2% sensitivity and 13.9% specificity. Patients with score 10 have 93.9% NPV for significant stenosis with 99.9% speci-ficity. Conclusion: This scoring system may help for better selection of patients for Doppler study before CABG.

  2. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

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    Marcelo A. Nakazone

    2010-01-01

    Full Text Available Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

  3. Correlations Between the Gradient of Contrast Density, Evaluated by Cardio CT, and Functional Significance of Coronary Artery Stenosis

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    Orzan Marius

    2016-06-01

    Full Text Available Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.

  4. Coronary Artery Stenosis Flow: Experimental and Computational Investigation

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    Egelhoff, Carla; Budwig, Ralph; Hansen, Byron; Foster, Jonathan

    2000-11-01

    The effects of symmetry, flowrate, wall roughness and size are investigated using realistic pulsatile waveforms for flow viz and LDV experimental models as well as CFD models using original code. Distal to the stenosis flow is characterized by a high speed jet which is central for symmetric models and attached to the wall for eccentric models. The jet is accompanied by a low speed recirculation zone which persists while lengthening and shortening during most of the cardiac cycle. Of particular note is the downstream onset of flow instability and turbulence for high flow rate conditions in symmetric and eccentric severely occluded stenoses. The location and extent of the unstable flow region continually changes throughout the cycle, which may be a factor contributing to the thrombogenesis which coronary arteries experience.

  5. Relationship between Renal Artery Stenosis and Severity of Coronary Artery Disease in Patients with Coronary Atherosclerotic Disease

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    Amirfarhang Zandparsa

    2012-09-01

    Full Text Available Objective: The aim of the present investigation was to explore probable association of renal artery stenosis (RAS with coronary artery disease (CAD and the prevalence of renal artery stenosis (RAS in patients with CAD. Patients and methods: This study comprised 165 consecutive patients with CAD, including 52.7% males and 47.2% females with respective mean ages of 60.3 ±8.9 and 59.5±10.1. The patients underwent simultaneous coronary and renal angiographies, and the lumen reduction of 50% or more was considered as significant stenosis. Indeed, stenosis of more than 70% of the arterial lumen was regarded as severe. Results: According to our findings, the prevalence of renal artery stenosis in our hypertensive and normotensive patients were 46.2% and 19.5% respectively (p=0.002. Renal artery angiography revealed that 64 (38.8% of the patients had simultaneous renal artery stenosis. RAS is more common in females than males (p=0.031. Multivariate analysis revealed that among all examined factors, hypertension and serum creatinine were associated with RAS. There was no correlations found between gensini score and RAS (p=0.63. Conclusion: We found a relatively high prevalence of RAS including 46.2% in hypertensive and 19.5% in normotensive patients in our patients with CAD.

  6. Intervening for RPA stenosis following Waterston shunt: Importance of anatomical definition of the coronary arteries.

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    Hovis, Ian W; Sutton, Nicole J; Pass, Robert H

    2014-03-01

    Right pulmonary artery (RPA) stenosis following Waterston shunt is common. We report a case of RPA stenosis many years following tetralogy of Fallot repair with take-down of a Waterston shunt and demonstrate an unusual and important anatomic variant of proximity of the left coronary artery to the mid-portion of the RPA. Copyright © 2013 Wiley Periodicals, Inc.

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

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    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.

  8. Safety and efficacy of coronary drug eluting stent for atherosclerotic stenosis of the small renal artery

    Institute of Scientific and Technical Information of China (English)

    LI Chun-jie; WU Zheng; YAN Hong-bing; WANG Jian; ZHAO Han-jun

    2009-01-01

    @@ Small diameter renal artery refers to the renal artery with the cross-section diameter less than 5 mm, the incidence of which is approximately 8%.1 Small diameter renal artery is common in patients with congenital multi-branch renal arteries, diabetes and multi-coronary artery lesions. Renal artery bare-mental stent (BMS) implantation is the standard treatment for ostial renal artery stenosis.2,3 However, the restenosis rate4-6 is too high and becomes one of the relative contraindications for small diameter renal artery stent implantation. Clinical trials (e.g. RAVEL,7,8 SIRIUS9 and TAXUS-IV10) have proved that drug eluting stent (DES), compared with BMS, can reduce the restenosis rate after the percutanous coronary intervention (PCI). And Huda et al11 claimed that DES had the better results than BMS in the treatment of obstructive superficial femoral artery disease. However,there are few studies involved restenosis after the renal artery intervention. We hypothesized that coronary DES applied in renal artery stenosis might inhibit intimal proliferation effectively as in coronary artery disease;therefore we evaluated the results of 25 patients with atherosclerotic renal artery stenosis treated using coronary DES to assess the safety and efficacy of coronary DES in patients with small renal artery stenotic lesions.

  9. Aortic valvular disease and right coronary artery stenosis induced by mediastinal irradiation; Report of a case

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    Suzuki, Makoto; Hamada, Mareomi; Matsumoto, Yuji; Hiwada, Kunio; Osuka, Yo (Ehime Univ., Shigenobu (Japan). School of Medicine)

    1993-05-01

    This report presents a case of aortic valvular dysfunction and right coronary artery disease following radiation therapy on the mediastinum. A 61-year-old woman had received mediastinal radiation for the treatment of right mammary cancer 20 years previously. She developed symptoms of congestive heart failure 6 months ago. The patient was found to have aortic valvular dysfunction and proximal stenosis of the right coronary artery. Surgical aortic valve replacement improved cardiac status, and vasodilator treatment reduced ischemia due to right coronary artery stenosis (author).

  10. The relationships of carotid arthroscleroses with coronary artery stenosis in candidates for angiography

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    Mohammad Reza Saeidi

    2014-09-01

    Full Text Available Background: Coronary artery and carotid stenosis risk factors are frequently common in these two problems. The present study was aimed to determine the relationships between carotid arthroscleroses and coronary artery stenosis in candidates for cardiovascular angiography. Methods: In a cross sectional study, 218 candidates for cardiovascular angiography, visiting Imam Ali hospital of Kermanshah, were divided into two groups of case (158 subjects and control (60 subjects and were investigated by angiography and Doppler echo. Data were analyzed by Chi-square test (χ2 and multiple logistic regressions. Results: Totally, 47 subjects (21.6% had carotid stenosis with >50% plaque. The frequencies of this value in the case and control groups were 37 (23.4% and 10 (16.7% cases, respectively, indicating no significant difference between groups (P=0.27. There was a significant association between coronary artery and carotid stenosis, and female gender (P=0.008. However, no significant correlation was observed between smoking and history of hypertension in terms of age (P<0.05. Conclusion: There was no significant association between coronary artery and carotid stenosis occurrence. However, among independent risk factors, only females had an effective role in their co-occurrence. Therefore, considering the females with coronary artery or carotid stenosis and conducting preventive measures are recommended to prevent co-occurrence of these two problems.

  11. Prognostic Value of Gai's Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis

    Institute of Scientific and Technical Information of China (English)

    Chuang Zhang; Shuang Yang; Lu-Yue Gai; Zhi-Qi Han; Qian Xin; Xiao-Bo Yang; Jun-Jie Yang

    2016-01-01

    Background:The prognostic values of the coronary computed tomography angiography (CCTA) score for predicting future cardiovascular events have been previously demonstrated in numerous studies.However,few studies have used the rich information available from CCTA to detect functionally significant coronary lesions.We sought to compare the prognostic values of Gai's plaque score and the coronary artery calcium score (CACS) of CCTA for predicting functionally significant coronary lesions,using fractional flow reserve (FFR) as the gold standard.Methods:We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients (mean age,59.6 ± 10.2 years;76.14% of males) who underwent CCTA,invasive coronary angiography,and invasive FFR measurement.An FFR <0.80 indicated hemodynamically significant coronary stenosis.Lesions were divided into two groups using an FFR cutoff value of 0.80.We compared Gai's plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR.The statistical methods included unpaired t-test,Mann-Whitney U-test,and Spearman's correlation coefficients.Results:Coronary lesions with FFR <0.80 had higher Gai's scores than those with FFR ≥0.80.Gai's score had the strongest correlation with FFR (r =-0.48,P < 0.01) and had a greater area under the curve =0.72 (95% confidence interval:0.61-0.82;P < 0.01) than the CACS of whole arteries and a single artery.Conclusions:Both CACS in a single artery and Gai's plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR.However,Gai's plaque score was more predictive of FFR <0.80.Gai's score can be easily calculated in daily clinical practice and could be used when considering revascularization.

  12. Correlation between mimecan expression and coronary artery stenosis in patients with coronary heart disease.

    Science.gov (United States)

    Hu, Youdong; Liu, Junying; Zhao, Qingna; Xu, Peijing; Chen, Ying; Zhou, Hualan; Li, Xia

    2015-01-01

    This study aimed to investigate the correlation between coronary artery stenosis and Mimecan expression in patients with coronary heart disease (CHD). Seventy eight patients with CHD and 80 controls without vascular lesions were recruited into present study. CHD patients were divided into one-vessel CHD subgroup, 2-vessel CHD subgroup and multivessel CHD subgroup. ELISA was performed to detect the expressions of serum Mimecan and nuclear factor kappaB (NF-κB). When compared with control group, the expressions of serum mimecan gene and NF-κB significantly increased in CHD groups (P coronary lesions (rmimecan=0.79, rNF-κB=0.83, P < 0.05). Increased expressions of serum mimecan and NF-κB in CHD patients are related to cardiac insufficiency, which may be ascribed to the binding of NF-κB to mimecan gene.

  13. "Killer coronary artery" and aortic valve stenosis: A tricky case.

    Science.gov (United States)

    Nader, Joseph; Labont, Béatris Alina; Houpe, David; Caus, Thierry

    2015-11-01

    Anomalous origin of the left main coronary artery from the right coronary sinus is rarely diagnosed in elderly patients. We report such an anomaly in a 75-year-old lady presenting with chest pain and syncope. Preoperative screening revealed that her aortic valve was moderately stenotic. The patient underwent a successful unroofing procedure combined with aortic valve replacement. The outcome was uncomplicated and the patient remained asymptomatic at one year postoperatively. © The Author(s) 2014.

  14. Quantification of stenosis in coronary artery via CTA using fuzzy distance transform

    Science.gov (United States)

    Xu, Yan; Saha, Punam K.; Hu, Guangshu; Liang, Guoyuan; Yang, Yan; Geng, Jinzhao

    2009-02-01

    tomographic angiography (CTA) being noninvasive, economical and informative, has become a common modality for monitoring disease status and treatment effects. Here, we present a new method for detecting and quantifying coronary arterial stenosis via CTA using fuzzy distance transform (FDT) approach. FDT computes local depth at each image point in the presence of partial voluming. Coronary arterial stenoses are detected and their severities are quantified by analyzing FDT values along the medial axis of an artery obtained by skeletonization. Also, we have developed a new skeletal pruning algorithm toward improving quality of medial axes and therefore, enhancing the accuracy of stenosis detection and quantification. The method is completed using the following steps - (1) fuzzy segmentation of coronary artery via CTA, (2) FDT computation of coronary arteries, (3) medial axis computation, (4) estimation of local diameter along arteries and (5) stenosis detection and quantification of arterial blockage. Performance of the method has been quantitatively evaluated on a realistic coronary artery phantom dataset with randomly simulated stenoses and the results are compared with a classical binary algorithm. The method has also been applied on a clinical CTA dataset from thirteen patients with 59 stenoses and the results are compared with an expert's quantitative assessment of stenoses. Results of the phantom experiment indicate that the new method is significantly more accurate as compared to the conventional binary method. Also, the results of the clinical study indicate that the computerized method is highly in agreement with the expert's assessments.

  15. Correlation between epicardial adipose tissue and severity of coronary artery stenosis evaluated by 64-MDCT.

    Science.gov (United States)

    Yang, Chunying; Li, Liang; Zha, Yunfei; Peng, Zhoufeng

    2016-01-01

    The purpose was to investigate the correlation between epicardial adipose tissue (EAT) thickness, EAT volume, and severity of coronary artery stenosis. We retrospectively enrolled 188 patients that underwent coronary computed tomography (CT) angiography for clinically suspected coronary artery disease using 64-MDCT. Images were reconstructed using a retrospective electrocardiogram-gated algorithm with 0.625-mm-thick sections. EAT thickness and volume were calculated. The coronary CT angiography showed 106 patients who had coronary artery pathology (178 lesions), 21 patients with moderate stenosis (27 lesions), 12 patients with severe stenosis (18 lesions), and 6 patients with complete occlusion (8 lesions). EAT thickness, EAT volume, and Gensini score were statistically different among groups (FT=32.306, FV=27.743, F=110.483, P=.000). Pearson correlation analysis showed that Gensini score had significantly positive correlation with EAT thickness and volume, respectively. EAT thickness and volume demonstrated a positive correlation with severity of coronary artery stenosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Assessment of myocardial segmental function with coronary artery stenosis in multi-vessel coronary disease patients with normal wall motion.

    Science.gov (United States)

    Xie, M-Y; Lv, Q; Wang, J; Yin, J-B

    2016-04-01

    To discover the impact of the various degrees of coronary artery stenosis (CAD) on the left ventricular systolic dysfunction in steady state with quantitative analysis of the regional systolic myocardium in longitudinal, radial and circumferential direction in patients with coronary artery disease by two-dimensional speckle tracking imaging (STI). Forty-three normal wall motion-multi vessel coronary artery disease (NWM-MVD) patients labeled as the experimental groups and forty-two subjects with little risk of CAD marked as the control group were enrolled in this study. The two-dimensional STI was obtained in the apical long axis and three levels of the short axis of the left ventricle. The left ventricular wall was divided into 18 segments. The affected myocardia were divided into three groups: group B (coronary stenosis degree ≤50%), group C (coronary stenosis degree 50%-99%)and group D (coronary stenosis degree ≥99%). Using the Q-analysis software, the longitudinal, radial and circumferential systolic strain (SL, SR, SC) and strain ratio (SrL, SrR, SrC) of the myocardium were analyzed. The bradycardia in the NWM-MVD group is greater than that in the control group (16/43 vs. 7/42, p coronary stenosis degree ≤50%), group C (coronary stenosis degree 50%-99%)and group D (coronary stenosis degree ≥99%), especially the longitudinal and radial systolic function, even though they had normal wall motion. The SrL equaled 1.085 for the cut-off value, and the sums (1.348) of sensitivity (0.673) and specificity (0.675) were the greatest. Bradycardia might be a compensatory mechanism in NWM-MVD patients.

  17. Influence of arterial wall-stenosis compliance on the coronary diagnostic parameters.

    Science.gov (United States)

    Konala, Bhaskar Chandra; Das, Ashish; Banerjee, Rupak K

    2011-03-15

    Functional diagnostic parameters such as Fractional Flow Reserve (FFR), which is calculated from pressure measurements across stenosed arteries, are often used to determine the functional severity of coronary artery stenosis. This study evaluated the effect of arterial wall-stenosis compliance, with limiting scenarios of stenosis severity, on the diagnostic parameters. The diagnostic parameters considered in this study include an established index, FFR and two recently developed parameters: Pressure Drop Coefficient (CDP) and Lesion Flow Coefficient (LFC). The parameters were assessed for rigid artery (RR; signifying high plaque elasticity), compliant artery with calcified plaque (CC; intermediate plaque elasticity) and compliant artery with smooth muscle cell proliferation (CS; low plaque elasticity), with varying degrees of epicardial stenosis. A hyperelastic Mooney-Rivlin model was used to model the arterial wall and plaque materials. Blood was modeled as a shear thinning, non-Newtonian fluid using the Carreau model. The arterial wall compliance was evaluated using the finite element method. The present study found that, with an increase in stenosis severity, FFR decreased whereas CDP and LFC increased. The cutoff value of 0.75 for FFR was observed at 78.7% area stenosis for RR, whereas for CC and CS the cutoff values were obtained at higher stenosis severities of 81.3% and 82.7%, respectively. For a fixed stenosis, CDP value decreased and LFC value increased with a decrease in plaque elasticity (RR to CS). We conclude that the differences in diagnostic parameters with compliance at intermediate stenosis (78.7-82.7% area blockage) could lead to misinterpretation of the stenosis severity. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Increased risk for intracranial arterial stenosis in subjects with coronary artery calcification.

    Science.gov (United States)

    Oh, Hyung-Geun; Chung, Pil-Wook; Rhee, Eun-Jung

    2015-01-01

    Intracranial arterial stenosis (ICAS) is considered an important cause of stroke in Asians. Coronary artery calcification (CAC) is a surrogate marker for subclinical atherosclerosis. We aimed to analyze the association of ICAS assessed by transcranial Doppler ultrasonography and CAC in middle-aged Korean population. This study included 10 550 participants (81.3% men, mean age 43 years) from a health screening program, in whom transcranial Doppler ultrasonography was used to detect >50% intracranial stenosis based on criteria modified from the stroke outcomes and neuroimaging of intracranial atherosclerosis trial. Multidetector computed tomography was used to assess coronary artery calcium score (CACS). CAC grade (0, 1-100, and >100) was defined by CACS. The subjects with CAC showed significantly higher proportion of subjects with ICAS compared with those without CAC (4.4% versus 2.8%; P400 compared with those with CACS=0 (odds ratio, 2.754; 95% confidence interval, 1.205-2.936). The risk for ICAS was significantly increased in middle-aged Korean subjects with CAC compared with that in those without CAC. These findings suggest the possibility of a separate undetected atherosclerotic focus in subjects with 1 atherosclerotic event. © 2014 American Heart Association, Inc.

  19. The use of coronary stent in hepatic artery stenosis after orthotopic liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Huang Mingsheng [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Shan Hong [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China)]. E-mail: gzshsums@public.guangzhou.gd.cn; Jiang Zaibo [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Li Zhengran [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Zhu Kangshun [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Guan Shouhai [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Qian Jiesheng [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Chen Guihua [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Lu Minqiang [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Yang Yang [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China)

    2006-12-15

    Purpose: This retrospective study was undertaken to evaluate the effectiveness of coronary stent placement in hepatic artery stenosis after orthotopic liver transplantation (OLT). Materials and methods: Of 430 consecutive adult orthotopic liver transplant recipients between November 2003 and September 2005, 17 had hepatic artery stenosis (HAS). Fourteen of them underwent coronary stent placement in the HAS. The technical results, complications, hepatic artery patency and clinical outcome were reviewed. Results: Technical and immediate success was 100%. After a mean follow-up of 159.4 days (range, 9-375 days), all patients obtained patent hepatic arteries except 2 patients occurred hepatic artery restenoses at 26 and 45 days after stent placement, respectively. Kaplan-Meier curve of patency showed cumulated stent patency at 3, 6, and 12 months of 78%, 58% and 45%, respectively. During the follow-up, 8 patients survived, 5 died of septic multiple-organ failure, 1 received retransplantation because of refractory biliary infection. Hepatic artery dissection induced by a guiding catheter occurred in one patient and was successfully treated with a coronary stent. Conclusion: Hepatic artery stenosis after OLT can be successfully treated with coronary stent placement with low complication rate and an acceptable 1-year hepatic artery patency rate.

  20. Aorta-LITA Bypass Grafting with Saphenous Vein in a Patient Undergoing Coronary Artery Surgery with Subclavian Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Kerim Çağlı

    2011-12-01

    Full Text Available The internal thoracic artery (ITA is the primary graft for coronary artery bypass grafting and can not be used if there is subclavian artery stenosis (SAS. Aorto-axillary, carotid-subclavian bypass and also angioplasty with stenting or other interventional treatments are acceptable procedures for SAS treatment. Aorta-ITA bypass with saphenous vein can be alternative and simple technique for SAS to save Winslow pathway for patients with peripheral artery disease.

  1. Stent implantation of left main coronary artery stenosis in an infant: Effective long-term treatment?

    Directory of Open Access Journals (Sweden)

    Christian Paech

    2015-01-01

    Full Text Available Coronary artery stenosis is a rare phenomenon in children. Coronary stent implantation is generally not considered a standard treatment option due to technical difficulties and potential complications in this group of patients. Nevertheless, several pediatric cases reporting successful implantation with acceptable short-term experiences have been described. The following case presents a successful stent implantation for left main coronary artery (LMCA stenosis early after surgery for anomalous left coronary artery from pulmonary artery (ALCAPA at the age of 6 months. The excellent mid-term results and notably the procedure′s potential as a long-term treatment in small children are highlighted. A 6-month-old infant underwent surgery for ALCAPA. Due to sudden postoperative deterioration, cardiac catheterization was performed. Coronary angiography revealed severe (90% ostial LMCA stenosis. A PROMUS drug-eluting stent (Promus Element AL3.0 Χ 8 mm, Boston Scientific, Natick, Massachusetts, USA was implanted. The procedure was performed without complications. Antiplatelet therapy with acetylsalicylic acid and clopidogrel was initiated. Subsequently, cardiac function improved slowly. Cardiac catheterization 3 years 8 months after stent implantation showed no restenosis with a proximal LMCA diameter still at the 50 th percentile for age. Neither were signs of heart failure reported at the last follow-up at 7 years of age. Presupposing normal growth, the implanted stent would thus provide sufficient myocardial perfusion with a LMCA lumen at the 40 th percentile at the age of 16 years. In selected cases, coronary stent implantation may be an effective mid- to long-term treatment of coronary artery stenosis even in very young children.

  2. Multislice Computed Tomography Accurately Detects Stenosis in Coronary Artery Bypass Conduits

    Science.gov (United States)

    Duran, Cihan; Sagbas, Ertan; Caynak, Baris; Sanisoglu, Ilhan; Akpinar, Belhhan; Gulbaran, Murat

    2007-01-01

    The aim of this study was to evaluate the accuracy of multislice computed tomography in detecting graft stenosis or occlusion after coronary artery bypass grafting, using coronary angiography as the standard. From January 2005 through May 2006, 25 patients (19 men and 6 women; mean age, 54 ± 11.3 years) underwent diagnostic investigation of their bypass grafts by multislice computed tomography within 1 month of coronary angiography. The mean time elapsed after coronary artery bypass grafting was 6.2 years. In these 25 patients, we examined 65 bypass conduits (24 arterial and 41 venous) and 171 graft segments (the shaft, proximal anastomosis, and distal anastomosis). Compared with coronary angiography, the segment-based sensitivity, specificity, and positive and negative predictive values of multislice computed tomography in the evaluation of stenosis were 89%, 100%, 100%, and 99%, respectively. The patency rate for multislice compu-ted tomography was 85% (55/65: 3 arterial and 7 venous grafts were occluded), with 100% sensitivity and specificity. From these data, we conclude that multislice computed tomography can accurately evaluate the patency and stenosis of bypass grafts during outpatient follow-up. PMID:17948078

  3. Development of coronary artery stenosis in a patient with metastatic renal cell carcinoma treated with sorafenib

    Directory of Open Access Journals (Sweden)

    Pantaleo Maria

    2012-06-01

    Full Text Available Abstract Background Tyrosine kinase inhibitors (TKIs are currently approved for the treatment of metastatic renal cell carcinoma (mRCC. The cardiotoxic effects of sorafenib and sunitinib may cause hypertension, left ventricular ejection fraction (LVEF dysfunction and/or congestive heart failure (CHF, and arterial thrombo-embolic events (ATE. Only three cases of coronary artery disease related to sorafenib therapy have been described in the literature, and all were due to arterial vasospasm without evidence of coronary artery stenosis on angiography. Cardiotoxicity is commonly associated with the presence of cardiovascular risk factors, such as a history of hypertension or coronary artery disease. Case presentation We describe a patient who experienced an unusual cardiac event after 2 years of sorafenib treatment. A 58-year-old man with mRCC developed acute coronary syndrome (ischemia/infarction associated with critical sub-occlusion of the common trunk of the left coronary artery and some of its branches, which was documented on coronary angiography. The patient underwent triple coronary artery bypass surgery, and sorafenib treatment was discontinued. He did not have any cardiovascular risk factors, and his cardiac function and morphology were normal prior to sorafenib treatment. Conclusions Further investigation of a larger patient population is needed to better understand cardiac damage due to TKI treatment. Understanding the usefulness of careful cardiovascular monitoring might be important for the prevention of fatal cardiovascular events, and to avoid discontinuation of therapy for the underlying cancer.

  4. Detection of severe left anterior descending coronary artery stenosis by transthoracic evaluation of resting coronary flow velocity dynamics

    Directory of Open Access Journals (Sweden)

    Edward G. Abinader

    2010-09-01

    Full Text Available In the presence of severe stenosis, coronary artery flow may be reduced at rest. Recent advances in echocardiography have made non-invasive sampling of velocities in the left an­terior descending coronary artery (LAD possible. The aim of our study was to evaluate feasi­bility and capability of transthoracic Doppler to detect severe stenosis of the LAD. The study population consisted of 42 subjects with suspected coronary artery disease scheduled for coronary angiography. All had complete transthoracic echocardiography and Doppler sampling of LAD velocities. Quantitative cor­onary angiography was performed within 24 hours of the echocardiogram. Correlations between LAD velocity profile, measurements and calculations, and the angiographic results were performed. Six subjects had LAD occlusion, 10 had severe (>80% diameter LAD stenosis, and 26 had normal or non-occlusive LAD disease. In all six subjects with LAD occlusion, distal LAD velocities were not detectable, while in the other 36 subjects, LAD velocities were recorded indicating the vessels were patent. In the 10 subjects with severe LAD stenosis, the diastolic/systolic velocity ratio was <1.5, while in those with non-signifi­cant LAD disease, the diastolic/systolic velocity ratio was >1.5 (P<0.005. Diastolic LAD flow was 21.8±13 mL/min in the presence of severe stenosis as compared to 48.5±20 mL/min in subjects without severe stenosis (P<0.0013. LAD velocities had high sensitiv­ity and specificity for the prediction of severe angiographic stenosis. Thus transthoracic Doppler measurement of LAD velocities is feas­ible and can predict the presence of severe LAD stenosis or occlusion.

  5. Correlation of ascending aorta elasticity and the severity of coronary artery stenosis in hypertensive patients with coronary heart disease assessed by M-mode and tissue Doppler echocardiography.

    Science.gov (United States)

    Lu, Qixiu; Liu, Houlin

    2015-03-01

    The main objective of this study is to investigate the relationship between ascending aorta elasticity and the severity of coronary artery stenosis in essential hypertensive patients with coronary heart disease (CHD) using M-mode and tissue Doppler echocardiography. A total of 184 hypertensive patients with CHD were enrolled. Patients were divided into three groups based on the severity of coronary stenosis measured by coronary arteriography (CAG): slight stenosis (group 1), moderate stenosis (group 2) and serious stenosis (group 3). M-mode and tissue Doppler echocardiography were performed, and elasticity indexes of ascending aorta including stiffness index, distensibility index, and S wave speed of anterior wall were calculated and correlated with the severity of coronary stenosis. Ascending aorta stiffness index was increased, whereas distensibility index and S wave speed of anterior wall were decreased in moderate and severe stenosis groups compared with slight stenosis group (P coronary artery, and there was a significant correlation between aortic elasticity and severity of coronary artery by Pearson correlation analysis (P coronary stenosis. Elasticity indexes of ascending aorta can serve as predictors for coronary arterial lesion in hypertensive patients.

  6. Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery : Six months' angiographic and clinical follow-up of a prospective randomized study

    NARCIS (Netherlands)

    Drenth, DJ; Winter, JB; Veeger, NJGM; Monnink, SHJ; van Boven, AJ; Grandjean, JG; Mariani, MA; Boonstra, PW

    Objective: We sought to compare minimally invasive coronary artery bypass grafting (surgical intervention) with percutaneous transluminal coronary angioplasty with primary stenting (stenting) in patients having an isolated high-grade stenosis (American College of Cardiology/American Heart

  7. Incidence of severe coronary stenosis in asymptomatic patients with peripheral arterial disease scheduled for major vascular surgery.

    Science.gov (United States)

    Hromadka, Milan; Baxa, Jana; Seidlerova, Jitka; Suchy, David; Sedivy, Jakub; Stepankova, Lucie; Rajdl, Daniel; Rokyta, Richard

    2016-08-01

    Peripheral arterial disease (PAD) has the risk equivalent of coronary heart disease. The biochemical parameters associated with functionally significant coronary artery stenosis were investigated in asymptomatic patients with PAD who were scheduled for major vascular intervention. A total of 50 PAD patients asymptomatic for coronary heart disease were examined using coronary computed tomography angiography (CTA). A stress myocardial CT perfusion (CTP) test was performed in patients who exhibited coronary stenosis >40%. In patients with stress-induced perfusion defects, the severity of stenosis was assessed using invasive coronary angiography including fractional flow reserve assessment. The CT findings were correlated with both classical and more recently developed parameters of atherosclerosis. According to the combined CT examination (CTA and stress CT perfusion), 36% of patients exhibited significant coronary stenosis. Stress-induced hypoperfusion was observed in 95.7% of severe stenotic lesions. After adjustment for confounders, the level of high-sensitivity troponin I was associated with severe coronary stenosis (OR 1.260 [95% CI 1.054 to 1.505]). Other biochemical parameters did not correlate with coronary stenosis. The annual mortality rate was 4%. The results of the present study confirm a significant diagnostic contribution of a complex cardiac CT examination in patients scheduled for major vascular surgery. A high prevalence of asymptomatic coronary heart disease was observed in this particular patient group. High-sensitivity measurements of troponin I correlated with the extent of the coronary stenosis.

  8. Does coronary calcium scoring with a SCORE better predict significant coronary artery stenosis than without? Correlation with computed tomography coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Durhan, Gamze; Hazirolan, Tuncay; Karcaaltincaba, Musturay; Akata, Deniz [Hacettepe University Medical School, Department of Radiology, Ankara (Turkey); Sunman, Hamza; Aytemir, Kudret [Hacettepe University Medical School, Department of Cardiology, Ankara (Turkey); Karakaya, Jale; Karaagaoglu, Ergun [Hacettepe University, Department of Biostatistics, Ankara (Turkey)

    2014-12-03

    To determine effectiveness of coronary artery calcium score (CACS) alone and combined with Systematic Coronary Risk Evaluation (SCORE) in adult patients for significant coronary artery stenosis by using computed tomography coronary angiography (CTCA) as reference standard. Two thousand twenty-one patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA. Patients were examined with dual-source CT and were grouped according to their age, gender, CACS, and estimated SCORE risk. Coronary plaque existence and degree of stenosis were assessed with CTCA. Sensitivity, specificity, and ROC curves were analyzed. CACS was the single independent variable in estimating relative risk of critical stenosis and had superior outcome when compared with SCORE risk in logistic regression and ROC curve. Area under the ROC curve was greatest in the interval between 50-59 years. When SCORE was combined with CACS in patients with zero CACS, percentage of significant stenosis increased from 1.4% to 7.0% in patients with high or very high SCORE risk, and decreased to 0.9 % in patients with low or moderate SCORE risk. CACS combination with SCORE risk predicts coronary artery stenosis. When CACS is zero, CTCA can be performed in patients with high or very high SCORE risk. (orig.)

  9. Noninvasive Detection of Coronary Artery Stenosis Using 16-slice Spiral CT: a Comparison with Selective X-ray Coronary Angiography

    Institute of Scientific and Technical Information of China (English)

    SHI Heshui; HAN Ping; KONG Xiangquan; FENG Gansheng; Martin HK Hoffmann

    2006-01-01

    The role of 16-slice spiral CT was evaluated in the diagnosis of coronary stenosis, with selective X-ray coronary angiography (SCA) serving as the reference standard. Sixty-five patients who were suspected of having coronary heart disease, without percutaneous transluminal coronary angioplasty or coronary bypass-grafting, were investigated using 16-slice CT. Eight patients with pre-scan heart rate of more than 80 beats/min were given β-blockers. After the retrospectively ECG-gated axial imaging reconstruction, volume redering (VR), multi-planar reconstruction (MPR), curved MPR and maximum intensity projection (MIP) were used to reconstruct. Every segment of coronary artery with a diameter ≥1.5 mm was assessed, and the presence on CT with a stenosis exceeding 50% diameter reduction was compared with that on SCA. The reasons which lead to some segments unevaluable were analysed. Compared with SCA, 93% coronary segments and 94 % main branches were evaluable. Residual cardiac motion artifacts, severe calcification and poor opacification made 58%, 28% and 14% of the remaining 60 segments unevaluable respectively. Without routine administration of β-blockers, good coronary imaging quality can be acquired using 16-slice spiral CT. It is a reliable noninvasive method for detection of obstructive coronary artery disease.

  10. Stenting for left main stenosis in a child with anomalous origin of left coronary artery: case report

    Institute of Scientific and Technical Information of China (English)

    CHEN Ming; HONG Tao; HUO Yong

    2005-01-01

    @@ Anomalous left coronary artery (LCA) arising from right cusp is an uncommon condition. Clinical evidence has shown that this coronary anomaly is consistently related to sudden death. Current treatment options include modification of behaviour, medicine or surgery. Stents have been successfully applied for left main stenosis for a decade. We report a case of LCA arising from right cusp with left main stenosis treated with coronary stent in a child patient.

  11. Increased level of glycated hemoglobin portends high risk of coronary artery stenosis

    Institute of Scientific and Technical Information of China (English)

    ZENG FAN-fang; WANG Li-li; LONG Juan; YI Wen-ya; LUO Ying

    2016-01-01

    Background Increased level of glycated hemoglobin (HbA1c) is associated with higher incidence of coronary artery disease (CAD) in the diabetics.However,the relationship between HbAlc and the risk of coronary artery stenosis in the non-diabetics is controversial.Methods A retrospective research was conducted on 338 enrolled participants who have undergone 2 times of coronary angiographic examination within the past year.Clinical and laboratory variables at the initial and the second time of admission were collected.According to the initial median HbA1c level,all participants were divided into two groups named lower and higher groups.The relationship between HbA1c level and the risk of coronary artery stenosis over time was evaluated.Results The initial values of HbA1c in lower and upper groups were 5.78 ± 0.35% and 6.21 ± 0.32% (P < 0.05).As compared to the lower group,the percentages of male and smoking participants,and the serum level of CRP were significantly higher in the higher group (P < 0.05).Other traditional risk factors were comparable between the two groups.There were 54.2% and 55.2% participants with single vessel stenosis,and 45.8% and 44.8% with multiple vessel stenoses,respectively in the two groups without significant difference.The second time of admission,were 308.5± 25.4 days (lower group) and 300.7 ± 30.1 days (higher group) from the initial admission.Although no significant changes of HbA1c level were observed when compared to initial,HbA1c level in the higher group was still significantly higher in comparison to the lower group (6.24 ± 0.39% vs.5.80 ± 0.36%,P =0.008).The percentage of new coronary artery stenosis (≥ 50% stenosis) was higher in the higher group than that in the lower group (41.7% vs.32.3%,P < 0.001).Multivariate regression analyses suggested that HbAlc remained independent factor associated with coronary artery stenoses after extensive adjustment for risk factors.Conclusion In the nondiabetics

  12. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE)

    DEFF Research Database (Denmark)

    Mäkikallio, Timo; Holm, Niels R; Lindsay, Mitchell

    2016-01-01

    Background Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main...... coronary artery disease. Methods In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1: 1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable......), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1 . 35 after up to 5 years of follow-up. The intention-to-treat principle...

  13. Assessment of coronary artery disease using coronary computed tomography angiography in patients with aortic valve stenosis referred for surgical aortic valve replacement

    DEFF Research Database (Denmark)

    Larsen, Linnea Hornbech; Kofoed, K Fuglsang; Dalsgaard, M

    2013-01-01

    BACKGROUND: In patients referred for aortic valve replacement (AVR) a pre-surgical assessment of coronary artery disease is mandatory to determine the possible need for additional coronary artery bypass grafting. The diagnostic accuracy of coronary computed tomography angiography (coronary CTA......) was evaluated in patients with aortic valve stenosis referred for surgical AVR. METHODS: Between March 2008 and March 2010 a total of 181 consecutive patients were included. All patients underwent pre-surgical coronary CTA (64- or 320-detector CT scanner) and invasive coronary angiography (ICA). The analyses...... with disagreement between ICA and coronary CTA in univariate analysis. CONCLUSION: In patients with aortic valve stenosis referred for surgical AVR the diagnostic accuracy of coronary CTA to identify significant coronary artery disease is moderate. Coronary CTA may be used successfully in a subset of patients...

  14. Tissue Doppler echocardiography improves the diagnosis of coronary artery stenosis in stable angina pectoris

    DEFF Research Database (Denmark)

    Hoffmann, Soren; Jensen, Jan Skov; Iversen, Allan Zeeberg

    2012-01-01

    by colour TDI at six mitral annular sites and averaged to provide global estimates. Duke score (DS), including ST depression, chest pain, and exercise capacity, was used as the outcome of the exercise ECG. Patients with an area stenosis of ≥70% in at least one epicardial coronary artery were categorized......Aim To determine if colour tissue Doppler imaging (TDI) performed at rest in patients with suspected stable angina pectoris (SAP) is able to predict the presence of significant coronary artery disease (CAD). METHODS AND RESULTS: This study comprises 296 consecutive patients with clinically...... suspected SAP, no previous cardiac history, and a normal ejection fraction. All patients were examined by colour TDI, exercise electrocardiogram (ECG), and coronary angiography (CAG). Regional longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured...

  15. Myocardial FFR (Fractional Flow Reserve in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience

    Directory of Open Access Journals (Sweden)

    Jagadish H. Ramaiah

    2013-02-01

    Full Text Available Background: The clinical significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of ¡I40% to ¡U70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Myocardial fractional flow reserve (FFR is an index of the functional severity of coronary stenosis that is calculated from pressure measurements made during coronary angiography. The objective of the study is to evaluate the usefulness of FFR in patients with angiographically intermediate coronary artery stenosis. Methods: 20 patients with intermediate coronary stenosis and chest pain of uncertain origin. The Exercise Electrocardiography (TMT, Myocardial Perfusion Imaging study (MPI, Quantitative Coronary Angiography (QCA were compared with the results of FFR measurements. Results: 20 patients were undergone FFR measurement during the study period. With the mean age of 57.25¡À11.2 and male patients were 16 (80%, female patients 4 (20%, in all 13 patients with an FFR of 0.75 tested negative for reversible myocardial ischemia on TMT and MPI study. No revascularization procedures were performed in 7 (35% patients, and no adverse cardiovascular events were noted in all these patients during 6 months of follow-up. Conclusions: In patients with coronary stenosis of intermediate severity, FFR

  16. Computer-aided diagnosis system for coronary artery stenosis using a neural network

    Science.gov (United States)

    Suzuki, Kenji; Horiba, Isao; Sugie, Noboru; Nanki, Michio

    2001-07-01

    We have developed a new computer-aided diagnosis system for coronary artery stenosis, which can learn medical doctors' clinical experiences and medical knowledge. In order to develop such a system, we have employed a multilayer neural network (NN). The NN has the capability to learn experts' experiences and knowledge. The proposed system consists of (a) automatic vessel tracking, (b) automatically extraction of the edges of the vessel, and (c) estimation of stenosis based on the NN. In order to evaluate the performance of the proposed system, two experiments with the phantoms and clinical images were performed. The stenoses estimated by the proposed system agreed well with not only the stenoses based on the actual measurement of the phantoms but also those diagnosed by a medical specialist from coronary arteriograms. The experimental results have shown that the proposed system has the capability to learn medical doctors' clinical experiences and medical knowledge. The proposed system has been proved to be useful to aid to diagnose coronary artery stenosis.

  17. The Vanishing Stenosis: ST Elevation Myocardial Infarction and Rhythm Disturbance due to Coronary Artery Spasm—Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    J. Gosai

    2010-01-01

    Full Text Available A 62-year-old lady was admitted with clinical and electrocardiograph features of acute myocardial infarction. Urgent coronary arteriography was performed, demonstrating a single discrete stenosis of one coronary artery. Following intracoronary injection of GTN, this stenosis completely resolved, as the symptoms did. The causes of acute myocardial infarction with normal coronary arteries are reviewed.

  18. Relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis

    Institute of Scientific and Technical Information of China (English)

    Jiaping Wei; Shenmao Li; Zhiyong Zhang; Feng Ling; Kang Li; Hong Zhao; Jifang He; Liqing Xu; Jing Wen; Chunyan Zhou; Xiaoguang Wu; Jiarui Wang

    2008-01-01

    To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)

  19. Serum ferritin is an independent factor in coronary artery stenosis among hemodialysis patients.

    Science.gov (United States)

    Lien, Chen-Tung; Tsai, Chiang-Chin; Chen, Chien-An; Kuo, Chieh; Tsai, Meng-Yi

    2016-10-01

    Hemodialysis patients frequently receive intravenous iron for the treatment of anemia. Iron status has been found to be correlated with coronary artery disease. In the post hoc study reported here, we evaluate the association between iron status and coronary arterial stenosis (CAS) in a 3-year follow-up period. We enrolled 76 patients and collected iron status, and clinical/biochemical data over 3 years. In this study, coronary arterial stenosis was considered significant when the narrowing of the coronary artery exceeded 50 % of the luminal diameter on coronary angiography. The mean age was 61 years old. The female/male ratio was 48/28, and the group included 16 diabetic patients and 23 smokers. Twenty-two of 76 patients had CAS. Mean intravenous iron dosage was 2167.11 ± 1738.38 in a 3-year period. On the univariate regression analysis, 3-year-averaged serum ferritin was positively associated with CAS (r = 0.288, P = 0.012). The 3-year-averaged intravenous iron dosage, DM, age, smoking, and other biochemical parameters showed no association with CAS. When these factors were added to the multivariate-adjusted models, 3-year-averaged serum ferritin remained a determinant of CAS event (β = 0.290, P = 0.029). The odds ratio for CAS was 6.93 (95 % CI 2.41-19.94; P = 0.001) for patients with 3-year-averaged serum ferritin ≥600 ng/mL. In summary, serum ferritin was an independent risk factor for CAS among this group of hemodialysis patients, especially when serum ferritin was ≥600 ng/mL.

  20. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography

    DEFF Research Database (Denmark)

    Rochitte, Carlos E; George, Richard T; Chen, Marcus Y

    2014-01-01

    AIMS: To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed...... tomography (SPECT). METHODS AND RESULTS: We conducted a multicentre study to evaluate the accuracy of integrated CTA-CTP for the identification of patients with flow-limiting CAD defined by ≥50% stenosis by invasive coronary angiography (ICA) with a corresponding perfusion deficit on stress single photon...

  1. Morphologic change in coronary artery stenosis with the Medtronic Wiktor Stent: initial results from the core laboratory for quantitative angiography

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); P.P.T. de Jaegere (Peter); M.E. Bertrand (Michel); G. Kober; J.F. Marquis; J. Piessens; R. Uebis; B. Valeix; V. Wiegand

    1991-01-01

    textabstractThe purpose of this study was to assess the early changes in stenosis geometry after implantation of the Medtronic Wiktor stent in human coronary arteries. Morphologic changes were evaluated by quantitative coronary angiography using automated edge detection. The hemodynamic significance

  2. Quantification of coronary artery stenosis with high-resolution CT in comparison with histopathology in an ex vivo study

    Energy Technology Data Exchange (ETDEWEB)

    Dettmer, Matthias, E-mail: dettmerms@upmc.edu [Department of Pathology and Laboratory Medicine, University of Pittsburgh, S-417 BST 200 Lothrop Street, Pittsburgh, PA 15261 (United States); Glaser-Gallion, Nicola, E-mail: nicola.glaser-gallion@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Stolzmann, Paul, E-mail: paul.stolzmann@usz.ch [Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich (Switzerland); Glaser-Gallion, Florian, E-mail: florian.glaser-gallion@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Fornaro, Juergen, E-mail: juergen.fornaro@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Feuchtner, Gudrun, E-mail: Gudrun.Feuchtner@i-med.ac.at [Department of Radiology II, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck (Austria); Jochum, Wolfram, E-mail: wolfram.jochum@kssg.ch [Institute of Pathology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Alkadhi, Hatem, E-mail: hatem.alkadhi@usz.ch [Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich (Switzerland); Wildermuth, Simon, E-mail: simon.wildermuth@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland); Leschka, Sebastian, E-mail: sebastian.leschka@kssg.ch [Institute of Radiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen (Switzerland)

    2013-02-15

    Purpose: To investigate the ex vivo performance of high-resolution computed tomography (CT) for quantitative assessment of percentage diameter stenosis in coronary arteries compared to histopathology. Materials and methods: High-resolution CT was performed in 26 human heart specimens after the injection of iodinated contrast media into the coronary arteries. Coronary artery plaques were visually identified on CT images and the grade of stenosis for each plaque was measured with electronic calipers. All coronary plaques were characterized by histopathology according to the Stary classification, and the percentage of stenosis was measured. Results: CT depicted 84% (274/326) of all coronary plaques identified by histology. Missed plaques by CT were of Stary type I (n = 31), type II (n = 16), and type III (n = 5). The stenosis degree significantly correlated between CT and histology (r = 0.81, p < 0.001). CT systematically overestimated the stenosis of calcified plaques (mean difference - 11.0 ± 9.5%, p < 0.01) and systematically underestimated the stenosis of non-calcified plaques (mean difference −6.8 ± 10.4%, p < 0.05), while there was no significant difference for mixed-type plaques (mean difference −0.4 ± 11.7%, p = 0.85). There was a significant underestimation of stenosis degree as measured by CT for Stary II plaques (mean difference −14 ± 9%, p < 0.01) and a significant overestimation for Stary VII plaques (mean difference 9 ± 10%, p < 0.05), but there was no significant difference in stenosis degree between both modalities for other plaque types. Conclusions: High-resolution CT reliably depicts advanced stage coronary plaques with an overall good correlation of stenosis degree compared to histology, however, the degree of stenosis is systematically overestimated in calcified and underestimated in non-calcified plaques.

  3. Direct visualization of a significant stenosis of the right coronary artery by transthoracic echocardiography. A case report

    Directory of Open Access Journals (Sweden)

    Wiseth Rune

    2007-10-01

    Full Text Available Abstract Non-invasive imaging of coronary arteries by transthoracic echocardiography is an emerging diagnostic tool to study the left main (LM, left descending artery (LAD, circumflex (Cx and right coronary artery (RCA. Impaired coronary circulation can be assessed by measuring coronary velocity flow reserve (CVFR by transthoracic Doppler echocardiography. Coronary artery stenoses can be identified as localized colour aliasing and accelerated flow velocities. We report a case with an acute coronary syndrome (ACS of a 46-year-old man. With non-invasive imaging of coronary arteries by transthoracic echocardiography (TTE, we identified a segment of the mid right coronary artery (RCA suggestive of stenosis with localized colour aliasing and accelerated flow velocity. We found a high ratio between the stenotic peak velocity and the prestenotic peak velocity, and a pathologic coronary flow velocity reserve (CFVR distal to the stenosis in the posterior interventricular descending branch (RDP. Subsequent coronary angiography demonstrated one vessel disease with a stenosis in segment 3 of RCA, which was successfully treated with percutaneos coronary intervention PCI. Two weeks following the PCI procedure he was readmitted to hospital with chest pain. A subacute stent thrombosis was questioned, and repeated echocardiography was preformed. The mid portion of RCA showed normal and laminar flow. The CVFR of RCA measured in the RDP showed normal vasodilatory response, confirming an open RCA without any flow limitation. A repeated coronary angiogram demonstrated only a mild in stent intimal hyperplasia. This case illustrates the value of transthoracic echocardiography as a tool both in the diagnosis and the follow-up of chest pain disorders and coronary flow problems. Transthoracic echocardiography allows both direct visualization of the various coronary segments and assessment of the CVFR.

  4. Successful Treatment of a Subclavian Artery Stenosis With a Coronary Bioresorbable Vascular Scaffold.

    Science.gov (United States)

    Giordano, Arturo; Messina, Stefano; Biondi-Zoccai, Giuseppe

    2016-08-01

    To report the use of a coronary bioresorbable vascular scaffold to treat subclavian artery disease. A 58-year-old man was admitted for left subclavian steal syndrome. Angiography showed significant left subclavian stenosis in proximity to the ostium of the left vertebral artery. To maximize radial support and minimize restenosis risk while avoiding the chance of vertebral compromise, a coronary bioresorbable vascular scaffold (3.5×28 mm) was implanted after predilation. The device was postdilated with a 1.0-mm oversized balloon, with immediate improvement in hemodynamics and symptoms. Two-year clinical and imaging follow-up confirmed vessel patency. This clinical vignette highlights the flexibility and potential of bioresorbable devices for endovascular specialists and calls for further development and use of this innovative technology. © The Author(s) 2016.

  5. Quantitative relationship between coronary vasodilator reserve assessed by {sup 82}Rb PET imaging and coronary artery stenosis severity

    Energy Technology Data Exchange (ETDEWEB)

    Anagnostopoulos, Constantinos [Brigham and Women' s Hospital, Division of Nuclear Medicine/PET, Boston, MA (United States); Royal Brompton Hospital, Department of Nuclear Medicine, London (United Kingdom); Brigham and Women' s Hospital, Harvard Medical School, London (United Kingdom); Almonacid, Alexandra; Popma, Jeffrey J. [Brigham and Women' s Hospital, Division of Cardiovascular Medicine, Department of Medicine, Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, London (United Kingdom); El Fakhri, Georges [Brigham and Women' s Hospital, Division of Nuclear Medicine/PET, Boston, MA (United States); Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Curillova, Zelmira; Dorbala, Sharmila; Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine/PET, Boston, MA (United States); Brigham and Women' s Hospital, Cardiovascular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Division of Cardiovascular Medicine, Department of Medicine, Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, London (United Kingdom); Sitek, Arkadiusz [Brigham and Women' s Hospital, Division of Nuclear Medicine/PET, Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, London (United Kingdom); Roughton, Michael [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom)

    2008-09-15

    The relationship between myocardial blood flow (MBF) and stenosis severity has been determined previously using cyclotron-produced radiotracers such as {sup 15}O-H{sub 2}O and {sup 13}N-ammonia. An attractive alternative to overcome the limitations related to the use of cyclotron might be to use the generator-produced {sup 82}Rb as a flow tracer. The current study was undertaken to investigate the relationship between MBF and coronary vasodilator reserve (CVR) as measured by {sup 82}Rb positron emission tomography (PET) and the percent diameter stenosis as defined by quantitative coronary arteriography. We prospectively evaluated 22 individuals: 15 patients (60 {+-} 11 years of age) with angiographically documented coronary artery disease (CAD) and seven age-matched (56 {+-} 9 years) asymptomatic individuals without risk factors for CAD. Dynamic {sup 82}Rb PET was performed at rest and after dipyridamole vasodilation. MBF, CVR and an index of 'minimal coronary resistance' (MCR) were assessed in each of the three main coronary territories. Rest and stress MBF in regions subtended by vessels with less than 50% diameter stenosis was similar to that of the individuals with no risk factors for CAD. As a result, CVR was also similar in the two groups (1.9, interquartile [IQ] range from 1.7 to 2.7 vs. 2.2, IQ range from 2 to 3.4 respectively, p=0.09). CVR successfully differentiated coronary lesions with stenosis severity 70% to 89% from those with 50% to 69% stenosis (1, IQ range from 1 to 1.3 vs. 1.7, IQ range from 1.4 to 2), respectively, p=0.001. In addition, hyperaemic MBF (r{sup 2}=0.74, p<0.001), CVR (r {sup 2}=0.69, p<0.001) and MCR (r{sup 2}=0.78, p<0.001) measurements were inversely and non-linearly correlated to the percent diameter stenosis on angiography. MBF and CVR are inversely and non-linearly correlated to stenosis severity. Quantitative {sup 82}Rb PET can be a clinically useful tool for an accurate functional assessment of CAD. (orig.)

  6. Correlation of coronary artery stenosis evaluation with left heart structure and function by multi-slice computed tomography.

    Science.gov (United States)

    Song, L N; Cao, A D; Niu, Y J; Liu, N

    2014-08-07

    The aim of this study was to determine the impact of multi-slice computed tomography (MSCT) evaluation of coronary artery stenosis on left heart structure and systolic function. Coronary artery CT angiography was performed in 200 patients diagnosed with coronary heart disease, and then according to the AHA coronary artery 17-segment fractionation method, the Gensini score (GS) was determined for every narrow segment, and one-stop assessment of the correlation between left heart structure and function was performed. After the grouping of GS quartiles from low to high, there were differences between different patients with regard to LVDD, LADD, LVEDV, LVESV, MM, LVEF, and FS, while no difference in SV and CO. GS showed linear negative correlation with LVEF and FS, and linear positive correlation with LVDD, LADD, LVEDV, LVESV, and MM, while no correlation with SV and CO. That is, GS of coronary artery stenosis was negatively correlated with left ventricular systolic function and positively correlated with myocardial mass. The narrower the coronary artery, the worse the cardiac function and the higher the myocardial hypertrophy. Coronary artery stenosis was one of the important causes of the decrease in left ventricular systolic function and cardiac remodeling.

  7. Effects of co-existence of coronary stenosis and the extent of coronary ectasia on the TIMI frame count in patients with coronary artery ectasia.

    Science.gov (United States)

    Kosar, Feridun; Acikgoz, Nusret; Sahin, Ibrahim; Topal, Ergun; Gunen, Hakan; Ermis, Necip; Cehreli, Sengul

    2005-03-01

    The measurement of the thrombosis in myocardial infarction (TIMI) frame count is a simple method for evaluating coronary blood flow. Although it is well known that slow coronary flow is present in patients with coronary artery ectasia (CAE), the effects of coexisting stenosis and the severity of ectatic involvement on coronory flow have not been adequately studied. Thus, we examined (1) the effect of coexistence of obstructive coronary artery disease on TIMI frame count (TFC) and (2) the relation between the severity of ectatic involvement and TFC in patients with CAE. Ninety-seven study patients with CAE were examined in two steps to determine if they were appropriate in terms of the aim of this study. In the first step, ectasias were divided into three groups: an isolated CAE group, a CAE group with coexisting nonsignificant stenosis, and CAE with coexisting significant stenosis. In the second step, ectasias were subdivided into three groups: CAE with one segment, two segments, and three segments (or diffuse) involvement. The TIMI frame counts for the right coronary artery (RCA), the left circumflex coronary artery (LCx), and the left anterior descending artery (LAD) in the ectasia group were significantly higher than that of the control group (P 0.05, for all). In addition, the severity of ectasia involvement, regardless of the localization of ectatic segments and the type of the affected vessel, did not change the TFC (P > 0.05, for all). These results suggest that neither the coexisting stenosis nor the extent of involvement significantly affect TFC in patients with coronary ectasia.

  8. Coronary CT Angiography in Heavily Calcified Coronary Arteries: Improvement of Coronary Lumen Visualization and Coronary Stenosis Assessment With Image Postprocessing Methods

    Science.gov (United States)

    Sun, Zhonghua; Ng, Curtise K.C.; Xu, Lei; Fan, Zhanming; Lei, Jing

    2015-01-01

    Abstract To compare the diagnostic value of coronary CT angiography (CCTA) with use of 2 image postprocessing methods (CCTA_S) and (CCTA_OS) and original data (CCTA_O) for the assessment of heavily calcified plaques. Fifty patients (41 men, 9 women; mean age 61.9 years ± 9.1) with suspected coronary artery disease who underwent CCTA and invasive coronary angiography (ICA) examinations were included in the study. Image data were postprocessed with “sharpen” and smooth reconstruction algorithms in comparison with the original data without undergoing any image postprocessing to determine the effects on suppressing blooming artifacts due to heavy calcification in the coronary arteries. Minimal lumen diameter and degree of stenosis were measured and compared between CCTA_S, CCTA_OS, and CCTA_O with ICA as the reference method. The area under the curve (AUC) by receiver-operating characteristic curve analysis (ROC) was also compared among these 3 CCTA techniques. On a per-vessel assessment, the sensitivity, specificity, positive predictive value and negative predictive value, and 95% confidence interval (CI) were 100% (95% CI: 89%, 100%), 33% (95% CI: 22%, 45%), 41% (95% CI: 30%, 53%), 100% (95% CI: 85%, 100%) for CCTA_O, 94% (95% CI: 79%, 99%), 66% (95% CI: 54%, 77%), 57% (95% CI: 43%, 70%), and 95% (95% CI: 85%, 99%) for CCTA_S, 94% (95% CI: 79%, 99%), 44% (95% CI: 32%, 57%), 44% (95% CI: 32%, 57%), and 97% (95% CI: 79%, 99%) for CCTA_OS, respectively. The AUC by ROC curve analysis for CCTA_S showed significant improvement for detection of >50% coronary stenosis in left anterior descending coronary artery compared to that of CCTA_OS and CCTA_O methods (P coronary stenosis in the left circumflex and right coronary arteries (P > 0.05). CCTA with “sharpen” reconstruction reduces blooming artifacts from heavy calcification, thus, leading to significant improvement of specificity and positive predictive value of CCTA in patients with heavily calcified

  9. Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography

    Directory of Open Access Journals (Sweden)

    Ugo Fabrizio

    2010-05-01

    Full Text Available Abstract Background We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE. Wall motion (WM assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD, particularly in patients with isolated intermediate (50%-70% coronary stenosis. Methods We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography. Results and discussion When CAD was defined as the presence of a ≥50% stenosis, the addition of MPI increased sensitivity (+30% and decreased specificity (-14%, with a final increase in total diagnostic accuracy (+16%, p Conclusions The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition (≥50% or > 70% stenosis, but it is mainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis. The total diagnostic accuracy increased only when defining CAD as ≥50% stenosis, since in patients with severe stenosis (> 70% the decrease in specificity is not counterbalanced by the minor sensitivity increase.

  10. Microparticle-Induced Coagulation Relates to Coronary Artery Atherosclerosis in Severe Aortic Valve Stenosis.

    Directory of Open Access Journals (Sweden)

    Patrick Horn

    Full Text Available Circulating microparticles (MPs derived from endothelial cells and blood cells bear procoagulant activity and promote thrombin generation. Thrombin exerts proinflammatory effects mediating the progression of atherosclerosis. Aortic valve stenosis may represent an atherosclerosis-like process involving both the aortic valve and the vascular system. The aim of this study was to investigate whether MP-induced thrombin generation is related to coronary atherosclerosis and aortic valve calcification.In a cross-sectional study of 55 patients with severe aortic valve stenosis, we assessed the coronary calcification score (CAC as indicator of total coronary atherosclerosis burden, and aortic valve calcification (AVC by computed tomography. Thrombin-antithrombin complex (TATc levels were measured as a marker for thrombin formation. Circulating MPs were characterized by flow cytometry according to the expression of established surface antigens and by measuring MP-induced thrombin generation.Patients with CAC score below the median were classified as patients with low CAC, patients with CAC Score above the median as high CAC. In patients with high CAC compared to patients with low CAC we detected higher levels of TATc, platelet-derived MPs (PMPs, endothelial-derived MPs (EMPs and MP-induced thrombin generation. Increased level of PMPs and MP-induced thrombin generation were independent predictors for the severity of CAC. In contrast, AVC Score did not differ between patients with high and low CAC and did neither correlate with MPs levels nor with MP-induced thrombin generation.In patients with severe aortic valve stenosis MP-induced thrombin generation was independently associated with the severity of CAC but not AVC indicating different pathomechanisms involved in coronary artery and aortic valve calcification.

  11. Hyperoxia Exacerbates Myocardial Ischemia in the Presence of Acute Coronary Artery Stenosis in Swine.

    Science.gov (United States)

    Guensch, Dominik P; Fischer, Kady; Shie, Nancy; Lebel, Julie; Friedrich, Matthias G

    2015-10-01

    Current guidelines limit the use of high oxygen tension after return of spontaneous circulation after cardiac arrest, focusing on neurological outcome and mortality. Little is known about the impact of hyperoxia on the ischemic heart. Oxygen is frequently administered and is generally expected to be beneficial. This study seeks to assess the effects of hyperoxia on myocardia oxygenation in the presence of severe coronary artery stenosis in swine. In 22 healthy pigs, we surgically attached a magnetic resonance compatible flow probe to the left anterior descending coronary artery (LAD). In 11 pigs, a hydraulic occluder was inflated distal to the flow probe. After increasing PaO2 to >300 mm Hg, LAD flow decreased in all animals. In 8 stenosed animals with a mean fractional flow reserve of 0.64±0.02, hyperoxia resulted in a significant decrease of myocardial signal intensity in oxygenation-sensitive cardiovascular magnetic resonance images of the midapical segments of the LAD territory. This was not seen in remote myocardium or in the other 8 healthy animals. The decreased signal intensity was accompanied by a decrease in circumferential strain in the same segments. Furthermore, ejection fraction, cardiac output, and oxygen extraction ratio declined in these animals. Changing PaCO2 levels did not have a significant effect on any of the parameters; however, hypercapnia seemed to nonsignificantly attenuate the hyperoxia-induced changes. Ventilation-induced hyperoxia may decrease myocardial oxygenation and lead to ischemia in myocardium subject to severe coronary artery stenosis. © 2015 American Heart Association, Inc.

  12. Serum ox-LDL Level is Reduced with the Extent of Stenosis in Coronary Arteries

    Directory of Open Access Journals (Sweden)

    Mohammad Najafi

    2013-05-01

    Full Text Available Oxidized LDL (ox-LDL lipoproteins are proposed as important modified particles triggering pro-inflammatory events through receptor-mediated pathways. We evaluated the circulating ox-LDL level on the concept that the chronic immune events may affect ox-LDL clearance as the vessel stenosis develops in coronary arteries. One hundred sixty five subjects underwent coronary angiography and then, subdivided into four subgroups controls (n=85; SVD, 2VD and 3VD (n=80. The serum ox-LDL level and other biochemical parameters were measured using ELISA method and routine laboratory techniques, respectively. The serum ox-LDL level in the control group (4.81±1.41 mU/mg was significantly higher than patients (4.28±1.73 mU/mg, P<0.05. The ox-LDL/LDL ratio was conversely reduced with the extent of stenosis as compared with the controls (P<0.05. Furthermore, no difference was observed in the ox-LDL/LDL ratio between the 2VD and 3VD patients. We suggested the atherosclerosis process increases the total clearing capacities of the circulating ox-LDL particles.

  13. Ostial stenosis of the left main coronary artery in a young woman 10 years after radiation therapy.

    Science.gov (United States)

    Orzan, F; Bellis, D; Mollo, F; Brusca, A

    1995-01-01

    A 26-year-old woman developed critical stenosis of the left main coronary artery 10 years after radiation treatment for Hodgkins disease. She was operated on but died in the immediate postoperative period. At autopsy the pathological findings were indistinguishable from those described in "typical" atherosclerotic plaques.

  14. Internal mammary artery dilatation in a patient with aortic coarctation, aortic stenosis, and coronary disease. Case report

    Directory of Open Access Journals (Sweden)

    Martinez Cereijo Jose M

    2011-04-01

    Full Text Available Abstract The ideal surgical approach is unclear in adult patients with coarctation of the aorta that is associated with other cardiovascular pathologies that require intervention. Standard median sternotomy allows simultaneous, coronary revascularization surgery, valve replacement and repair of aortic coarctation. However the collateral circulation and the anatomy of the mammary arteries must be determined, to avoid possible complications. We report a case of a 69 year-old man with aortic coarctation, aortic stenosis, coronary artery disease and internal mammary artery dilatation who underwent concomitant surgical procedures through a median sternotomy.

  15. A case of IgG4-related lymphadenopathy, pericarditis, coronary artery periarteritis and luminal stenosis.

    Science.gov (United States)

    Hourai, Ryoto; Miyamura, Masatoshi; Tasaki, Ryunosuke; Iwata, Akiko; Takeda, Yoshihiro; Morita, Hideaki; Hanaoka, Nobuharu; Tanigawa, Jun; Shibata, Kensaku; Takeshita, Atsushi; Kawano, Mitsuhiro; Sato, Yasuharu; Hirose, Yoshinobu; Ishizaka, Nobukazu

    2016-10-01

    Immunoglobulin G4 (IgG4)-related disease is an emerging new clinicopathological disorder that is characterized by elevation of serum IgG4 levels and histological findings of IgG4-positive plasmacytic infiltration. IgG4-related disease may appear synchronously or metachronously in a wide variety of organs. The current patient was found to have pericardial effusion and retroperitoneal fibrosis. He was subsequently diagnosed with coronary artery stenosis. (18)F-FDG positron emission tomography showed enhanced FDG uptake in lymph nodes as well as pericardial and peri-aortic tissue. Histopathology of the mediastinal lymph node showed the infiltration of numerous IgG4-positive cells, leading to the diagnosis of IgG4-related lymphadenopathy with pericardial and periarterial involvement.

  16. Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    Eun Jeong Cho; Sung-Ji Park; Sung-A Chang; Dong Seop Jeong; Sang-Chol Lee; Seung Woo Park; Pyo Won Park

    2014-01-01

    Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS),even in patients without significant coronary artery disease (CAD).However,the incidence of angina pectoris and related CAD in such patients is controversial.There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS.The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.Methods Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995.Clinical and echocardiographic follow-up data were recorded into the database annually.Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography.We excluded patients with multiple valve disease,significant aortic regurgitation,or prior CAD or valve surgery.Results Totally 574 patients with severe AS (mean age,(65.9±9.6) years) were enrolled in this study.Significant CAD was found in 61 patients (10.6%).Factors associated with increased likelihood of CAD were age,hypertension,diabetes mellitus,chronic renal failure,carotid disease,and aorta calcification.In Logistic regression analysis,the independent predictor of the presence of CAD was age (P=0.011).The incidence of CAD increased significantly at 69.2 years of age.Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.Conclusions There was a low incidence of significant CAD in a population of Korean patients with severe AS.Therefore,coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than

  17. Association of Polymorphisms in Angiotensin-converting Enzyme and Type 1 Angiotensin Ⅱ Receptor Genes with Coronary Heart Disease and the Severity of Coronary Artery Stenosis

    Institute of Scientific and Technical Information of China (English)

    QIU Chunguang; HAN Zhanying; LU Wenjie; ZHANG Cuntai

    2007-01-01

    To explore the relation of angiotensin-converting enzyme (ACE) and angiotensin Ⅱ type 1 receptor (AT1R) gene polymorphism with coronary heart disease (CHD) and the severity of coronary artery stenosis, 130 CHD patients who underwent coronary angiography were examined for the number of affected coronary vessels (≥75% stenosis) and coronary Jeopardy score. The inser- tion/deletion of ACE gone polymorphism and ATIR gene polymorphism (an A→C transversion at nucleotide position 1166) were detected by using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) in CHD patients and 90 healthy serving as controls. The re- sults showed that DD genotype and of ACE were more frequent in CHD patients than that in control group (38.5% vs 14.4%, P<0.001). The frequency of the AT1R A/C genotypes did not differ between the patients and the controls (10% vs 13.1%, P0.05). The relative risk associated with the ACE-DD was increased by ATIR-AC genotype. Neither the number of affected coronary vessels nor the coro-nary score differed among the ACE I/D genotypes (P0.05). But the number of affected coronary vessels and the coronary score were significantly greater in the patients with the AT1R-AC genotype than in those with the AA genotype (P<0.05). In conclusion, DD genotype may he risk factor for CHD and MI in Chinese people, and is not responsible for the development of the coronary artery stenosis. The AT1R-C allele may increase the relative risk associated with the ACE-DD genotype, and may be involved in the development of the stenosis of coronary artery.

  18. Association analysis between endothelial function related factors and coronary artery stenosis degree in coronary heart disease patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Li, Quanmin; Zhang, Zhifang; Du, Ruiqin; Hu, Xiaoqiang; Yan, Yan; Gao, Qing; Fan, Yanting

    2012-01-01

    To investigate the relationship between soluble intercellular adhesion molecule (sICAM-1), vascular endothelial cell adhesion molecule (VCAM-1), monocytes chemotactic protein (MCP-1), von Willebrand factor (vWF), and coronary artery stenoses degree in coronary heart disease (CHD) within type 2 diabetes mellitus (T2DM) patients. A total of 92 subjects were treated with coronary angiography (CAG), including 62 subjects with CHD. The individuals were divided into three groups, group A (32 patients with CHD and T2DM), group B (30 patients with CHD but no T2DM) and group C (30 patients with no CHD and T2DM). All patients were treated with a Gensini coronary angiography check. The correlations between sICAM-1, VCAM-1, MCP-1 and vWF in peripheral blood and coronary artery stenosis degree were analyzed. The average score of coronary artery stenosis degree was 30.75 +/-12.67 in group A, which was significantly higher than group B (11.20 +/-7.51) and group C (2.40 +/- 1.23) (p coronary artery stenosis and the mean level of sICAM-1, VCAM-1, MCP-1, vWF in group A (p 0.05). Association analysis shown that the level of sICAM-1, VCAM-1, MCP-1 and vWF elevated in CHD with T2DM patients. Vascular endothelial dysfunction could be caused to the coronary artery stenosis pathophysiological process. Results from this study suggested that sICAM-1, VCAM-1, MCP-1 and vWF may contribute to the occurrence and development of vascular lesions in T2DM. These endothelial function related factors could be acceptable as a prediction and testing index of vascular complications in T2DM.

  19. [Combined surgical treatment for coronary heart disease as well as heart valve diseases and carotid artery stenosis].

    Science.gov (United States)

    Reichart, B; Kemkes, B M; Klinner, W; Kreuzer, E; Becker, H M; Harrington, O B; Crosby, V G; Wolf, R Y

    1979-04-26

    This is an account on combined procedures in 124 patients suffering from arteriosclerotic vessel disease. In order to judge the proceedings and the results the patients were divided up into two groups. in 15 patients (group I) a carotid endarterectomy combined with an aorto-coronary bypass operation was performed; once a subclavian artery stenosis was resected at the same time. One patient of that group died after 31 days (7%). In group II 108 heart valve operations were performed together with a coronary artery revascularisation. Early and late mortality divided up as follows: aortic stenosis 6/44 (14%) respectively 2/44 (5%); aortic insufficiency 1/14 (7%) resp. 0; combined aortic disease 1/8 )13%) resp. 0; mitral stenosis 1/11 (9%) resp. 0; mitral insufficiency 6/26 (23%) resp. 2/26 (8%); combined mitral valve disease 1/2 (50%) resp. 0; three times both valves (aorta, mitral) were replaced without mortality. In our opinion combined procedures, resection of supraaortic artery stenosis respectively cardiac valve operations and aorto-coronary bypass are indicated especially since the functional long-term results are excellent. Though one should consider the high operative risk in patients with mitral insufficiency and combined mitral valve disease.

  20. A Preoperative Assessment of Significant Coronary Stenosis Based on a Semiquantitative Analysis of Coronary Artery Calcification on Noncontrast Computed Tomography in Aortic Stenosis Patients Undergoing Aortic Valve Replacement

    Science.gov (United States)

    Hwang, Ji-Won; Kim, Sung Mok; Park, Sung-Ji; Cho, Eun Jeong; Lee, Sans-Chol; Choe, Yeon Hyeon; Park, Seung Woo

    2016-01-01

    Abstract Invasive coronary angiography (ICA) is the recommended assessment for coronary artery disease in patients undergoing elective aortic valve replacement (AVR). Noncontrast computed tomography (CT) is useful for evaluating lung lesions and calcifications at the cannulation site of the ascending aorta. The purpose of this study was to evaluate the role of noncontrast CT in the visual assessment of coronary artery calcification (CAC) in patients undergoing AVR. We retrospectively identified patients with significant aortic stenosis (AS) who were referred for AVR between January 2006 and December 2013. Among these, we included 386 patients (53.6% males, 69.2 ± 8.4 years) who underwent both noncontrast CT and ICA. Significant coronary artery stenosis (CAS) in the ICA was defined as luminal stenosis ≥70%. The 4 main coronary arteries were visually assessed on noncontrast CT and were scored based on the Weston score as follows: 0, no visually detected calcium; 1, a single high-density pixel detected; 3, calcium was dense enough to create a blooming artifact; and 2, calcium in between 1 and 3. Four groups were reclassified by the sum of the Weston scores from each vessel, as follows: noncalcification (0); mild calcification (1–4); moderate calcification (5–8); and severe calcification (9–12). Receiver-operating characteristic (ROC) analysis was generated to identify the cutoff Weston score values for predicting significant CAS. Diagnostic estimates were calculated based on these cutoffs. In the ICA analysis, 62 of the 386 patients (16.1%) had significant CAS. All patients were divided into 4 groups. The noncalcification group had 97 subjects (Weston score 0), the mild degree group had 100 (2.6 ± 1.0), the moderate calcification group had 114 (6.6 ± 1.1), and the severe calcification group had 75 (10.7 ± 1.1). The prevalence of significant CAS in the noncalcification, mild, moderate, and severe groups was 1% (1/97), 5% (5/100), 24% (27

  1. SPECT myocardial perfusion imaging as an adjunct to coronary calcium score for the detection of hemodynamically significant coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    von Ziegler Franz

    2012-12-01

    Full Text Available Abstract Background Coronary artery calcifications (CAC are markers of coronary atherosclerosis, but do not correlate well with stenosis severity. This study intended to evaluate clinical situations where a combined approach of coronary calcium scoring (CS and nuclear stress test (SPECT-MPI is useful for the detection of relevant CAD. Methods Patients with clinical indication for invasive coronary angiography (ICA were included into our study during 08/2005-09/2008. At first all patients underwent CS procedure as part of the study protocol performed by either using a multidetector computed tomography (CT scanner or a dual-source CT imager. CAC were automatically defined by dedicated software and the Agatston score was semi-automatically calculated. A stress-rest SPECT-MPI study was performed afterwards and scintigraphic images were evaluated quantitatively. Then all patients underwent ICA. Thereby significant CAD was defined as luminal stenosis ≥75% in quantitative coronary analysis (QCA in ≥1 epicardial vessel. To compare data lacking Gaussian distribution an unpaired Wilcoxon-Test (Mann–Whitney was used. Otherwise a Students t-test for unpaired samples was applied. Calculations were considered to be significant at a p-value of Results We consecutively included 351 symptomatic patients (mean age: 61.2±12.3 years; range: 18–94 years; male: n=240 with a mean Agatston score of 258.5±512.2 (range: 0–4214. ICA verified exclusion of significant CAD in 66/67 (98.5% patients without CAC. CAC was detected in remaining 284 patients. In 132/284 patients (46.5% with CS>0 significant CAD was confirmed by ICA, and excluded in 152/284 (53.5% patients. Sensitivity for CAD detection by CS alone was calculated as 99.2%, specificity was 30.3%, and negative predictive value was 98.5%. An additional SPECT in patients with CS>0 increased specificity to 80.9% while reducing sensitivity to 87.9%. Diagnostic accuracy was 84.2%. Conclusions In patients

  2. Transluminal attenuation gradient in coronary computed tomography angiography for determining stenosis severity of calcified coronary artery: a primary study with dual-source CT

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Minwen; Wei, Mengqi; Wen, Didi; Zhao, Hongliang; Liu, Ying; Li, Jian [Fourth Military Medical University, Department of Radiology, Xijing Hospital, Xi' an, Shaanxi Province (China); Li, Jiayi [Fourth Military Medical University, Department of Cardiology, Xijing Hospital, Xi' an, Shaanxi Province (China)

    2015-05-01

    To evaluate the diagnostic accuracy of transluminal attenuation gradient (TAG) for stenosis severity of calcified lesions assessed by coronary computed tomography angiography (CCTA). One hundred seven patients who underwent CCTA and coronary angiography (CAG) were enrolled. TAGs of 309 major epicardial coronary arteries were measured. The impact of plaque composition, Agatston scores, and lesion length ratio on TAG were analyzed. Diagnostic performance vs. CAG of TAG, CCTA, and combined TAG/CCTA were evaluated, and incremental value of TAG for reclassification of CCTA stenosis severity in calcified lesions was also analyzed. TAG decreased consistently with stenosis severity. TAG was significantly lower in coronary arteries with calcification scores >300 and lesion length ratios >2/3. TAG improved diagnostic accuracy of CCTA (c-statistic =0.982 vs. 0.942, P = 0.0001) in calcified lesions, and the sensitivity, specificity, positive, and negative predictive values of TAG cutoff ≤ -11.33 were 72 %, 91 %, 88 %, and 78 %, respectively. The addition of TAG to CCTA resulted in significant reclassification (NRI =0.093, P = 0.022) in calcified vessels. Measurement of TAG may improve diagnostic performance and reclassification of CCTA in coronary stenosis caused by calcified lesions. (orig.)

  3. Additional Value of Transluminal Attenuation Gradient in CT Angiography to Predict Hemodynamic Significance of Coronary Artery Stenosis

    Science.gov (United States)

    Stuijfzand, Wynand J.; Danad, Ibrahim; Raijmakers, Pieter G.; Marcu, C. Bogdan; Heymans, Martijn W.; van Kuijk, Cornelis C.; van Rossum, Albert C.; Nieman, Koen; Min, James K.; Leipsic, Jonathon; van Royen, Niels; Knaapen, Paul

    2015-01-01

    OBJECTIVES The current study evaluates the incremental value of transluminal attenuation gradient (TAG), TAG with corrected contrast opacification (CCO), and TAG with exclusion of calcified coronary segments (ExC) over coronary computed tomography angiogram (CTA) alone using fractional flow reserve (FFR) as the gold standard. BACKGROUND TAG is defined as the contrast opacification gradient along the length of a coronary artery on a coronary CTA. Preliminary data suggest that TAG provides additional functional information. Interpretation of TAG is hampered by multiple heartbeat acquisition algorithms and coronary calcifications. Two correction models have been proposed based on either dephasing of contrast delivery by relating coronary density to corresponding descending aortic opacification (TAG-CCO) or excluding calcified coronary segments (TAG-ExC). METHODS Eighty-five patients with intermediate probability of coronary artery disease were prospectively included. All patients underwent step-and-shoot 256-slice coronary CTA. TAG, TAG-CCO, and TAG-ExC analyses were performed followed by invasive coronary angiography in conjunction with FFR measurements of all major coronary branches. RESULTS Thirty-four patients (40%) were diagnosed with hemodynamically-significant coronary artery disease (i.e., FFR ≤0.80). On a per-vessel basis (n = 253), 59 lesions (23%) were graded as hemodynamically significant, and the diagnostic accuracy of coronary CTA (diameter stenosis ≥50%) was 95%, 75%, 98%, and 54% for sensitivity, specificity, negative predictive value, and positive predictive value, respectively. TAG and TAG-ExC did not discriminate between vessels with or without hemodynamically significant lesions (−13.5 ± 17.1 HU [Hounsfield units] × 10 mm−1 vs. −11.6 ± 13.3 HU × 10 mm−1, p = 0.36; and 13.1 ± 15.9 HU × 10 mm−1 vs. −11.4 ± 11.7 HU × 10 mm−1, p = 0.77, respectively). TAG-CCO was lower in vessels with a hemodynamically-significant lesion (−0

  4. Estimation of coronary artery stenosis by low-dose adenosine stress real-time myocardial contrast echocardiography: a quantitative study

    Institute of Scientific and Technical Information of China (English)

    ZHOU Xiao; ZHI Guang; XU Yong; WANG Jing; YAN Guo-hui

    2012-01-01

    Background Coronary microcirculation reserve is an important field in the research of coronary artery disease,but it is difficult to identify clinically.Currently it is widely accepted that myocardial contrast echocardiography (MCE) is a safe,inexpensive method and has comparatively high image resolution.The present study used quantitative low-dose adenosine stress real-time (RT)-MCE to estimate myocardial perfusion and the coronary stenosis.Methods Forty-nine left ventricular (LV) segments from 14 unselected patients were divided into three groups according to the coronary angiography or CT angiography results:group 1 (n=20,41%) without significant stenosis (<70%),group 2 (n=12,24%)with successful percutaneous coronary intervention (PCI),and group 3 (n=17,35%)with significant stenosis (>70%).RT-MCE was performed in these patients with low-dose adenosine stress and continuous infusion of Sonovue.The replenishing curves were drawn according to the contrast density measured at the end-diastolic frame of every cardiac circle by ACQ software.Results Forty-nine LV segments with satisfactory image quality were picked for quantitative contrast echo analysis.The replenishing curves were analyzed at baseline and after stress.Perfusion of group 3 did not decrease significantly at baseline,and showed no improvement during adenosine stress and was significantly different from groups 1 and 2 (P <0.05).The A·β and β increased more significantly in group 1 than in groups 2 and 3 (P <0.05).In a receiver operating characteristic (ROC) curve analysis,A·β under adenosine stress <1.74 dB/s had a sensitivity and specificity of 71% for diagnosis of coronary artery stenosis,reduced adenosine-induced rise (percentage of A·β <81%) had a sensitivity and specificity of 83% and 79% for the diagnosis of low-reserve,and β <54% had a sensitivity of 86% and specificity of 79%.Conclusions Rest perfusion of severely stenosed arteries may be normal

  5. Model Validation for a Noninvasive Arterial Stenosis Detection Problem

    Science.gov (United States)

    2013-06-09

    Diastolic murmur caused by coronary artery stenosis , Ann. Int. Med, 72 (1970), 543. [33] T. Deffieux, G. Montaldo, M. Tanter, Shear wave spectroscopy for...Circulation, 103 (2001), 604–616. [45] N. Owsley and A. Hull, Beamformed nearfield imaging of a simulated coronary artery containing a stenosis , IEEE...murmur of coronary artery stenosis , Brit. Heart J., 35 (1973), 840. [53] J. Semmlow and K. Rahalkar, Acoustic detection of coronary artery disease, Annu

  6. Circulating Malondialdehyde-Modified LDL-Related Variables and Coronary Artery Stenosis in Asymptomatic Patients with Type 2 Diabetes

    OpenAIRE

    Kazuya Fujihara; Hiroaki Suzuki; Akira Sato; Satoru Kodama; Yoriko Heianza; Kazumi Saito; Hitoshi Iwasaki; Kazuto Kobayashi; Shigeru Yatoh; Akimitsu Takahashi; Naoya Yahagi; Hiroaki Yagyu; Hirohito Sone; Hitoshi Shimano

    2015-01-01

    Aims. To elucidate the levels of malondialdehyde-modified LDL (MDA-LDL)-related variables for predicting coronary artery stenosis (CAS) by coronary CT angiography (CCTA) in asymptomatic patients with type 2 diabetes (T2DM). Methods. Enrolled were 36 Japanese patients with T2DM who underwent CCTA and in whom MDA-LDL levels were measured. Definition of CAS was luminal narrowing of ≥50%. Trends through tertiles of each MDA-LDL-related variable were analyzed with a general linear model. The abili...

  7. Four-dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis.

    Science.gov (United States)

    Deng, Yan; Peng, Long; Liu, Yuan-Yuan; Yin, Li-Xue; Li, Chun-Mei; Wang, Yi; Rao, Li

    2017-07-28

    The aim of this prospective study was to assess the diagnosis value of four-dimensional echocardiography area strain (AS) combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis. Based on treadmill exercise load status, two-dimensional conventional echocardiography and four-dimensional echocardiography area strain were performed on patients suspected coronary artery disease before coronary angiogram. Thirty patients (case group) with mild left anterior descending coronary artery stenosis (stenosis coronary artery stenosis according to the coronary angiogram results were prospectively enrolled. All the patients had no left ventricular regional wall motion abnormality in two-dimensional echocardiography at rest and exercise stress. There was no significant difference in the 16 segmental systolic peak AS at rest between two groups. After exercise stress, the peak systolic ASrest-stress at mid anterior wall (-7.00%±10.90% vs 2.80%±23.69%) and mid anterolateral wall (-4.40%±18.81% vs 8.80%±19.16%) were decreased, while increased at basal inferolateral wall (14.00%±19.27% vs -5.60%±15.94%) in case group compared with control group (Pcoronary artery stenosis, the area strain was decreased at involved segments, while compensatory increased at noninvolved segments after exercise stress. Four-dimensional echocardiography area strain combined with exercise stress echocardiography could sensitively find left ventricular regional systolic function abnormality in patients with mild single vessel coronary artery stenosis, and locate stenosis coronary artery accordingly. © 2017, Wiley Periodicals, Inc.

  8. Mild coronary artery stenosis has no impact on cardiac and vascular parameters in miniature swine exposed to positive acceleration stress.

    Science.gov (United States)

    Zhang, Haitao; Luo, Huilan; Sun, Jinjin; Liu, Chaozhong; Tian, Yi; Chen, Hao; Zhang, Chao

    2016-10-01

    Exposure of pilots' heart to acceleration-associated stress (+Gz stress) is an adverse effect of high-performance aviation. The occurrence of coronary heart diseases is one of the most frequent medical causes leading to cessation of flying. To assess the effects of +Gz stress on coronary artery stenosis (CAS) in a minimally invasive miniature swine model with a fast recovery. The proximal left anterior descending branch was ligated in 20 swine using silk suture. CAS degree (mild, moderate, severe) was analyzed by quantitative computerized angiography. Five swine underwent a sham operation. +Gz stress exposure was performed and venous blood was collected before/after exposure. Plasma C-reactive protein (CRP), endothelin (ET)-1, angiotensin (Ang) II and urotensin 2 (U2) levels were measured. CAS models were successful in 18 animals. Two swine exhibited ventricular fibrillation during the procedure and died. Plasma CRP, ET-1, Ang II and U2 changed significantly after maximal tolerated +Gz stress exposure (all P stenosis groups, compared with the sham group (all P stenosis group and the sham group (all P > 0.05). The fully endoscopic operation method successfully generated animal models of different degrees of CAS. Plasma CRP, ET-1, Ang II and U2 levels increased after +Gz stress exposure with increasing CAS severity. Animals with mild stenosis showed no ill effect under +Gz stress, suggesting that pilots with mild stenosis might be allowed to continue flying, but it must be confirmed in humans.

  9. Parallel comparison of risk factors between progression of organic stenosis in the coronary arteries and onset of acute coronary syndrome by covariance structure analysis.

    Science.gov (United States)

    Ogawa, Kazuo; Minai, Kosuke; Kawai, Makoto; Tanaka, Toshikazu; Nagoshi, Tomohisa; Ogawa, Takayuki; Yoshimura, Michihiro

    2017-01-01

    It is widely accepted that progression of organic stenosis in the coronary arteries and onset of acute coronary syndrome (ACS) are similar in the development of atherosclerosis. However, the extent of the association of each risk factor with the respective pathological conditions has not been fully elucidated. We investigated the differences in risk factors between these conditions using a statistical procedure. The study population consisted of 1,029 patients with ischemic heart disease (IHD). We divided the study population into two groups (ACS and non-ACS) and by diseased vessels (organic stenosis). Covariance structure analysis was simultaneously performed in one equation model for determination and comparison of the risk factors for organic stenosis and ACS. The analysis revealed that age (standardized regression coefficient, β: 0.206, P stenosis. HDL level (β: 0100, P = 0.002) and MDA-LDL level (β: 0.335, P stenosis than ACS, while MDA-LDL was significantly more strongly associated with ACS than organic stenosis. The current statistical analysis revealed clear differences among the risk factors between the progression of organic stenosis and the onset of ACS. Among them, the MDA-LDL level should be considered to indicate a substantial risk of ACS.

  10. Detection of significant coronary artery stenosis with cardiac dual-source computed tomography angiography in heart transplant recipients.

    Science.gov (United States)

    von Ziegler, Franz; Rümmler, Janine; Kaczmarek, Ingo; Greif, Martin; Schenzle, Jan; Helbig, Susanne; Becker, Christoph; Meiser, Bruno; Becker, Alexander

    2012-10-01

    Present study evaluates clinical feasibility of cardiac dual-source computed tomography angiography (DSCTA) to detect significant coronary stenosis because of chronic allograft vasculopathy (CAV) after heart transplantation (HTX). An overall of 51 consecutive heart transplant recipients (43 men, 8 women, mean age: 52.3 ± 13.6 years) underwent DSCTA 1 ± 2 days before annual routine invasive coronary angiography (ICA). Three patients were excluded from further analysis. Total 714/717 (99.6%) segments in remaining 48 patients were depicted in diagnostic image quality by DSCTA with three vessel segments in two patients being additionally excluded because of motion artefacts. On a segment-based analysis, sensitivity, specificity, and diagnostic accuracy (DA) for detection of significant stenosis were calculated as 100%, 98.9% and 98.9% respectively. On a patient-based evaluation, sensitivity, specificity and DA were 100%, 86.0% and 93.0% respectively for remaining 46 patients. Negative predictive value (NPV) was 100%. DSCTA enables diagnosis and especially the exclusion of significant coronary artery stenosis in patients after HTX with a high NPV. The low rate of excluded vessel segments compared with former studies indicates improvement in image acquisition and robustness of latest scanner technology and thus may make subsequent annual invasive coronary angiography unnecessary. © 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.

  11. A Case of Severe Carotid Stenosis in a Patient with Familial Hypercholesterolemia without Significant Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Marcos Aurélio Lima Barros

    2014-01-01

    Full Text Available Familial hypercholesterolemia (FH is an inherited metabolic disorder characterized by elevated low-density lipoprotein cholesterol levels in the blood. In its heterozygous form, it occurs in 1 in 500 individuals in the general population. It is an important contributor to the early onset of coronary artery disease (CAD, accounting for 5–10% of cases of cardiovascular events in people younger than 50 years. Atherogenesis triggered by hypercholesterolemia generally progresses faster in the coronary arteries, followed by the subsequent involvement of other arteries such as the carotids. Thus, symptoms of CAD commonly appear before the onset of significant carotid stenosis. Herein, we report the case of a patient with untreated FH who had severe carotid atherosclerosis at the age of 46 years but had no evidence of significant CAD.

  12. [Prediction of coronary artery stenosis by measurement of total plaque area and thickness versus intima media thickness of the carotid artery].

    Science.gov (United States)

    Adams, Ansgar; Bojara, Waldemar

    2015-08-01

    Total plaque area (TPA), maximum plaque thickness and intima media thickness (IMT) in the carotid arteries of 431 patients aged 27-88 years were measured 1 day before a planned coronary artery angiography without any clinical knowledge about the patient. Age-related cut-off values of the TPA for the presence of coronary stenosis were evaluated. Using ultrasound four types of carotid artery atherosclerosis were identified. The accuracy of detection of cardiovascular coronary stenosis was 87% for types III and IVb. No type I patient had coronary stenosis. The IMT was significantly less predictive: the area under the curve (AUC) for TPA by age and plaque thickness was 0.82 (95% CI: 0.78-0.85) versus IMT 0.59 (95% CI: 0.54-0.64, p = 0.001). Prediction with TPA measurement by age and plaque thickness was better than TPA alone: AUC 0.82 (95% CI: 0.78-0.85) versus 0.77 (95% CI: 0.73-0.81, p = 0.0028), respectively. In a second cohort of 2566 healthy men and 1216 healthy women aged between 20 and 64 years who were examined in an occupational screening program, 11.2% of the men and 3.4% of the women showed a type III or IVb result. In the mean follow-up of period of 23.4 ± 14.4 months, 14 heart attacks, 7 bypass operations and 3 stent implantations occurred and 6 subjects showed coronary stenosis between 50% and 95% in coronary angiography. In the baseline examination 26 out of 30 patients showed a type III or IVb result. In the case of men and women with types III and IVb diagnosis by ultrasound, pharmaceutical treatment could be indicated in order to reduce the risk of cardiovascular events. Type I patients do not need preventive medication or coronary catheterization.

  13. In-Vitro Evaluation of Coronary Stents and 64-Detector-Row Computed Tomography Using a Newly Developed Model of Coronary Artery Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Schlosser, T.; Scheuermann, T.; Ulzheimer, S.; Mohrs, O.K.; Kuehling, M.; Albrecht, P.E.; Voigtlaender, T.; Barkhausen, J.; Schmermund, A. (Cardiovascular Center Bethanien (CCB), Frankfurt (DE))

    2008-02-15

    Background: Stent implantation is the predominant therapy for non-surgical myocardial revascularization in patients with coronary artery disease. However, despite substantial advances in multidetector computed tomography (MDCT) coronary imaging, a reliable detection of coronary in-stent restenosis is currently not possible. Purpose: To examine the ability of 64-detector-row CT to detect and to grade in-stent stenosis in coronary stents using a newly developed ex-vivo vessel phantom with a realistic CT density pattern, artificial stenosis, and a thorax phantom. Material and Methods: Four different stents (Liberte and Lunar ROX, Boston Scientific; Driver, Medtronic; Multi-Link Vision, Guidant) were examined. The stents were placed on a polymer tube with a diameter of 2.5, 3.0, 3.5, or 4.0 mm. Different degrees of stenosis (0%, 30%, 50%, 70-80%) were created inside the tube. For quantitative analysis, attenuation values were measured in the non-stenotic vessel outside the stent, in the non-stenotic vessel inside the stent, and in the stenotic area inside the stent. The grade of stenosis was visually assessed by two observers. Results: All stents led to artificial reduction of attenuation, the least degree of which was found in the Liberte stent (11.3+-10.2 HU) and the Multi-Link Vision stent (17.6+-17.9 HU; P 0.25). Overall, the non-stenotic vessel was correctly diagnosed in 55.5%, the low-grade stenosis in 58.3%, the intermediate stenosis in 63.8%, and the high-grade stenosis in 80.5%. In the 3.0-, 3.5-, and 4.0-mm vessels, in none of the cases was a non-stenotic or low-grade stenotic vessel misdiagnosed as intermediate or high-grade stenosis. The average deviation from the real grade of stenosis was 0.40 for the Liberte stent, 0.46 for the Lunar ROX stent, 0.45 for the Driver stent, and 0.58 for the Multi-Link Vision stent. Conclusion: Our ex-vivo data show that non-stenotic stents and low-grade in-stent stenosis can be reliably differentiated from intermediate and

  14. ABSENCE OF SEPTAL Q WAVES: An Important Predictor of Significant Coronary Artery Disease and Mainly Proximal Stenosis of the Left Anterior Descending Artery.

    Science.gov (United States)

    Matta, Anthony; Kallab, Kamal; Kharma, Alexandre

    2016-01-01

    Data concerning the correlation between the absence of septal q waves and significant stenosis of proximal left anterior descending (LAD) artery shows conflicting results. This retrospective study was conducted to show that absence of septal q waves in leads V5-V6 could be of value in predicting significant coronary artery disease (CAD) and mainly significant proximal LAD coronary artery stenosis. Our study included 500 consecutive patients who had coronary angiography, retrospectively chosen, excluding patients with acute coronary syndromes, and patients with abnormal ECGs (abnormal QRS duration, pathological q waves and hemiblocks). ECG and angiography films were reviewed. For the 2x2 tables analysis, a chi-square test was used. Of the 500 patients, 386 had significant CAD defined as 70% luminal stenosis, and 260 had no septal q wave. Of the 386 patients with significant CAD, 233 (60%) did not have septal q waves. Of 260 who did not have septal q wave, 192 (73%) had significant stenosis of proximal LAD. Statistical analysis shows that significant CAD correlates with the absence of septal q waves, with a sensitivity of 60% and a specificity of 76%, and that stenosis of proximal LAD could be predicted by absence of septal q waves in leads V5-V6 with a sensitivity of 83% and a specificity of 74%. The absence of septal q waves in leads V5-V6 on the ECG correlates with the presence of significant CAD and is of highly predictive value in those with significant stenosis of proximal LAD (p < 0.0001).

  15. Effect of heart rate on the diagnostic accuracy of 256-slice computed tomography angiography in the detection of coronary artery stenosis: ROC curve analysis.

    Science.gov (United States)

    Wang, Gang; Wu, Yifen; Zhang, Zhentao; Zheng, Xiaolin; Zhang, Yulan; Liang, Manqiu; Yuan, Huanchu; Shen, Haiping; Li, Dewei

    2016-05-01

    The aim of the present study was to investigate the effect of heart rate (HR) on the diagnostic accuracy of 256-slice computed tomography angiography (CTA) in the detection of coronary artery stenosis. Coronary imaging was performed using a Philips 256-slice spiral CT, and receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic value of 256-slice CTA in coronary artery stenosis. The HR of the research subjects in the study was within a certain range (39-107 bpm). One hundred patients suspected of coronary heart disease underwent 256-slice CTA examination. The cases were divided into three groups: Low HR (HR coronary segments on a four-point ordinal scale. An image quality of grades 1-3 was considered diagnostic, while grade 4 was non-diagnostic. A total of 97.76% of the images were diagnostic in the low-HR group, 96.86% in the moderate-HR group and 95.80% in the high-HR group. According to the ROC curve analysis, the specificity of CTA in diagnosing coronary artery stenosis was 98.40, 96.00 and 97.60% in the low-, moderate- and high-HR groups, respectively. In conclusion, 256-slice coronary CTA can be used to clearly show the main segments of the coronary artery and to effectively diagnose coronary artery stenosis. Within the range of HRs investigated, HR was found to have no significant effect on the diagnostic accuracy of 256-slice coronary CTA for coronary artery stenosis.

  16. Critical stenosis of a right ventricle to coronary artery fistula seen at dual-source CT in a newborn with pulmonary atresia and intact ventricular septum.

    Science.gov (United States)

    Séguéla, Pierre-Emmanuel; Houyel, Lucile; Loget, Philippe; Piot, Jean-Dominique; Paul, Jean-François

    2011-08-01

    We report the case of a newborn with pulmonary atresia with intact ventricular septum and right ventricle-dependent coronary circulation. He died several weeks after a Blalock-Taussig procedure because of a progressive stenosis of the main coronary artery. We present echocardiographic and dual-source CT images of the stenosis, with autopsy correlation. To our knowledge, CT images of this quality have never been reported in a newborn. This case illustrates the extreme difficulty in prognosticating the outcome for these patients and underlines the need for a detailed neonatal coronary mapping to assess right ventricle-dependent coronary circulation.

  17. Stent-induced coronary artery stenosis characterized by multimodal nonlinear optical microscopy

    Science.gov (United States)

    Wang, Han-Wei; Simianu, Vlad; Locker, Mattew J.; Cheng, Ji-Xin; Sturek, Michael

    2011-02-01

    We demonstrate for the first time the applicability of multimodal nonlinear optical (NLO) microscopy to the interrogation of stented coronary arteries under different diet and stent deployment conditions. Bare metal stents and Taxus drug-eluting stents (DES) were placed in coronary arteries of Ossabaw pigs of control and atherogenic diet groups. Multimodal NLO imaging was performed to inspect changes in arterial structures and compositions after stenting. Sum frequency generation, one of the multimodalities, was used for the quantitative analysis of collagen content in the peristent and in-stent artery segments of both pig groups. Atherogenic diet increased lipid and collagen in peristent segments. In-stent segments showed decreased collagen expression in neointima compared to media. Deployment of DES in atheromatous arteries inhibited collagen expression in the arterial media.

  18. Prediction of the true fractional flow reserve of left main coronary artery stenosis with concomitant downstream stenoses: in vitro and in vivo experiments.

    Science.gov (United States)

    Yamamoto, Erika; Saito, Naritatsu; Matsuo, Hitoshi; Kawase, Yoshiaki; Watanabe, Shin; Bao, Bingyuan; Watanabe, Hiroki; Higami, Hirooki; Nakatsuma, Kenji; Kimura, Takeshi

    2016-02-01

    The functional impact of downstream coronary stenoses on left main coronary artery (LMCA) stenosis has not been fully elucidated. This study therefore aimed to use in vitro and in vivo experiments to assess two novel equations that predict the true fractional flow reserve (FFR) of a left main coronary artery (LMCA) stenosis with concomitant downstream stenoses. Two novel equations were derived. One equation predicts the true fractional flow reserve (FFR) of an LMCA stenosis with a downstream stenosis (Equation A), and the other predicts the true FFR of an LMCA stenosis with downstream stenoses in both the left anterior descending and left circumflex arteries (Equation B). The equations were validated in both in vitro and in vivo models of the coronary circulation. The agreements between the apparent FFR (FFRapp), the predicted FFR (FFRpred) and the true FFR (FFRtrue) were assessed by Passing-Bablok regression analysis. Passing-Bablok regression analysis revealed that there were fixed proportional errors between FFRapp-m and FFRtrue-m, though a very small fixed error and no proportional errors between FFRpred-m and FFRtrue-m. The absolute differences between FFRpred and FFRtrue were significantly lower as compared to those between FFRapp and FFRtrue in all experiments. Two novel equations which predict the true FFR of LMCA stenosis were demonstrated to be correct. The study also revealed that the functional impact of downstream stenoses on the LMCA stenosis became stronger when the downstream stenoses became more severe.

  19. Carotid artery stenting in patients with acute coronary syndrome: a possible primary therapy for symptomatic carotid stenosis.

    Science.gov (United States)

    Casana, Renato; Halliday, Alison; Bianchi, Paolo; Fresa, Emanuele; Silani, Vincenzo; Parati, Gianfranco; Blengino, Simonetta; Cireni, Lea; Adobbati, Laura; Calvillo, Laura; Tolva, Valerio S

    2013-08-01

    To report the results of carotid artery stenting (CAS) in symptomatic patients (stroke/transient ischemic attack) after recent percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS). Between January 2009 and July 2011, 28 consecutive patients (18 women; mean age 66 years, range 42-82) underwent protected CAS for symptomatic carotid stenosis following recent PTCA that included bare or drug-eluting stents requiring uninterrupted dual antiplatelet therapy. Primary technical success, neurological complications, major adverse cardiovascular events, and death were evaluated at 30 days and over midterm follow-up. Technical success was 96%; 1 patient suffered a nonfatal major stroke (3.5% 30-day stroke rate) during the procedure. During a median 21.6-month follow-up, 4 (14%) patients died of myocardial infarction (all diabetic smokers with ejection fractions 34 kg/m(2). This preliminary experience demonstrated that CAS is a reasonable, safe, and effective treatment for patients with symptomatic carotid artery stenosis who were recently treated with coronary stents requiring uninterrupted dual antiplatelet therapy.

  20. Accuracy of automated software-guided detection of significant coronary artery stenosis by CT angiography: comparison with invasive catheterisation

    Energy Technology Data Exchange (ETDEWEB)

    Anders, Katharina; Uder, Michael [University of Erlangen, Department of Radiology, Erlangen (Germany); Achenbach, Stephan; Petit, Isabel; Daniel, Werner G.; Pflederer, Tobias [University of Erlangen, Department of Internal Medicine 2 (Cardiology), Erlangen (Germany)

    2013-05-15

    True automated detection of coronary artery stenoses might be useful whenever expert evaluation is not available, or as a ''second reader'' to enhance diagnostic confidence. We evaluated the accuracy of a PC-based stenosis detection tool alone and combined with expert interpretation. One hundred coronary CT angiography datasets were evaluated with the automated software alone, by manual interpretation (axial images, multiplanar reformations and maximum intensity projections in free double-oblique planes), and by expert interpretation aware of the automated findings. Stenoses {>=} 50 % were noted per-vessel and per-patient, and compared with invasive angiography. Automated post-processing was successful in 90 % of patients (88 % of vessels). When excluding uninterpretable datasets, per-patient sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 89 %, 79 %, 74 % and 92 % (per-vessel: 82 %, 85 %, 48 % and 96 %). All 100 datasets were evaluable by expert interpretation. Per-patient sensitivity, specificity, PPV and NPV were 95 %, 95 %, 93 % and 97 % (per-vessel: 89 %,98 %, 88 % and 98 %). Knowing the results of automated interpretation did not improve the performance of expert readers. Automated off-line post-processing of coronary CT angiography shows adequate sensitivity, but relatively low specificity in coronary stenosis detection. It does not increase accuracy of expert interpretation. Failure of post-processing in 10 % of all patients necessitates additional manual image work-up. (orig.)

  1. Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations.

    Science.gov (United States)

    Di Gioia, Giuseppe; Pellicano, Mariano; Toth, Gabor G; Casselman, Filip; Adjedj, Julien; Van Praet, Frank; Stockman, Bernard; Degrieck, Ivan; Trimarco, Bruno; Wijns, William; De Bruyne, Bernard; Barbato, Emanuele

    2016-04-01

    We evaluated the clinical outcome of patients with moderate/severe aortic stenosis and significant coronary disease not treated according to guidelines, recommending combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). From 2002 to 2010, we assessed death up to 5 years in 650 patients with moderate/severe aortic stenosis and at least one coronary lesion (>50 %): 23 % were treated conservatively (MT), 17 % with percutaneous coronary intervention (PCI), 11 % with AVR, and 49 % with combined CABG and AVR. At a median follow-up of 58 months, overall death decreased over the groups (MT, 68 % vs. PCI, 44 % vs. AVR, 34 % vs. CABG and AVR, 23 %, p < 0.01). Compared to the MT group, Cox regression analysis adjusted for potential confounders showed significantly reduced mortality in the PCI, AVR, and CABG and AVR groups. When combined CABG and AVR is not feasible, PCI or AVR alone still improves significantly long-term survival as compared with MT alone.

  2. [Clinical aspects of arteriosclerotic stenosis of the left coronary artery main stem].

    Science.gov (United States)

    Volth, L; Csapó, K; Mihóczy, L

    1991-06-23

    Authors have found 37 significant (greater than 50%) or severe (greater than 75%) cases of left main stem stenosis (LMS) (3.4%, 35 male and 2 female) during 1097 consecutive selective coronarography. Retrospective analysis of the clinical data of the 35 male pts. showed severe effort or resting anginal complaints in the 2/3 of the pts., however this was not in tight connection with the degree of the LMS stenosis or the number of associated peripheral coronary stenoses respectively, similar to the ischaemic disorders of the resting ECG. In the bycicle ergometry ECG data lone the double index showed statistically significant difference between the groups of less than or equal to 2 and 3 vessel diseases connected to the severe LMS. Myocardium scintigraphy was performed out in 6 pts., all of them has given positive result. They emphasise the necessarity of urgent revascularisation against the higher risk of the intervention because of the pour results of the medical treatment.

  3. Combining Personality Traits with Traditional Risk Factors for Coronary Stenosis: An Artificial Neural Networks Solution in Patients with Computed Tomography Detected Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Angelo Compare

    2013-01-01

    Full Text Available Background. Coronary artery disease (CAD is a complex, multifactorial disease in which personality seems to play a role but with no definition in combination with other risk factors. Objective. To explore the nonlinear and simultaneous pathways between traditional and personality traits risk factors and coronary stenosis by Artificial Neural Networks (ANN data mining analysis. Method. Seventy-five subjects were examined for traditional cardiac risk factors and personality traits. Analyses were based on a new data mining method using a particular artificial adaptive system, the autocontractive map (AutoCM. Results. Several traditional Cardiovascular Risk Factors (CRF present significant relations with coronary artery plaque (CAP presence or severity. Moreover, anger turns out to be the main factor of personality for CAP in connection with numbers of traditional risk factors. Hidden connection map showed that anger, hostility, and the Type D personality subscale social inhibition are the core factors related to the traditional cardiovascular risk factors (CRF specifically by hypertension. Discussion. This study shows a nonlinear and simultaneous pathway between traditional risk factors and personality traits associated with coronary stenosis in CAD patients without history of cardiovascular disease. In particular, anger seems to be the main personality factor for CAP in addition to traditional risk factors.

  4. Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Mijušković Dragan

    2012-01-01

    Full Text Available Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

  5. Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: A two-center study.

    Science.gov (United States)

    Henein, Michael; Hällgren, Peter; Holmgren, Anders; Sörensen, Karen; Ibrahimi, Pranvera; Kofoed, Klaus Fuglsang; Larsen, Linnea Hornbech; Hassager, Christian

    2015-12-01

    The underlying pathology in aortic stenosis (AS) and coronary artery stenosis (CAS) is similar including atherosclerosis and calcification. We hypothesize that coronary artery calcification (CAC) is likely to correlate with aortic root calcification (ARC) rather than with aortic valve calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue. We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve. CAC was present in 92%, AVC in 100% and ARC in 82% of patients. CAC correlated with ARC (rho = 0.51, p coronary arteries correlated with ARC (rho = 0.45, p coronary stenosis (>50%), but these were not different in the pattern of calcification from those without CAS. CAC was consistently higher in patients with risk factors for atherosclerosis compared to those without. The observed relationship between coronary and aortic root calcification suggests a diffuse arterial disease. The lack of relationship between coronary and aortic valve calcification suggests a different pathology. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Noninvasive diagnosis of coronary artery stenosis in women with limited exercise capacity: comparison of dobutamine stress echocardiography and 99mTc sestamibi single-photon emission CT

    NARCIS (Netherlands)

    A. Elhendy (Abdou); J.J. Bax (Jeroen); P.R. Nierop; M.L. Geleijnse (Marcel); M.M. Ibrahim; J.R.T.C. Roelandt (Jos); R.T. van Domburg (Ron)

    1998-01-01

    textabstractOBJECTIVES: To compare the accuracy of dobutamine stress echocardiography (DSE) and simultaneous 99mTc sestamibi (MIBI) single-photon emission CT (SPECT) imaging for the diagnosis of coronary artery stenosis in women. PATIENTS: Seventy women with limited

  7. The assessment of serum levels of malondialdehyde and total antioxidant capacity after the use of atorvastatin in patients with coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    Gholamreza Shahsavari

    2015-02-01

    significant reduction of plasma MDA levels as well as a significant enhancement of TAC in coronary artery stenosis patients with long time receiving atorvastatin contribute to the lowering oxidative stress in this patients.

  8. [Surgical treatment of a patient with coronary artery disease combined with stenosis of the left subclavian artery].

    Science.gov (United States)

    Sevastyanov, A V; Chernyavsky, A M; Chernyavsky, M A; Edemsky, A G; Nesmachnyi, A S; Tarkova, A R

    2016-01-01

    Presented in the article is a clinical case report regarding successfully used hybrid technology in combined lesions of the coronary arteries and the first segment of the left subclavian artery. The patient was subjected to simultaneous hybrid operation, i. e., transaortic angioplasty with stenting of the left subclavian artery by means of the Assurant stent accompanied by coronary artery bypass grafting. The early postoperative period turned out uneventful. The patient was discharged with no complications and in a satisfactory condition. At the 12-month follow-up visit, the patient presented no complaints, felling satisfactory as he stated, and there was no evidence of restenosis as revealed by the findings of ultrasonographic examination. This clinical case report demonstrates that in this type of combined lesion the use of hybrid technologies makes it possible to obtain a favourable surgical outcome both in the immediate and remote postoperative periods.

  9. Improved assessment of functional severity of coronary artery stenosis by analysis of combined intracoronary pressure and flow velocity signals

    NARCIS (Netherlands)

    Nolte, F.

    2014-01-01

    Coronary artery disease (CAD) accounts for almost 2 million deaths per year within the EU. CAD is often characterized by focal narrowing of epicardial arteries, limiting coronary arterial flow and myocardial perfusion. Treatment of critical lesions by percutaneous coronary intervention (PCI) can be

  10. The Association Between Small Dense Low Density Lipoprotein,Apolipoprotein B, Apolipoprotein B/apolipoprotein A1 Ratio and coronary Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Abbas Zavarehee

    2009-05-01

    Full Text Available Background:Recently,small dense low density lipoprotein (sdLDL has been highlighted as a new risk factor for the coronary artery disease(CAD.Small dense LDLs are believed to be atherogenic since these particles are taken up more easily by arterial wall.They are readily oxidized and have reduced affinity for low density lipoprotein (LDL receptor and increased affinity for arterial proteoglicans.LDL cholesterol is only a measure of the cholesterol level in the LDL whereas apolipoprotein B(apo B is a measure of the cholesterol levels of all the atherogenic particles,including very low density lipoprotein, intermediate density, and low density lipoproteins. Therefore,it might be a better marker than other traditional lipids. The aim of the present study was to evaluate the association between serum small dense LDL, apolipoprotein B, apolipoprotein A1 (apo A1 and apoB/apoA1 ratio and the coronary stenosis.Methods: 86 patients with coronary stenosis, 35 patients without coronary stenosis   identified by angiography who were referred to Rajaii Heart Center , and 30 healthy individuals were studied.SdLDL was measured by a direct homogenous LDL-C assay in the supernatant of serum which remained after heparin-magnesium precipitation.Serum apolipoprotein A1 and apolipoprotein B were measured by using immunoturbidimetric method.Results: The results showed that the sdLDL levels were higher in patients with coronary stenosis than patients without coronary stenosis and healthy individuals   (21.54±7.1, 16.88±4.4 and 15.45±5mg/dl, p=0.001, respectively. In addition the level   of apoB (with stenosis: 113.71±21.8, without stenosis:100.88±18.7 and healthy:102.30±9.6, p=0.003 and apoB/apoA1 ratio (with stenosis:1.100±0.24, without stenosis :0.589±0.26 and healthy:0.751±0.16, p=0.001 were significantly higher in patients with coronary stenosis. SdLDL levels were positively correlated with the level of apoB(r=0.589, apoB/apoA1 ratio(r=0.416, triglyceride

  11. Multi-scale feature extraction for learning-based classification of coronary artery stenosis

    Science.gov (United States)

    Tessmann, Matthias; Vega-Higuera, Fernando; Fritz, Dominik; Scheuering, Michael; Greiner, Günther

    2009-02-01

    Assessment of computed tomography coronary angiograms for diagnostic purposes is a mostly manual, timeconsuming task demanding a high degree of clinical experience. In order to support diagnosis, a method for reliable automatic detection of stenotic lesions in computed tomography angiograms is presented. Thereby, lesions are detected by boosting-based classification. Hence, a strong classifier is trained using the AdaBoost algorithm on annotated data. Subsequently, the resulting strong classification function is used in order to detect different types of coronary lesions in previously unseen data. As pattern recognition algorithms require a description of the objects to be classified, a novel approach for feature extraction in computed tomography angiograms is introduced. By generation of cylinder segments that approximate the vessel shape at multiple scales, feature values can be extracted that adequately describe the properties of stenotic lesions. As a result of the multi-scale approach, the algorithm is capable of dealing with the variability of stenotic lesion configuration. Evaluation of the algorithm was performed on a large database containing unseen segmented centerlines from cardiac computed tomography images. Results showed that the method was able to detect stenotic cardiovascular diseases with high sensitivity and specificity. Moreover, lesion based evaluation revealed that the majority of stenosis can be reliable identified in terms of position, type and extent.

  12. Arterial pulse wave dynamics after percutaneous aortic valve replacement: fall in coronary diastolic suction with increasing heart rate as a basis for angina symptoms in aortic stenosis.

    Science.gov (United States)

    Davies, Justin E; Sen, Sayan; Broyd, Chris; Hadjiloizou, Nearchos; Baksi, John; Francis, Darrel P; Foale, Rodney A; Parker, Kim H; Hughes, Alun D; Chukwuemeka, Andrew; Casula, Roberto; Malik, Iqbal S; Mikhail, Ghada W; Mayet, Jamil

    2011-10-04

    Aortic stenosis causes angina despite unobstructed arteries. Measurement of conventional coronary hemodynamic parameters in patients undergoing valvular surgery has failed to explain these symptoms. With the advent of percutaneous aortic valve replacement (PAVR) and developments in coronary pulse wave analysis, it is now possible to instantaneously abolish the valvular stenosis and to measure the resulting changes in waves that direct coronary flow. Intracoronary pressure and flow velocity were measured immediately before and after PAVR in 11 patients with unobstructed coronary arteries. Using coronary pulse wave analysis, we calculated the intracoronary diastolic suction wave (the principal accelerator of coronary blood flow). To test physiological reserve to increased myocardial demand, we measured at resting heart rate and during pacing at 90 and 120 bpm. Before PAVR, the basal myocardial suction wave intensity was 1.9±0.3×10(-5) W · m(-2) · s(-2), and this increased in magnitude with increasing severity of aortic stenosis (r=0.59, P=0.05). This wave decreased markedly with increasing heart rate (β coefficient=-0.16×10(-4) W · m(-2) · s(-2); Pcoronary physiological reserve with increasing heart rate (β coefficient=0.9×10(-3) W · m(-2) · s(-2); P=0.014). In aortic stenosis, the coronary physiological reserve is impaired. Instead of increasing when heart rate rises, the coronary diastolic suction wave decreases. Immediately after PAVR, physiological reserve returns to a normal positive pattern. This may explain how aortic stenosis can induce anginal symptoms and their prompt relief after PAVR. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01118442.

  13. Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries.

    Science.gov (United States)

    Kefer, Joelle M; Coche, Emmanuel; Vanoverschelde, Jean-Louis J; Gerber, Bernhard L

    2007-01-01

    The purpose of this study was to assess the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for detecting in-stent restenosis. Fifty patients with 69 previously implanted coronary stents underwent 16-slice MDCT before quantitative coronary angiography (QCA). Diagnostic accuracy of MDCT for detection of in-stent restenosis defined as >50% lumen diameter stenosis (DS) in stented and nonstented coronary segments >1.5-mm diameter was computed using QCA as reference. According to QCA, 18/69 (25%) stented segments had restenosis. In addition, 33/518 (6.4%) nonstented segments had >50% DS. In-stent restenosis was correctly identified on MDCT images in 12/18 stents, and absence of restenosis was correctly identified in 50/51 stents. Stenosis in native coronary arteries was correctly identified in 22/33 segments and correctly excluded in 482/485 segments. Thus, sensitivity (67% vs 67% p=1.0), specificity (98% vs 99%, p=0.96) and overall diagnostic accuracy (90% vs 97%, p=0.68) was similarly high for detecting in-stent restenosis as for detecting stenosis in nonstented coronary segments. MDCT has similarly high diagnostic accuracy for detecting in-stent restenosis as for detecting coronary artery disease in nonstented segments. This suggests that MDCT could be clinically useful for identification of restenosis in patients after coronary stenting.

  14. Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kefer, Joelle M.; Vanoverschelde, Jean-Louis J.; Gerber, Bernhard L. [Cliniques Universitaires St. Luc UCL, Department of Cardiology, Brussels (Belgium); Coche, Emmanuel [Cliniques Universitaires St. Luc UCL, Department of Radiology, Brussels (Belgium)

    2007-01-15

    The purpose of this study was to assess the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for detecting in-stent restenosis. Fifty patients with 69 previously implanted coronary stents underwent 16-slice MDCT before quantitative coronary angiography (QCA). Diagnostic accuracy of MDCT for detection of in-stent restenosis defined as >50% lumen diameter stenosis (DS) in stented and nonstented coronary segments >1.5-mm diameter was computed using QCA as reference. According to QCA, 18/69 (25%) stented segments had restenosis. In addition, 33/518 (6.4%) nonstented segments had >50% DS. In-stent restenosis was correctly identified on MDCT images in 12/18 stents, and absence of restenosis was correctly identified in 50/51 stents. Stenosis in native coronary arteries was correctly identified in 22/33 segments and correctly excluded in 482/485 segments. Thus, sensitivity (67% vs 67% p=1.0), specificity (98% vs 99%, p=0.96) and overall diagnostic accuracy (90% vs 97%, p=0.68) was similarly high for detecting in-stent restenosis as for detecting stenosis in nonstented coronary segments. MDCT has similarly high diagnostic accuracy for detecting in-stent restenosis as for detecting coronary artery disease in nonstented segments. This suggests that MDCT could be clinically useful for identification of restenosis in patients after coronary stenting. (orig.)

  15. Prevalence and risk factors of atherosclerotic renal artery stenosis

    Institute of Scientific and Technical Information of China (English)

    严健华

    2013-01-01

    Objective To explore the prevalence and risk factors of atherosclerotic renal artery stenosis(ARAS) in patients undergoing coronary angiography.Methods A total of 2506 patients with suspected and known coronary

  16. Assessment of the relationship between stenosis severity and distribution of coronary artery stenoses on multislice computed tomographic angiography and myocardial ischemia detected by single photon emission computed tomography

    Science.gov (United States)

    Tamarappoo, Balaji K.; Gutstein, Ariel; Cheng, Victor Y.; Nakazato, Ryo; Gransar, Heidi; Dey, Damini; Thomson, Louise E. J.; Hayes, Sean W.; Friedman, John D.; Germano, Guido; Slomka, Piotr J.

    2010-01-01

    Background The relationship between luminal stenosis measured by coronary CT angiography (CCTA) and severity of stress-induced ischemia seen on single photon emission computed tomographic myocardial perfusion imaging (SPECT-MPI) is not clearly defined. We sought to evaluate the relationship between stenosis severity assessed by CCTA and ischemia on SPECT-MPI. Methods and Results ECG-gated CCTA (64 slice dual source CT) and SPECT-MPI were performed within 6 months in 292 patients (ages 26-91, 73% male) with no prior history of coronary artery disease. Maximal coronary luminal narrowing, graded as 0, ≥25%, 50%, 70%, or 90% visual diameter reduction, was consensually assessed by two expert readers. Perfusion defect on SPECT-MPI was assessed by computer-assisted visual interpretation by an expert reader using the standard 17 segment, 5 point-scoring model (stress perfusion defect of ≥5% = abnormal). By SPECT-MPI, abnormal perfusion was seen in 46/292 patients. With increasing stenosis severity, positive predictive value (PPV) increased (42%, 51%, and 74%, P = .01) and negative predictive value was relatively unchanged (97%, 95%, and 91%) in detecting perfusion abnormalities on SPECT-MPI. In a receiver operator curve analysis, stenosis of 50% and 70% were equally effective in differentiating between the presence and absence of ischemia. In a multivariate analysis that included stenosis severity, multivessel disease, plaque composition, and presence of serial stenoses in a coronary artery, the strongest predictors of ischemia were stenosis of 50-89%, odds ratio (OR) 7.31, P = .001, stenosis ≥90%, OR 34.05, P = .0001, and serial stenosis ≥50% OR of 3.55, P = .006. Conclusions The PPV of CCTA for ischemia by SPECT-MPI rises as stenosis severity increases. Luminal stenosis ≥90% on CCTA strongly predicts ischemia, while stenosis strongly predicts the absence of ischemia. Serial stenosis of ≥50% in a vessel may offer incremental value in addition to

  17. Utility of nonspecific resting electrocardiographic features for detection of coronary artery stenosis by Computed Tomography in acute chest pain patients: from the ROMICAT trial

    Science.gov (United States)

    Banerji, Dahlia; Ptaszek, Leon M.; Taylor, Carolyn; Fontes, Joao D.; Kriegel, Matthias; Irlbeck, Thomas; Nagurney, John T.; Hoffmann, Udo

    2011-01-01

    Twelve-lead surface electrocardiography (ECG) and computed tomography (CT) are used to evaluate for myocardial ischemia and coronary artery disease (CAD), respectively. We aimed to determine features on resting ECG that predict coronary artery stenosis by cardiac CT. In 309 acute chest pain patients, we compared the initial triage resting ECG to contrast-enhanced 64-slice cardiac CT angiography. We assessed for 6 quantitative (QT interval, QTc interval, QTc > 440 ms, gender-specific QTc, QT dispersion and QRS duration) and 4 qualitative ECG parameters (ST depression >0.05 to ≤0.1 mV, T wave inversion ≥0.1 mV, T wave flattening, and any T wave abnormalities) and for the presence of coronary stenosis by CT (>50% luminal narrowing). Specificities of these ECG parameters were excellent (83.6–97.0%) while sensitivities were poor (12.2–29.3%). For coronary stenosis detection, the ECG features with the greatest performance were the presence of ST depression (positive likelihood ratio [LR+] 4.09) and T wave inversion (LR+ 4.58). In multivariable analyses, the risk for coronary stenosis increased by 33–41% for every 20 ms prolongation of the QTc interval after adjusting for age, gender, and cardiac risk factors or adjustment for Framingham risk score. Similarly, there was an increase of fourfold with the presence of ST depression >0.05 to ≤0.1 mV or T wave inversion ≥0.1 mV. In acute chest pain patients, resting ECG features of QTc interval prolongation, mild ST depression, and T wave inversion are independently associated with the presence of CT coronary stenosis and their presence suggests an increase risk of CAD. PMID:21287278

  18. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  19. 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.

  20. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  1. Ten-year follow-up of percutaneous transluminal coronary angioplasty for proximal left anterior descending coronary artery stenosis in 351 patients.

    Science.gov (United States)

    Ten Berg, J M; Gin, M T; Ernst, S M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E; Plokker, H W

    1996-07-01

    We sought to evaluate the short- and long-term results of balloon angioplasty for stenoses in the proximal left anterior descending coronary artery. Both the supposedly high rate of acute complications and relatively poor long-term results of balloon angioplasty for stenoses in the proximal left anterior descending coronary artery have led to a search for alternative interventional techniques. We analyzed the success rates and long-term follow-up results in 351 consecutive patients who underwent balloon angioplasty for stenosis of the left anterior descending coronary artery proximal to its first side branch. The power of the study was >80% in detecting a difference of 9% in the proportion of patients who survived at 10 years, assuming an 80% survival rate in the control group. There were 60 ostial and 291 nonostial stenoses. Follow-up lasted a median of 85 months (range 0 to 137) and was 100% complete. The angiographic success rate was 90.9%. The clinical success rate was 86.3%. Nine patients (2.6%) died, 17 (4.8%) needed emergency coronary artery bypass graft surgery, and 10 (2.8%) developed a myocardial infarction. Several patients had subsequent complications. The success and complication rates were not significantly different for patients with ostial and nonostial stenoses. Ten years after balloon angioplasty, freedom from mortality was 80%, freedom from cardiac death was 87%, freedom from myocardial infarction was 84%, freedom from vessel-related reinterventions was 66%, and freedom from angina pectoris was 33%. There were more reinterventions for ostial stenoses, with a 1-year relative risk of ostial versus nonostial stenoses for related reinterventions of 1.7 (95% confidence interval 1 to 2.8, p = 0.049). More than 10 years ago, balloon angioplasty for stenoses in the proximal left anterior descending coronary artery, either ostial or nonostial, had a high success rate. Although the long-term results are satisfactory, ostial stenoses are associated with a

  2. The influence of low and moderate carotid stenosis on neurophysiologic status of patients undergoing on-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Olga eTrubnikova

    2012-01-01

    Full Text Available Background: Significant (>70% extracranial stenosis of the internal carotid artery (ICA is a known risk factor for brain damage in patients with coronary heart disease (CHD undergoing coronary artery bypass grafting (CABG. There is no clear evidence of the low and moderate ICA stenoses influence on the neurophysiologic status of patients after CABG. This work was aimed at studying the influence ICA stenoses (<50% on the dynamics of neurophysiologic status in patients undergone CABG. Methods: We examined neurophysiologic functions and EEG in CHD patients (N=45 aged from 45 to 70 years. All patients were divided into two groups: with ICA stenosis (n=20 and without one (n= 25. Results: It was established that the group ICA stenosis had a negative dynamics of neurophysiologic status 6 months follow-up after CABG compared with patients without stenosis. Conclusions: Our results suggest that the presence of low and moderate ICA stenosis is one of the factors affecting the neurophysiologic status of CHD patients. It has been assumed that the patients with ≤50% ICA stenoses constitute a high-risk group for cerebral complications after on-pump CABG.

  3. Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Ruzsics, Balazs; Costello, Philip [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Lee, Heon [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Seoul Medical Center, Department of Radiology, Seoul (Korea); Zwerner, Peter L.; Schoepf, U.J. [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Charleston, SC (United States); Gebregziabher, Mulugeta [Medical University of South Carolina, Department of Biostatistics, Bioinformatics, and Epidemiology, Charleston, SC (United States)

    2008-11-15

    We aimed to evaluate the feasibility of diagnosing coronary stenosis and myocardial ischemia with a single dual-energy CT (DECT) acquisition. Thirty-five patients underwent contrast-enhanced, ECG-gated DECT of the heart while independently operating the two tubes of a dual-source CT system at high- and low-energy X-ray spectra. From the same raw data, coronary CTA (cCTA) studies were reconstructed for stenosis detection, and the myocardial blood-pool was analyzed by determining the tissue iodine content. Two independent observers analyzed all studies for stenosis and myocardial blood-pool deficits. Results were correlated with SPECT, coronary catheterization and cCTA on a segmental basis. cCTA had 98% sensitivity, 88% specificity and 92% accuracy for detection of >50% stenosis. DECT detected myocardial ischemia with 84% sensitivity, 94% specificity and 92% accuracy. Our initial experience may warrant further exploration of DECT as a possibly feasible single imaging investigation for the comprehensive diagnosis of coronary stenosis and myocardial ischemia. (orig.)

  4. Accuracy of 16-slice multi-detector CT to quantify the degree of coronary artery stenosis: Assessment of cross-sectional and longitudinal vessel reconstructions

    Energy Technology Data Exchange (ETDEWEB)

    Cury, Ricardo C. [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States)]. E-mail: rcury@partners.org; Ferencik, Maros [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Achenbach, Stephan [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Division of Cardiology, Massachusetts General Hospital, Boston, MA (United States); Department of Internal Medicine II, University of Erlangen (Germany); Pomerantsev, Eugene [Division of Cardiology, Massachusetts General Hospital, Boston, MA (United States); Nieman, Koen [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Moselewski, Fabian [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Division of Cardiology, Massachusetts General Hospital, Boston, MA (United States); Abbara, Suhny [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Jang, Ik-Kyung [Division of Cardiology, Massachusetts General Hospital, Boston, MA (United States); Brady, Thomas J. [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Hoffmann, Udo [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States)

    2006-03-15

    Background: Sixteen-slice multi-detector computed tomography (MDCT) permits reliable noninvasive detection of significant coronary stenosis based on qualitative visual assessment. The purpose of this study was to determine the accuracy of MDCT to quantify the degree of coronary stenosis as compared to quantitative coronary angiography (QCA) using two different reconstruction methods. Methods: We studied 69 coronary artery lesions from 38 consecutive patients that underwent 16-slice MDCT as a part of research study, which enrolled consecutive subjects scheduled for clinically indicated invasive coronary angiography. Nine coronary artery lesions with motion artifacts, heavily calcified plaques or stents were excluded from the analysis. The degree of stenosis was calculated by two independent readers non-blinded to the location of the stenosis, but blinded to the results of the QCA. MDCT luminal diameters were measured in cross-sectional multi-planar reformatted (CS-MPR) images created perpendicular to the centerline of the vessel and in 5 mm thin-slab maximum intensity projections (MIP) parallel to the long axis of the vessel. Both MDCT methods were compared against QCA. Results: The mean degree of stenosis as measured by MDCT was closely correlated to QCA for both methods (CS-MPR versus QCA: 61 {+-} 23% versus 64 {+-} 29%; r {sup 2} = 0.83, p < 0.001 and MIP versus QCA: 64 {+-} 22% versus 64 {+-} 29%; r {sup 2} = 0.84, p < 0.001 for MIP. Bland-Altman analysis demonstrated a negative bias of the degree of stenosis of -2.8 {+-} 12% using CS-MPR and a minimally positive bias of 0.6 {+-} 12% for MIP. In stratified analysis for lesion severity (mild, 0-40%; moderate, 41-70% or severe, >70%) the agreement between both CS-MPR and MIP was high when compared to QCA ({kappa} = 0.74 and 0.71, respectively). Conclusion: Multi-detector spiral CT permits accurate quantitative assessment of the degree of coronary stenosis in selected data sets of sufficient quality using both

  5. Diagnostic accuracy of 320-slice computed-tomography for detection of significant coronary artery stenosis in patients with various heart rates and heart rhythms compared with conventional coronary-angiography.

    Science.gov (United States)

    Uehara, Masae; Takaoka, Hiroyuki; Kobayashi, Yoshio; Funabashi, Nobusada

    2013-08-10

    To evaluate the diagnostic accuracy of 320-slice CT for detection of significant coronary artery stenosis in patients with various heart rates (HR) and heart rhythms, including tachycardia and chronic atrial-fibrillation (CAF) compared with conventional-coronary-angiography (CAG). One-hundred-six consecutive patients underwent both 320-slice CT and CAG within 3 months (normal-sinus-rhythm [NSR] 91.5%, CAF 8.5%, mean HR 65 ± 15 beats/min). There were no cardiac events between the 2 procedures. Patients were divided in 2 groups: Group 1 (HR 64 with NSR or heart rhythm irregularities at CT scan, n=44). Patients with >50% or >75% luminal stenosis on CT were compared with those with >50% or >75% stenosis on CAG, respectively. In a segment-by-segment analysis, in all patients, sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of >50% stenosis on CT for predicting >50% stenosis on CAG were 69, 98, 78, and 97%, respectively, and those of >75% stenosis on CT for predicting >75% stenosis on CAG were 78, 98, 64, and 99%, respectively. Sensitivity, specificity, PPV, and NPV of >50% and 75% stenosis on CT for predicting >50% and >75% stenosis, respectively, on CAG were comparable. Diagnostic accuracy was essentially the same in both groups. 320-slice CT had high diagnostic accuracy for the detection of significant coronary artery stenosis compared with CAG. Even though the numbers were small, patients with high HR or heart rhythm irregularities might have essentially equivalent results to those with low HR with NSR. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. Coronary flow reserve : a functional measure of stenosis severity

    NARCIS (Netherlands)

    F. Zijlstra (Felix)

    1988-01-01

    textabstractIn 1959 Sones developed selective coronary cineangiography. To date, this technique has remained the only means available for the visualization of the coronary arterial system with such image contrast and resolution, that the presence and severity of coronary stenosis can be

  7. Parental consanguinity and family history of coronary artery disease strongly predict early stenosis.

    Science.gov (United States)

    Youhanna, Sonia; Platt, Daniel E; Rebeiz, Abdallah; Lauridsen, Michael; Deeb, Mary E; Nasrallah, Antoine; Alam, Samir; Puzantian, Houry; Kabbani, Samer; Ghoul, Melanie; Zreik, Tony G; el Bayeh, Hamid; Abchee, Antoine; Zalloua, Pierre

    2010-10-01

    Coronary artery disease (CAD) is a multifactorial disease with acquired and inherited components. We investigated the roles of family history and consanguinity on CAD risk and age at diagnosis in 4284 patients. The compounded impact of diabetes, hyperlipidemia, hypertension, smoking, and BMI, which are known CAD risk factors, on CAD risk and age at diagnosis was also explored. CAD was determined by cardiac catheterization. Logistic regression and stratification were performed to determine the impact of family history and consanguinity on risk and onset of CAD, controlling for diabetes, hyperlipidemia, hypertension, smoking, and BMI. Family history of CAD and gender significantly increased the risk for young age at diagnosis of CAD (p<0.001). Consanguinity did not promote risk of CAD (p=0.38), but did affect age of disease diagnosis (p<0.001). The mean age at disease diagnosis was lowest, 54.8 years, when both family history of CAD and consanguinity were considered as unique risk factors for CAD, compared to 62.8 years for the no-risk-factor patient category (p<0.001). Family history of CAD and smoking are strongly associated with young age at diagnosis. Furthermore, parental consanguinity in the presence of family history lowers the age of disease diagnosis significantly for CAD, emphasizing the role of strong genetic and cultural CAD modifiers. These findings highlight the increased role of genetic determinants of CAD in some population subgroups, and suggest that populations and family structure influence genetic heterogeneity between patients with CAD. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  8. Examining a hypothetical quantitative model for better approximation of culprit coronary artery and site of stenosis on 99mTc-sestamibi gated myocardial perfusion SPECT.

    Science.gov (United States)

    Pal, Sushanta; Sen, Srabani; Das, Debasis; Basu, Sandip

    2016-10-01

    A hypothetical quantitative model of analyzing gated myocardial perfusion SPECT is proposed and examined for the feasibility of its use as a predictor of diseased coronary artery and approximating the site of stenosis to determine whether it could serve as a useful noninvasive complement for coronary angiography. The extent and severity of perfusion defects on rest gated myocardial perfusion imaging SPECT-images were assessed on a five-point scale in a standard 17-segment model and total perfusion deficit was quantified by automated software. The first step was to locate the diseased coronary artery using a quantitative method: for this, the score of each segment belonging to a particular coronary artery was determined using a systematic presumptive approach. After determination of specific coronary artery segments, the scores of the contiguous segments in three short axis slices (apical, middle, and basal) were summed for six subdivisions (anterior, anterolateral, inferolateral, inferior, anteroseptal, and inferoseptal). The site of stenosis was determined from (a) the initial approximation of the involved segments with a defect score of 2-4 and (b) subsequent calculation of the defect score of each of the six subdivisions and allocating the site through a preassigned number for each coronary artery. For each coronary artery, only the subdivision with the highest defect score was considered. Proximal, middle, and distal segments of left anterior descending artery (LAD) were considered to be represented when the summed value of a subdivision within a particular arterial territory was more than or equal to 7, between 5 and 7, 5 and 3, respectively. For the left circumflex and right coronary artery, summed scores (of respective subdivisions) of more than or equal to 5 and between 3 and 5 were preassigned to proximal and distal stenosis, respectively. The results were then correlated with the coronary angiographic data. On coronary angiography, proximal LAD occlusion

  9. Interdisciplinary three-step strategy to treat aortic stenosis and coronary artery disease in a patient with end-stage chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Schmitz C

    2012-04-01

    Full Text Available Sebastian Michel1, Amir K Bigdeli1, Andres Beiras-Fernandez2, Christoph Schmitz1, Manuel Wolf1, Ralf Sodian1, Ingo Kaczmarek11Department of Cardiac Surgery, Ludwig Maximilians University of Munich, Munich, Germany; 2Department of Thoracic and Cardiovascular Surgery, Goethe University Frankfurt, Frankfurt am Main, GermanyBackground: Valvular aortic stenosis is a common disease in the elderly, often in multimorbid patients. It is often associated with coronary artery disease and peripheral artery disease. In this situation, the risk of conventional open-heart surgery is too high, and other treatment strategies have to be evaluated.Case report: A 79-year-old female patient with severe aortic stenosis, coronary artery disease and end-stage chronic obstructive pulmonary disease suffering from dyspnea at rest and permanently dependent on oxygen was treated in three steps. Firstly, her pulmonary infection was treated with antibiotics for 7 days. Then, the left anterior descending artery was stented (bare-metal stent. In the same session, valvuloplasty of the aortic valve was performed. She was sent to rehabilitation to improve her pulmonary condition and took clopidogrel for 4 weeks. Finally, she underwent transapical aortic valve replacement. She was released to rehabilitation on postoperative day 12.Conclusion: A combination of modern interventional and minimally invasive surgical techniques to treat aortic stenosis and coronary heart disease can be a viable option for multimorbid patients with extremely high risk in conventional open-heart surgery.Keywords: aortic stenosis, transapical aortic valve replacement, minimally invasive cardiac surgery

  10. Single coronary artery with bicuspid aortic valve stenosis and aneurysm of the ascending aorta: report of a case.

    Science.gov (United States)

    Ishida, Narihiro; Shimabukuro, Katsuya; Matsuno, Yukihiro; Ogura, Hiroki; Takemura, Hirofumi

    2014-03-01

    A 73-year-old man with a severely stenosed bicuspid valve and an aneurysm of the ascending aorta underwent valve and aortic surgery. Preoperative imaging revealed a single coronary artery arising from the right side of the sinus of Valsalva and a branch that perfused into the left side of the heart to pass through the front of the pulmonary artery. We replaced the aortic valve and ascending aorta, painstakingly avoiding damage to the coronary artery and obstruction of the sole coronary ostium.

  11. Coronary artery anatomy and variants

    Energy Technology Data Exchange (ETDEWEB)

    Malago, Roberto; Pezzato, Andrea; Barbiani, Camilla; Alfonsi, Ugolino; Nicoli, Lisa; Caliari, Giuliana; Pozzi Mucelli, Roberto [Policlinico G.B. Rossi, University of Verona, Department of Radiology, Verona (Italy)

    2011-12-15

    Variants and congenital anomalies of the coronary arteries are usually asymptomatic, but may present with severe chest pain or cardiac arrest. The introduction of multidetector CT coronary angiography (MDCT-CA) allows the detection of significant coronary artery stenosis. Improved performance with isotropic spatial resolution and higher temporal resolution provides a valid alternative to conventional coronary angiography (CCA) in many patients. MDCT-CA is now considered the ideal tool for three-dimensional visualization of the complex and tortuous anatomy of the coronary arteries. With multiplanar and volume-rendered reconstructions, MDCT-CA may even outperform CCA in determining the relative position of vessels, thus providing a better view of the coronary vascular anatomy. The purpose of this review is to describe the normal anatomy of the coronary arteries and their main variants based on MDCT-CA with appropriate reconstructions. (orig.)

  12. Acute Myocardial Infarction Due to Coronary Artery Embolism in a 22-Year-Old Woman with Mitral Stenosis with Atrial Fibrillation Under Warfarinization: Successful Management with Anticoagulation.

    Science.gov (United States)

    Sinha, Santosh Kumar; Jha, Mukesh Jitendra; Razi, Mahmadula; Chaturvedi, Vikash; Erappa, Yatish Besthenahalli; Singh, Shravan; Mishra, Vikas; Khanra, Dibbendhu; Singh, Karandeep

    2017-04-07

    BACKGROUND Coronary artery embolization is an exceedingly rare cause of myocardial infarction, but a few cases in association with prosthetic mechanical valves have been reported. We report a case of embolic myocardial infarction caused by a thrombus in the left atrium with deranged coagulation profile in a patient with critical mitral stenosis under warfarinization. CASE REPORT A 22-year-old woman was taken to the catheterization lab for early coronary intervention in lieu of non-ST elevation myocardial infarction. Electrocardiography showed T↓ in V1 to V4, and atrial fibrillation with controlled ventricular rate. Coronary angiography showed total occlusion of the mid-left anterior descending artery with thrombus. After upstream treatment with tirofiban, the apparent thrombus was dislodged distally while passing a BMW wire. No abnormalities were seen by intravascular ultrasound study. Echocardiography revealed critical mitral stenosis, and left atrial clot with mild left ventricular dysfunction. Coagulation profile revealed sub-therapeutic international normalized ratio levels. The sequential angiographic images, normal intravascular ultrasound study, and presence of atrial fibrillation are confirmatory of coronary embolism as the cause of myocardial infarction. Anticoagulation and treatment of acute coronary syndrome were initiated and she was referred for closed mitral valvulotomy. CONCLUSIONS Coronary artery thromboembolism as a nonatherosclerotic cause of acute coronary syndrome is rare. The treatment consists of aggressive anticoagulation, antiplatelet therapy, and interventional options, including simple wiring when possible. In this context, primary prevention in the form of patient education on optimal anticoagulation with oral vitamin K antagonist and medical advice about imminent thromboembolic risks are of extreme importance.

  13. Values of osteoprotegerin in aortic valve tissue in patients with significant aortic stenosis depend on the existence of concomitant coronary artery disease.

    Science.gov (United States)

    Fojt, Richard; Pirk, Jan; Kamenický, Peter; Karpíšek, Michal; Straka, Zbyněk; Malý, Marek; Moťovská, Zuzana

    2016-01-01

    Calcific aortic valve stenosis (CAVS) is a serious clinical problem. The strongest predictor of CAVS progression is the amount of calcium in the aortic valve. The pathogenesis of CAVS is largely consistent with the pathogenesis of atherosclerosis; however, about 50% of patients with CAVS do not exhibit significant atherosclerosis. Cardiovascular calcification is currently considered an actively regulated process, in which the important role is attributed to the RANKL/RANK/OPG (receptor activator of nuclear factor κB ligand/RANK/osteoprotegerin) axis. We measured OPG levels in the tissue of calcified, stenotic aortic valves in relation to the presence or absence of coronary artery disease (CAD). Aortic valve samples were collected from 105 patients with calcified, mainly severe aortic stenosis, who were divided into two groups according to the presence of CAD. In Group A (n=44), there were normal coronary artery findings, while in Group B (n=61), there was angiographically demonstrated >50% stenosis of at least one coronary artery. The control Group C (n=21) consisted of patients without aortic stenosis and with normal angiographic findings on coronary arteries. The highest tissue concentrations of OPG [median (pmol/L), 25th-75th percentile] were found in Group A [6.95, 3.96-18.37], which was significantly different compared to the other two groups (P=.026 and .001, respectively). The levels of OPG in Group B [4.15, 2.47-9.16] and in Group C [2.25, 1.01-5.08] did not differ significantly (P=.078); however, the lowest concentrations of OPG were found in Group C. Neither age nor gender in our study had effect on tissue levels of OPG (P=.994 for gender; P=.848 for age). Calcified and narrowed aortic valves, compared to the normal valves, were accompanied by a change in tissue concentrations of OPG, which is, in addition, dependent on the presence or absence of CAD. The highest tissue concentrations of OPG in our work were found in patients with significant aortic

  14. Pitavastatin-incorporated nanoparticle-eluting stents attenuate in-stent stenosis without delayed endothelial healing effects in a porcine coronary artery model.

    Science.gov (United States)

    Tsukie, Noriaki; Nakano, Kaku; Matoba, Tetsuya; Masuda, Seigo; Iwata, Eiko; Miyagawa, Miho; Zhao, Gang; Meng, Wei; Kishimoto, Junji; Sunagawa, Kenji; Egashira, Kensuke

    2013-01-01

    The use of currently marketed drug-eluting stents presents safety concerns including increased late thrombosis, which is thought to result mainly from delayed endothelial healing effects (impaired re-endothelialization resulting in abnormal inflammation and fibrin deposition). We recently developed a bioabsorbable polymeric nanoparticle (NP)-eluting stent using a novel cationic electrodeposition technology. Statins are known to inhibit the proliferation of vascular smooth muscle cells (VSMC) and to promote vascular healing. We therefore hypothesized that statin-incorporated NP-eluting stents would attenuate in-stent stenosis without delayed endothelial healing effects. Among six marketed statins, pitavastatin (Pitava) was found to have the most potent effects on VSMC proliferation and endothelial regeneration in vitro. We thus formulated a Pitava-NP-eluting stent (20µg Pitava per stent). In a pig coronary artery model, Pitava-NP-eluting stents attenuated in-stent stenosis as effectively as polymer-coated sirolimus-eluting stents (SES). At SES sites, delayed endothelial healing effects were noted, whereas no such effects were observed in Pitava-NP-eluting stent sites. Pitava-NP-eluting stents attenuated in-stent stenosis as effectively as SES without the delayed endothelial healing effects of SES in a porcine coronary artery model. This nanotechnology platform could be developed into a safer and more effective device in the future.

  15. Correlation between Coronary Artery Stenosis and Plaque Nature Dual-Source Computed Tomography for Coronary Angiography%双源 CT 对冠状动脉狭窄及斑块性质的应用价值

    Institute of Scientific and Technical Information of China (English)

    柏辉; 李国晖

    2015-01-01

    目的:探讨双源CT对冠状动脉狭窄及不同性质冠状动脉斑块的诊断价值。方法:对50例临床确诊及拟诊冠心病患者行双源CT冠状动脉成像(CCTA)检查及冠状动脉造影(CCA),以CCA结果为参考标准,评估双源CT对不同性质斑块所致冠状动脉狭窄的特异度、敏感度、阳性预测值、阴性预测值及准确性,分析狭窄程度与斑块成分间的相关性。结果:与CCA对照,50例患者中,双源CT对诊断冠状动脉狭窄的特异度、敏感度、阳性预测值、阴性预测值依次如下:轻度狭窄分别为98.9%、46.7%、77.8%、95.8%;中度狭窄分别为97.6%、71.0%、84.6%、94.8%;重度狭窄分别为96.6%、96.4%、96.4%、98.6%。误诊冠状动脉狭窄共20支,诊断符合率为89.8%。对非钙化性斑块所致管腔狭窄的诊断符合率达84.3%,高于钙化性斑块(76.9%)。结论:双源CT冠状动脉成像能够有效判断冠状动脉狭窄程度及斑块成分。%Objective: To discuss the diagnosis value for coronary artery of different components of plaque and stenosis by dual-source computed tomography coronary artery imaging.Method:A total of 50 pa-tients diagnosed with coronary heart disease underwent dual-source computed tomography coronary artery ( CCTA) imaging and coronary angiography( CCA) .The specificity,sensitivity, positive predictive value,neg-ative predictive value,and accuracy for the quantitative detection of stenosis assessed.Result:In the 50 pa-tients,The specificity,sensitivity, positive predictive value,negative predictive value and accuracy for the de-tection of coronary artery stenosis assessed with dual-source CT were respectively:for<50 stenosis,98.9%, 46.7%,77.8%,95.8%;for 50 ~74 stenosis,97.6%,71.0%,84.6%,94.8%;for≥75 stenosis,96.6%、96. 4%、96.4%、98.6%.Comparing with CCA,misdiagnosis was observed in 20 of 196 arteries with dual-source CT

  16. OCLUSIÓN TOTAL CRÓNICA DEL TRONCO CORONARIO IZQUIERDO Y ESTENOSIS DE LA CORONARIA DERECHA / Chronic total occlusion of the left main coronary artery and right coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    Roberto Bermúdez Yera

    2012-01-01

    Full Text Available ResumenLa estenosis del tronco coronario izquierdo se encuentra entre el 3-5 % de los pacientes a los que se les realiza una coronariografía, pero su oclusión total es rara (0,05-0,1 %. En este artículo presentamos el caso de un paciente de 42 años con oclusión total de este vaso, que presentaba además, una estenosis de 85 % en la arteria coronaria derecha y fue revascularizado quirúrgicamente de forma exitosa. Se implantaron 3 injertos, mamaria a la descendente anterior, y vena safena a una obtusa marginal y a la descendente posterior. Se presentan las imágenes angiográficas y de la cirugía, y se comentan las alternativas terapéuticas, donde lo más importante es individualizar el tratamiento, con el objetivo de brindar la mejor opción a cada paciente en particular. Para lograrlo es imprescindible una excelente relación del equipo de trabajo donde, como en este caso, el cardiólogo intervencionista y el cirujano cardiovascular se complementen, para el bien del paciente. AbstractThe left main coronary artery stenosis is found in 3-5 % of patients who undergo coronary angiography, but total occlusion is rare (0,05-0,1 %. In this article, the case of a 42-year-old patient with chronic total occlusion of the left main coronary artery is presented. This patient, who also had 85 % stenosis of the right coronary artery, was surgically and successfully revascularized. 3 grafts were implanted: mammary artery to the anterior descending artery and saphenous vein to the obtuse marginal and posterior descending artery. The angiographic and surgery images are shown, and treatment options are discussed, where the most important thing is to individualize treatment in order to provide the best option for each patient. It order to achieve this, an excellent team work is essential, in which, as in this case, the interventional cardiologist and cardiovascular surgeon complement each other for the good of the patient.

  17. Intermittent Left Bundle Branch Block and Myocardial Ischemia in Patient Without Coronary Artery Stenosis: A Case Report

    Institute of Scientific and Technical Information of China (English)

    Ju-fang CHI; Hang-yuan GUO; Long-bin LIU

    2009-01-01

    @@ Left bundle branch block (LBBB), traditionally viewed as an electrophysiologic abnormality, is increas-ingly recognized for its effects on hemodynamics and patient's prognosis[1]. Exercise nuclear studies frequently show reversible perfusion defects in the absence of ob-structive coronary artery disease[2] and some patients with intermittent LBBB develop angina coincident with the onset of LBBB[3]. We report a case of intermittent LBBB with abnormal stress technetium 99mTc single-pho-ton emission computed tomography (SPECT) study and normal coronary artery angiography.

  18. COMPUTER SIMULATION OF NON-NEWTONIAN FLOW AND MASS TRANSPORT THROUGH CORONARY ARTERIAL STENOSIS

    Institute of Scientific and Technical Information of China (English)

    李新宇; 温功碧; 李丁

    2001-01-01

    A numerical analysis of Newtonian and non-Newtonian flow in an axi-symmetric tube with a local constriction simulating a stenosed artery under steady and pulsatile flow conditions was carried out. Based on these results, the concentration fields of LDL ( low density lipoprotein ) and Albumin were discussed. According to the results, in great details the macromolecule transport influences of wall shear stress, non-Newtonian fluid character and the scale of the molecule etc are given. The results of Newtonian fluid flow and non Newtonian fluid flow , steady flow and pulsatile flow are compared. These investigations can provide much valuable information about the correlation between the flow properties, the macromolecule transport and the development of atherosclerosis.

  19. Text mining applied to electronic cardiovascular procedure reports to identify patients with trileaflet aortic stenosis and coronary artery disease.

    Science.gov (United States)

    Small, Aeron M; Kiss, Daniel H; Zlatsin, Yevgeny; Birtwell, David L; Williams, Heather; Guerraty, Marie A; Han, Yuchi; Anwaruddin, Saif; Holmes, John H; Chirinos, Julio A; Wilensky, Robert L; Giri, Jay; Rader, Daniel J

    2017-08-01

    Interrogation of the electronic health record (EHR) using billing codes as a surrogate for diagnoses of interest has been widely used for clinical research. However, the accuracy of this methodology is variable, as it reflects billing codes rather than severity of disease, and depends on the disease and the accuracy of the coding practitioner. Systematic application of text mining to the EHR has had variable success for the detection of cardiovascular phenotypes. We hypothesize that the application of text mining algorithms to cardiovascular procedure reports may be a superior method to identify patients with cardiovascular conditions of interest. We adapted the Oracle product Endeca, which utilizes text mining to identify terms of interest from a NoSQL-like database, for purposes of searching cardiovascular procedure reports and termed the tool "PennSeek". We imported 282,569 echocardiography reports representing 81,164 individuals and 27,205 cardiac catheterization reports representing 14,567 individuals from non-searchable databases into PennSeek. We then applied clinical criteria to these reports in PennSeek to identify patients with trileaflet aortic stenosis (TAS) and coronary artery disease (CAD). Accuracy of patient identification by text mining through PennSeek was compared with ICD-9 billing codes. Text mining identified 7115 patients with TAS and 9247 patients with CAD. ICD-9 codes identified 8272 patients with TAS and 6913 patients with CAD. 4346 patients with AS and 6024 patients with CAD were identified by both approaches. A randomly selected sample of 200-250 patients uniquely identified by text mining was compared with 200-250 patients uniquely identified by billing codes for both diseases. We demonstrate that text mining was superior, with a positive predictive value (PPV) of 0.95 compared to 0.53 by ICD-9 for TAS, and a PPV of 0.97 compared to 0.86 for CAD. These results highlight the superiority of text mining algorithms applied to electronic

  20. Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio, and non-invasive coronary flow reserve.

    Science.gov (United States)

    Meimoun, P; Clerc, J; Ardourel, D; Djou, U; Martis, S; Botoro, T; Elmkies, F; Zemir, H; Luycx-Bore, A; Boulanger, J

    2016-10-17

    To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50-70 % diameter stenosis), were prospectively studied. IFR was calculated as a trans-lesion pressure ratio during the wave-free period in diastole; FFR as distal pressure divided by mean aortic pressure during maximal hyperemia (using 180 μg intracoronary adenosine); and CFR as hyperemic peak LAD flow velocity divided by baseline flow velocity using intravenous adenosine (140 μg/kg/min over 2 min). The mean values of IFR, FFR, and CFR were 0.88 ± 0.07, 0.81 ± 0.09, and 2.4 ± 0.6 respectively. A significant correlation was found between CFR and FFR (r = 0. 68), FFR and IFR (r = 0.6), and between CFR and IFR (r = 0.5) (all, p < 0.01). Using a ROC curve analysis, the best cut-off to detect a significant lesion based on FFR assessment (FFR ≤ 0.8, n = 31) was IFR ≤ 0.88 with a sensitivity (Se) of 74 %, specificity (Sp) of 73 %, AUC 0.81 ± 0.04, accuracy 72 %; and CFR ≤ 2 with a Se = 77 %, Sp = 89 %, AUC 0.88 ± 0.04, accuracy 85 % (all, p < 0.001). In stable patients with LAD stenosis of IS, non-invasive CFR is a useful tool to detect a significant lesion based on FFR. Furthermore, there was a better correlation between CFR and FFR than between CFR and IFR, and a trend to a better diagnostic performance for CFR versus IFR.

  1. Transient blood flow in elastic coronary arteries with varying degrees of stenosis and dilatations: CFD modelling and parametric study.

    Science.gov (United States)

    Wu, Jianhuang; Liu, Guiying; Huang, Wenhua; Ghista, Dhanjoo N; Wong, Kelvin K L

    2015-01-01

    In this paper, we have analysed pulsatile flow through partially occluded elastic arteries, to determine the haemodynamic parameters of wall shear stress (WSS), wall pressure gradient and pressure drops (ΔP), contributing to enhanced flow resistance and myocardial ischaemic regions which impair cardiac contractility and cause increased work load on the heart. In summary, it can be observed that stenoses in an artery significantly influence the haemodynamic parameters of wall shear stress and pressure drop in contrast to dilatations case. This deduces that stenosis plays a more critical role in plaque growth and vulnerability in contrast to dilatation, and should be the key element in cardiovascular pathology and diagnosis. Through quantitative analysis of WSS and ΔP, we have provided a clearer insight into the haemodynamics of atherosclerotic arteries. Determination of these parameters can be helpful to cardiologists, because it is directly implicated in the genesis and development of atherosclerosis.

  2. [A case of primary coronary artery dissection].

    Science.gov (United States)

    Nishino, M; Kato, J; Ezumi, A; Nozaki, S; Nishino, Y; Tanahashi, H; Yasuno, M; Kobayashi, K; Yamada, Y; Abe, H

    1990-06-01

    Primary coronary artery dissection occurring as a spontaneous event and not associated with trauma due to catheter manipulation is rare. We recently experienced (a case of) a 52-year-old man with primary artery dissection. He was admitted to our hospital with severe chest pain as his chief complaint on September 6, 1988. Electrocardiography and laboratory data showed acute inferior myocardial infarction. He was treated with medication and underwent coronary angiograms on October 3, 1988. Right coronary angiogram revealed an intimal flap and false lumen. But right coronary angiograms 6 months after the onset of myocardial infarction revealed progression of stenosis but no intimal flap, and coronary spasm was not evoked after acetylcholine administration. Primary coronary artery dissection has been reported since Pretty's first description of it in 1931. The majority of earlier cases were diagnosed at autopsy, but recently reports of survivors have been increasing due to the progress in and popularization of coronary angiographic technics. This case is the 46th case of primary coronary dissection found by coronary angiography. So it is not extremely rare. In our case the involved artery was the right coronary artery. In survivors, right coronary artery dissection is more frequent than left, because the area supplied by the right coronary artery is smaller than the area supplied by the left one. Although in our case coronary artery stenosis progressed, after a long term resolution of dissection may occur. There are a few cases in which resolution of dissection occurred naturally.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Quantification of left coronary bifurcation angles and plaques by coronary computed tomography angiography for prediction of significant coronary stenosis: A preliminary study with dual-source CT

    Science.gov (United States)

    Cui, Yue; Zeng, Wenjuan; Yu, Jie; Lu, Jing; Hu, Yuannan; Diao, Nan; Liang, Bo; Han, Ping; Shi, Heshui

    2017-01-01

    Purpose To evaluate the diagnostic performance of left coronary bifurcation angles and plaque characteristics for prediction of coronary stenosis by dual-source CT. Methods 106 patients suspected of coronary artery disease undergoing both coronary computed tomography angiography (CCTA) and invasive coronary angiography (CAG) within three months were included. Left coronary bifurcation angles including the angles between the left anterior descending artery and left circumflex artery (LAD-LCx), left main coronary artery and left anterior descending artery (LM-LAD), left main coronary artery and left circumflex artery (LM-LCx) were measured on CT images. CCTA plaque parameters were calculated by plaque analysis software. Coronary stenosis ≥ 50% by CAG was defined as significant. Results 106 patients with 318 left coronary bifurcation angles and 126 vessels were analyzed. The bifurcation angle of LAD-LCx was significantly larger in left coronary stenosis ≥ 50% than stenosis coronary stenosis (OR = 1.423, P = 0.002). In ROC curve analysis, LAD-LCx predicted significant left coronary stenosis with a sensitivity of 66.7%, specificity of 78.4%, positive predictive value of 85.2% and negative predictive value of 55.8%. The lipid plaque volume improved the diagnostic performance of CCTA diameter stenosis (AUC: 0.854 vs. 0.900, P = 0.045) in significant coronary stenosis. Conclusions The bifurcation angle of LAD-LCx could predict significant left coronary stenosis. Wider LAD-LCx is related to non-calcified lesions. Lipid plaque volume could improve the diagnostic performance of CCTA for coronary stenosis prediction. PMID:28346530

  4. A Computational Model to Assess Poststenting Wall Stresses Dependence on Plaque Structure and Stenosis Severity in Coronary Artery

    Directory of Open Access Journals (Sweden)

    Zuned Hajiali

    2014-01-01

    Full Text Available The current study presents computational models to investigate the poststenting hemodynamic stresses and internal stresses over/within the diseased walls of coronary arteries which are in different states of atherosclerotic plaque. The finite element method is applied to build the axisymmetric models which include the plaque, arterial wall, and stent struts. The study takes into account the mechanical effects of the opening pressure and its association with the plaque severity and the morphology. The wall shear stresses and the von Mises stresses within the stented coronary arteries show their strong dependence on the plaque structure, particularly the fibrous cap thickness. Higher stresses occur in severely stenosed coronaries with a thinner fibrous cap. Large stress concentrations around the stent struts cause injury or damage to the vessel wall which is linked to the mechanism of restenosis. The in-stent restenosis rate is also highly dependent on the opening pressure, to the extent that stenosed artery is expanded, and geometry of the stent struts. The present study demonstrates, for the first time, that the restenosis is to be viewed as a consequence of biomechanical design of a stent repeating unit, the opening pressure, and the severity and morphology of the plaque.

  5. Association between the Gensini Score and Carotid Artery Stenosis

    Science.gov (United States)

    Fidan, Serdar; Tabakçı, Mehmet Mustafa; Toprak, Cuneyt; Alizade, Elnur; Acar, Emrah; Bayam, Emrah; Tellice, Muhammet; Naser, Abdurrahman; Kargın, Ramazan

    2016-01-01

    Background and Objectives The aim of this study was to evaluate the association between the extent of coronary artery disease assessed by the Gensini score and/or the SYNTAX score and the significant carotid stenosis in patients undergoing coronary artery bypass grafting (CABG). Subjects and Methods A total of 225 patients who had carotid doppler ultrasonography prior to CABG were included retrospectively. Significant coronary artery disease was assumed as a lumen diameter stenosis of ≥50% in any of the major epicardial coronary arteries. The severity of carotid stenosis was determined by B-mode and duplex ultrasonography. Clinically significant carotid stenosis was defined as peak systolic velocity greater than 125 cm/s. Results The mean value of SYNTAX score and Gensini score was highest in patients allocated to significant carotid stenosis (22.98±7.32, p<0.001 and 77.40±32.35, p<0.001, respectively). The other risk factors for significant carotid stenosis were found to be male gender (p=0.029), carotid bruit (p<0.001), diabetes (p=0.021), left main disease (p=0.002), 3-vessel disease (p=0.008), chronic total coronary occlusion (p=0.001), and coronary artery calcification (p=0.001) in univariate analysis. However, only the Gensini score (odds ratio[OR]=1.030, p=0.004), carotid bruit (OR=0.068, p<0.001), and male gender (OR=0.190, p=0.003) were the independent predictors. The Gensini score cut off value predicting significant carotid stenosis was 50.5 with 77% sensitivity (p<0.001). Conclusion The Gensini score may be used to identify patients at high risk for significant carotid stenosis prior to CABG. PMID:27721854

  6. Risk Factors and Relation Between Clinical,Biochemical Marker and Stenosis Extent of Coronary Artery in Young Adults With Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Weiping Zhang; Zuyi Yuan; Yan Liu; Prabindra Maharjan; Yan Zhao

    2008-01-01

    Objectives To analyze risk factors and the relation between clinical,biochemical marker and the stenosis extent of coronary artery in patients below the age of 45 years with acute myocardial infarction (AMI).Methods A retrospective investigation was performed on 92 patients below the age of 45 with AMI at the First Affiliated Hospital of Medical School of Xi'an Jiaotong University in 2003~2007.The etiology,morbidity,risk factors,clinical features and results of coronary angiography were studied.Various clinical and biochemical markers were assessed to find out what were associated with the stenosis extent of coronary artery.Meanwhile,the differences between one-vessel disease (group A)and two-vessel or multi-vessel disease (group B) patients with AMI were comparatively analyzed.Results Risk factors analysis revealed that a history of cigarette smoking,metabolic disorders and abusive drinking were mainly found in young AMI patients below the age of 45 years,and metabolic disorder mainly consists of decreased high-density lipoprotein cholesterol (HDL-C) and hypertriglyceridemia.AMI in patients below the age of 45 years account for 10.3%of all AMI.Angiographically,the incidence of one-vessel affected was most frequent in the young adults (73.75%).The most committed vessel was LAD(80.00% ).A higher incidence with history of hypertension and diabetes or impaired glucose tolerance was found in group B,but a history of preceding angina 1 month earlier was more frequently found in group A.Improved Genisi scores of coronary angiography was lower in group A than in group B (7.49±3.63vs 15.08±6.08).Correlation analysis showed that Iog(LDL-C/HDL-C) (r=0.238,P=0.037),TC/HDL-C(r=0.232,P=0.046) were directly correlated with angiographic scores,and HDL-C(r=-0.202,P=0.042) was inversely correlated.Multielement gradual linear regression analysis showed log(LDL-C/HDL-C),TC/HDL-C were associated with the extent of stenosis of coronary artery.Furthermore,the correlation was linear

  7. Rubidium-82 PET-CT for quantitative assessment of myocardial blood flow: validation in a canine model of coronary artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lautamaeki, Riikka; Higuchi, Takahiro; Merrill, Jennifer; Voicu, Corina; Bengel, Frank M. [Johns Hopkins Medical Institutions, Department of Radiology, Division of Nuclear Medicine, Baltimore, MD (United States); George, Richard T.; Kitagawa, Kakuya; DiPaula, Anthony; Lima, Joao A.C. [Johns Hopkins Medical Institutions, Department of Medicine, Division of Cardiology, Baltimore, MD (United States); Nekolla, Stephan G. [Technischen Universitaet Muenchen, Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Munich (Germany); Lardo, Albert C. [Johns Hopkins Medical Institutions, Department of Medicine, Division of Cardiology, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Department of Biomedical Engineering, Baltimore, MD (United States)

    2009-04-15

    Absolute quantification of myocardial blood flow expands the diagnostic potential of PET for assessment of coronary artery disease. {sup 82}Rb has significantly contributed to increasing utilization of PET; however, clinical studies are still mostly analysed qualitatively. The aim of this study was to reevaluate the feasibility of {sup 82}Rb for flow quantification, using hybrid PET-CT in an animal model of coronary stenosis. Nine dogs were prepared with experimental coronary artery stenosis. Dynamic PET was performed for 8 min after {sup 82}Rb(1480-1850 MBq) injection during adenosine-induced vasodilation. Microspheres were injected simultaneously for reference flow measurements. CT angiography was used to determine the myocardial regions related to the stenotic vessel. Two methods for flow calculation were employed: a two-compartment model including a spill-over term, and a simplified retention index. The two-compartment model data were in good agreement with microsphere flow (y=0.84x+0.20; r=0.92, p<0.0001), although there was variability in the physiological flow range <3 ml/g per minute (y=0.54x+0.53; r=0.53, p=0.042). Results from the retention index also correlated well with microsphere flow (y=0.47x+0.52; r=0.75, p=0.0004). Error increased with higher flow, but the correlation was good in the physiological range (y=0.62x+0.29; r=0.84, p=0.0001). Using current state-of-the-art PET-CT systems, quantification of myocardial blood flow is feasible with {sup 82}Rb. A simplified approach based on tracer retention is practicable in the physiological flow range. These results encourage further testing of the robustness and usefulness in the clinical context of cardiac hybrid imaging. (orig.)

  8. Coronary anomaly: the single coronary artery

    Institute of Scientific and Technical Information of China (English)

    QIN Xu-guang; XIONG Wei-guo; LU Chun-peng; GONG Cheng-jie; SHANG Li-hua

    2010-01-01

    @@ Single coronary artery (SCA), defined as an artery that arises from the arterial trunk and nourishes the entire myocardium, is rare. We report two cases of SCA, one is the right coronary artery (RCA) originating from the middle of left descending artery (LAD), and the other is the left main coronary artery (LMCA) arising from the proximal right coronary artery.

  9. A new method of detecting subendocardial ischemia in patients with aortic valvular stenosis without coronary artery disease using thallium-201 single photon emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Umamoto, Ikuo; Sugihara, Hiroki; Harada, Yoshiaki (Kyoto Prefectural Univ. of Medicine (Japan)) (and others)

    1993-02-01

    The purpose of this study was to detect myocardial ischemia in aortic valvular stenosis (AVS) without coronary artery disease by using exercise Tl-201 SPECT. The subjects were 18 AVS patients. Twenty other patients were served as controls. Transient 'left ventricular subendocardial dilation and decreased wall thickness', obtained on early SPECT images, were quantitatively determined by transient dilation index (TDI). Washout rates (WR) were calculated from overlapping early and delayed images to obtain WR map. According to TDI, 18 AVS patients were classified as having TDI[<=]1.11 (Group A, n=9) and TDI>1.11 (Group B, n=9). WR map in Group B presented the direction from the pericardial toward the endocardial side, revealing a pattern of decreased WR and a decreased coronary flow reserve on the endocardial side. Both pressure gradient between the aorta and left ventricle and left ventricular wall thickness were significantly greater in Group B than Group A. In 3 patients in Group B, TDI returned to normal and WR map became homogeneous after aortic valve replacement. In addition, fibrosis was noted in the endocardial site on biopsy. In AVS associated with great pressure gradient, endocardial ischemia may occur on exercise, resulting from a decreased coronary flow reserve, and a decreased compliance due to fibrosis and hypertrophy. Exercise Tl-201 myocardial SPECT is capable of detecting distribution patterns of subendocardial ischemia and coronary flow reserve in AVS. (N.K.).

  10. Screening for Carotid Artery Stenosis

    Science.gov (United States)

    ... including stroke, heart attack or death. In addition, screening all adults will lead to many false-positive results because ... Force reviewed. 1 The Task Force recommends against screening for asymptomatic carotid artery stenosis in the general adult population . Grade D Notes 1 screening Conducting an ...

  11. 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.

  12. Myocardial Strain Analysis by 2-Dimensional Speckle Tracking Echocardiography Improves Diagnostics of Coronary Artery Stenosis in Stable Angina Pectoris

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Hoffmann, Soren; Mogelvang, Rasmus

    2014-01-01

    of the exercise test. Patients with an area stenosis≥70% in ≥1 epicardial coronary artery were categorized as having significant CAD (n=107). Global longitudinal peak systolic strain was significantly lower in patients with CAD compared with patients without (17.1±2.5% versus 18.8±2.6%; P... an independent predictor of CAD after multivariable adjustment for baseline data, exercise test, and conventional echocardiography (odds ratio, 1.25 [P=0.016] per 1% decrease). Area under receiver operating characteristic curve for exercise test and global longitudinal peak systolic strain in combination...

  13. Alterations in echocardiographic left ventricular function after percutaneous coronary stenting in diabetic patients with isolated severe proximal left anterior descending artery stenosis.

    Science.gov (United States)

    Nabati, Maryam; Taghavi, Morteza; Saffar, Naser; Yazdani, Jamshid; Bagheri, Babak

    There are conflicting theories regarding the use of percutaneous coronary intervention (PCI) of isolated severe proximal left anterior descending (LAD) artery stenosis in place of left internal mammary artery grafting in diabetic patients. The aim of this study was to investigate the effect of PCI on left ventricular function and determine difference between diabetics and non-diabetics. A prospective study was conducted on 50 patients with isolated severe proximal LAD stenosis: 23 diabetic and 27 non-diabetic patients. Successful PCI with everolimus-eluting stents was performed for all of the patients. These patients underwent transthoracic echocardiography within 24h before and 1 month after PCI, and alterations in the left ventricular parameters were compared between the two groups. There was a significant 12% increment in the mitral annular peak systolic velocity (s') (p=0.02), 21% decrement in the trans mitral early filling deceleration time (DT) (p<0.001), 10% decrement in the systolic left ventricular internal dimension (LVIDs) (p=0.002), significant increment in the left ventricular ejection fraction (LVEF) (p=0.004), and significant decrement in the left atrial diameter (p=0.006) in the diabetic patients after performing PCI. Conversely, the non-diabetic patients showed a statistically significant 14% increase in the DT, 6.3% decrease in the s' velocity, 8% increase in the LVIDs, significant increment in the left atrial diameter and no change in LVEF after PCI. Our study demonstrated that everolimus-eluting stents favorably improved the markers of left ventricular systolic and diastolic function in diabetic patients with isolated severe proximal LAD stenosis compared with those of non-diabetic patients with the same condition. Copyright © 2016. Published by Elsevier B.V.

  14. Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting.

    Science.gov (United States)

    Illuminati, Giulio; Ricco, Jean-Baptiste; Caliò, Francesco; Pacilè, Maria Antonietta; Miraldi, Fabio; Frati, Giacomo; Macrina, Francesco; Toscano, Michele

    2011-10-01

    This study evaluated the timing of carotid endarterectomy (CEA) in the prevention of stroke in patients with asymptomatic carotid stenosis >70% receiving a coronary artery bypass graft (CABG). From January 2004 to December 2009, 185 patients with unilateral asymptomatic carotid artery stenosis >70%, candidates for CABG, were randomized into two groups. In group A, 94 patients received a CABG with previous or simultaneous CEA. In group B, 91 patients underwent CABG, followed by CEA. All patients underwent preoperative helical computed tomography scans, excluding significant atheroma of the ascending aorta or aortic arch. Baseline characteristics of the patients, type of coronary artery lesion, and preoperative myocardial function were comparable in the two groups. In group A, all patients underwent CEA under general anesthesia with the systematic use of a carotid shunt, and 79 patients had a combined procedure and 15 underwent CEA a few days before CABG. In group B, all patients underwent CEA, 1 to 3 months after CABG, also under general anesthesia and with systematic carotid shunting. Two patients (one in each group) died of cardiac failure in the postoperative period. Operative mortality was 1.0% in group A and 1.1% in group B (P = .98). No strokes occurred in group A vs seven ipsilateral ischemic strokes in group B, including three immediate postoperative strokes and four late strokes, at 39, 50, 58, and 66 days, after CABG. These late strokes occurred in patients for whom CEA was further delayed due to an incomplete sternal wound healing or because of completion of a cardiac rehabilitation program. The 90-day stroke and death rate was 1.0% (one of 94) in group A and 8.8% (eight of 91) in group B (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.01-0.91; P = .02). Logistic regression analysis showed that only delayed CEA (OR, 14.2; 95% CI, 1.32-152.0; P = .03) and duration of cardiopulmonary bypass (OR, 1.06; 95% CI, 1.02-1.11; P = .004) reliably predicted

  15. Head-to-head comparison of dipyridamole, dobutamine and pacing stress echocardiography for the detection of myocardial ischemia in an animal model of coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    A. Schmidt

    2001-07-01

    Full Text Available To compare the sensitivity of dipyridamole, dobutamine and pacing stress echocardiography for the detection of myocardial ischemia we produced a physiologically significant stenosis in the left circumflex artery of 14 open-chest dogs (range: 50 to 89% reduction in luminal diameter. In each study, dobutamine (5 to 40 µg kg-1 min-1 in 3-min stages and pacing (20 bpm increments, each 2 min, up to 260 bpm were performed randomly, and then followed by dipyridamole (up to 0.84 mg/kg over 10 min. The positivity of stress echocardiography tests was quantitatively determined by a significant (P<0.05 reduction of or failure to increase absolute and percent systolic wall thickening in the stenotic artery supplied wall, as compared to the opposite wall (areas related to the left anterior descending artery. Systolic and diastolic frozen images were analyzed off-line by two blinded observers in the control and stress conditions. The results showed that 1 the sensitivity of dobutamine, dipyridamole and pacing stress tests was 57, 57 and 36%, respectively; 2 in animals with positive tests, the mean percent change of wall thickening in left ventricular ischemic segments was larger in the pacing (-19 ± 11% and dipyridamole (-18 ± 16% tests as compared to dobutamine (-9 ± 6% (P = 0.05, but a similar mean reduction of wall thickening was observed when this variable was normalized to a control left ventricular segment (area related to the left anterior descending artery (pacing: -16 ± 7%; dipyridamole: -25 ± 16%; dobutamine: -26 ± 10%; not significant, and 3 a significant correlation was observed between magnitude of coronary stenosis and left ventricular segmental dysfunction induced by ischemia in dogs submitted to positive stress tests. We conclude that the dobutamine and dipyridamole stress tests showed identical sensitivities for the detection of myocardial ischemia in this one-vessel disease animal model with a wide range of left circumflex artery

  16. Acute Right Coronary Ostial Stenosis during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Sarwar Umran

    2012-01-01

    Full Text Available We report a rare case of acute right coronary artery stenosis developing in a patient undergoing aortic valve replacement. We present a case report with a brief overview of the literature relating to coronary artery occlusion associated with cardiac valve surgery - the theories and treatments are discussed. A 85 year-old female was admitted under the care of the cardiothoracic team with signs and symptoms of heart failure. Investigations, including cardiac echocardiography and coronary angiography, indicated a critical aortic valve stenosis. Intraoperative right ventricular failure ensued post aortic valve replacement. Subsequent investigations revealed an acute occlusion of the proximal right coronary artery with resultant absence of distal flow supplying the right ventricle. An immediate right coronary artery bypass procedure was performed with resolution of the right ventricular failure. Subsequent weaning off cardiopulmonary bypass was uneventful and the patient continued to make excellent recovery in the postoperative phase. To our knowledge this is one of the few documented cases of intraoperative acute coronary artery occlusion developing during valve surgery. However, surgeons should be aware of the potential for acute occlusion so that early recognition and rapid intervention can be instituted.

  17. Successful percutaneous coronary intervention for chronic total occlusion of right coronary artery in patient with dextrocardia.

    Science.gov (United States)

    Munawar, Muhammad; Hartono, Beny; Iskandarsyah, Kurniawan; Nguyen, Thach N

    2013-07-01

    Situs inversus with dextrocardia is rare congenital anomaly. Coronary artery disease in such patients is quite rare. We reported a 52-year-old man with dextrocardia and chronic total occlusion at the proximal right coronary artery just after conus branch and severe stenosis at the proximal left anterior descending artery. He underwent successful percutaneous coronary intervention with stenting of total occluded right coronary artery and simultaneously stenting of the proximal left anterior descending artery.

  18. Endoplasmic Reticulum Is Involved in Myocardial Injury in a Miniature Swine Model of Coronary Artery Stenosis Exposed to Acceleration-Associated Stress

    Science.gov (United States)

    Zhang, Haitao; Chai, Meng; Liu, Chaozhong; Sun, Jinjin; Huang, Congchun; Yu, Xinya; Tian, Yi; Luo, Huilan

    2015-01-01

    This study aimed to investigate the effects of myocardial injury in a minimally-invasive miniature swine model with different levels of coronary artery stenosis (CAS) and exposed to maximal tolerated +Gz. Proximal left anterior descending branch was ligated in 20 swine. Five swine underwent a sham operation. A trapezoid acceleration curve was used for +Gz stress. Pathological changes of myocardial tissue were detected by H&E staining. Apoptotic cardiomyocytes were detected by TUNEL. GRP78 and CHOP were investigated by immunohistochemistry and western blot. CAS models were successful in 18 animals.Compared with the sham-operated group (+8.00±0.71 Gz), the maximal tolerated +Gz values of the moderate stenosis (+6.00±0.89 Gz, Pstenosis groups (+5.20±0.84 Gz, Pstenosis group (60.50±9.35%, Pstenosis groups (0.35±0.04), while expression was high in the moderate (0.72±0.04, Pstenosis groups (0.65±0.07, Pstenosis groups. These results indicated that Under maximum exposure to +Gz stress, different levels of CAS led to different levels of myocardial injury. Endoplasmic reticulum response is involved in the apoptosis of cardiomyocytes after +Gz stress. PMID:26167928

  19. Percutaneous transradial artery approach for coronary stent implantation.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J

    1993-10-01

    A new approach for implantation of Palmaz Schatz coronary stents is reported. We describe the technique and rationale of coronary stenting with miniaturized angioplasty equipment via the radial artery. This technique is illustrated in three patients. One patient underwent Palmaz Schatz stent implantation for a saphenous vene coronary bypass graft stenosis, the second patient for a restenosis in the anterior descending coronary artery after atherectomy, and the third patient for a second restenosis after balloon angioplasty in the circumflex coronary artery.

  20. Role of Coronary Calcium Scoring in the Assessment of Physiological Ischemia in Patients with Intermediate Stenosis

    Science.gov (United States)

    Horie, Kazunori; Kikuchi, Yuichi; Takizawa, Kaname; Inoue, Naoto

    2015-01-01

    Although coronary artery calcium (CAC) is an established marker of coronary atherosclerosis, whether it also reflects the physiological significance is unknown. This study aims to evaluate if CAC could indicate physiological ischemia in intermediate stenosis defined by an invasive fractional flow reserve (FFR). CAC score (CACS) derived from either whole coronary arteries or individual arteries was measured by computed tomography among patients with intermediate de novo lesions (percent diameter stenosis from 30% to less than 70%). All stenoses were evaluated by invasive FFR; lesions with an FFR ≤ 0.80 were considered significant. We enrolled 119 patients with 143 lesions. Of these, 42 lesions (29.4%) demonstrated significant ischemia by FFR measurement. FFR values had modest but significant correlations with CACS in individual arteries with intermediate stenosis (r = − 0.290; p stenosis had 71.4% sensitivity and 67.3% specificity as a predictor of significant ischemia at a cut off value of 145.9. Multivariable analysis showed that percent diameter stenosis and CACS in individual arteries with intermediate stenosis were independent predictors for significant ischemia. By net reclassification improvement analysis, CACS in individual arteries with intermediate stenosis provided incremental prediction for significant ischemia over minimum lumen diameter, percent diameter stenosis, and lesion length. CACS measured in each artery, but not the total CACS, provides additional information as to whether an angiographically intermediate stenosis within the artery is significant enough to cause myocardial ischemia. PMID:26648671

  1. Diagnosis and treatment of renal artery stenosis.

    NARCIS (Netherlands)

    Plouin, P.F.; Bax, L.

    2010-01-01

    A reduction in the diameter of the renal arteries can lead to hypertension, renal dysfunction and/or pulmonary edema. About 90% of patients with renal artery stenosis have atherosclerosis, and 10% have fibromuscular dysplasia. Atherosclerotic renal artery stenosis is a common condition that typicall

  2. [Bilateral coronary artery-pulmonary artery fistulas in a case with unstable angina pectoris].

    Science.gov (United States)

    Kepez, Alper; Kaya, Ergün Bariş; Aytemir, Kudret; Oto, Ali

    2008-03-01

    Bilateral coronary artery fistulas originating from both right and left coronary arteries are rare congenital abnormalities. A 58-year-old man presented with chest pain unrelated to exertion. Coronary angiography showed a fistula originating from the level of the first diagonal branch of the left anterior descending (LAD) coronary artery and a 95% stenosis just distal to the fistula. Right coronary angiography showed another fistula originating from the ostium of the right coronary artery. Both fistulas drained into the pulmonary artery. Coronary bypass surgery was performed for the LAD lesion using the left internal mammary artery graft, during which both fistulas were ligated. No complications were encountered postoperatively.

  3. Coronary Artery Bypass Surgery

    Science.gov (United States)

    In coronary artery disease (CAD), the arteries that supply blood and oxygen to your heart muscle grow hardened and narrowed. You may try ... these treatments don't help, you may need coronary artery bypass surgery. The surgery creates a new ...

  4. [Fractional flow reserve and instantaneous wave-free ratio for the physiological assessment of coronary artery stenosis in the catheterization laboratory: Practical tips].

    Science.gov (United States)

    Picard, F; Tadros, V X; Pighi, M; Spagnoli, V; De Hemptinne, Q; Ly, H Q

    2017-02-01

    In recent years, a large body of evidence has revealed the limitations of angiographic evaluation in determining the physiological significance of coronary stenosis, particularly when these are intermediate lesions. Percutaneous coronary interventions (PCI) guided by physiological assessment using fractional flow reserve (FFR) have been shown to reduce cardiovascular events when compared to angiography alone. Recently, another coronary physiologic parameter has been introduced: the "instantaneous wave-free ratio" (iFR). In this review, we will discuss the FFR, the iFR, and their use in the functional assessment of coronary stenosis in the cardiac catheterization laboratory. This review will cover theoretical aspects for non-interventional cardiologists, as well as practice points and common pitfalls related to coronary physiological assessment for interventional cardiologists.

  5. 颈动脉狭窄合并冠心病的分期介入治疗及随访研究%Staged interventional therapy for coexistent carotid artery stenosis and coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    段鸿洲; 李良; 张扬; 伊志强; 张家湧; 陈明; 刘兆平; 李建平; 鲍圣德

    2012-01-01

    Objective To investigate the effect of staged interventional therapy in treatment of coexistent carotid artery stenosis and coronary artery disease. Methods The data of fifty-seven patients with carotid artery stenosis and coronary artery disease confirmed by CT angiography (CTA) or Digital Subtraction Angiography (DSA) were analysed retrospectively. Percutaneous Coronary Intervention(PCI) was performed in all patients firstly, and Carotid Artery Stent (CAS) was done one week later. Hydration was performed perioperatively to protect the renal function. Neurological function (mRS) , renal function and complications were evaluated perioperatively. The patients were followed-up to observe if there was myocardial infarction or cerebral infarction and if there was stenosis in stent. Results Staged interventional therapy were performed successfully in all patients. Intraoperative angiography shew satisfied stenosis release and forward blood flow. There was no obvious alteration in mRS and renal function (P > 0.05). One patient with cerebral ischemia deteriorated 3 days after PCI and was quickly recovered after CAS immediately. Although carotid sinus reflection occurred in 16 patients during CAS, there was no myocardial infarction and cerebral infarction occurred postoperatively. There was also no myocardial infarction, cerebral infarcion corelated with stent and death during the following up. Conclusions For patients coexistent with carotid artery stenosis and coronary artery disease, staged PCI followed by CAS may be a safe and feasible strategy1.%目的 探讨分期介入治疗颈动脉狭窄合并冠心病患者的疗效,并发症及随访效果.方法 回顾性分析了57例经冠状动脉及脑血管造影或CT血管成像(CTA)证实的颈动脉狭窄合并冠心病患者的临床资料,所有患者均先行经皮冠状动脉介入治疗(PCI),术后1周左右再行颈动脉支架术(CAS),手术前后均进行水化以保护肾功能,观察手术前后患者的神

  6. Discrepant findings of computed tomography quantification of minimal lumen area of coronary artery stenosis: Correlation with intravascular ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Li, Yuehua, E-mail: andrewradiologist@hotmail.com [Department of Radiology, Shanghai No. 6 People' s Hospital, School of Medicine, Shanghai Jiaotong University, No. 600, Yishan Rd, Shanghai 200233 (China); Zhang, Jiayin, E-mail: andrewssmu@msn.com [Department of Radiology, Shanghai No. 6 People' s Hospital, School of Medicine, Shanghai Jiaotong University, No. 600, Yishan Rd, Shanghai 200233 (China); Lu, Zhigang, E-mail: andrewradiologist@gmail.com [Department of Cardiology, Shanghai No. 6 People' s Hospital, School of Medicine, Shanghai Jiaotong University (China); Pan, Jingwei, E-mail: andrewssmu@gmail.com [Department of Cardiology, Shanghai No. 6 People' s Hospital, School of Medicine, Shanghai Jiaotong University (China)

    2012-11-15

    Objectives: To study the diagnostic performance of computed tomography (CT) quantification of minimal lumen area (MLA) based on multiple factors (image quality, calcification and lesion locations), with reference to intravascular ultrasound (IVUS). Methods: Consecutive clinically ordered patients were prospectively enrolled in our study. CT quantification of MLA was manually measured on cross-sectional view and further compared with IVUS findings. A significant lesion was defined as {<=}6 mm{sup 2} MLA for the left main (LM) coronary artery and a {<=}4 mm{sup 2} MLA for other epicardial vessels. Results: Non-calcified lesions had good correlation between CT and IVUS (r = 0.96) and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 85% (51/60), 93.94% (31/33), 96.23% (51/53) and 77.5% (31/40) respectively. Decreased correlation (r = 0.814) lower specificity (23.81% (5/21)) and positive predictive value (60.98% (25/41)) were observed in calcified subgroup. Artifact-absent lesions demonstrated excellent correlation (r = 0.967) and the sensitivity, specificity, PPV and NPV were 96% (48/50), 93.94% (31/33), 96% (48/50) and 93.94% (31/33) respectively. Impaired correlation (r = 0.584) was noted in artifact-present lesions and the sensitivity, specificity, PPV and NPV were 80% (28/35), 23.81% (5/21), 63.64% (28/44) and 41.67% (5/12) respectively. Excellent correlation between CT and IVUS was noted in proximal epicardial vessels (r = 0.908) and the sensitivity, specificity, PPV and NPV were 92.31% (36/39), 78.13% (25/32), 83.72% (36/43) and 89.29% (25/28) respectively. Middle right coronary artery lesions showed non-significant correlation (r = 0.54, p = 0.055). Conclusions: CT quantification of MLA can only be accurately achieved in non-calcified lesions with absence of artifact. Diagnostic performance is impaired in calcified lesions.

  7. A case of William's syndrome associated peripheral pulmonary arterial stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Kyung Hwa; Hwang, Mi Soo; Kim, Sun Yong; Chang, Jae Chun; Park, Bok Hwan [College of Medicine, Yeungam University, Daegu (Korea, Republic of)

    1988-06-15

    William's syndrome, in order to more completely delineate the total spectrum of the disorder, indicates that 'infantile hypercalcemia', 'peculiar facies' and 'supravalvular aortic stenosis.' In has other many vascular anomalies, such as peripheral pulmonary arterial stenosis, coronary arterial stenosis, celiac arterial stenosis, and renal aterial stenosis. Only 32% of the patients have evidence of supravalvular aortic stenosis. And it is very rare disease entity that has been reported rarely in Korea. Recently authors experienced a case that was questioned William's syndrome with peripheral pulmonary arterial stenosis, clinically and preliminary radiologically and this case was confirmed by operation. Here we report a case of William's syndrome with peripheral pulmonary arterial stenosis and reviewed literatures.

  8. Coronary Artery Disease

    Science.gov (United States)

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due ...

  9. Clinical Value of Dual Source CT in the Diagnosis of Coronary Artery Stenosis%双源CT诊断不同程度冠状动脉狭窄的临床价值

    Institute of Scientific and Technical Information of China (English)

    高振兴; 佟晖

    2015-01-01

    Objective To investigate the clinical value of dual source CT in the diagnosis of coronary artery stenosis.MethodsThirty-six patients with clinicaly suspected coronary heart disease in our hospital received with dual source CT and conventional coronary angiography.Results Dual source CT findings and coronary angiography results were compared and the diagnosis of coronary artery stenosis sensitivity for 94.7%,specificity of diagnosis of 95.5%,the positive predictive value for 83.4%,the negative predictive value was 98.78%. The diagnostic accuracy rate was 95.3%. Dual source CT in the diagnosis of severe stenosis diagnostic sensitivity was significantly lower than that of mild stenosis,moderate stenosis diagnosis sensitivity, he difference had statistical significance(P< 0.05).Conclusion With the traditional coronary artery stenosis diagnosis coronary angiography were compared with and dual source CT scan with rapid scanning,high accuracy in the diagnosis and noninvasive clinical advantage.%目的:探讨双源CT诊断不同程度冠状动脉狭窄的临床价值。方法选取来我院因临床拟诊冠心病而接受双源CT和传统冠状动脉造影检查的患者36例。结果双源CT检查结果与冠状动脉造影检查结果相比,其冠状动脉狭窄诊断的敏感度为94.7%、诊断特异性为95.5%、阳性预测值为83.4%、阴性预测值为98.78%,诊断准确率为95.3%。双源CT检查对重度狭窄诊断敏感度低于轻度狭窄和中度狭窄的诊断敏感度,比较差异具有统计学意义(P<0.05)。结论与传统冠状动脉狭窄诊断方式冠状动脉造影相比,双源CT扫描具有扫描迅速、诊断准确率较高,无创伤等临床优势。

  10. Coronary artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

    1982-04-01

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

  11. Outcome of patients with significant coronary stenosis but without ischemic evidence on exercise myocardial perfusion scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Kawaguchi, Ren; Toyama, Takuji; Sekiguchi, Makoto; Takama, Noriaki; Adachi, Hitoshi; Naito, Shigeto; Hoshizaki, Hiroshi; Oshima, Shigeru; Taniguchi, Koichi [Gunma Prefectural Cardiovascular Center, Maebashi (Japan)

    2001-03-01

    The rates of cardiac events and coronary revascularization were evaluated in patients with significant coronary stenosis of more than 75% by the American Heart Association (AHA) classification but no ischemic evidence by exercise myocardial perfusion scintigraphy. Subjects were 171 patients (113 males, 58 females, mean age 66{+-}9 years) undergoing coronary angiography and without scintigraphic evidence of myocardial ishemia. They were divided into two groups according to the severity of coronary artery stenosis based on AHA classification. Group A was composed of 139 patients with more than 75% stenosis (101 patients with 75% stenosis and 38 patients with more than 90% stenosis), and Group B was composed of 32 patients with 50% stenosis. Cardiac events including angina pectoris (n=63), myocardial infarction (n=1), heart failure (n=2) and cardiac death (n=0), coronary revascularization and predictive factors were evaluated during follow-up of 34{+-}21 months. Furthermore, the interval between coronary revascularization and exercise myocardial perfusion scintigraphy was estimated. The rates of cardiac events (45%) and coronary revascularization (29%) in Group A were significantly higher than the rate of cardiac events (9%, p<0.05) and coronary revascularization (6%, p<0.05) in Group B. Only percentage stenosis and the number of diseased vessels affected the rates of cardiac event and coronary revascularization. Patients with significant coronary stenosis, but without ischemic evidence by exercise myocardial perfusion scintigraphy, have a relatively high rate of cardiac event and coronary revascularization, especially in patients with severe stenosis or multivessel disease. However, coronary revascularization should not be performed in all patients with significant coronary stenosis. (author)

  12. Emergency off-pump coronary artery surgery

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja; Zulfiqar Haider; Haider Zaman

    2004-01-01

    Background Off-pump coronary artery bypass grafting is fast-becoming a procedure of choice for elective revascularization in high-risk patients with multi-vessel coronary artery disease. However, the role of off-pump coronary artery bypass grafting for patients with acute coronary syndromes requiring emergency revascularization still requires validation. We present our experience to show the feasibility of off-pump coronary artery surgery as an emergency revascularization technique. Methods From April 2001 to September 2003, emergency (operation within 24 hours after hospitalization) coronary artery bypass grafting without cardiopulmonary bypass (CPB) was performed in 66 patients with a mean age of (66.9±5.4) years (range 49-72 years). They presented acute coronary syndromes with 38 patients on platelet glycoprotein Ⅱb/Ⅲa receptor antagonists. All patients underwent off-pump coronary artery bypass surgery via sternotomy with the intention of complete coronary revascularization.Results An average of 2.9 grafts per patient were performed and the posterior descending artery and marginal branches of the circumflex artery were grafted in 83.3% of the patients. There were 4 events of intraoperative cardiac instability, precipitated by occlusion of right coronary artery or positioning of a cardiomegaly heart, leading to immediate conversion to CPB. The mortality rate was 3% (2/66). Two patients suffered postoperative stroke while three needed hemofiltration for acute renal failure. Post surgery elective coronary angiography (n=46) showed no significant stenosis.Conclusion Emergency off-pump coronary artery surgery with complete revascularization is feasible in patients with acute coronary syndrome with low morbidity and mortality and excellent early results.

  13. Fusion of 3D cardiac SPECT and 64-channel-CT angiography using personal computer in functionally relevant coronary artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung-Ae General Hospital, Seoul (Korea, Republic of)

    2007-06-15

    Image fusion is fast catching attention as Wagner pointed out in this 2006 version of the recent progress and development presented at the annual meeting of Society of Nuclear Medicine. Prototypical fusion of bone scan and radiograph was already attempted at in 1961 when Fleming et al. published an article on strontium-85 bone scan. They simply superimposed dot scan on radiograph enabling simultaneous assessment of altered bone metabolism and local bone anatomy. Indeed the parallel reading of images of bone scan and radiography, CT, MRI or ultrasonography has been practiced in nuclear medicine long since. It is fortunate that recent development of computer science and technology along with the availability of refined CT and SPECT machines has permitted us to open a new avenue to digitally produce precise fusion image so that they can readily be read, exchanged and disseminated using internet. Ten years ago fusion was performed using Bresstrahlung SPECT/CT and it is now achievable by PET/CT and SPECT/CT software and SPECT/CT hardware. The merit of image fusion is its feasibility of reliable assessment of morphological and metabolic change. It is now applicable not only to stationary organs such as brain and skeleton but also to moving organs such as the heart, lung and stomach. Recently, we could create useful fusion image of cardiac SPECT and 64-channel CT angiograph. The former provided myocardial metabolic profile and the latter vascular narrowing in two patients with coronary artery stenosis and myocardial ischemia.

  14. Hemoglobin A1c is associated with severity of coronary artery stenosis but not with long term clinical outcomes in diabetic and nondiabetic patients with acute myocardial infarction undergoing primary angioplasty.

    Science.gov (United States)

    She, Jianqing; Deng, Yangyang; Wu, Yue; Xia, Yulong; Li, Hongbing; Liang, Xiao; Shi, Rui; Yuan, Zuyi

    2017-08-08

    Acute myocardial infarction (AMI) patients with type 2 diabetes mellitus are known to present with multiple vessel lesions during coronary angiography. The underlying mechanism remains elusive and there is a shortage of serum prediction markers. In this study, we investigate the relationship between admission HbA1c and severity of coronary artery stenosis and subsequent prognosis in AMI patients with or without diabetes. We measured admission HbA1c, and vessel scores based on the number of diseased coronary vessels with significant stenosis in 628 patients diagnosed with AMI. Simple and multi-regression analysis were performed to investigate the correlation between HbA1c and the severity of coronary artery stenosis. Major adverse cardiovascular events (MACE), including new-onset myocardial infarction, acute heart failure and cardiac death, were documented during the follow-up. 272 non-DM participants and 137 DM participants were separated into two groups based on HbA1c levels for survival analysis during a 2-year follow up. 448 non-DM patients and 180 DM patients were included in the initial observational analysis. 272 non-DM patients and 137 DM patients were included in the follow-up survival analysis. The admission HbA1c level was found to be significantly positively correlated to the number of affected vessels suffering from significant coronary artery stenosis both in DM (R square = 0.012; 95% CI 0.002 to 0.623, P = 0.049) and non DM patients (R square = 0.025; 95% CI 0.009 to 0.289, P = 0.037). Kaplan-Meier survival analysis revealed no significant difference with regard to different HbA1c levels either in DM or non-DM patients at the end of follow-up. In patients with AMI, admission HbA1c is an important predictor for the severity of coronary artery stenosis in non-DM and DM patients. Further studies are needed to determine whether longer term follow-up could further identify the prognosis effect of HbA1c on MACE.

  15. Cardiac CT: coronary arteries and beyond

    Energy Technology Data Exchange (ETDEWEB)

    Mahnken, Andreas H. [RWTH Aachen University, Department of Diagnostic Radiology, University Hospital, Aachen (Germany); RWTH Aachen University, Applied Medical Engineering, Aachen (Germany); Muehlenbruch, Georg; Guenther, Rolf W.; Wildberger, Joachim E. [RWTH Aachen University, Department of Diagnostic Radiology, University Hospital, Aachen (Germany)

    2007-04-15

    Multi-detector-row computed tomography (MDCT) has emerged as a rapidly developing method for non-invasive imaging of the heart. An understanding of ECG synchronization, contrast material administration, patient preparation and image post-processing is needed to optimize image quality. The basic technical principles and essentials of these technical basics are described here. Correctly applied cardiac MDCT allows imaging of the coronary arteries including coronary anatomy and stenosis detection. The same is true for evaluation of coronary artery bypass grafts and, to some extent, coronary artery stents. While quantification of total calcified plaque burden has been long established, coronary MDCT allows assessing plaque morphology and constitution. Recent approaches go beyond the coronaries and include evaluation of left ventricular function at rest and myocardial viability. In combination with experimental approaches for assessing aortic valve function and myocardial perfusion imaging, cardiac MDCT offers the potential for a comprehensive examination of the heart using a single breath-hold examination. (orig.)

  16. Minimally invasive direct coronary artery bypass plus coronary stent for acute coronary syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    Caiyi Lu; Gang Wang; Qi Zhou; Jinwen Tian; Lei Gao; Shenhua Zhou; Jinyue Zhai; Rui Chen; Zhongren Zhao; Cangqing Gao; Shiwen Wang; Yuxiao Zhang; Ming Yang; Qiao Xue; Cangsong Xiao; Wei Gao; Yang Wu

    2008-01-01

    A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a smallleft circumflex,70-90%stenosis at the paroxysmal and middle part of a dominant fight coronary artery (RCA),and a normal left internalmammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occludedlesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davincirobot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then thepatient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique befeasible and safe in the treatment of elderly patient with multiple coronary diseases.

  17. Instantaneous wave-free ratio derived from coronary computed tomography angiography in evaluation of ischemia-causing coronary stenosis

    Science.gov (United States)

    Ma, Yue; Liu, Hui; Hou, Yang; Qiao, Aike; Hou, Yingying; Yang, Qingqing; Guo, Qiyong

    2017-01-01

    Abstract The instantaneous wave-free ratio (iFR) closely related to fractional flow reserve (FFR) is a adenosine-independent physiologic index of coronary stenosis severity. We sought to evaluate whether iFR derived from coronary computed tomographic angiography (iFRCT) can be used as a novel noninvasive method for diagnosis of ischemia-causing coronary stenosis. We retrospectively enrolled 33 patients (47 lesions) with coronary artery disease (CAD) and examined with coronary computed tomographic angiography (CTA), invasive coronary angiography (ICA), and FFR. Patient-specific anatomical model of the coronary artery was built by original resting end-diastolic CTA images. Based on the model and computational fluid dynamics, individual boundary conditions were set to calculate iFRCT as the mean pressure distal to the stenosis divided by the mean aortic pressure during the diastolic wave-free period of rest state. Ischemia was assessed by an FFR of up to 0.8, while anatomically obstructive CAD was defined by a stenosis of at least 50% by ICA. The correlation between iFRCT and FFR was evaluated. The receiver operating characteristic (ROC) curve was used to select the cut-off value of iFRCT for diagnosis of ischemia-causing stenosis. The diagnostic performances of iFRCT, coronary CTA, and iFRCT plus CTA for ischemia-causing stenosis were compared with ROC curve and Delong method. On a per-vessel basis, iFRCT and FFR had linear correlation (r = 0.75, p coronary CTA (AUC = 0.60), iFRCT yielded diagnostic improvement over stenosis assessment with AUC increasing from 0.6 by CTA to 0.87 (P coronary CTA for detection of ischemia-causing coronary stenosis. PMID:28121952

  18. Accuracy of Noninvasive Coronary Stenosis Quantification of Different Commercially Available Dedicated Software Packages

    NARCIS (Netherlands)

    Dikkers, Riksta; Willems, Tineke P.; de Jonge, Gonda J.; Marquering, Henk A.; Greuter, Marcel J. W.; van Ooijen, Peter M. A.; van der Weide, Marijke C. Jansen; Oudkerk, Matthijs

    2009-01-01

    Purpose: The purpose of this study was to investigate the noninvasive quantification of coronary artery stenosis using cardiac software packages and vessel phantoms with known stenosis severity. Materials and Methods: Four different sizes of vessel phantoms were filled with contrast agent and

  19. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  20. Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

    NARCIS (Netherlands)

    A. Coenen (Adriaan); M. Lubbers (Marisa); A. Kurata (Akira); A.K. Kono (Atsushi K.); A. Dedic (Admir); R.G. Chelu (Raluca Gabriela); M.L. Dijkshoorn (Marcel); Rossi, A. (Alexia); R.J.M. van Geuns (Robert Jan); K. Nieman (Koen)

    2016-01-01

    textabstractObjectives: To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Methods: Subjects with suspected or known coro

  1. Multiple coronary arterial loops as a cause of myocardial ischemia

    Science.gov (United States)

    Bashour, Tali T.; Mansour, Nagi N.; Lee, Damon

    1993-01-01

    A case of long-standing angina with ischemia documented by exercise testing and thallium scintigraphy in a patient who had multiple proximal loops in all three major coronary arteries in the absence of luminal stenosis, is reported.

  2. Transradial artery coronary angioplasty.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; de Melker, E

    1995-01-01

    This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site-related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery (n = 5) or the brachial artery (n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions

    Directory of Open Access Journals (Sweden)

    Bongiovani Hércules Lisboa

    2002-01-01

    Full Text Available Previously described surgical treatment for ostial coronary artery stenosis relied on either venous or arterial bypasses or ostial patch angioplasty. These surgical procedures are performed with bovine pericardium, saphenous vein or internal thoracic artery. We describe a technique of right coronary artery re-implantation into the aorta. The procedure was performed in four patients with right coronary artery ostial stenosis along with other left coronary artery lesions.

  4. Duplex ultrasound for identifying renal artery stenosis

    DEFF Research Database (Denmark)

    Zachrisson, Karin; Herlitz, Hans; Lönn, Lars

    2017-01-01

    Background Renal artery duplex ultrasound (RADUS) is an established method for diagnosis of renal artery stenosis (RAS), but there is no consensus regarding optimal RADUS criteria. Purpose To define optimal cutoff values for RADUS parameters when screening for RAS using intra-arterial trans...

  5. Smoking and hyperlipidemia are important risk factors for coronary artery spasm

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective To investigate the role of coronary artery spasm in the etiology of chest pain lacking significant coronary stenosis and to identify the clinical risk factors related to coronary artery spasm. Methods Two hundred and seventy five patients with chest pain, but without significant coronary artery stenosis underwent the intracoronary acetylcholine test. Coronary artery spasm was diagnosed while coronary artery stenosis increased to 90% and was accompanied by the usual chest pain with or without ischemic changes on electrocardiogram. Logistic regression was employed to investigate the relationships between coronary artery spasm and sex, age, hypertension, diabetes mellitus, smoking, hyperlipidemia and results of electrocardiographic treadmill stress test. Left ventricular ejection fraction and end diastolic pressure were compared between spasm group and non-spasm group. Results Coronary artery spasm was detected in 103 out of 271 patients, a rate of 38%. Logistic regression analysis showed that smoking and hyperlipidemia increased the relative risk of coronary artery spasm 4.2 times and 2.3 times, respectively. There was a significantly negative relationship between diabetes mellitus and coronary artery spasm. Furthermore, there was no coronary artery spasm detected in left ventricular ejection fraction and end diastolic pressure. Conclusions Coronary artery spasm was one of the important etiological factors for patients with chest pain but no coronary artery stenosis. Smoking and hyperlipidemia were the main clinical risk factors for coronary artery spasm.

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

    Directory of Open Access Journals (Sweden)

    Ghabili K

    2011-10-01

    patients had a history of coronary artery disease, six patients had hypertension, and ten patients had diabetes mellitus. Significant ICA stenosis was present in four patients (4.2% with peripheral arterial disease in one healthy individual (1% of the control group (P > 0.05. In terms of the risk factors for atherosclerosis, no statistically significant relationship was found between individual atherosclerotic risk factors and significant ICA stenosis (P > 0.05.Conclusion: The prevalence of significant ICA stenosis in Iranian patients with peripheral arterial disease is low. In addition, there is no relationship between individual atherosclerotic risk factors and significant ICA stenosis.Keywords: carotid artery stenosis, atherosclerosis, peripheral arterial disease, Iranian

  7. Carotid artery stenosis after neck radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shimamura, Munehisa; Hashimoto, Yoichiro; Kasuya, Junji; Terasaki, Tadashi [Kumamoto City Hospital (Japan); Uchino, Makoto

    2000-02-01

    Carotid artery stenosis sometimes occurs after cervical radiotherapy. We report a 70-year-old woman with a history of radiotherapy for thyroid cancer at the age of 28 years. She had no signs and symptoms except the skin lesion at the irradiation site. Duplex ultrasonography revealed heterogeneous plaques showing 50% stenosis of bilateral common carotid arteries. Those lesions were observed within segment of irradiation, where atheromatous plaque usually seldom occurs. These indicated that the carotid stenosis was induced by radiotherapy. Although the efficacy of antiplatelet therapy for radiation-induced plaque is not clear, the plaques remained unchanged for 4 years in spite of aspirin administration. (author)

  8. Long-term Prognosis of Patients With Non-ST-segment Elevation Acute Myocardial Infarction and Coronary Arteries Without Significant Stenosis.

    Science.gov (United States)

    Redondo-Diéguez, Alfredo; Gonzalez-Ferreiro, Rocío; Abu-Assi, Emad; Raposeiras-Roubin, Sergio; Aidhodjayeva, Ozoda; López-López, Andrea; Castiñeira-Busto, María; Peña-Gil, Carlos; García-Acuña, Jose María; González-Juanatey, José Ramón

    2015-09-01

    There is debate regarding the prognostic significance of the absence of significant coronary lesions in patients with non-ST-segment elevation acute myocardial infarction. We investigated long-term prognosis in a contemporary cohort of these patients. Retrospective observational study of 5203 patients with acute coronary syndrome. Propensity score matching was used to create 2 groups of 367 patients with non-ST-segment elevation acute myocardial infarction matched by the absence or presence of significant coronary lesions. In the matched cohort, we determined the impact of the absence of significant coronary lesions on mortality or readmission for acute coronary syndrome for 4.8 (2.6) years after discharge. Mortality or readmission for acute coronary syndrome was lower among patients without significant lesions (26.4% vs 32.7%; P = .09). Mortality in both groups was 19.1%. In contrast, patients without significant lesions had a lower incidence of readmission for acute coronary syndrome (2.0/100 vs 3.9/100 person-years; P = .003). The incidence of mortality or readmission for acute coronary syndrome was similar in patients without significant lesions and those with significant 1-vessel disease (26.4% vs 27.5%; P = .19), but lower than that in patients with 2-vessel disease (37.8%; P = .007) and 3-vessel disease or left main coronary artery disease (41.1%; P = .002). Patients with non-ST-segment elevation acute myocardial infarction and coronary arteries without significant lesions have similar long-term mortality but lower readmission rates for acute coronary syndrome than patients with significant lesions. Mortality or readmission for acute coronary syndrome is similar in patients without significant lesions and patients with 1-vessel disease, but lower than in patients with disease in 2 or more vessels. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  9. Coronary Artery Imaging in Children

    Science.gov (United States)

    2015-01-01

    Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy. PMID:25741188

  10. 代谢综合征与冠状动脉狭窄程度及心血管危险评分的关系%Relation Between Metabolic Syndrome and Coronary Artery Stenosis, Cardiovascular Risk Score

    Institute of Scientific and Technical Information of China (English)

    李婉; 白小涓

    2012-01-01

    目的 了解代谢综合征患者冠状动脉狭窄程度及心血管危险评分的特点,以探讨代谢综合征与后两者之间的关系.方法 连续收集胸部不适并行冠状动脉CT检查的136例患者,所有患者均检查血压、空腹血糖及血脂,包括甘油三酯、总胆固醇、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇.应用美国2001年NCEP-ATPⅢ代谢综合征诊断标准,将其分为代谢综合征组及非代谢综合征组.冠状动脉狭窄程度用多层螺旋CT测量,比较两组间冠状动脉狭窄程度的差异,并对心血管危险评分中各项指标的差异进行比较.结果 冠状动脉狭窄程度代谢综合征组均较非代谢综合征组为重,两组的高血压、糖尿病患者、血脂异常及心血管危险评分存在明显差异.结论 代谢综合征患者冠状动脉狭窄程度较重,且多数心血管危险评分较高.代谢综合征可作为冠心病的重要危险因素,早期全面干预其中的各个成分有助于冠心病的防治.%Aim To analyze the characteristics of coronary artery stenosis and the cardiovascular risk score I. E. Framingham risk score (FRS) in the metabolic syndrome (MS) patients. Methods Collect 136 patients who have chest discomfort and have undergone coronary multi slicespiral CT examination continuously, and check their blood pressure , fasting blood glucose and lipids, including triglycerides, total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol. Use the United States 2001 NCEP-ATP Ⅲ diagnostic criteria of metabolic syndrome to divide the study population into non-MS group and MS group. Use multi-slicespiral CT to measure the degree of coronary artery stenosis, and compare the differences of the coronary artery stenosis between non-MS group and MS group, and also compare the differences of the contents in the cardiovascular risk score. Results MS group shows more severe coronary artery stenosis compared with

  11. Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh

    2017-01-01

    A family history of coronary artery disease (CAD) is an important risk factor for adverse coronary events, in particular if the disease has an early onset. The risk of CAD is influenced by genetic and environmental factors with a greater genetic contribution earlier in life. Through recent years...... Registry and risk factor control was evaluated. The study revealed that risk factors are common in early-onset CAD and that a large room for risk factor improvement remains. In study II, we used coronary computed tomography angiography to compare the coronary plaque burden and characteristics between 88...... first-degree relatives of patients with early-onset CAD and 88 controls with no familial predisposition. Relatives had a significantly increased coronary plaque burden, which displayed characteristics associated with myocardial ischemia and adverse coronary events. In study III, 134 patients with early...

  12. 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

  13. 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

  14. Acetylcholine-Provoked Coronary Spasm at Site of Significant Organic Stenosis Predicts Poor Prognosis in Patients With Coronary Vasospastic Angina.

    Science.gov (United States)

    Ishii, Masanobu; Kaikita, Koichi; Sato, Koji; Tanaka, Tomoko; Sugamura, Koichi; Sakamoto, Kenji; Izumiya, Yasuhiro; Yamamoto, Eiichiro; Tsujita, Kenichi; Yamamuro, Megumi; Kojima, Sunao; Soejima, Hirofumi; Hokimoto, Seiji; Matsui, Kunihiko; Ogawa, Hisao

    2015-09-08

    Coronary artery spasm contributes to the pathogenesis of variant angina and ischemic heart disease and may play a role in the progression of atherosclerosis. It is unclear whether the location of spasm is related to outcome. This study compared the clinical features and prognosis of patients with coronary spasm at the site of significant atherosclerotic stenosis with patients with spasm at sites without stenosis or nonsignificant stenosis. This was a retrospective, observational study of 1,877 consecutive patients with typical or atypical angina-like chest pain undergoing acetylcholine (ACh)-provocation testing. A total of 1,760 patients were eligible for analysis. ACh-provoked coronary spasm and significant organic stenosis were observed in 873 and 358 patients, respectively. In patients with significant atherosclerotic stenosis, ACh-positive patients (n = 233) were younger and without diabetes mellitus compared with nonspasm patients (n = 125). In patients without organic stenosis, ACh-positive patients (n = 640) were older, had dyslipidemia, and were more likely to have a family history of ischemic heart disease than nonspasm patients (n = 762). Multiple logistic regression analysis identified ST-segment elevation during anginal attacks, organic stenosis of the left anterior descending artery, and multivessel spasm as correlates of spasm at sites of significant organic stenosis (n = 192). Multivariate analysis identified ACh-provoked spasm at the site of significant stenosis and use of nitrates as the 2 prognostic factors for major adverse cardiac events. The clinical features and prognosis of patients with ACh-provoked coronary spasm were different when it occurred at the site of significant atherosclerotic stenosis compared with patients with spasm elsewhere. Both spasm at the site of significant organic stenosis and nitrate use were significant predictors of major adverse cardiac events. Copyright © 2015 American College of Cardiology Foundation. Published

  15. 心肌桥近端冠状动脉狭窄性病变的临床特点分析%Imaging and clinical characteristics of patients with coronary artery stenosis located proximally to myocardial bridging

    Institute of Scientific and Technical Information of China (English)

    洪衡; 姚康宝; 史静琤; 任海明; 王磊; 李明昌; 王河; 刘群; 王明生; 顼志敏

    2013-01-01

    Objective To explore the imaging and clinical characteristics and related risk factors of patients with coronary artery stenosis located proximally to myocardial bridging.Methods This study enrolled 603 patients with angiography evidenced myocardial bridging-mural coronary artery between May 2004 to May 2009.Angiographic and clinic data were collected according to uniform protocol and standard questionnaires were used to obtain patients' demographic and clinical information.Univariate and multivariate analysis were performed to explore related risk factors.Results Chest pain was present in 247cases (41.0%).Dynamic ST-T changes were found in 229 cases (38%).A total of 644 myocardial bridging-mural coronary arteries were detected including 382 (62.4%) segments located proximally to myocardial bridging.Diastolic vessel diameters in the myocardial bridging segment were significantly smaller than reference segments (all P < 0.01).Stepwise multiple regression analysis suggested that vascular bifurcation lesions,the degree of narrowing and the number of diseased coronary vessels of non-myocardial bridging-mural coronary arteries,age,LDL-C/HDL-C,male gender,diabetes,and systolic narrow rate of myocardial bridging-mural coronary arteries were positively related with the narrowing degree of the first coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01).Vascular bifurcation lesions,the degree of narrowing and the number of diseased coronary vessels of non-myocardial bridging-mural coronary arteries,age,LDL-C/HDL-C,male,diabetes and dyslipidemia were positively related with the narrowing degree of the most severe coronary artery stenosis located proximally to myocardial bridging(P < 0.05 or P < 0.01).Conclusions Myocardial ischemia is common in patients with myocardial bridging and the artery segments located proximally to myocardial bridging are prone to stenosis.Systolic narrow rate of myocardial bridging-mural coronary

  16. Studies on diagnosis and treatment of renal artery stenosis

    NARCIS (Netherlands)

    P. Krijnen (Pieta)

    2004-01-01

    textabstractThis thesis describes studies on ~onosis and treatment of renal artery stenosis in patients with drug-resistant hypertension. In Chapter 1, the clinical problem of renal artery stenosis is discussed. Renal artery stenosis, a narrowing of the renal artery, is a potential cause of

  17. Comparison of a Two-Lead, Computerized, Resting ECG Signal Analysis Device, the MultiFunction-CardioGramsm or MCG (a.k.a. 3DMP, to Quantitative Coronary Angiography for the Detection of Relevant Coronary Artery Stenosis (>70% - A Meta-Analysis of all Published Trials Performed and Analyzed in the US

    Directory of Open Access Journals (Sweden)

    John E. Strobeck, Joseph T. Shen, Binoy Singh, Kotaro Obunai, Charles Miceli, Howard Sacher, Franz Ritucci, Michael Imhoff

    2009-01-01

    Full Text Available Background: Accurate, non-invasive diagnosis of, and screening for, coronary artery disease (CAD and restenosis after coronary revascularization has been a challenge due to either low sensitivity/specificity or relevant morbidity associated with current diagnostic modalities. Methods: To assess sensitivity and specificity of a new computerized, multiphase, resting electrocardiogram analysis device (MultiFunction-CardioGramsm or MCG a.k.a. 3DMP for the detection of relevant coronary stenosis (>70%, a meta-analysis of three published prospective trials performed in the US on patient data collected using the US manufactured device and analyzed using the US-based software and New York data analysis center from patients in the US, Germany, and Asia was completed. A total of 1076 patients from the three trials (US - 136; Germany - 751; Asia - 189 (average age 62 ± 11.5, 65 for women, 60 for men scheduled for coronary angiography, were included in the analysis. Patients enrolled in the trials may or may not have had prior angiography and/or coronary intervention. Angiographic results in all studies were classified for hemodynamically relevant stenosis (> 70% by two US based angiographers independently. Results: Hemodynamically relevant stenosis was diagnosed in 467 patients (43.4%. The device, after performing a frequency-domain, computational analysis of the resting ECG leads and computer-database comparison, calculated a coronary ischemia “severity” score from 0 to 20 for each patient. The severity score was significantly higher for patients with relevant coronary stenosis (5.4 ± 1.8 vs. 1.7 ± 2.1. The study device (using a cut-off score for relevant stenosis of 4.0 correctly classified 941 of the 1076 patients with or without relevant stenosis (sensitivity-91.2%; specificity-84.6%; NPV 0.942, PPV 0.777. Adjusted positive and negative predictive values (PPV and NPV were 81.9% and 92.6%, respectively (ROC AUC = 0.881 [95% CI: 0

  18. [Morphofunctional correlation in congenital anomalies of the coronary arteries. II. The ectopic origin of the coronary arteries].

    Science.gov (United States)

    Rangel-Abundis, A; Muñoz-Castellanos, L; Chávez-Pérez, E; Sánchez-Moreira, L M; Marín, G; Badui, E; Solorio, S

    1994-01-01

    The authors describe the morphogenesis and functional alterations of the coronary arterial net in the ectopic coronary arteries: a) with origin in the aorta or its branches and b) with origin in the pulmonary artery. The coronary arteries are developed from: 1) endothelial sprouts localized in the great arteries walls at the level of the sigmoidal values, 2) right and left subepicardial vascular network and 3) the intramyocardial sinusoids. Most of the ectopic coronary arteries result from alterations in the connection between these three embryonic elements. The deviation of one of the subepicardial vascular network in a wrong way (in direction of pulmonary artery or the opposite Valsalva sinus) will stimulate the development of endothelial sprouts which will connect such network originating abnormal connections and anomalous origin of the coronary arteries. The origin of both coronary arteries from the pulmonary artery is in compatible with life. Myocardial ischemia is absent in patients with type I (infant) or type II (adult) anomalous origin of one coronary artery from the pulmonary artery, only in the transitional phase between both types (I and II) there is myocardial ischemia previous to the formation of the collateral coronary circulation. The ectopic origin of the coronary artery from the aortic Valsalva sinus have very little hemodynamic repercussion in the patient. Although there are cases with postexercise sudden dead. These anomalies associated to atherosclerotic coronary stenosis have an impact on the evolution and prognosis of ischemic heart disease.

  19. 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

  20. Acoustic Coupler for the Acquisition of Coronary Artery Murmurs

    DEFF Research Database (Denmark)

    Zimmermann, Niels Henrik; Schmidt, Samuel; Hansen, John

    The weak murmurs originating from stenosis in the coronary arteries can only be acquired with a dedicated coupler and system design. The aim of the study was to design and evaluate such a coupler. The suggested design is based on the use of a high quality microphone, coupled to the chest through...... that the sensor is suitable for recording of coronary murmurs....

  1. Case Report: Coronary arterial spasm in single right coronary artery

    Institute of Scientific and Technical Information of China (English)

    En-zhi JIA; Qi-jun SHAN; Zhi-jian YANG; Tie-bing ZHU; Lian-sheng WANG; Ke-jiang CAO; Wen-zhu MA

    2009-01-01

    We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.

  2. Feasibility and Diagnostic Accuracy for Assessment of Coronary Artery Stenosis of Prospectively Electrocardiogram-gated High-pitch Spiral Acquisition Mode Dual-source CT Coronary Angiography in Patients with Relatively Higher Heart Rates:in Comparison wit

    Institute of Scientific and Technical Information of China (English)

    Kai Sun; Rui-juan Han; Li-fang Cui; Rui-ping Zhao; Li-jun Ma; Li-jun Wang; Li-gang Li; Chang-yong Li

    2012-01-01

    Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA).Methods Forty-seven consecutive patients with relatively higher HR (>65 and < 100 bpm) (20 male,27 female; age 55 ± 10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study.All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition.All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1:excellent to 3:non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%).Considered CCA as the standard of reference,the sensitivity,specificity,positive predictive value and negative predictive value were calculated.Radiation dose values were calculated using the dose-length product.Results Image quality was rated as being score 1 in 92.4% of segments,score 2 in 6.1% of segments and score 3 in 1.5% of segments.The average image quality score per segment was 1.064±0.306.The HR variability of patients with image score 1,2 and 3 were 2.29± 1.06 bpm,5.17± 1.37 bpm,8.88± 1.53 bpm,respectively.The average HR variability of patients with different image scores were significantly different (F=170.402,P=0.001).The sensitivity,specificity,positive and negative predictive values were 92.6%,97.0%,87.6%,98.3%,respe ctively,per segment and 90.0%,95.2%,85.3%,96.9%,respectively,per vessel and 100%,63.6%,90.0%,100%,respectively,per patient.The effective radiation dose was on average 0.86±0.16 mSv.Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia

  3. 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.

  4. The ASSURE ROT Registry: Bioresorbable Vascular Scaffold Following Rotablation for Complex Coronary Lesions

    Science.gov (United States)

    2015-02-05

    Cardiovascular Diseases; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Coronary Restenosis; Heart Diseases; Coronary Stenosis; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases

  5. Stenosis of calcified carotid artery detected on Panoramic Radiography

    Energy Technology Data Exchange (ETDEWEB)

    Cho, So Yang; Oh, Won Mann; Yoon, Suk Ja; Yoon, Woong; Lee, Jae Seo; Kang, Byung Cheol [School of Dentistry, Chonnam National University, Seoul (Korea, Republic of); Palomo, Juan M. [Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland (United States)

    2009-09-15

    This study aimed to investigate the luminal stenosis of the internal carotid artery with calcification detected on panoramic radiographs. This study used fifty carotid arteries of 36 dental patients whose panoramic radiograph and computed tomography angiography (CTA) revealed the presence of carotid artery calcification. A neuroradiologist interpreted CTA to determine the degree of stenosis of the internal carotid arteries. The degree of stenosis was stratified in four stages; normal (no stenosis), mild stenosis (1-49%), moderate stenosis (50-69%) and severe stenosis (70-99%). Among the fifty carotid arteries with calcification detected on both panoramic radiography and CTA, 20 carotid arteries (40%) were normal, 29 carotid arteries (18%) had mild stenosis, 1 carotid artery (2%) had moderate stenosis, and there was none with severe stenosis. Sixty percent of the carotid arteries with calcification detected on both panoramic radiography and CTA had internal luminal stenosis, and two percent had moderate stenosis. When carotid atheroma is detected on panoramic radiograph, it is possible that the dental patient has luminal stenosis of the internal carotid artery.

  6. [Role of angioplasty in the treatment of renal artery stenosis].

    Science.gov (United States)

    Armero, S; Bonello, L; Paganelli, F; Barragan, P; Roquebert, P-O; Commeau, P

    2011-12-01

    Atherosclerotic renal artery stenosis is frequent and is associated with a high incidence of morbidity and mortality, with a strong correlation with coronary artery disease, (Kalra et al., 2005; Cheung et al., 2002; Guo et al., 2007 [1-3]). The atherosclerotic renal artery stenosis is an independent predictive factor of death (Conlon et al., 1998 [4]). The treatment of this lesion does not have strong evidence. A lot of studies in this area suggest the angioplasty is superior in a big majority between surgery, and angioplasty with stent is superior between balloon angioplasty, but some studies fail to prove the superiority of angioplasty versus medical treatment. These studies have sadly a lot of mistakes and nowadays we don't know what is the treatment for our patients in a lot of cases. The angioplasty is indicated when there is a failure of antihypertensive medications for control of blood pressure, when it is associated with a renal insufficiency quickly progressive or when there is a lesion on each renal artery. Other studies must be organized for prove the superiority of angioplasty when there is a real stenosis, maybe with the use of fractional flow reserve.

  7. Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Coenen, Adriaan; Lubbers, Marisa M.; Dedic, Admir; Chelu, Raluca G.; Geuns, Robert-Jan M. van; Nieman, Koen [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Cardiology, Rotterdam (Netherlands); Kurata, Akira; Kono, Atsushi; Dijkshoorn, Marcel L. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Rossi, Alexia [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Barts Health NHS Trust, NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Department of Cardiology, London (United Kingdom)

    2017-06-15

    To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80. Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification. Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value. (orig.)

  8. Coronary artery to left ventricle fistula

    Directory of Open Access Journals (Sweden)

    Kumar Vivek

    2005-11-01

    Full Text Available Abstract Background Coronary cameral fistulas are an uncommon entity, the etiology of which may be congenital or traumatic. They involve abnormal termination of a coronary artery, usually the right coronary, into a cardiac chamber, usually the right ventricle. Case Presentation We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up an abnormal flow traversing the septum into the left ventricle was identified and Doppler interrogation demonstrated a continuous flow, with a predominantly diastolic component, consistent with coronary arterial flow. Conclusion The literature on coronary cameral fistulas is reviewed and the etiology of the diagnostic findings discussed. In our patient, a coronary artery to left ventricle fistula was the most likely explanation secondary to trauma to the septal perforator artery during myectomy. Since the patient was asymptomatic at the time of diagnosis no intervention was recommended and has done well on follow-up.

  9. Superdominant Right Coronary Artery with Absence of Left Circumflex and Anomalous Origin of the Left Anterior Descending Coronary from the Right Sinus: An Unheard Coronary Anomaly Circulation

    Directory of Open Access Journals (Sweden)

    Marcos Danillo Peixoto Oliveira

    2015-01-01

    Full Text Available Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. We present herein the case of a 70-year-old man with symptomatic severe aortic valvar stenosis whose preoperative coronary angiogram revealed a so far unreported coronary anomaly circulation pattern.

  10. 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

    Background Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular CAS) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular CAS and the therapeutic efficacy of calcium channel blockers. Methods and Results Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test, with simultaneous measurements of transcardiac lactate production and of changes in the quantitative coronary blood flow. We diagnosed microvascular CAS according to lactate production and a decrease in coronary blood flow without epicardial vasospasm during the acetylcholine provocation test. We prospectively followed up the patients with calcium channel blockers for microvascular coronary artery disease. We identified 50 patients with microvascular CAS who demonstrated significant impairment of the endothelium-dependent vascular response, which was assessed by coronary blood flow during the acetylcholine provocation test. Administration of isosorbide dinitrate normalized the abnormal coronary flow pattern in the patients with microvascular CAS. Multivariate logistic regression analysis indicated that female sex, a lower body mass index, minor–borderline ischemic electrocardiogram findings at rest, limited–baseline diastolic-to-systolic velocity ratio, and attenuated adenosine triphosphate–induced coronary flow reserve were independently correlated with the presence of microvascular CAS. Receiver-operating characteristics curve analysis revealed that the aforementioned 5-variable model showed good correlation with the presence of microvascular CAS (area under the curve: 0.820). No patients with microvascular CAS treated with calcium channel blockers developed cardiovascular

  11. 清醒心肌缺血模型的可控冠状动脉狭窄程度%Controlled coronary artery stenosis in conscious myocardial ischemia model

    Institute of Scientific and Technical Information of China (English)

    刘远春; 宋小文; 杨红

    2016-01-01

    背景:麻醉是动物实验对动物采取的保护措施,但相应麻醉药物的使用会对实验结果产生不同程度的影响。  目的:分析清醒与麻醉状态下,冠状动脉狭窄心肌缺血模型犬的各项指标差异及治疗效果。  方法:将20只Beagle犬分5组,每组4只,按照完全正交拉丁方安排进行实验,按照不同的步骤进行依次干预,干预步骤包括正常观察(正常对照10 min后观察30 min)、清醒模型(正常对照后狭窄冠状动脉10 min,再观察30 min)、清醒治疗(正常对照后狭窄冠状动脉10 min,舌下含服50μg/kg硝酸甘油,观察30 min)、麻醉模型(对动物进行麻醉,正常对照后狭窄冠状动脉10 min,再观察30 min)、麻醉治疗(对动物进行麻醉,正常对照后狭窄冠状动脉10 min,舌下含服50μg/kg硝酸甘油,观察30 min)。记录清醒状态下冠状动脉狭窄后,犬心电、血压、心率和体温水平,以及心肌缺血犬清醒与麻醉状态下的平均动脉压、体温、心率、心电图 ST 段变化,观察硝酸甘油对心肌缺血犬清醒与麻醉状态下的治疗效果。  结果与结论:冠状动脉狭窄后,清醒犬心电、血压、心率和体温均发生一定改变,其中心电图ST段出现显著上升情况。心肌缺血模型犬麻醉状态下的血压、心率明显高于清醒状态(P OBJECTIVE:To analyze the differences of various indexes and the therapeutic effect ofmyocardial ischemia canine model of coronary stenosis under the condition of consciousness and anesthesia. METHODS:Twenty Beagle canine myocardial ischemia models were equaly assigned to five groups, and prepared according to the complete orthogonal Latin square arrangement for the experiment. Intervention procedures included the normal observation (normal control for 10 minutes, observation for 30 minues), conscious model (after normal control, coronary artery stenosis for 10 minutes, and observation

  12. Stent treatment of symptomatic intracranial arterial stenosis

    Directory of Open Access Journals (Sweden)

    DONG Feng-ju

    2012-08-01

    Full Text Available Objective To investigate the safety, feasibility and efficacy of the Wingspan stent in treatment of symptomatic intracranial arterial stenosis. Methods Wingspan stenting was applied in 90 cases with symptomatic intracranial arterial stenosis. The surgical success rate and periprocedural neurological complications were observed. Digital subtraction angiography was performed at 6 months after stenting to detect the occurrence of restenosis. Results The technical success rate was 98.92% (92/93. Pre-treatment stenosis (83.42 ± 9.53% was improved to (21.82 ± 9.86% after stent placement. The difference was statistically significant (t = 3.280, P = 0.002. There were 5 patients (5.56% occurred major periprocedural neurological complications, 3 of them died within 30 days after the procedure. The restenosis rate at 6 months after operation was 19.10% (17/89. Conclusion Symptomatic intracranial arterial stenosis can be treated by Wingspan stenting with high technical success rate. The occurrence of complication is low and short-term efficacy is good. However, further study is needed to investigate long-term effect.

  13. The coronary calcium score is a more accurate predictor of significant coronary stenosis than conventional risk factors in symptomatic patients

    DEFF Research Database (Denmark)

    Nicoll, R; Wiklund, U; Zhao, Y;

    2016-01-01

    risk factor assessment, computed tomographic coronary angiogram (CTCA) or conventional angiography and a CT scan for coronary artery calcium (CAC) scoring. 1539 (27.9%) patients had significant stenosis, 5.5% of whom had zero CAC. In 5074 patients, multiple binary regression showed the most important...... predictor of significant stenosis to be male gender (B=1.07) followed by diabetes mellitus (B=0.70) smoking, hypercholesterolaemia, hypertension, family history of CAD and age but not obesity. When the log transformed CAC score was included, it became the most powerful predictor (B=1.25), followed by male...... gender (B=0.48), diabetes, smoking, family history and age but hypercholesterolaemia and hypertension lost significance. The CAC score is a more accurate predictor of >50% stenosis than risk factors regardless of the means of assessment of stenosis. The sensitivity of risk factors, CAC score...

  14. [Coronary subclavian steal syndrome: two cases after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Penninga, L.; Damgaard, S.

    2008-01-01

    Reverse flow in the internal mammary artery (IMA) graft due to stenosis or occlusion of the proximal ipsilateral subclavian artery causes coronary subclavian steal syndrome (CSSS). We describe two patients who were diagnosed with CSSS following CABG. Patient A presented with angina pectoris...

  15. Relationship between dyslipidemia and vascular endothelial function in patients with coronary artery spasm

    Institute of Scientific and Technical Information of China (English)

    向定成

    2006-01-01

    Objectives To investigate the effects of dyslipidemia on vascular endothelial function in patients with coronary artery spasm. Methods Sixty-four patients with chest pain but without significant angiographic stenosis were divided into coronary spasm group (n=46 with coronary spasm) and control group (n=18 without coronary spasm) according to acetylcholine provoking test. Endothelin-1 (ET-1), nitric oxide (NO) and lipids were

  16. The prevalence and clinical predictors of incidental atherosclerotic renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ozkan, Ugur [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey)], E-mail: radugur@yahoo.com; Oguzkurt, Levent; Tercan, Fahri [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey); Nursal, Tarik Z. [Baskent University Faculty of Medicine, Department of General Surgery, Ankara/Turkey (Turkey)

    2009-03-15

    Objective: To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD). Materials and methods: To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%) (mean age {+-} S.D.: 61.5 {+-} 11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis ({>=}60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement). Results: Renal artery disease was found in 33% (207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n = 60) had significant ({>=}60%) renal artery stenosis. Only age and hypertension (blood pressure systolic >140 mmHg or diastolic >90 mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5 {+-} 8.9 years compared with 61 {+-} 11.2 years for patients without RAS (p < 0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p = 0.01). Conclusion: Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

  17. Spontaneous Coronary Artery Dissection.

    Science.gov (United States)

    Tweet, Marysia S; Gulati, Rajiv; Hayes, Sharonne N

    2016-07-01

    Spontaneous coronary artery dissection is an important etiology of nonatherosclerotic acute coronary syndrome, myocardial infarction, and sudden death. Innovations in the catheterization laboratory including optical coherence tomography and intravascular ultrasound have enhanced the ability to visualize intimal disruption and intramural hematoma associated with SCAD. Formerly considered "rare," these technological advances and heightened awareness suggest that SCAD is more prevalent than prior estimates. SCAD is associated with female sex, young age, extreme emotional stress, or extreme exertion, pregnancy, and fibromuscular dysplasia. The clinical characteristics and management strategies of SCAD patients are different than for atherosclerotic heart disease and deserve specific consideration. This review will highlight recent discoveries about SCAD as well as describe current efforts to elucidate remaining gaps in knowledge.

  18. Evaluation of ischemic cerebrovascular lesions by ultrasonography in patients with coronary artery stenosis and its relationship with risk factors%颈动脉超声对冠状动脉狭窄患者缺血性脑血管疾病的评价及其与传统危险因素的关系

    Institute of Scientific and Technical Information of China (English)

    张蕾; 王维平; 李亚琼; 高承梅; 刘晶; 李晓辉

    2012-01-01

    Objective To evaluate the value for predicting cerebrovascular stenosis in patients with coronary artery stenosis via carotid ultrosonography and its advantages than traditional risk factors. Methods CDFI and TCD were used to examine the carotid artery and intracranial artery respectively for the 209 patients whose diagnosis of coronary artery stenosis(≥70% ) via selective coronary angiography. The patients were divided into carotid stenosis and non - carotid stenosis groups as well as intracranial artery stenosis and non - intracranial artery stenosis groups. The risk factor variables were evaluated in the stenosis and non - stenosis groups respectively. Results Carotid ultrasound findings were more sensitive for predicting the ischemic heart and cerebralvascular disease than traditional risk factors. Conclusion The carotid maximum intima - media thickness (IMT) , hypertension, plaque number, heterogeneous plaque and multiple plaques seems to increase the risk for ischemic cerebralvascular disease of coronary artery stenosis. Elucidate the relationship between the risk factors of intracranial and extra - cranial artery stenosis with coronary artery stenosis. Therefore, it is important for patient management and evaluation of therapies for stroke prevention . CDFI should be applied for ischemic coronary artery diseases patients.%目的 探讨颈动脉超声对预测冠状动脉狭窄患者颅内动脉狭窄的价值,以及颈动脉超声相对于其它动脉粥样硬化主要危险因素预测缺血性心脑血管疾病的优越性.方法 对209例经血管造影证实冠状动脉狭窄(≥70%)的患者采用彩色多谱勒血流成像(CDFI)和经颅多普勒超声(TCD)分别检查颈动脉和颅内动脉,并将患者分为颈动脉狭窄组与非狭窄组;脑动脉狭窄组与非狭窄组,分别比较狭窄组与非狭窄组之间的危险因素及生化指标,进一步对冠状动脉狭窄合并颅内动脉狭窄的主要危险因素与颈动脉超声结果中

  19. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  20. Questions and Answers about Treating Arterial Stenosis and Preventing Stroke

    Science.gov (United States)

    ... and Answers About Treating Arterial Stenosis and Preventing Stroke A stroke is any sudden event affecting the ... and high cholesterol. How does stenosis contribute to stroke? Atherosclerosis can activate cells involved in blood clotting. ...

  1. Exploring Coronary Circulatory Response to Stenosis and Its Association with Invasive Physiologic Indices Using Absolute Myocardial Blood Flow and Coronary Pressure.

    Science.gov (United States)

    Lee, Joo Myung; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Tong, Yaliang; Kim, Chee Hae; Bang, Ji-In; Suh, Minseok; Paeng, Jin Chul; Cheon, Gi Jeong; Koo, Bon-Kwon

    2017-08-29

    Background -Although invasive physiologic assessment for coronary stenosis has become a standard practice to guide treatment strategy, coronary circulatory response and changes in invasive physiologic indices, according to different anatomical and hemodynamic lesion severity, have not been fully demonstrated in patients with coronary artery disease. Methods -One hundred fifteen patients with left anterior descending artery stenosis who underwent both (13)N-ammonia positron emission tomography (PET) and invasive physiologic measurement were analyzed. Myocardial blood flow (MBF) measured using PET and invasively measured coronary pressures were used to calculate microvascular resistance (MVR) and stenosis resistance. Results -With progressive worsening of angiographic stenosis severity, both resting and hyperemic trans-stenotic pressure gradient and stenosis resistance increased (Pstenosis severity, stenosis resistance, and trans-stenotic pressure gradient increased, and hyperemic MBF decreased (all P valuescoronary flow reserve (CFR), the diagnostic accuracy of FFR and iFR did not differ, regardless of cut-off values of hyperemic MBF and CFR. Conclusions -This study demonstrated how the coronary circulation changes in response to increasing coronary stenosis severity using (13)N-ammonium PET-derived MBF and invasively measured pressure data. Currently used resting and hyperemic pressure-derived invasive physiologic indices have similar patterns of relationships to the different anatomic and hemodynamic lesion severity. Clinical Trial Registration -URL: https://clinicaltrials.gov Unique Identifier: NCT01366404.

  2. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos;

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis.......The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  3. Quantitative coronary CT angiography: absolute lumen sizing rather than %stenosis predicts hemodynamically relevant stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Plank, Fabian [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Innsbruck Medical University, Department of Internal Medicine III - Cardiology, Innsbruck (Austria); Burghard, Philipp; Mayr, Agnes; Klauser, Andrea; Feuchtner, Gudrun [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Friedrich, Guy; Dichtl, Wolfgang [Innsbruck Medical University, Department of Internal Medicine III - Cardiology, Innsbruck (Austria); Wolf, Florian [Vienna Medical University, Department of Cardiovascular and Interventional Radiology, Vienna (Austria)

    2016-11-15

    To identify the most accurate quantitative coronary stenosis parameter by CTA for prediction of functional significant coronary stenosis resulting in coronary revascularization. 160 consecutive patients were prospectively examined with CTA. Proximal coronary stenosis was quantified by minimal lumen area (MLA) and minimal lumen diameter (MLD), %area and %diameter stenosis. Lesion length (LL) was measured. The reference standard was invasive coronary angiography (ICA) (>70 % stenosis, FFR <0.8). 210 coronary segments were included (59 % positive). MLA of ≤1.8 mm{sup 2} was identified as the optimal cut-off (c = 0.97, p < 0.001; 95 % CI 0.94-0.99) (sensitivity 90.9 %, specificity 89.3 %) for prediction of functional-relevant stenosis (for MLA >2.1 mm{sup 2} sensitivity was 100 %). The optimal cut-off for MLD was 1.2 mm (c = 0.92; p < 0.001; 95 % CI 0.88-95) (sensitivity 90.9, specificity 85.2) while %area and %diameter stenosis were less accurate (c = 0.89; 95 % CI 0.84-93, c = 0.87; 95 % CI 0.82-92, respectively, with thresholds at 73 % and 61 % stenosis). Accuracy for LL was c = 0.74 (95 % CI 0.67-81), and for LL/MLA and LL/MLD ratio c = 0.90 and c = 0.84. MLA ≤1.8 mm{sup 2} and MLD ≤1.2 mm are the most accurate cut-offs for prediction of haemodynamically significant stenosis by ICA, with a higher accuracy than relative % stenosis. (orig.)

  4. Automatic detection of plaques with severe stenosis in coronary vessels of CT angiography

    Science.gov (United States)

    Dinesh, M. S.; Devarakota, Pandu; Kumar, Jitendra

    2010-03-01

    Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of coronary arteries and is the leading cause of death worldwide. Computed tomography angiography (CTA) has been proved to be very useful for accurate noninvasive diagnosis and quantification of plaques. However, the existing methods to measure the stenosis in the plaques are not accurate enough in mid and distal segments where the vessels become narrower. To alleviate this, we propose a method that consists of three stages namely, automatic extraction of coronary vessels; vessels straightening; lumen extraction and stenosis evaluation. In the first stage, the coronary vessels are segmented using a parametric approach based on circular vessel model at each point on the centerline. It is assumed that centerline information is available in advance. Vessel straightening in the second stage performs multi-planar reformat (MPR) to straighten the curved vessels. MPR view of a vessel helps to visualize and measure the plaques better. On the straightened vessel, lumen and vessel wall are segregated using a nearest neighbor classification. To detect the plaques with severe stenosis in the vessel lumen, we propose a "Diameter Luminal Stenosis" method for analyzing the smaller segments of the vessel. Proposed measurement technique identifies the segments that have plaques and reports the top three severely stenosed segments. Proposed algorithm is applied on 24 coronary vessels belonging to multiple cases acquired from Sensation 64 - slice CT and initial results are promising.

  5. Successful correction of unroofed coronary sinus with pulmonary vein stenosis.

    Science.gov (United States)

    Li, Yang; An, Qi; Zhang, Eryong

    2012-07-01

    We present a case of an infant with an unroofed coronary sinus associated with a persistent left superior vena cava draining into the left atrium, right superior pulmonary vein stenosis, an atretic left superior pulmonary vein and a double-outlet right ventricle. For pulmonary vein stenosis and atresia, we used a sutureless technique with an autologous pericardial patch to create a neoatrium.

  6. 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 • ...

  7. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease

    DEFF Research Database (Denmark)

    Mygind, Naja Dam; Michelsen, Marie Mide; Peña, Adam

    2016-01-01

    artery stenosis (coronary flow velocity reserve......BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary...... microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing. METHODS AND RESULTS: After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary...

  8. Quantification of coronary flow using dynamic angiography with 320-detector row CT and motion coherence image processing: Detection of ischemia for intermediate coronary stenosis.

    Science.gov (United States)

    Nagao, Michinobu; Yamasaki, Yuzo; Kamitani, Takeshi; Kawanami, Satoshi; Sagiyama, Koji; Yamanouchi, Torahiko; Shimomiya, Yamato; Matoba, Tetsuya; Mukai, Yasushi; Odashiro, Keita; Baba, Shingo; Maruoka, Yasuhiro; Kitamura, Yoshiyuki; Nishie, Akihiro; Honda, Hiroshi

    2016-05-01

    Anatomical coronary stenosis is not always indicative of functional stenosis, particularly for intermediate coronary lesions. The purpose of this study is to propose a new method for quantifying coronary flow using dynamic CT angiography for the whole heart (heart-DCT) and investigate its ability for detecting ischemia from intermediate coronary stenosis. Participants comprised 36 patients with coronary artery disease who underwent heart-DCT using 320-detector CT with tube voltage of 80kV and myocardial perfusion scintigraphy (MPS). Heart-DCT was continuously performed at mid-diastole throughout 15-25 cardiac cycles with prospective ECG-gating after bolus injection of contrast media (12-24ml). Dynamic datasets were computed into 90-100 data sets by motion coherence image processing (MCIP). Next, time-density curves (TDCs) for coronary arteries with a diameter >3mm were automatically calculated for all phases using MCIP. On the basis of the maximum slope method, coronary flow index (CFI) was defined as the ratio of the maximum upslope of coronary artery attenuation to the upslope of ascending aorta attenuation on the TDC, and was used to quantify coronary flow. CFIs for the proximal and distal sites of coronary arteries with mild-to-moderate stenosis were calculated. Coronary territories were categorized as non-ischemic or ischemic by MPS. Receiver-operating-characteristic (ROC) analysis was performed to determine the optimal cutoff for CFI to detect ischemia. Distal CFI was significantly lower for ischemia (0.26±0.08) than for non-ischemia (0.50±0.17, pcoronary flow quantification using heart-DCT. Distal CFI can detect myocardial ischemia derived from intermediate coronary stenosis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Successful percutaneous transluminal angioplasty and stenting for symptomatic intracranial vertebral artery stenosis using intravascular ultrasound virtual histology.

    Science.gov (United States)

    Takayama, Katsutoshi; Taoka, Toshiaki; Nakagawa, Hiroyuki; Myouchin, Kaoru; Wada, Takeshi; Sakamoto, Masahiko; Fukusumi, Akio; Iwasaki, Satoru; Kurokawa, Shinichiro; Kichikawa, Kimihiko

    2007-06-01

    This is the first report of percutaneous transluminal angioplasty (PTA) of an intracranial artery applying intravascular ultrasound virtual histology (IVUS-VH), which has been recently developed for tissue characterization of coronary artery plaque. We report a case of successful PTA and stenting for symptomatic intracranial vertebral artery stenosis using IVUS-VH.

  10. The Relationship of Epicardial Fat Volume to Coronary Plaque, Severe Coronary Stenosis, and High-Risk Coronary Plaque Features Assessed by Coronary CT Angiography

    Science.gov (United States)

    Rajani, Ronak; Shmilovich, Haim; Nakazato, Ryo; Nakanishi, Rine; Otaki, Yuka; Cheng, Victor Y.; Hayes, Sean W.; Thomson, Louise E.J.; Friedman, John D.; Slomka, Piotr J.; Min, James K.; Berman, Daniel S.; Dey, Damini

    2013-01-01

    Background Associations of epicardial fat volume (EFV) measured on non-contrast cardiac computed tomography (NCT) include coronary plaque, myocardial ischemia and adverse cardiac events. Objectives This study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and to the presence of high-risk plaque features (HRPFs). Methods We retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day non-contrast cardiac computed tomography (NCT) and coronary CT angiography (CTA). EFV was measured on NCT using validated, semi-automated, software. The coronary arteries were evaluated for coronary plaque type [calcified (CP), non-calcified (NCP) or partially-calcified (MP)] and coronary stenosis severity ≥70% using coronary CTA. For patients with NCP and PCP, 2 high risk plaque features were evaluated: Low-attenuation plaque and positive remodeling. Results There were 402 patients with a median age of 66 years (range 23–92) of whom 226 (56%) were male. The EFV was larger in patients with CP (112 ± 55 cm3 vs. 89 ± 39 cm3), PCP (110 ± 57 cm3 vs. 98 ± 45 cm3) and NCP (115 ± 44 cm3 vs. EFV 100 ± 52 cm3. In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (OR 3.0, 95% CI 1.3–6.6, p=0.008), any high risk plaque features (OR 1.7, 95% CI 0.9–3.4, p=0.04) and low attention plaque (OR 2.4, 95% CI 1.1–5.1, p=0.02), but not of positive remodeling. Conclusions Epicardial fat volume is larger in patients with CP, PCP and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high risk plaque features and low attenuation plaque. PMID:23622507

  11. Horner syndrome due to vertebral artery stenosis.

    Science.gov (United States)

    Kim, Chul Han

    2013-11-01

    The author reports a rare case of Horner syndrome in a patient who resulted from stenosis of the vertebral artery after blunt trauma. A 31-year-old man was transferred to our department for evaluation of left medial orbital wall and nasal bone fractures. Five days ago, he was hospitalized due to multiple second to fourth rib fractures of the right chest following blunt trauma of the face, neck, and chest. Surgery was performed. Ten days later, he complained of drooping of the right eyelid. Physical examination revealed a discrete miosis and ptosis with normal levator function in the right eye. A workup for Horner syndrome was performed. Magnetic resonance angiography of the head and neck revealed a stenosis of the distal part of the right vertebral artery without the abnormality of carotid artery. He wore a cervical collar and underwent anticoagulation. However, Horner syndrome was not resolved over the next 12 months. Acute traumatic Horner syndrome may be associated with vertebral artery dissection in which the possibility of life-threatening injury can be masked.

  12. Current status of coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin

    2009-01-01

    @@ Surgical revascularization for atherosclerotic heart disease, also called coronary artery bypass grafting (CABG), was first performed in 1962, and is one of the great achievements in medicine. Relief of angina, improvement of exercise tolerance, and the realization of survival benefit have been documented.1 CABG has been used in multi-vessel disease and left main stenosis for over 40 years.2 In the last two decades the mortality of CABG has decreased to less than 2% despite an aging population with increased risk factors. However, percutaneous coronary intervention (PCI), especially with drug-eluting stents, has been challenging CABG, While PCI has improved, CABG has also progressed with better peri-operative management, a higher use of arterial grafting, off-pump surgery, and improved techniques with minimally invasive surgical options.3,4

  13. Transesophageal echocardiography in the assessment of coronary arteries; Echokardiografia przezprzelykowa w ocenie proksymalnych odcinkow naczyn wiencowych

    Energy Technology Data Exchange (ETDEWEB)

    Adamek-Kosmider, A.; Kasprzak, J.; Kosmider, M.; Krzeminska-Pakula, M. [Akademia Medyczna, Lodz (Poland)

    1993-12-31

    The study was undertaken to assess the usefulness of TEE for evaluation of morphology and flow in coronary arteries. TEE (2D, spectral and color Doppler imaging) and coronary angiography were performed in 75 patients - 41 with valvular heart disease and 34 with ischemic heart disease. Proximal coronary artery stenosis was detected by coronarography in 11 pts (9-left main coronary artery, 2-right coronary artery). TEE visualization of proximal coronary arteries was possible in all pts. Echocardiographic features of artery stenosis were: the narrowing of the vessel in 2D image (9 pts), high flow velocity spectral Doppler (4 pts, mean 135 cm/s vs 55 cm/s in normal arteries) and mosaic, turbulent flow in color Doppler (10 pts). Sensitivity and specificity of TEE for coronary artery stenosis detection was respectively 81%/98% for 2D imaging and 90%/100% for color Doppler. TEE is a new, noninvasive and safe method for the evaluation of proximal coronary arteries. Detection of LMCA stenosis prior to atheterization may enhance the safety of coronary angiography. (author) 21 refs, 8 figs

  14. Percutaneous radial intervention for complex bilateral renal artery stenosis using paclitaxel eluting stents.

    Science.gov (United States)

    Granillo, Gastón A Rodriguez; van Dijk, Lukas C; McFadden, Eugène P; Serruys, Patrick W

    2005-01-01

    Techniques used in the coronary circulation may be useful in peripheral intervention. We report a case of bilateral renal artery stenosis treated via a radial approach by direct stenting with distal protection at a right ostial lesion and modified crush stenting at a left renal bifurcation lesion using paclitaxel-eluting stents.

  15. Robotics and coronary artery surgery.

    Science.gov (United States)

    Magee, Mitchell J; Mack, Michael J

    2002-11-01

    Significant progress in cardiac surgery, and specifically the surgical management of coronary artery disease, has been due in large part to enabling technology. Robotic systems have been recently developed and refined for use in cardiac surgery to facilitate, among other procedures, a totally endoscopic approach to coronary artery bypass surgery. These systems enhance precision through endoscopic approaches by specifically addressing the inherent limitations of conventional endoscopic coronary microsurgical instrumentation via computerized, digital interface, telemanipulation technology. With a combined experience of 125 patients, several groups have independently demonstrated the clinical feasibility of totally endoscopic coronary artery bypass with two commercially available robotic telemanipulation systems. Additional enabling technology is needed to overcome the challenges currently limiting development and widespread application of totally endoscopic off-pump multivessel coronary artery bypass surgery.

  16. Transesophageal echocardiography assessment of severe ostial left main coronary stenosis

    Science.gov (United States)

    Firstenberg, M. S.; Greenberg, N. L.; Lin, S. S.; Garcia, M. J.; Alexander, L. A.; Thomas, J. D.

    2000-01-01

    Doppler echocardiography is commonly used in the assessment of stenotic valvular orifices. We describe the application of transesophageal echocardiography for the detection of a critical ostial left main coronary stenosis. Because preoperative coronary angiography often is not routinely performed in young patients undergoing valve surgery, application of Doppler echocardiography can potentially prevent catastrophic complications, particularly in atypical cases.

  17. Coronary collateral circulation in patients of coronary ectasia with significant coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Po-Chao Hsu

    Full Text Available OBJECTIVES: Patients with coronary ectasia (CE usually have coexisting coronary stenosis resulting in myoischemia. Coronary collateral plays an important role in protecting myocardium from ischemia and reducing cardiovascular events. However, limited studies investigate the role of CE in coronary collaterals development. METHODS: We evaluated 1020 consecutive patients undergoing coronary angiography and 552 patients with significant coronary artery disease (SCAD, defined as diameter stenosis more than 70%, were finally analyzed. CE is defined as the ectatic diameter 1.5 times larger than adjacent reference segment. Rentrop collateral score was used to classify patients into poor (grades 0 and 1 or good (grades 2 and 3 collateral group. RESULTS: 73 patients (13.2% had CE lesions which were most located in the right coronary artery (53.4%. Patients with CE had a lower incidence of diabetes (43.8% vs 30.1%, p = 0.03, higher body mass index (25.4±3.5 vs 26.7±4.6, p = 0.027 and poorer coronary collateral (58.2% vs 71.2%, p = 0.040. Patients with poor collateral (n = 331 had a higher incidence of CE (15.7% vs 9.5%, p = 0.040 and fewer diseased vessels numbers (1.96±0.84 vs 2.48±0.69, p<0.001. Multivariate analysis showed diabetes (odd ratio (OR 0.630, p = 0.026, CE (OR = 0.544, p = 0.048, and number of diseased vessels (OR = 2.488, p<0.001 were significant predictors of coronary collaterals development. CONCLUSION: The presence of CE was associated with poorer coronary collateral development in patients with SCAD.

  18. Prevalence of carotid artery stenosis in patients with valvular heart disease and coronary disease%心瓣膜病患者颈动脉狭窄的发病情况评估

    Institute of Scientific and Technical Information of China (English)

    刘加立; 蒋世良; 郑宏; 赵世华; 徐仲英; 凌坚; 吕滨

    2013-01-01

    目的:评估瓣膜病患者颈动脉狭窄的发病率,并对其相关危险因素进行研究.方法:196例超声确诊欲行瓣膜置换术的患者,术前常规冠状动脉造影的同时行颈动脉血管造影.根据造影结果分成两组,单纯瓣膜病组147例(75%),瓣膜病伴发冠心病组49例(25%),分析颈动脉狭窄的发病率.同时将年龄、体质指数、高血压病史、吸烟史及相关生化危险因素作为独立危险因素行多因素逐步Logistic回归分析.结果:瓣膜病伴发颈动脉狭窄总发病率为13%,其中颈动脉狭窄≥70%发生率为7%.单纯瓣膜病组颈动脉狭窄发病率为6%,瓣膜病伴发冠心病组为34%,差异有统计学意义(P<0.01),多因素Logistic回归分析显示,年龄、冠心病史和高血压史与颈动脉狭窄密切相关(P<0.05).结论:瓣膜病伴发冠心病患者的颈动脉狭窄发病率达34%.术前常规冠状动脉造影的同时,可行颈动脉造影以确诊.%Objective: To explore the prevalence and risk factors of carotid artery stenosis (CS) in patients with valvular heart disease. Method: The 196 patients with valvular heart disease confirmed by echocardiography accepted coronary angiography and carotid artery angiography simultaneously before valvular replacement procedures. According to the results, patients were classified into two groups: group 1, patients with only valvlar heart disease (n=149); group 2. patients with coexistent valvular heart disease and coronary artery disease (n = 49). We compared the prevalence of CS in two groups. Significant variable such as age, BMI, history of hypertension, history of smoking and biochemical and lipid risk factors related to coronary arterty disease (CAD) were entered into a forward stepwise Logistic model to indentify independent risk factors associated with significant CS. Result: The incidence of CS of total valvular heart disease patients was 13%. Taking CS ≥70% as a cutoff point, significant

  19. Hemodynamic significance of coronary stenosis by vessel attenuation measurement on CT compared with adenosine perfusion MRI

    Energy Technology Data Exchange (ETDEWEB)

    Dekker, Martijn A.M. den; Pelgrim, Gert Jan; Pundziute, Gabija; Heuvel, Edwin R. van den; Oudkerk, Matthijs; Vliegenthart, Rozemarijn, E-mail: r.vliegenthart@umcg.nl

    2015-01-15

    Highlights: • The majority of anatomical coronary stenoses do not cause myocardial ischemia. • cCTA-derived CCO decrease expresses luminal density gradient across stenosis. • CCO decrease differentiates between anatomical stenoses with and without associated myocardial ischemia. • CCO decrease assessment can exclude the majority of stenoses without hemodynamic significance. - Abstract: Purpose: We assessed the association between corrected contrast opacification (CCO) based on coronary computed tomography angiography (cCTA) and inducible ischemia by adenosine perfusion magnetic resonance imaging (APMR). Methods: Sixty cardiac asymptomatic patients with extra-cardiac arterial disease (mean age 64.4 ± 7.7 years; 78% male) underwent cCTA and APMR. Luminal CT attenuation values (Hounsfield Units) were measured in coronary arteries from proximal to distal, with additional measurements across sites with >50% lumen stenosis. CCO was calculated by dividing coronary CT attenuation by descending aorta CT attenuation. A reversible perfusion defect on APMR was considered as myocardial ischemia. Results: In total, 169 coronary stenoses were found. Seven patients had 8 perfusion defects on APMR, with 11 stenoses in corresponding vessels. CCO decrease across stenoses with hemodynamic significance was 0.144 ± 0.112 compared to 0.047 ± 0.104 across stenoses without hemodynamic significance (P = 0.003). CCO decrease in lesions with and without anatomical stenosis was similar (0.054 ± 0.116 versus 0.052 ± 0.101; P = 0.89). Using 0.20 as preliminary CCO decrease cut-off, hemodynamic significance would be excluded in 82.9% of anatomical stenoses. Conclusions: CCO decrease across coronary stenosis is associated with myocardial ischemia on APMR. CCO based on common cCTA data is a novel method to assess hemodynamic significance of anatomical stenosis.

  20. 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.

  1. The 'Harmonizing Optimal Strategy for Treatment of coronary artery stenosis - sAfety & effectiveneSS of drug-elUting stents & antiplatelet REgimen' (HOST-ASSURE trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Park Kyung

    2012-03-01

    Full Text Available Abstract Background Second-generation drug-eluting stents (DES have raised the bar of clinical performance. These stents are mostly made from cobalt chromium alloy. A newer generation DES has been developed from platinum chromium alloy, but clinical data regarding the efficacy and safety of the platinum chromium-based everolimus-eluting stent (PtCr-EES is limited, with no comparison data against the cobalt chromium-based zotarolimus-eluting stent (CoCr-ZES. In addition, an antiplatelet regimen is an integral component of medical therapy after percutaneous coronary intervention (PCI. A 1-week duration of doubling the dose of clopidogrel (double-dose antiplatelet therapy (DDAT was shown to improve outcome at 1 month compared with conventional dose in acute coronary syndrome (ACS patients undergoing PCI. However in Asia, including Korea, the addition of cilostazol (triplet antiplatelet therapy (TAT is used more commonly than doubling the dose of clopidogrel in high-risk patients. Methods In the 'Harmonizing Optimal Strategy for Treatment of coronary artery stenosis - sAfety & effectiveneSS of drug-elUting stents & antiplatelet REgimen' (HOST-ASSURE trial, approximately 3,750 patients are being prospectively and randomly assigned in a 2 × 2 factorial design according to the type of stent (PtCr-EES vs CoCr-ZES and antiplatelet regimen (TAT vs DDAT. The first primary endpoint is target lesion failure at 1 year for the stent comparison, and the second primary endpoint is net clinical outcome at 1 month for comparison of antiplatelet therapy regimen. Discussion The HOST-ASSURE trial is the largest study yet performed to directly compare the efficacy and safety of the PtCr-EES versus CoCr-ZES in an 'all-comers' population. In addition, this study will also compare the clinical outcome of TAT versus DDAT for 1-month post PCI. Trial registration ClincalTrials.gov number NCT01267734.

  2. 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.

  3. Evaluation of coronary arterial lesions due to Kawasaki disease using optical coherence tomography.

    Science.gov (United States)

    Kakimoto, Nobuyuki; Suzuki, Hiroyuki; Kubo, Takashi; Suenaga, Tomohiro; Takeuchi, Takashi; Shibuta, Shoichi; Ino, Yasushi; Akasaka, Takashi; Yoshikawa, Norishige

    2014-08-01

    Optical coherence tomography (OCT) is a high-resolution intracoronary arterial imaging modality. We describe 2 patients who were admitted to undergo coronary angiography and OCT for follow-up of Kawasaki disease with coronary artery aneurysms. OCT clearly demonstrated thrombus, stenosis, fibrotic intimal thickening with lamellar calcification, and partial disappearance of the tunica media at the aneurysm site. In addition, focal calcification, intimal thickening, and medial irregularity were observed even in regions of coronary arterial walls that appeared to be normal using coronary angiography. OCT is useful for evaluating coronary arterial sequelae of Kawasaki disease. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  4. 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

    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.......%) coronary artery diameter stenosis with a sensitivity, specificity, and positive and negative predictive value of 99%, 81%, 96% and 95%, respectively. CCTA was used to triage patients into guideline defined treatment groups of "no or medical treatment", "referral to percutaneous coronary intervention...

  5. Anomalous origin of right coronary artery from pulmonary artery

    Directory of Open Access Journals (Sweden)

    Rajat Gupta

    2012-01-01

    Full Text Available Anomalous origin of coronary artery from the pulmonary artery is a rare anomaly that most frequently involves the left coronary artery and very rarely the right coronary artery. These lesions can be missed on echocardiography unless carefully looked for. We describe a case of isolated anomalous origin of right coronary artery from pulmonary artery diagnosed on echocardiography and confirmed by computed tomography (CT angiography.

  6. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  7. Impact of uncontrolled blood pressure on diagnostic accuracy of coronary flow reserve for detecting significant coronary stenosis in hypertensive patients

    Institute of Scientific and Technical Information of China (English)

    LI Wei-hong; XU Wei-xian; LI Zhao-ping; LI Cui-ping; WANG Xin-yu; HE Li-yun; ZHAO Wei

    2013-01-01

    Baciground Impaired coronary flow reserve (CFR) in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction.Antihypertensive treatment has been shown to improve coronary microvascular dysfunction.The aim of this study was to evaluate the impact of uncontrolled blood pressure (BP) on diagnostic accuracy of CFR for detecting significant coronary stenosis.Methods A total of 98 hypertensive patients scheduled for coronary angiography (CAG) due to chest pain were studied.Of them,45 patients had uncontrolled BP (defined as the office BP >140/90 mmHg (1 mmHg=0.133 kPa) in general hypertensive patients,or >130/80 mmHg in hypertensive individuals with diabetes mellitus),and the remaining 53 patients had well-controlled BP.CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography (TTDE) within 48 hours prior to CAG.Significant LAD stenosis was defined as >70% luminal narrowing.Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis.Results CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP (2.1±0.6 vs.2.6±0.9,P <0.01).Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis (β=-0.445,P <0.0001) and the presence of uncontrolled BP (β=-0.272,P=0.014).With a receiver operating characteristic analysis,CFR <2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients (AUC 0.83,95%C/0.75-0.91) with a sensitivity of 75%,a specificity of 78%,and an accuracy of 77%.A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP (67% vs.93%,P=0

  8. Management of Renal Artery Stenosis - an Update

    Directory of Open Access Journals (Sweden)

    Alhadad A

    2008-01-01

    Full Text Available The role of the renal vasculature in eliciting renovascular hypertension (RVH was established in 1934, when Goldblatt et al. [1] in a classical experimental study demonstrated that partial obstruction of the renal artery increased mean arterial blood pressure (BP. The pathophysiology of renal artery stenosis (RAS is incompletely understood but has been postulated to be related to increased afterload from neurohormonal activation and cytokine release [2].Atherosclerotic RAS (ARAS is increasingly diagnosed in the expanding elderly population, which also has a high prevalence of arterial hypertension. There is still considerable uncertainty concerning the optimal management of patients with RAS. Many hypertensive patients with RAS have co-existing essential hypertension and furthermore, it is often difficult to determine to what degree the RAS is responsible for the impairment of renal function. There are three possible treatment strategies: medical management, surgery, or percutaneous transluminal renal angioplasty (PTRA with or without stent implantation. The use of stents has improved the technical success rate of PTRA and also led to lower risk of restenosis, in particular for ostial RAS. PTRA with stenting has therefore replaced surgical revascularisation for most patients with RAS and has led to a lower threshold for intervention. The treatment of choice to control hypertension in fibromuscular dysplasia (FMD is generally accepted to be PTRA [3]. In ARAS, on the other hand, the benefits with PTRA are less clear [4] and the challenge to identify which patients are likely to benefit from revascularisation remains unknown.

  9. 心肌桥远端冠状动脉狭窄性病变的临床预测因子分析%Clinical predictive factors of coronary artery stenosis located distally to myocardial bridging

    Institute of Scientific and Technical Information of China (English)

    洪衡; 王明生; 史静琤; 刘群; 王河; 李明昌; 王磊; 任海明; 顼志敏

    2013-01-01

    目的 评价心肌桥远端冠状动脉狭窄性病变可能的临床预测因子.方法 连续入选2004年5月至2009年5月北京市石景山医院心内科首次冠状动脉造影发现心肌桥-壁冠状动脉(MB-MCA)的患者共603例,收集患者临床资料及冠状动脉造影资料,对可能与心肌桥远端冠状动脉狭窄病变密切相关的预测因子进行单因素及多因素分析.结果 共发现MB-MCA644段.MCA舒张期管径明显小于MCA参考管径[(2.29±0.39)比(2.48±0.40) mm,P<0.01].36例(5.9%)患者心肌桥远端冠状动脉存在造影可见的狭窄性病变,明显少于心肌桥近端382例(62.4%)冠状动脉狭窄性病变的比例(P<0.01).单因素分析提示:MB-MCA近端冠状动脉首先发现的狭窄病变的狭窄程度、非MB-MCA所在的冠状动脉中最严重狭窄病变的狭窄程度及病变支数、高血压患病年限与心肌桥远端冠状动脉狭窄病变狭窄率显著正相关(均P <0.05).多因素Logistic回归分析提示:每天吸烟支数、非MB-MCA所在冠状动脉中最严重狭窄病变的狭窄程度、MB-MCA近端冠状动脉首先发现的狭窄病变狭窄程度及MCA舒张期狭窄率与心肌桥远端冠状动脉狭窄病变的有无呈显著正相关,标准化回归系数β分别为0.763、0.727、0.420、0.403,对应的Exp(β)分别为2.146(1.089~4.229)、2.070(1.371~3.125)、1.521(1.050~2.204)、1.496(1.094~2.045)(均P<0.05).结论 每天吸烟支数、心肌桥近端冠状动脉狭窄程度、非MB-MCA所在的冠状动脉中最严重狭窄病变的狭窄程度、MCA舒张期狭窄率可能是心肌桥远端冠状动脉狭窄病变有意义的预测因子.%Objective To explore the clinical predictive factors of coronary artery stenosis located distally to myocardial bridging (MB).Methods A total of 603 patients with MB-mural coronary artery (MB-MCA) diagnosed by angiography initially were enrolled during May 2004 to May 2009.Their angiographic and clinical data were

  10. Ectopic Origin of Coronary Arteries Diagnozed by Coronary Angiography

    Science.gov (United States)

    Krasniqi, Xhevdet; Gorani, Daut; Sejdiu, Basri; Citaku, Hajdin

    2016-01-01

    Introduction: Anomalous origin of coronary arteries from opposite sinus of Valsalva is rare finding. The incidence of anomalous origination of the left coronary artery from right sinus is 0.15% and the right coronary artery from the left sinus is 0.92%. The ectopic origin of left coronary artery or right coronary artery from opposite sinus depending on pathways and considering atherosclerotic changes are manifested with different clinical significance. Case report: We report two cases, the first case the coronary angiography showed the left coronary artery arising from the right coronary sinus, presenting with proximally and distally stenosed left anterior descending artery (LAD), associated with medial and distal stenosed right coronary artery (RCA). The second case the coronary angiography revealed the right coronary artery arising from the left coronary sinus, associated with tortuous medial and distal segments of left anterior descending artery (LAD), without atherosclerotic changes. The first case successfully underwent treatment procedures based on guidelines for revascularization. Conclusion: The coronary angiography of patients with coronary ischemia determines atherosclerotic disease with possibility of the presence of coronary artery anomalies that in cases with ectopic origin from opposite sinus continues to exist as a challenge during treatment in interventional cardiology. PMID:27482140

  11. Diagnostic value of dual-energy CT (DECT) to coronary artery stenosis and ischemic cardiomyopathy%DECT诊断冠状动脉狭窄及缺血性心肌价值

    Institute of Scientific and Technical Information of China (English)

    刘征; 李海军; 王爱国; 张立甲; 张蕾

    2016-01-01

    目的:利用受试者工作特征曲线(ROC)评价双源CT(dual energy CT,DECT)诊断冠状动脉狭窄及缺血性心肌的价值。方法回顾性分析2011年1月~2013年10月新乡市中心医院就诊疑似冠心病(CHD)的患者70例,先后接受DECT和冠状动脉造影术(CAG)检查;其中40例患者在DECT检查后2周内行99mTc-MIBI单光子发射型计算机扫描(SPECT)运动-静息心肌灌注显像(MPI);70例患者中男性48例,女性22例,年龄51~78岁,平均(61.8±7.2)岁。以CAG(狭窄≥50%、≥75%)和SPECT MPI结果为“金标准”,计算DECT诊断冠状动脉狭窄和缺血性心肌的敏感度、特异度、阳性预测值、阴性预测值和正确指数。结果①当CAG检查结果冠状动脉内径狭窄≥50%、≥75%时,DECT诊断冠状动脉狭窄的灵敏度为74.19%(92/124)、81.52%(75/92),特异度为90.26%(139/154)、93.01%(173/186),阳性预测值为85.98%(92/107)、85.22%(75/88),阴性预测值为81.29%(139/171)、91.05%(173/190),正确指数83.09%(231/278)、89.21%(248/278)。ROC曲线下面积(AUC)及Z检验0.82、0.87,Z=13.96、16.64,P均<0.001。②DECT碘图与SPECT MPI结果对比,DECT诊断缺血性心肌的灵敏度为90.00%,特异度为80.00%,阳性预测值为49.09%,阴性预测值为97.39%,正确指数为81.76%,AUC=0.823,Z=18.722,P<0.001。结论 DECT诊断冠状动脉狭窄及缺血性心肌具有较高效能,能为临床诊治提供有效的影像学依据。%Objective To review the value of dual-energy CT (DECT) to coronary artery stenosis and ischemic cardiomyopathy by using receiver operating characteristic curve (ROC).Methods CHD patients (n=70, male 48, female 22, aged from 51 to 78 and average age=61.8±7.2) were chosen from Jan. 2011 and Oct. 2013. The patients accepted successively DECT and coronary angiography (CAG), and 40 of 70 patients were given SPECT stress

  12. The association of global left ventricular systolic function evaluated by real-time three dimensional speckle tracking imaging with coronary artery stenosis%实时三维斑点追踪成像评估左心室整体收缩功能与冠状动脉狭窄的关系

    Institute of Scientific and Technical Information of China (English)

    林书佳; 胡元平; 管丽洁

    2015-01-01

    目的:探究实时三维斑点追踪成像(RT3D- STI)评估左心室整体收缩功能与冠状动脉狭窄的关系。方法冠状动脉造影(CAG)异常但常规超声心动图检查无节段性室壁运动异常的冠心病患者66例,根据CAG结果,分为A组:冠状动脉轻中度狭窄(冠状动脉狭窄均<70%)33例;B组:冠状动脉重度狭窄(至少有一支冠状动脉狭窄≥70%)33例,无冠状动脉病变者30例为对照组,均行RT3D- STI检查。测定左心室收缩末容积(LVESV)、舒张末容积(LVEDV)、左心室射血分数(LVEF)及左心室整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS)、整体面积应变(GAS),作组间比较,计算诊断冠状动脉严重狭窄的ROC曲线下面积。结果 B组GLS、GCS、GRS、GAS较对照组及A组降低(均P<0.05),A组GLS、GAS较对照组降低(均P<0.05);ROC曲线显示GAS诊断冠状动脉重度狭窄的敏感度及特异度较其他参数高;GAS与LVEF相关性较高(r=-0.691,P<0.05)。结论 RT3D- STI能发现二维超声动图上难以发现的左心室收缩活动异常,GAS与冠状动脉狭窄程度相关。%Objective To assess the association of global left ventricular systolic function evaluated by real- time three dimensional speckle tracking imaging (RT3D- STI) with coronary artery stenosis. Methods Sixty- six patients with coronary artery stenosis determined by coronary arteriography (CAG) and no regional ventricular wal motion abnormalities on 2D echocardiography were enrol ed. Of them, 33 cases had coronary artery stenosis<70%(group A) and 33 cases had at least one coronary artery stenosis≥70%(group B). RT3D- STI was performed in al patients as wel as in 30 healthy people without coronary artery stenosis. Left ventricular end- systolic volume, end- diastolic volume, ejection fraction, global longitudinal strain (GLS), global circumferential strain (GCS), global

  13. Association of C-reactive protein and homocysteine with subclinical coronary plaque subtype and stenosis using low-dose MDCT coronary angiography.

    Science.gov (United States)

    Lin, Tsann; Liu, Juhn-Cherng; Chang, Li-Ya; Shen, Chien-Wei

    2010-10-01

    Given the uncertainty regarding the relationship of C-reactive protein (CRP) and homocysteine (Hcy) to atherosclerotic burden, our aim was to determine whether CRP and Hcy are related to the presence of subclinical coronary plaque and stenosis. We did a cross-sectional analysis of data gathered on 1248 consecutive, newly self-referred, middle-aged subjects who underwent health check ups at China Medical University Hospital. Participants had at least one cardiac risk factor, but no known coronary heart disease. Low-dose multidetector computed tomography coronary angiography (MDCT-CA) was used to measure coronary artery stenosis and identify plaque subtypes. Subjects were divided into quartiles based on levels of high-sensitivity (hs)-CRP and Hcy. hs-CRP level and Hcy level were associated with the relative proportion of plaque subtypes; Hcy level (P0.05) was associated with prevalence of artery segment stenosis. After multivariate adjustment for traditional cardiovascular risk factors through logistic regression analysis, neither hs-CRP level nor Hcy level was independently associated with coronary plaque subtypes and stenosis (P>0.05). Subclinical atherosclerosis is mildly increased in subjects with higher CRP and Hcy levels, but this association is not independent of traditional cardiovascular risk factors. CRP and Hcy are poor predictors of atherosclerotic burden and coronary stenosis. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Prevalence of renal artery stenosis in patients undergoing cardiac catheterization.

    Science.gov (United States)

    Marcantoni, Carmelita; Carmelita, Marcantoni; Rastelli, Stefania; Stefania, Rastelli; Zanoli, Luca; Luca, Zanoli; Tripepi, Giovanni; Giovanni, Tripepi; Di Salvo, Marilena; Marilena, Di Salvo; Monaco, Sergio; Sergio, Monaco; Sgroi, Carmelo; Carmelo, Sgroi; Capodanno, Davide; Davide, Capodanno; Tamburino, Corrado; Corrado, Tamburino; Castellino, Pietro; Pietro, Castellino

    2013-08-01

    To investigate the prevalence of significant renal artery stenosis (RAS ≥50%), and to identify clinical predictors for significant RAS in patients with an elevated cardiovascular risk, such as those affected by ischemic heart disease. In patients with an elevated cardio-vascular risk, both atherosclerotic renovascular disease and coronary artery disease (CAD) are likely to occur. Prospectively from April 2007 to March 2008, all consecutive patients with ischemic heart disease undergoing non-emergent cardiac catheterization were also evaluated for atherosclerotic RAS by renal arteriography. A RAS ≥50% was considered as significant. A total of 1,298 patients underwent cardiac and renal angiography. Significant RAS was found in 70 out of 1,298 patients (5.4%). The presence of peripheral vascular disease, eGFR 66 years, dyslipidemia, CAD severity and pulse pressure >52 mmHg were independent clinical predictors of significant RAS, and jointly produced a ROC AUC of 0.79 (95% CI 0.73-0.85, P < 0.001). Based on these data, a prediction rule for significant RAS was developed, and it showed an adequate predictive performance with 64% sensitivity and 82% specificity. In a large cohort of patients undergoing coronary angiography, significant RAS is a relatively rare comorbidity (5.4%). A model based on simple clinical variables may be useful for the clinical identification of high CV risk patients who may be suitable for renal arteriography at the time of cardiac catheterization.

  15. Randomized Comparison of the Nobori Biolimus A9-Eluting Coronary Stent With the Taxus Liberté Paclitaxel-Eluting Coronary Stent in Patients With Stenosis in Native Coronary Arteries: The NOBORI 1 Trial—Phase 2

    National Research Council Canada - National Science Library

    Chevalier, Bernard; Silber, Sigmund; Park, Seung-Jung; Garcia, Eulogio; Schuler, Gerhard; Suryapranata, Harry; Koolen, Jacques; Hauptmann, Karl E; Wijns, William; Morice, Marie-Claude; Carrie, Didier; van Es, Gerrit-Anne; Nagai, Hirofumi; Detiege, Danny; Paunovic, Dragica; Serruys, Patrick W

    2009-01-01

    BACKGROUND—The newly developed Nobori coronary stent coated with a bioresorbable polymer, polylactic acid, and the antiproliferative agent Biolimus A9 has the potential to reduce restenosis by suppressing neointima formation...

  16. Myocardial ischemia during cardiopulmonary bypass. The hazards of ventricular fibrillation in the presence of a critical coronary stenosis.

    Science.gov (United States)

    Ciardullo, R C; Schaff, H V; Flaherty, J T; Gott, V L

    1977-05-01

    The effect of a critical coronary artery stenosis on myocardial blood flow and metabolism in the fibrillating heart was assessed by placing 10 dogs on cardiopulmonary bypass, venting the ventricle, inducing ventricular fibrillation, and applying critical stenosis to the left anterior descending coronary artery (LAD). Endocardial and epicardial blood flows were measured by the radioactive microsphere technique prior to the application of the stenosis and after one hour and 2 hours of fibrillation. Intramyocardial oxygen tension (PO2) and carbon dioxide tension (PCO2) were continuously monitored in the LAD-supplied myocardium by a mass spectrometer probe inserted at midmyocardial depth. Selective arterial-coronary venous lactate differences were determined at control, one hour, and 2 hours. At the end of the 2 hour period, vital dye injection defined the distribution of the LAD. Endocardial flow to the myocardium of the stenosed LAD was reduced by 50 per cent after one hour and by 70 per cent after 2 hours (p less than 0.05). Epicardial flow fell 40 per cent after one hour and 50 per cent after 2 hours (p less than 0.05). Endocardial and epicardial flow in the distribution of the unstenosed circumflex coronary artery remained unchanged. Changes in myocardial PO2 and PCO2 in the LAD-supplied myocardium indicated the development of severe ischemia in all 10 dogs and suggested myocardial infarction in 5. There was a conversion from lactate extraction to lactate production during the 2 hour period of ventricular fibrillation. From this study, it is concluded that the myocardium distal to a critical stenosis suffers a progressive reduction in flow during ventricular fibrillation which does not occur in regions supplied by unstenosed coronary arteries. Thus prolonged fibrillation in the presence of a flow-limiting coronary stenosis may play a role in the pathogenesis of myocardial infarction during coronary bypass surgery.

  17. 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

  18. 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

  19. Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies.

    Science.gov (United States)

    Zimmerman, Stefan L; Lin, Cheng T; Chu, Linda C; Eng, John; Fishman, Elliot K

    2016-06-01

    The feasibility of remote reading of coronary CT examinations on tablet computers has not been evaluated. The purpose of this study is to evaluate the accuracy of coronary CT angiography reading using an iPad compared to standard 3D workstations. Fifty coronary CT angiography exams, including a spectrum of coronary artery disease and anatomic variants, were reviewed. Coronary CT angiography exams were interpreted by two readers independently on an iPad application (Siemens Webviewer) and a clinical 3D workstation at sessions 2 weeks apart. Studies were scored per vessel for severity of stenosis on a 0-3 scale (0 none, 1 Coronary anomalies were recorded. A consensus read by two experienced cardiac imagers was used as the reference standard. Level of agreement with the reference for iPad and 3D workstations was compared. Multivariate logistic regression was used to analyze the relationship between agreement and display type and to adjust for inter-reader differences. For both readers, there was no significant difference in agreement with the reference standard for per-vessel stenosis scores using either the 3D workstation or the iPad. In a multivariable logistic regression analysis including reader, workstation, and vessel as co-variates, there was no significant association between workstation type or reader and agreement with the reference standard (p > 0.05). Both readers identified 100 % of coronary anomalies using each technique. Reading of coronary CT angiography examinations on the iPad had no influence on stenosis assessment compared to the standard clinical workstation.

  20. Relationship of cerebral arterial stenosis to cognitive and memory disorders

    Institute of Scientific and Technical Information of China (English)

    Jifeng Li; Zhou Wang; Shenggang Sun; Gaomei Cai; Kejin Gu; Yaoqun Li

    2006-01-01

    BACKGROUND: Cerebral arterial stenosis can cause cerebral hypoperfusion, and than result in the decline of cognitive function, whereas the cognitive dysfunction induced by different cerebral arterial stenosis have different manifestations and types.OBJECTIVE: To observe the differences of cognitive and memory dysfunctions in patients with cerebral arterial stenosis of different types.DESIGN: A comparative observation.SETTING: Affiliated Hospital of Jining Medical College.PARTICIPANTS: Forty-two outpatients or inpatients with cerebral arterial stenosis were selected from the Department of Neurology, Affiliated Hospital of Jining Medical College from February 2005 to January 2006,including 25 males and 17 females. There were 18 cases of internal carotid arterial stenosis, 14 cases of vertebrobasilar arterial stenosis and 10 cases of whole cerebral arterial stenosis. The diagnostic standards for cerebral arterial stenosis were identified according to North American Symptomatic Carotid Endarterectomy Trial (NAS CET). Meanwhile, 18 healthy physical examinees were enrolled as the control group, including 10males and 8 females, aged 58-80 years old. All the enrolled subjects were informed and agreed with the detection and evaluation.METHODS: ① The memory function was evaluated using revised Wechsler memory scale for adults, including long-term memory (experience, orientation and counting), short-term memory (visual recognition, picture memory, visual regeneration, association and thigmesthesia) and sensory memory (forward and backward recitation of numbers). The scale scores were turned to memory quotients. The higher the scores, the better the memory function. ② The cognitive function was evaluated using revised Wechsler adult intelligence scale:It consisted of eleven subtests, including six language scales (information, digit span, vocabulary, arithmetics,apprehension, similarity) and five operation scales (picture completion, picture arrangement, block design

  1. Clinical Analyses of Risk Factors for Severe Coronary Artery Stenosis%冠状动脉重度狭窄相关危险因素的临床分析

    Institute of Scientific and Technical Information of China (English)

    桂建伟; 谌瑾寰; 许晓琼

    2015-01-01

    【目的】探讨引发冠状动脉重度狭窄的相关危险因素。【方法】选取笔者所在医院2011年4月至2014年4月收治的冠状动脉狭窄患者113例和体检健康者50例。将其分为三组,A组为体检健康者50例, B组为轻中度冠状动脉狭窄者61例,C组为重度冠状动脉狭窄者52例。观察各组腹型肥胖比例、高血压比例、体质量指数(BMI)、血尿酸(BUA)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL‐C)、低密度脂蛋白胆固醇(LDL‐C)、脂联素、胰岛素抵抗指数(HOMA‐IR)、心率(HR)等指标,进行组间比较。【结果】C组、B组 HOMA‐IR、BMI、HR、高血压比例、腹型肥胖比例、TC、TG、LDL‐C、BUA均高于A组,差异有统计学意义( P <0.05);C组、B组HDL‐C、脂联素均低于A组,差异有统计学意义( P <0.05);C组 HOM A‐IR、BMI、HR、高血压比例、腹型肥胖比例、TC、TG、LDL‐C、BUA均高于B组,差异有统计学意义( P <0.05);C组HDL‐C、脂联素均低于B组,差异有统计学意义( P <0.05)。【结论】冠状动脉重度狭窄患者伴有糖脂代谢紊乱及血尿酸及脂联素异常,高血尿酸有显著影响其并发严重冠状动脉狭窄的可能性。%[Objective] To explore the risk factors for severe coronary artery stenosis .[Methods] A total of 113 cases of coronary heart disease were recruited along with 50 healthy subjects (group A ) .And mild/moderate stenosis ( n=61 ,group B) and severe stenosis ( n=52 ,group C) were assigned .The proportion of abdominal obesity ,hypertension ,proportion of body mass index (BMI) ,blood uric acid (BUA) ,total choles‐terol (TC) ,triglyceride (TG) ,high density lipoprotein cholesterol (HDL‐C) ,low density lipoprotein choles‐terol (LDL‐C) ,adiponectin ,insulin resistance index (calculated HOMA‐IR) and heart rate (HR) indices were compared .[Results] In

  2. Effect of Coronary Artery Stenosis on the Transmural Extent of the Rest Myocardial Perfusion of Different Segments of Left Ventricular Wall Using 640 Slices CT%静息态下冠状动脉狭窄对左室壁透壁心肌灌注影响的640层CT研究

    Institute of Scientific and Technical Information of China (English)

    陈为军; 李丹; 孙永青; 卢明明; 全冠民; 车东东; 袁涛; 刘亚飞; 门肾力; 杨卓

    2012-01-01

    目的 确定静息态下透壁心肌灌注指数(TPR)的正常值,并探讨静息态下不同分支的冠状动脉狭窄与各冠状动脉分支的不同狭窄程度对左室壁不同节段TPR的影响.方法 274例患者行Toshiba 640层CT检查,包括冠状动脉CTA及左心室室壁CT灌注(CTP)检查.根据冠状动脉狭窄程度及17节段进行分组.计算正常组及不同冠状动脉狭窄程度组之间相应节段内TPR是否存在差异,以及冠状动脉狭窄程度与相应节段TPR的相关性.结果 前降支及左旋支病变对于左室壁心肌灌注影响较为明显,前降支狭窄主要影响中间段前壁(r=-0.288)、心尖段前壁(r=-0.263)及中间段间隔壁(r=-0.196),左旋支主要影响基底部前侧壁(r=-0.241)、基底部后侧壁(r=-0.279)及心尖段侧壁(r=-0.201),而右冠状动脉病变影响较小,主要影响中间段后壁(r=-0.195);冠状动脉中、重度狭窄组对于左室壁心肌灌注影响程度较大(P<0.05),轻度狭窄影响较小;左室前壁心肌灌注最易受到冠状动脉狭窄影响;在静息状态下前降支供血区域组、左旋支供血区域组及右冠状动脉供血区域组正常心肌和重度狭窄心肌平均TPR值分别为1.14±0.09和1.07±0.13、1.13±0.11和1.06±0.14、1.15±0.14和1.10±0.12.结论 不同冠状动脉分支狭窄分别可以影响不同节段的心肌透壁灌注;不同冠状动脉狭窄程度可以不同程度地影响心肌的TPR,二者具有相关性;静息状态下TPR正常值大于负荷状态下TPR.本研究提供了TPR静息态下的正常值.%Objective To evaluate the influence of different branches and degree of the coronary artery stenosis on the myocardial transmural perfusion ratio of different segments of left ventricular wall, and to discuss the normal myocardial transmural perfusion ratio(TPR) of each territory of left ventricular wall in the rest state. Methods CT images of 274 patients who received Toshiba 640 slices CT for CTA and CTP

  3. Successful angioplasty during pregnancy for renal artery stenosis.

    Science.gov (United States)

    Margueritte, François; Velasco, Stephane; Pourrat, Olivier; Pierre, Fabrice

    2016-03-01

    Renal artery stenosis can be diagnosed during pregnancy and treated at the same time. A 30-year-old woman had a sudden, severe but asymptomatic hypertensive crisis at 21 weeks of gestation. The diagnosis of renal artery stenosis suspected on Doppler ultrasonography was confirmed and treated by renal angioplasty, which reduced her blood pressure. At 27 weeks of gestation, her blood pressure increased again, associated with significant proteinuria, suggesting pre-eclampsia. A cesarean section was performed giving birth to a healthy 940-g child. Renal artery stenosis should be considered when sudden and early-onset hypertension appears during pregnancy.

  4. Physiologic assessment of coronary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  5. Assessment of coronary artery disease by post-mortem cardiac MR

    Energy Technology Data Exchange (ETDEWEB)

    Ruder, Thomas D., E-mail: thomas.ruder@irm.uzh.ch [Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, CH-3012 Bern (Switzerland); Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zuerich, CH-8057 Zuerich (Switzerland); Bauer-Kreutz, Regula [Department of Forensic Pathology, Institute of Forensic Medicine, University of Bern, CH-3012 Bern (Switzerland); Ampanozi, Garyfalia [Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zuerich, CH-8057 Zuerich (Switzerland); Rosskopf, Andrea B. [Department of Diagnostic and Interventional Radiology, University Hospital, CH-3010 Bern (Switzerland); Pilgrim, Thomas M. [Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern (Switzerland); Weber, Oliver M. [Siemens Switzerland AG, Healthcare Sector, CH-3007 Bern (Switzerland); Thali, Michael J. [Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zuerich, CH-8057 Zuerich (Switzerland); Hatch, Gary M. [Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, CH-3012 Bern (Switzerland)

    2012-09-15

    Objectives: Minimally invasive or virtual autopsies are being advocated as alternative to traditional autopsy, but have limited abilities to detect coronary artery disease. It was the objective of this study to assess if the occurrence of chemical shift artifacts (CSA) along the coronary arteries on non-contrast, post-mortem cardiac MR may be used to investigate coronary artery disease. Methods: We retrospectively compared autopsy and CT findings of 30 cases with significant (≥75%), insignificant (<75%), or absent coronary artery stenosis to post-mortem cardiac MR findings. The chi-square test was used to investigate if the occurrence of CSA depends on the presence or absence of stenosis. Sensitivity, specificity and predictive values were calculated for each finding. Results: CSA indicates the absence of (significant) stenosis (p < 0.001). The occurrence of paired dark bands in lieu of CSA on post-mortem cardiac MR suggests (significant) coronary arteries stenosis (p < 0.001). Both findings have a high specificity but low sensitivity. Conclusions: CSA is a marker of vessel patency. The presence of paired dark bands indicates stenosis. These criteria improve the ability of minimally invasive or virtual autopsy to detect coronary artery disease related deaths.

  6. Can segmented 3D images be used for stenosis evaluation in coronary CT angiography?

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Chunliang [Linkoeping Univ., Center for Medical Image Science and Visualization, Linkoeping (Sweden); Linkoeping Univ., Div. of Radiological Sciences, Linkoeping (Sweden)], e-mail: chunliang.wang@liu.se; Persson, Anders; De Geer, Jakob; Smedby, Oerjan [Linkoeping Univ., Center for Medical Image Science and Visualization, Linkoeping (Sweden); Linkoeping Univ., Div. of Radiological Sciences, Linkoeping (Sweden); Linkoeping Univ. Hospital, Dept. of Radiology, Linkoeping (Sweden); Engvall, Jan [Linkoeping Univ., Center for Medical Image Science and Visualization, Linkoeping (Sweden); Linkoeping Univ. Hospital, Dept. of Clinical Physiology, Linkoeping (Sweden); Czekierda, Waldemar; Bjoerkholm, Anders [Linkoeping Univ. Hospital, Dept. of Radiology, Linkoeping (Sweden); Fransson, Sven-Goeran [Linkoeping Univ., Div. of Radiological Sciences, Linkoeping (Sweden); Linkoeping Univ. Hospital, Dept. of Radiology, Linkoeping (Sweden)

    2012-10-15

    Background Thanks to the development of computed tomography (CT) scanners and computer software, accurate coronary artery segmentation can be achieved with minimum user interaction. However, the question remains whether we can use these segmented images for reliable diagnosis. Purpose To retrospectively evaluate the diagnostic accuracy of coronary CT angiography (CCTA) using segmented 3D data for the detection of significant stenosis. Material and Methods CCTA data-sets from 30 patients were acquired with a 64-slice CT scanner and segmented using the region growing (RG) method and the 'virtual contrast injection' (VC) method. Three types of images of each patient were reviewed by different reviewers for the presence of stenosis with diameter reduction of 50% or more. The evaluation was performed on four main arteries of each patient (120 arteries in total). For the original series, the reviewer was allowed to use all the 2D and 3D visualization tools available (conventional method). For the segmented results from RG and VC, only maximum intensity projection was used. Evaluation results were compared with catheter angiography (CA) for each artery in a blinded fashion. Results Overall, 34 arteries with significant stenosis were identified by CA. The percentage of evaluable arteries, accuracy and negative predictive value for detecting stenosis were, respectively, 86%, 74%, and 93% for the conventional method, 83%, 71%, and 92% for VC, and 64%, 56%, and 93% for RG. Accuracy was significantly lower for the RG method than for the other two methods (P < 0.01), whereas there was no significant difference in accuracy between the VC method and the conventional method (P = 0.22). Conclusion The diagnostic accuracy for the RG-segmented 3D data is lower than those with access to 2D images, whereas the VC method shows diagnostic accuracy similar to the conventional method.

  7. Quantitativa analysis by 64-slice computed tomography in diagnosis of intermediate coronary artery stenosis%64排CT冠状动脉造影定量分析在冠状动脉临界病变中的价值

    Institute of Scientific and Technical Information of China (English)

    施鸿毓; 陈晖; 仇兴标; 曲新凯; 方唯一

    2012-01-01

    目的 评价64排CT冠状动脉造影对临界病变定量分析的可行性.方法 入选2009年5月-2010年8月于上海交通大学附属胸科医院行64排CT冠状动脉造影检查提示为临界病变的91例患者,共205处病变.在2周内进行经皮冠状动脉造影及定量冠状动脉造影(QCA)分析.采用Bland-Altman分析和Pearson相关分析对比64排CT冠状动脉造影定量分析与QCA的结果.结果 64排CT冠状动脉造影检查示,病变参考直径为(3.1±0.4) mm,病变长度为(14.2±11.3)mm;狭窄程度为(57.8±0.7)%,与QCA测定的(58.2±13.9)%的差异无统计学意义(P=0.64).205个经64排CT冠状动脉造影定量分析示冠状动脉狭窄程度为40%~70%的病变中,QCA检查示27个病变(13.2%)的狭窄程度低于40%,43个病变(21.0%)高于70%,135个病变(65.9%)属于冠状动脉狭窄程度为40%~70%的临界病变.64排CT冠状动脉造影定量分析与QCA结果呈中度相关(r=0.599,P<0.001),但一致性较差(平均偏差为0.4%,95%一致性可信区间为-22.1%~22.9%).结论 64排CT冠状动脉造影对临界病变的诊断价值有限,其定量分析与QCA的一致性欠佳,目前临床实用价值有限.%Objective To evaluate the feasibility of quantitative analysis by 64-slice computed tomography (CT) in intermediate coronary artery lesions. Methods Totally 91 patients with 205 lesions were diagnosed as intermediate coronary artery stenosis by 64-slice CT from May 2009 to August 2010. Conventional percutaneous coronary angiography was performed within 2 weeks after CT scan. The results of 64-slice CT quantitative analysis and quantitive coronary angiography (OCA) were compared by Bland-Altman analysis and Pearson correlations. Results The average reference values of lesions were (3.1 ±0.4) mm in diameter and (14.2±11.3) mm in length by CT scan. Diameter stenosis was (57.8 + 0.7)% by CT quantification and (58.2 + 13.91)% by OCAi there was no significant difference

  8. 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

  9. Coronary Artery Bypass in Octogenarians

    Directory of Open Access Journals (Sweden)

    Chen-Yen Chien

    2012-09-01

    Full Text Available Prevalence of coronary artery disease (CAD has increased with the expansion of life span among the elderly population in the world. Hence, the issue of the coronary artery bypass in octogenarians has attracted more attention. Recent literature about the topic revealed nearly the same excellent results as those in the younger population under the newly developed operative techniques and improving concept in perioperative management and postoperative care. In this article, we review the current status of the procedure that was thought to be dangerous in the earlier era, including its risk factors, result, and benefit.

  10. Simultaneous rota-stenting and transcatheter aortic valve implantation for patients with heavily calcified coronary stenosis and aortic stenosis

    Directory of Open Access Journals (Sweden)

    Yung-Tsai Lee

    2016-09-01

    Full Text Available Given that coronary artery disease (CAD in octogenarians undergoing transcatheter aortic valve implantation (TAVI often presents with more complex lesions and extensive calcification, rotational atherectomy (RA may be needed in some cases before stenting. However, data regarding the feasibility and safety of simultaneous RA during TAVI using the Medtronic CoreValve (MCV; Medtronic, Minneapolis, MN, USA system are lacking. Three out of 107 (2.8% patients (2 females, average age 85.6 years, mean aortic valve area 0.5 cm2, mean left ventricular ejection fraction 39%, mean Logistic EuroScore 70%, with complex, heavily calcified coronary stenosis, and severe valvular aortic stenosis (AS were treated with TAVI and RA due to high surgical risk. After balloon valvuloplasty, all coronary lesions were successfully treated with RA and stenting, immediately followed by transfemoral TAVI with a self-expandable MCV. Our data suggested that in the very elderly patients with severe and heavily calcified CAD and AS who were turned down for cardiac surgery, RA and stenting followed by TAVI may be performed successfully in a combined, single-stage procedure.

  11. 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.

  12. Anomalous origin of right coronary artery from left coronary sinus.

    Science.gov (United States)

    Hamzeh, Gadah; Crespo, Alex; Estarán, Rafael; Rodríguez, Miguel A; Voces, Roberto; Aramendi, José I

    2008-08-01

    Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.

  13. Coronary artery spasm

    Science.gov (United States)

    ... Saunders; 2016:chap 71. Giugliano RP, Cannon CP, Braunwald E. Non-ST elevation acute coronary syndromes In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of ...

  14. Evaluation of renal artery stenosis using color Doppler sonography in young patients with multiple renal arteries

    Institute of Scientific and Technical Information of China (English)

    QIN Wei; ZHANG Xin; YANG Min; ZHONG Xu-hui; ZHAO Ming-hui

    2011-01-01

    Background Some individuals have multiple renal arteries. Severe stenosis in one of the arteries may cause refractory hypertension. The detection of stenosis within one of the multiple renal arteries usually required invasive procedures, such as computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). This study reported the application of color Doppler sonography (CDS) in the detection of severe stenosis in one of the multiple arteries.Methods Patients with multiple renal arteries and one of the arteries with severe stenosis were retrospectively studied. Peak systolic velocities (PSV) of renal arteries and the intrarenal CDS patterns were collected and compared. The diagnosis was confirmed by digital subtraction angiography (DSA).Results Four children with multiple renal arteries and one of the arteries with stenosis were investigated. They were admitted due to refractory hypertension. CDS screening identified two renal arteries in one kidney of each patient with one of the two renal arteries having stenosis >70%. The PSV of the stenosed arteries were much higher, and the intrarenal CDS patterns supplied by the stenosed arteries changed into T-P patterns.Conclusion Non-invasive CDS technology may be a useful method to identify severe stenosis in one of multiple renal arteries in young patients.

  15. Relationship between carotid artery stenosis and ischemic ocular diseases

    Directory of Open Access Journals (Sweden)

    Qian Chen

    2015-01-01

    Full Text Available AIM: To investigate the relationship between carotid artery stenosis and ischemic ocular diseases.METHODS: The clinical data of 30 cases(37 eyesof patients with ischemic eye diseases were collected from November 2010 to May 2014, and they were accepted the fundus fluorescein angiography(FFA, transcranial Doppler(TCDultrasonic blood vessels of the eye, neck vascular color Doppler flow imaging(CDFI, the neck CT angiography(CTAand carotid artery digital subtraction angiography(DSAexamination, and then the ischemic eye disease patients with ocular symptoms were analyzed. The peak systolic velocity(PSVand resistance index(RIof ophthalmic artery and central retinal artery were compared. Correlation between the internal carotid artery intima-media thickness(IMTand ophthalmic artery, central retinal artery PSV and RI correlation risk; ipsilateral internal carotid artery plaque and ophthalmic artery PSV and RI; PSV and RI associated ipsilateral internal carotid artery plaque and central retinal artery were analyzed. RESULTS: Eye symptoms: a black dim, reduced vision, the eyes flash, and around the eye pain were 75.7%, 83.8%, 51.4% and 32.4%; The eye signs: the dilatation of retinal vein, retinal hemorrhage, arterial stenosis and cotton spot and the contralateral side were regarded as main signs. Ophthalmic artery PSV and RI value of the differences were statistically significant(PPP>0.05; The ipsilateral internal carotid artery plaque and ophthalmic artery PSV had no correlation with RI values(P>0.05; PSV and RI and the ipsilateral internal carotid artery plaque and central retinal artery had no correlation(P>0.05.CONCLUSION: The incidence of ischemic eye diseases and internal carotid artery stenosis is associated with very close, the clinical can regard the degree of internal carotid artery stenosis as an important basis for diagnosis and treatment of eye diseases.

  16. 冠状动脉狭窄时ST段压低动物模型的建立%Establishment of an animal model of ST-segment depression in coronary artery stenosis

    Institute of Scientific and Technical Information of China (English)

    辛卫朋; 陈士良; 陈国雄; 方波; 王红娜

    2016-01-01

    目的:建立冠状动脉狭窄引起ST段压低的动物模型,探讨其病理生理改变。方法运用自制的微米缩窄器对16例犬的左旋支进行定量狭窄,观察左旋支血流量、冠状动脉远端小动脉平均压,左心室收缩峰压、左心室压力最大上升速率、左心室舒张末压、心肌耗氧量和乳酸的变化。结果当冠状动脉狭窄达87%(面积)时,可引起ST段压低(压低0.1mV),此时左旋支血流量降至(20±7)ml/min,冠状动脉远端小动脉平均压降至(55±8)mmHg,与狭窄前[(36±6)ml/min、(90±14) mmHg]比较,差异均有统计学意义(t=4.54、10.806,P<0.01),左心室收缩峰压和左心室压力最大上升速率[(106±18) mmHg、(2210±700)mmHg/s]较狭窄前[(114±20)mmHg、(2450±760)mmHg/s]降低,乳酸升高[(43.5±14)%比(26.4±6.9)%],心肌耗氧量降低[(2.22±0.64)ml/(100g·min)比(43.5±14.7)ml/(100g·min)],差异均有统计学意义(P<0.05或0.01)。结论在冠状动脉狭窄达87%时,可造成ST段压低的急性心肌缺血动物模型。%Objective To establish an animal model of ST- segment depression induced by coronary artery stenosis and investigate its pathophysiological changes. Methods An animal model of ST- segment depression was established in 16 dogs by quantitatively constricting left circumflex coronary artery (LCCA) with a micrometer constrictor. The coronary blood flow(CBF) and blood pressure of LCCA, left ventricular peak systolic pressure(LVPSP), maximum rate of left ventricular pressure increase (dp/dt max), left ventricular end diastolic pressure(LVEDP), myocardial oxygen consumption and lactate were measured. Results ST- segment depression developed as the degree of coronary stenosis reached to 87%(cross- sectional area) with CBF reduced from(36±6)ml/min to(20±7)ml/min, distal LCCA pressure decreased from(90±14) mmHg to(55±8)mmHg, LVPSP reduced from

  17. Brief Report: Intestinal Microbiota-Produced Trimethylamine-N-Oxide and Its Association With Coronary Stenosis and HIV Serostatus.

    Science.gov (United States)

    Miller, P Elliott; Haberlen, Sabina A; Brown, Todd T; Margolick, Joseph B; DiDonato, Joseph A; Hazen, Stanley L; Witt, Mallory D; Kingsley, Lawrence A; Palella, Frank J; Budoff, Matthew; Jacobson, Lisa P; Post, Wendy S; Sears, Cynthia L

    2016-05-01

    Recent evidence has shown a complex relationship between the gut microbiota, dietary nutrients, and cardiovascular disease (CVD). Trimethylamine-N-oxide (TMAO) production, initiated by the microbiota, has been associated with CVD events. We sought to test if this association exists in HIV-infected persons. After adjusting for aspirin use and CVD risk factors, HIV-infected men were more likely to have coronary stenosis in the second and third TMAO quartiles compared with the first quartile, but did not differ significantly in the fourth quartile. We found an inverted U-shaped association between TMAO levels and the presence of coronary artery stenosis among HIV-infected men.

  18. Middle cerebral artery stenosis associated with moyamoya pattern collateralization

    Directory of Open Access Journals (Sweden)

    Randall Edgell

    2010-11-01

    Full Text Available Background and Purpose: Moyamoya disease is a well described phenomenon presenting with terminal internal carotid artery occlusion and rete pattern of collateralization around the occlusion. The development of moyamoya-like collaterals secondary to isolated middle cerebral artery stenosis or occlusion and the natural history of this entity in Caucasians have not been well described. Methods: Cerebral angiograms and CT angiograms performed between August 2004 and August of 2006 demonstrating moyamoya collateralization at a single US center were retrospectively reviewed. All cases of middle cerebral artery stenosis associated with a rete pattern of collateralization were included in this series. Demographic, clinical, and angiographic data were obtained. Results: There were 3 cases of middle cerebral artery stenosis associated with a moyamoya pattern of collateralization. The average age of the patients was 36 years old, 2 were male, and all were Caucasian. All patients presented with ischemic symptoms. The average degree of stenosis was 91%. No stenosis was seen in the supraclinoid internal carotid arteries or elsewhere in the intracranial vasculature. Conclusion: We describe a moyamoya-like pattern of anastomosis associated with isolated severe middle cerebral artery stenosis or occlusion in Caucasians.

  19. 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.

  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. Development of bilateral coronary artery aneurysms in a child with Noonan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Mauro, David M.; Flors, Lucia; Norton, Patrick T.; Hagspiel, Klaus D. [University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA (United States); Hoyer, Andrew W. [University of Virginia Health System, Department of Pediatrics, Division of Pediatric Cardiology, Charlottesville, VA (United States); Pediatric Cardiology Center of Oregon, Portland, OR (United States)

    2016-03-15

    Noonan syndrome is a constellation of congenital malformations including heart defects, facial anomalies and short stature. The cardiovascular defects are variable and extensive, with the most common being pulmonary stenosis and hypertrophic cardiomyopathy. Coronary artery anomalies have only been reported in a few cases. We report a child with Noonan syndrome status post pulmonary stenosis and atrial septal defect repair, who developed bilateral coronary artery aneurysms. The aneurysms were diagnosed with both cardiac magnetic resonance imaging and coronary computed tomography angiography. There had been no evidence of them on a cardiac MR exam 5 years previously. (orig.)

  2. 64-multyslice computed tomography: detection of coronary artery disease in patients with ischemic heart disease

    Directory of Open Access Journals (Sweden)

    A. S. Nikonenko

    2015-02-01

    Full Text Available At present time, the death rate from cardiovascular disease occupies leading position in the structure of total mortality worldwide. The opportunity to conduct non-invasive studies of the coronary arteries has appeared through the development and implementation of multislice computed tomography (MSCT into medical practice, which carry 64 or more sections. Aim. The purpose of this research is the identification of diagnostic capabilities of 64-slice MSCT in the verification of the severity of coronary artery lesions in patients with proven coronary artery disease. Methods and results. The study has been conducted on a 64-slice CT scanner Optima 660 (GE, USA. The degree of stenosis and calcification of the coronary arteries and also central hemodynamics have been studied. The analysis of survey results of 65 patients with coronary heart disease (30.8% of patients had a history of myocardial infarction has been carried out. The average age of patients in observation group was 60.2 ± 10.56 years. Male patients were dominated (75.4%. According to the 64-slice MSCT it has been found that coronary artery stenosis occurs ≥ 50% in 90.0% of patients with myocardial infarction, and in 32.5% of patients with symptomatic coronary artery disease. Conclusion. Therefore, MSCT has sufficient specificity in the diagnosis of occlusive and stenotic lesions of the coronary arteries, and can be used for screening patients with suspected coronary artery disease.

  3. 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

  4. 冠心病患者颈动脉内膜中层厚度、微量白蛋白尿与冠脉狭窄程度的相关性分析%The analysis of the correlation between coronary heart disease patients with carotid intima -media thickness, ;microalbuminuria and the degree of coronary artery stenosis

    Institute of Scientific and Technical Information of China (English)

    王健; 滕涛

    2015-01-01

    目的:观察冠心病患者尿微量白蛋白、颈动脉内膜中层厚度(CIMT)及冠脉 Gensini 评分水平,探讨冠脉狭窄程度与尿微量白蛋白、颈动脉内膜中层厚度的相关性。方法选取冠心病住院患者50例及健康对照组50例,比较两组间尿微量白蛋白、CIMT 及冠脉 Gensini 评分。结果冠心病组尿微量白蛋白、CIMT分别为(38.36±19.51)mg/L、(1.18±0.25)mm,健康对照组尿微量白蛋白、CIMT 分别为(27.52±15.44)mg/L、(0.76±0.17)mm,两组差异均有统计学意义(t =3.080,P =0.002;t =9.823,P =0.000),冠心病组冠脉 Gensini评分与尿微量白蛋白、CIMT 呈正相关(r =0.288,P =0.430;r =0.308,P =0.290)。结论冠心病患者尿微量白蛋白、CIMT 与冠脉狭窄程度呈正相关关系,通过测定尿微量白蛋白及颈动脉内膜中层厚度,可预测冠状动脉狭窄程度。%Objective To observe the microdose albumin in urine,carotid intima -media thickness(CIMT) of coronary heart disease(CHD)patients′and coronary Gensini score level,to investigate the correlation between the extent of coronary stenosis and microalbuminuria,CIMT.Methods 50 cases of hospitalized patients with CHD and healthy control group of 50 cases were selected,to compare the score between the two groups of microalbuminuria, CIMT and coronary Gensini.Results CHD group:microalbuminuria and CIMT were (38.36 ±19.51 )mg/L, (1.18 ±0.25)mm respectively.Healthy control group:microalbuminuria and CIMT were (27.52 ±15.44)mg/L, (0.76 ±0.17)mm respectively.Differences between the two groups were statistically significant(t =3.080,P =0.002;t =9.823,P =0.000).CHD group:coronary Gensini score was positively correlated with microalbuminuria, CIMT(r =0.288,P =0.430 r =0.308,P =0.290).Conclusion The correlation between CHD patients'microalbu-minuria,CIMT and the degree of coronary artery stenosis is positive

  5. Aneurysm of the left main coronary artery

    Directory of Open Access Journals (Sweden)

    Ênio E. Guérios

    2000-12-01

    Full Text Available Aneurysm of the left main coronary artery is a rare angiographic finding, with few cases described in the international literature. We report the case of a 42-year-old male with a previous history of acute myocardial infarction, whose coronariography indicated triple vessel coronary disease and an aneurysm of the left main coronary artery. A review of the etiology, clinical aspects, and surgical management of coronary arterial aneurysm is presented.

  6. Application of 64 slice spiral CT in evaluating the patency of coronary artery after stent implantation

    Institute of Scientific and Technical Information of China (English)

    Yong-Shu Gao; Xing-Can Ma

    2015-01-01

    Objective:To explore the feasibility and effectiveness of 64 slice spiral CT in evaluating the patency of coronary artery after stent implantation.Methods:The 64 slice spiral CT image data of 125 patients after coronary artery stent implantation were collected, meanwhile, the image data of 25 patients underwent coronary angiography were also collected. The feasibility and accuracy of 64 slice spiral CT coronary artery stent imaging were comparatively analyzed. Results: The 64 slice spiral CT imaging quality with a stent diameter greater than 3.00 mm was significantly superior to that with a diameter of 2.25-3.00 mm. The CT imaging quality in the left main coronary artery and anterior descending artery was significantly higher than that in the left circumflex coronary artery. The CT imaging quality in the left main coronary artery was significantly higher than that in the right coronary artery. The CT reconstruction imaging quality in the drug coating stent was significantly superior to that in the bare metal stent. The sensitivity of 64 slice spiral CT was 100.00%, and the accuracy was 100.00%. In detecting the coronary artery with occlusion and stenosis (stent stenosis greater than 50%), the sensitivity was 90.00%, the false negative rate was 10.00%, and the positive predicative value was 100.00%.Conclusions:The effect of 64 slice spiral CT coronary imaging in evaluating the patency of coronary artery after stent implantation is highly consistent with that by coronary angiography, with a simple operation, less risk, and low cost, and thus, it can be completely taken as the imaging method in evaluating the patency of coronary artery after stent implantation.

  7. Exercised-Induced Coronary Spasm in Near Normal Coronary Arteries

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    Damian Franzen

    2010-01-01

    Full Text Available In contrast to effort-induced symptoms in obstructive coronary disease, spasm in normal coronary arteries is characterized by angina at rest. We describe a 44-year-old patient with minor coronary plaques and pure exercised-induced coronary spasm. The case questions the differential pathogenic considerations of variant of the variant as opposed to Prinzmetal's variant angina.

  8. Plasminogen and fibrinogen plasma levels in coronary artery disease

    Science.gov (United States)

    Lima, Luciana Moreira; Carvalho, Maria das Graças; Sousa, Marinez de Oliveira

    2012-01-01

    Objective The formation of thrombi at the site of atherosclerotic lesions plays a central role in atherothrombosis. Impaired fibrinolysis may exacerbate pre-existing coronary artery disease and potentiate its evolution. While the fibrinogen plasma level has been strongly associated with the severity of coronary artery disease, its relevance in the evaluation of plasminogen in coronary artery disease patients remains unclear. This study evaluated fibrinogen and plasminogen levels in subjects with coronary artery disease as diagnosed by angiography. Methods This is a cross-sectional study. Blood samples obtained from 17 subjects with angiographically normal coronary arteries (controls), 12 with mild/moderate atheromatosis and 28 with severe atheromatosis were evaluated. Plasma plasminogen and fibrinogen levels were measured by chromogenic and coagulometric methods, respectively. Results Fibrinogen levels were significantly higher in the severe atheromatosis group compared to the other groups(p-value < 0.0001). A significant positive correlation was observed between the severity of coronary artery diseaseand increasing fibrinogen levels (r = 0.50; p-value < 0.0001) and between fibrinogen and plasminogen levels (r =0.46; p-value < 0.0001). There were no significant differences in the plasminogen levels between groups. Conclusion Plasma fibrinogen, but not plasminogen levels were higher in patients with coronary artery disease compared to angiographically normal subjects. The plasma fibrinogen levels also appear to be associated with the severity of the disease. The results of this study provide no evidence of a significant correlation between plasma plasminogen levels and the progress of coronary stenosis in the study population. PMID:23049444

  9. Transmural myocardial perfusion gradients in relation to coronary artery stenoses severity assessed by cardiac multidetector computed tomography

    DEFF Research Database (Denmark)

    Linde, Jesper James; Kühl, Jørgen Tobias; Hove, Jens Dahlgaard

    2015-01-01

    To assess the relationship between epicardial coronary artery stenosis severity and the corresponding regional transmural perfusion at rest and during adenosine stress, using multidetector computed tomography (MDCT). We evaluated the relationship between the severity of coronary artery diameter...... = stress - PI/rest - PI), and the transmural perfusion ratio (TPR = subendocardium/subepicardium) were calculated. A coronary artery stenosis ≥50 % was present in 49 patients (25 %). Rest-PI and rest-TPR values were similar in patients with and without a coronary artery stenosis ≥50 %, whereas stress...... stenosis assessed by MDCT angiography and semi-quantitative myocardial MDCT perfusion in 200 symptomatic patients. The perfusion index (PI = mean myocardial attenuation density/mean left ventricular lumen attenuation density) at rest and during adenosine stress, the myocardial perfusion reserve (MPR...

  10. Anomalous Coronary Artery: Run of a Lifetime.

    Science.gov (United States)

    Green, Michael Stuart; Sehgal, Sankalp; Smukler, Naomi; Suber, LaDouglas Jarod; Saththasivam, Pooven

    2016-09-01

    The anatomy of the coronary circulation is well described with incidence of congenital anomalies of approximately 0.3% to 1.0%. Although often incidental, 20% are life-threatening. A 25-year-old woman with syncopal episodes collapsed following a 10-km run. Coronary anatomy evaluation showed an anomalous left main coronary artery originating from the right sinus of valsalva and following a course between the aorta and the pulmonary outflow tract. Percutaneous coronary intervention was followed by eventual surgical revascularization. Abnormal course of coronary arteries plays a role in the pathogenesis of sudden death on exertion. Origin of the left main coronary from the right sinus of valsalva is a rare congenital anomaly. The expansion of the roots of the aorta and pulmonary trunk with exertion lead to compression of the coronary artery and syncope. Our patient raises awareness of a potentially fatal coronary artery path. Intraoperative identification of anomalous coronaries by utilizing intraoperative transesophageal echocardiography was critical.

  11. A Rare Case of Triple Coronary Artery Fistulae Originating from Left Main and Right Coronary Arteries

    Directory of Open Access Journals (Sweden)

    Mehmet Ali Elbey

    2012-10-01

    Full Text Available ABSTRACTDual coronary artery fistulae (CAF involving both right and left coronary trees are uncommon; accounting for only 5% of all CAFs. A 48-year-old male patient was admitted to our institution for evaluation of chest pain. The coronary angiography revealed fistulae from left main coronary artery (LMCA and right coronary artery (RCA to the pulmonary artery. We concluded that angina pectoris was caused by a steal phenomenon and the patient was recommended surgical intervention. To our knowledge, this is the first paper reporting three fistulae associated with multiple aneurysms originating from proximal coronary arteries, which were connected to the pulmonary artery.

  12. Renal vein oxygen saturation in renal artery stenosis

    DEFF Research Database (Denmark)

    Nielsen, K; Rehling, M; Henriksen, Jens Henrik Sahl

    1992-01-01

    Renal vein oxygen-saturation was measured in 56 patients with arterial hypertension and unilateral stenosis or occlusion of the renal artery. Oxygen-saturation in blood from the ischaemic kidney (84.4%, range 73-93%) was significantly higher than that from the 'normal' contralateral kidney (81...

  13. Drug-eluting stents in renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Zaehringer, M. [Marienhospital Stuttgart, Department of Radiology, Stuttgart (Germany); Pattynama, P.M.T. [Erasmus MC-University Medical Center Rotterdam, Rotterdam (Netherlands); Talen, A. [genae associates nv, Antwerp (Belgium); Sapoval, M. [Hopital Europeen Georges Pompidou, Service de Radiologie Cardio-Vasculaire, Paris (France); Inserm U 780 epidemiologie Cardio Vasculaire, Paris (France)

    2008-04-15

    Because of higher acute and long-term success rates compared with balloon angioplasty alone, percutaneous stent implantation has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis. Restenosis rates after successful renal stent placement vary from 6 up to 40%, depending on the definition of restenosis, the diameter of the treated vessel segment and comorbidities. The safety and efficacy of drug-eluting stents for the treatment of renal-artery stenosis is poorly defined. The recently published GREAT study is the only prospective study, comparing bare-metal and sirolimus-coated low profile stent systems in renal artery stenosis, showing a relative risk reduction of angiographic binary in-stent restenosis by 50%. This is an opinion paper on indications, current treatment options and restenosis rates following renal artery stenting and the potential use of drug-eluting stents for this indication. (orig.)

  14. [Prevalence of renal artery stenosis in patients with critical limb ischemia].

    Science.gov (United States)

    Esteban, Carlos; Presas, Ana; Ara, Jordi; Pérez, Paulina; Martorell, Alberto; Lisbona, Carlos; Lerma, Rosa; Romero, Ramón; Callejas, José María

    2007-04-21

    Our purpose was to evaluate the prevalence of renal artery stenosis in patients with critical limb ischemia and to study any clinical or laboratory indicator that could predict this association. One hundred consecutive patients with critical limb ischemia evaluated by angiogram were included in the study from January to July 2003. Cardiovascular risk factors and renal function were analyzed. One hundred angiographic studies have been analyzed. Thirty nine (39%) of our patients had some type of pathology of the renal artery but the rest, 61 (61%), had normal and healthy renal arteries. In 5 patients, a bilateral renal pathology was found. Severe disease (> 60% stenosis, bilateral or renal occlusion) was present in 15 cases including 6 occlusions. Once we compared the patients with healthy renal arteries with the patients with different degrees of stenosis, we did not appreciate significant differences in hypertension, diabetes, coronary disease or smoking habit, nor with laboratory data such as creatinine, urea, c-reactive protein, total cholesterol or atherogenic index. No differences were found either comparing patients with normal renal artery with patients with bilateral pathology or with unilateral occlusion. There is a high prevalence of renal artery pathology in patients with critical limb ischemia although we have not found any clinical or laboratory factors useful to identify them.

  15. Coronary Physiology During Exercise and Vasodilation in the Healthy Heart and in Severe Aortic Stenosis.

    Science.gov (United States)

    Lumley, Matthew; Williams, Rupert; Asrress, Kaleab N; Arri, Satpal; Briceno, Natalia; Ellis, Howard; Rajani, Ronak; Siebes, Maria; Piek, Jan J; Clapp, Brian; Redwood, Simon R; Marber, Michael S; Chambers, John B; Perera, Divaka

    2016-08-16

    Severe aortic stenosis (AS) can manifest as exertional angina even in the presence of unobstructed coronary arteries. The authors describe coronary physiological changes during exercise and hyperemia in the healthy heart and in patients with severe AS. Simultaneous intracoronary pressure and flow velocity recordings were made in unobstructed coronary arteries of 22 patients with severe AS (mean effective orifice area 0.7 cm(2)) and 38 controls, at rest, during supine bicycle exercise, and during hyperemia. Stress echocardiography was performed to estimate myocardial work. Wave intensity analysis was used to quantify waves that accelerate and decelerate coronary blood flow (CBF). Despite a greater myocardial workload in AS patients compared with controls at rest (12,721 vs. 9,707 mm Hg/min(-1); p = 0.003) and during exercise (27,467 vs. 20,841 mm Hg/min(-1); p = 0.02), CBF was similar in both groups. Hyperemic CBF was less in AS compared with controls (2,170 vs. 2,716 cm/min(-1); p = 0.05). Diastolic time fraction was greater in AS compared with controls, but minimum microvascular resistance was similar. With exercise and hyperemia, efficiency of perfusion improved in the healthy heart, demonstrated by an increase in the relative contribution of accelerating waves. By contrast, in AS, perfusion efficiency decreased due to augmentation of early systolic deceleration and an attenuated rise in systolic acceleration waves. Invasive coronary physiological evaluation can be safely performed during exercise and hyperemia in patients with severe aortic stenosis. Ischemia in AS is not related to microvascular disease; rather, it is driven by abnormal cardiac-coronary coupling. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Assessment of myocardial fibrosis and coronary arteries in hypertrophic cardiomyopathy using combined arterial and delayed enhanced CT: comparison with MR and coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Lei; Ma, Xiaohai; Zhang, Chen; Liu, Yi; Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China); DeLano, Mark C. [Michigan State University, Division of Radiology and Biomedical Imaging, College of Human Medicine, Lancing, MI (United States); Jiang, Tengyong [Capital Medical University, Department of Cardiology, Beijing Anzhen Hospital, Beijing (China)

    2013-04-15

    We sought to determine the feasibility and accuracy of dual-source computed tomography (DSCT) in assessing coronary artery disease and myocardial fibrosis of hypertrophic cardiomyopathy (HCM) compared with cardiac magnetic resonance (CMR) imaging and coronary angiography (CA). Forty-seven consecutive patients with HCM were prospectively enrolled. DSCT images were acquired in the arterial and late phases following intravenous contrast medium. The CMR and CA were performed within 7 days. Independent blinded readers read each study. Patients were classified according to myocardial delayed enhanced (MDE) CMR, coronary artery stenosis by CA, and arterial and MDE-DSCT. The diagnostic accuracy of DSCT in detecting coronary stenosis and MDE was analysed. Wall thickness determined by DSCT was strongly correlated with MR results (r = 0.91). DSCT and CMR MDE showed substantial agreement for the detection of myocardial fibrosis on per-patient and per-segment levels. The CT classification of patients by arterial stenosis and delayed enhancement had excellent agreement with MR and CA methods. The comprehensive cardiac CT examination provides reliable coronary artery and myocardial assessments. MDE-DSCT is a robust alternative method to MDE-CMR in assessing myocardial fibrosis in HCM particularly in patients with pacemakers or other contraindications to CMR. (orig.)

  17. 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.)

  18. Coronary Flow Reserve Predicts Cardiopulmonary Fitness in Patients with Coronary Artery Disease Independently of Systolic and Diastolic Function

    DEFF Research Database (Denmark)

    Snoer, Martin; Olsen, Rasmus Huan; Monk-Hansen, Tea

    2014-01-01

    Aims Despite revascularization and optimal medical treatment, patients with coronary artery disease (CAD) have reduced exercise capacity. In the absence of coronary artery stenosis, coronary flow reserve (CFR) is a measure of coronary microvascular function, and a marker of future poor outcome...... early (E) and late (A) inflow velocities, and tissue Doppler diastolic (e′) and systolic (s′) velocities. Peak coronary flow velocity (CFV) was measured in the LAD using pulse-wave Doppler. CFR was calculated as the ratio between peak CFV at rest and during vasodilator stress. Median CFR was 2.22 (1....... Conclusions Coronary flow reserve measured noninvasively predicts cardiopulmonary fitness independently of resting systolic and diastolic function in CAD patients, indicating that cardiac output during maximal exercise is dependent on the ability of the coronary circulation to adapt to the higher metabolic...

  19. Severe hypertension due to renal polar artery stenosis in an adolescent treated with coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Docx, Martine K. [Koningin Paola Kinderziekenhuis, Department of Paediatrics, Chronic Diseases and Hypertension, Antwerp (Belgium); Vandenberghe, Philippe [Koningin Paola Kinderziekenhuis, Department of Paediatric Cardiology, Antwerp (Belgium); Maleux, Geert [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Gewillig, Marc [University Hospitals Leuven, Department of Paediatric Cardiology, Leuven (Belgium); Mertens, Luc [Hospital for Sick Children, Paediatric Cardiology, Toronto (Canada)

    2009-11-15

    A 12-year-old boy presented with severe arterial hypertension due to a severe subsegmental renal artery stenosis. Treatment consisted of selective embolization of the stenosed polar artery, which resulted in near normalization of the arterial pressures. Renal artery stenosis should always be considered, even in young adolescents, as a cause for arterial hypertension. Only selective angiography was able to demonstrate the subsegmental artery stenosis in this patient. (orig.)

  20. 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.

  1. Early severe coronary artery disease and aortic coarctation in a child with familial hypercholesterolaemia.

    Science.gov (United States)

    Labib, Dina; Soliman, Haytham; Said, Kareem; Sorour, Khaled

    2016-11-30

    An 11-year-old boy presented with easy fatigability, multiple xanthomas, and absent pedal pulsations. Laboratory workup showed severe hypercholesterolaemia and non-invasive imaging revealed 'normally functioning' bicuspid aortic valve and tight aortic coarctation. Coronary angiography showed severe right coronary artery (RCA) stenosis. Medical treatment resulted in significant improvement of dyslipidaemia. We successfully performed balloon dilation and stenting of his coarctation, as well as percutaneous coronary intervention for RCA lesion.

  2. Relationship between coronary artery ectasia, cocaine abuse and acute coronary syndromes

    Institute of Scientific and Technical Information of China (English)

    Gregory Dendramis; Claudia Paleologo; Davide Piraino; Pasquale Assennato

    2016-01-01

    Coronary artery ectasia(CAE)often represents a coronary angiography finding casually detected or following the occurrence of an acute coronary syndrome.The pathogenetic role of cocaine abuse in the genesis of CAE is still little known and very few data are available in literature.We describe a case of a 31-year-old male cocaine user admitted to our department for typical acute chest pain.Coronary angiography showed diffuse coronary ectasia with slow flows and without hemodynamically significant stenosis.An increasing of matrix metalloproteinases values and a reduction of their tissue inhibitors was showed both during hospitalization and at one month after discharge.This case report emphasizes the close relationship between cocaine abuse,CAE and acute coronary syndromes in patients without hemodynamically significant coronary stenosis.As reported by Satran et al,cocaine abuse should be considered an important risk factor for CAE and these patients appear to be at increased risk of angina and acute myocardial infarct.Further studies that can strengthen this hypothesis would be useful to deepen and better analyze this interesting association.

  3. New Technologies in Coronary Artery Surgery

    Directory of Open Access Journals (Sweden)

    David Taggart

    2013-07-01

    Full Text Available Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1 stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2 discussing the advantages and disadvantages of off-pump coronary artery bypass; 3 presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4 debating a novel external stenting technique for saphenous vein grafts.

  4. 血管内超声评估冠状动脉管腔狭窄伴外弹力膜扩张性血管重构的临床研究%Intravascular Ultrasound Evaluation on Coronary Artery Remodeling for Lumen Stenosis With Enlarged External Elastic Membrane in Patients of Acute Coronary Syndrome

    Institute of Scientific and Technical Information of China (English)

    宋达琳; 祝庆; 刘国树; 康维强

    2011-01-01

    Objective: To investigate the characteristics of coronary ranodeling for Ixnen stenosis accompanied witi enlarged external elastic manbrane( EEM) in patients of acute coronary syndrane( ACS).Methods: We stidiedlCB ACS patients who received elective coronary artery angfography and MJS,103 target lesions were compared witi the reference vessel sites Accoiriing to ranodeling indej( Rl) , the patients were divided as positive ranodeling RI>1 ,n=67 and negative ranodeling RISl ,n=36. The ratio of Ixnen stenosis was defined as the target Ixnen area/ the average reference Ixnen cross section area The plaque parameters, Imen stenosis and EEM conditions were analyzed between two groups of patientsResults; There were5 patients witi the sane Ixnen area to reference vessels, 1 patient witiout the lesion at the reference vessel site 102 patientswiti lesions at reference vessels presented tiat tiere were more plaque at target lesion tian the near site and ranote site of reference vessel as(71. 76 ±9. 17)% , (39. 76 ±12.54)% and(32.38 ±13. 97)% , more dminished hxnen area at target lesion a<3. 81±1. 09) mm , (8. 91±2. 43) mm and(9. 03 ±2. 16) mm ; the target lesion had decreased EEM tian ranote site of reference vessel as( 14. 71 ±2. 89) mm vs(28.37 ±4. 48) mm ,P<0. 001 respectively The ratio ofhxnen stenosis was negatively related to plaque buirien,r=-0. 84,P<0. 001 and positively related to ixnen area,r=0. 70,P =0. 007. There were no statistical relationship between RI and other parametersConclusion: ACS patients have coronary artery bi-direction ranodeling as humen stenosis accompanied with enlarged EEM The ratio of humen stenosis might be an mportant factor for evaluating coronary artery ranodeling.%目的:应用血管内超声评估冠状动脉(冠脉)管腔狭窄伴外弹力膜扩张性血管重构的临床研究.方法:103例急性冠状动脉综合症(ACS)患者,男68例,女35例,年龄平均(60±11)岁;常规冠脉造影,血管内超声检测103处靶病变和

  5. Takotsubo Cardiomyopathy With Significant Coronary Stenosis and Atrioventricular Conduction Block: A Rare Case Report With 3 Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Saadatifar

    2015-12-01

    Full Text Available Introduction Takotsubo cardiomyopathy (TCMP is a rare acute cardiomyopathy characterized by acute chest pain syndrome, similar to myocardial infarction, except that no significant stenosis is observed on coronary angiography in patients with this condition; these findings aid the diagnosis of TCMP. Case Presentation We discuss an unusual case of TCMP in a 45-year-old woman with complete heart block and significant coronary artery stenosis. Maximal exercise test and perfusion scan after 1 month from the acute event did not show any ischemia; therefore, revascularization was not recommended. Her follow-up with normal echocardiographic data 3 years after the first event showed no recurrence Conclusions The present case and a few previous cases have showed that severe coronary artery disease may be occur in patients with TCMP and that TCMP may be associated with a high-degree atrioventricular block. The association between atrioventricular conduction block and TCMP as well as significant coronary stenosis is rarely reported; therefore, coronary angiography should be performed in all patients with clinical TCMP and the previous definition should be reconsidered. The occurrence of arrhythmia and later recovery is expected in these patients (due to a catecholamine surge.

  6. The influence of stenosis degrees and graft suture position on local hemodynamics of coronary bypass

    Science.gov (United States)

    Totorean, A. F.; Bernad, S. I.; Susan-Resiga, R. F.

    2016-06-01

    Bypass graft failure is mainly caused by intimal hyperplasia (IH) that occurs at the graft anastomosis after coronary artery bypass grafting (CABG) surgery. It has been shown that local hemodynamics influences the process of IH initiation and progression. A main concern at this type of surgery is to increase the graft patency, respectively to improve the local hemodynamics. This paper analyzes the influence of different degree of stenosis severity and graft suture position on graft patency, taking into consideration the local hemodynamics. Bypass configurations with anastomosis angle of 45° were numerically investigated, with respect to wall shear stress and pressure variation. We can assume that in the conditions of our study, different stenosis degrees and position of the graft suture influence the local blood flow conditions, and, nevertheless, the graft patency.

  7. CT Angiographic Analysis of Carotid Artery Stenosis: Comparison of Manual Assessment, Semiautomatic Vessel Analysis, and Digital Subtraction Angiography

    National Research Council Canada - National Science Library

    Silvennoinen, H.M; Ikonen, S; Soinne, L; Railo, M; Valanne, L

    2007-01-01

    ...) in detection and grading of carotid artery bifurcation stenosis. METHODS: Consecutive patients with sonography evidence of a marked internal carotid artery stenosis underwent both carotid CTA and DSA...

  8. Applicability of 3-Dimensional Quantitative Coronary Angiography-Derived Computed Fractional Flow Reserve for Intermediate Coronary Stenosis.

    Science.gov (United States)

    Yazaki, Kyoichiro; Otsuka, Masato; Kataoka, Shohei; Kahata, Mitsuru; Kumagai, Asako; Inoue, Koji; Koganei, Hiroshi; Enta, Kenji; Ishii, Yasuhiro

    2017-06-23

    Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).Methods and Results:We analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined contrast flow QFR, which was derived from 3-dimensional quantitative coronary angiography (3-D QCA) withThrombolysis in Myocardial Infarction (TIMI) frame counts, was compared with FFR as a reference. QFR had good correlation (r=0.80, P<0.0001) and agreement (mean difference: 0.01±0.05) with FFR. After applying the FFR cut-off ≤0.8, the overall accuracy rate of QFR ≤0.8 was 88.0%. On receiver operating characteristics analysis, the area under the curve was 0.93 for QFR. In contrast, 3-D QCA-derived anatomical indices had insufficient correlation with FFR and diagnostic performance compared with QFR. QFR had good correlation and agreement with FFR and high diagnostic performance in the evaluation of intermediate coronary stenosis, suggesting that QFR may be an alternative tool for estimating myocardial ischemia.

  9. Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries

    Directory of Open Access Journals (Sweden)

    İsmet Dindar

    2012-06-01

    Full Text Available A 71-year-old woman with chest pain occurring on physicalexercise was admitted to cardiology department.Myocardial perfusion scintigraphy revealed inferior andanteroapical segment hypoperfusion. Selective coronaryangiography revealed multiple coronary-cameral fistulasoriginating from the left anterior descending artery andthe right coronary artery and emptying into the left ventriclewithout any significant coronary artery stenosis. Coronaryartery fistulas are defined as abnormal communicationsbetween a coronary artery and a cardiac chamber ormajor vessel. Coronary-cameral fistulas terminating in theleft ventricle are uncommon. Small fistulas usually do notcause any hemodynamic compromise. However, the largerand multiple fistulas may cause myocardial ischemiaascribed to a coronary steal phenomenon. The best wayto manage cameral fistulae is uncertain largely due to therarity of the condition. In the present case, anti-ischemicmedications with metoprolol 50 mg/day provided an uneventfulfollow-up of six months without any intervention.

  10. Significance of noncalcified coronary plaque in asymptomatic subjects with low coronary artery calcium score: assessment with coronary computed tomography angiography.

    Science.gov (United States)

    Yoo, Dong Hyun; Chun, Eun Ju; Choi, Sang Il; Kim, Jeong A; Jin, Kwang Nam; Yeon, Tae-Jin; Choi, Dong-Ju

    2011-12-01

    We aimed to investigate the prevalence and severity of noncalcified coronary plaques (NCP) using coronary CT angiography (CCTA) and analyze predictors of significant coronary stenosis by NCP in asymptomatic subjects with low coronary artery calcium score (CACS). The institutional review board approved this retrospective study and all patients gave written, informed consent. The presence of plaque, severity of stenosis, plaque characteristics, and CACS were assessed in 7,515 asymptomatic subjects. We evaluated the prevalence and severity of NCP in subjects having low CACS (707 subjects; men with CACS from 1 to 50 and women from 1 to 10) in comparison to those having 0 CACS (6,040 subjects) as the reference standard. Conventional risk factors were assessed for predictors of NCP and significant stenosis by NCP. We also investigated the cardiac events of the patients through medical records. Compared to subjects with 0 CACS, those with low CACS showed higher prevalence of NCP (6.9% vs. 31.5%, P NCP (0.8% vs. 7.5%, P NCP included diabetes mellitus (DM), hypertension, and elevated low-density lipoprotein (LDL)-cholesterol (all P NCP were classified into the low to intermediate risk according to Framingham Risk Score. At the median follow up of 42 months (range: 3-60 months), cardiac events were significantly higher in the low CACS group compared to the 0 CACS group (2.6% vs. 0.27%, P NCP were higher as compared to subjects having zero CACS and predictors of significant stenosis by NCP were DM, hypertension and LDL-Cholesterol. Therefore, CCTA may be useful for risk stratification of coronary artery disease as added value over CACS in selected populations with low CACS who have predictors of significant NCP.

  11. Cone pathway function in relation to asymmetric carotid artery stenosis

    DEFF Research Database (Denmark)

    Kofoed, Peter Kristian; Munch, Inger Christine; Holfort, Stig K;

    2013-01-01

    in the same patient. Results:  Ophthalmic systolic pressure was 95.8 ± 13.1 mmHg on the side with the highest degree of carotid artery stenosis (mean 94.0%) and 111.7 ± 10.3 mmHg in the fellow eyes on the side with the lesser degree of stenosis (mean 33.9%). Summed mfERG implicit times (N1 and P1) were 3......Purpose:  To examine retinal function in relation to retinal perfusion pressure in patients with carotid artery stenosis. Methods:  Thirteen patients with carotid artery stenosis without clinical eye disease underwent assessment of ophthalmic artery systolic blood pressure (OSP) by ocular...... pneumoplethysmography, carotid artery obstructive disease by ultrasonography, intraocular pressure by applanation tonometry, retinal perfusion by fluorescein angiography and retinal function by multifocal electroretinography (mfERG). Data analysis compared the eye on the most stenotic side with the fellow eye...

  12. Cardiac CT angiography after coronary artery surgery in children using 64-slice CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Davide; Agnoletti, Gabriella [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); Brunelle, Francis [University Paris Descartes, UFR Necker-Enfants Malades, Department of Pediatric Radiology, APHP, Paris (France); Sidi, Daniel; Bonnet, Damien [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); Ou, Phalla [Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Universite Paris Descartes, UFR Necker-Enfants Malades, Paris (France); University Paris Descartes, UFR Necker-Enfants Malades, Department of Pediatric Radiology, APHP, Paris (France)], E-mail: phalla.ou@nck.aphp.fr

    2009-09-15

    Objective: The purpose of this study was to compare the diagnostic accuracy of 64-slice CT with that of invasive angiography in the detection of graft and/or coronary angioplasty stenosis in children who had undergone coronary artery surgery. Population and methods: Fifteen consecutive children (8 male and 7 female; age 9.2 {+-} 6.1 years) underwent 64-slice CT because of chest pain or ECG changes mean 4.8 {+-} 3.7 years after surgical coronary artery surgery; 10 patients had coronary angioplasty using a patch from the saphenous vein, four had mammary artery bypass, and one had saphenous vein bypass. Six main segments of the coronary arteries and all the bypass graft considered as a single segment were analyzed and compared with invasive angiography used as the reference standard. Results: CT correctly identified the four children with coronary angioplasty and mammary graft lesions that were confirmed by conventional angiography: one patient had a significant stenosis (>50% stenosis) at the mammary bypass graft anastomosis site; three other had non-significant stenosis (<50% stenosis) including a mild lesion of the saphenous vein patch in two patients and a mild lesion at the anastomosis site of the mammary bypass in one. All segments identified as normal by CT in the other 11 children were also found to be normal by conventional angiography. Conclusion: In centers expert in this technique, 64-slice CT scanning is a promising, rapid, and useful diagnostic technique for evaluating both coronary angioplasty and bypass graft lesions in children who had undergone coronary artery surge0008.

  13. 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.

  14. Radiation induced renal arterial stenosis detected by color duplex ultrasonography: case report

    Institute of Scientific and Technical Information of China (English)

    Jing Gao; Byong K Park; Arnold Alday

    2005-01-01

    Renal artery stenosis as a complication from radiation therapy is not common, but it is life threatening and needs to be corrected urgently in order to prevent renal failure even losing kidney. The diagnostic criteria of renal artery stenosis in the adults by color duplex ultrasonography have been established, which may play an important role in screening radiation induced renal artery stenosis.

  15. Subclavian artery stenosis caused by a prominent first rib

    Directory of Open Access Journals (Sweden)

    Isabelle Claus

    2015-04-01

    Full Text Available Thoracic outlet syndrome is a mechanical space problem in which the brachial plexus and/or subclavian vessels are compressed. Arterial compression is least common and almost always associated with a bony anomaly. We present a case of a 49-year-old woman with a prominent first rib which caused a subclavian artery stenosis. There are many options for subclavian artery repair through open surgery. In high-risk patients, minimal invasive techniques are favorable. To date, few case reports exist on an endovascular artery repair combined with open first rib resection. While long-term follow-up will be necessary, our preliminary results seem promising.

  16. 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

  17. 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

  18. Dual-source computed tomographic coronary angiography: image quality and stenosis diagnosis in patients with high heart rates.

    Science.gov (United States)

    Zheng, Minwen; Li, Jiayi; Xu, Jian; Chen, Kang; Zhao, Hongliang; Huan, Yi

    2009-01-01

    We sought to evaluate prospectively the effects of heart rate and heart-rate variability on dual-source computed tomographic coronary image quality in patients whose heart rates were high, and to determine retrospectively the accuracy of dual-source computed tomographic diagnosis of coronary artery stenosis in the same patients.We compared image quality and diagnostic accuracy in 40 patients whose heart rates exceeded 70 beats/min with the same data in 40 patients whose heart rates were 70 beats/min or slower. In both groups, we analyzed 1,133 coronary arterial segments. Five hundred forty-five segments (97.7%) in low-heart-rate patients and 539 segments (93.7%) in high-heart-rate patients were of diagnostic image quality. We considered P coronary artery, nor were any significant differences found between the groups in the accurate diagnosis of angiographically significant stenosis.Calcification was the chief factor that affected diagnostic accuracy. In high-heart-rate patients, heart-rate variability was significantly related to the diagnostic image quality of all segments (P = 0.001) and of the left circumflex coronary artery (P = 0.016). Heart-rate variability of more than 5 beats/min most strongly contributed to an inability to evaluate segments in both groups. When heart rates rose, the optimal reconstruction window shifted from diastole to systole.The image quality of dual-source computed tomographic coronary angiography at high heart rates enables sufficient diagnosis of stenosis, although variability of heart rates significantly deteriorates image quality.

  19. Left main coronary artery obstruction by dislodged native-valve calculus after transcatheter aortic valve replacement.

    Science.gov (United States)

    Durmaz, Tahir; Ayhan, Huseyin; Keles, Telat; Aslan, Abdullah Nabi; Erdogan, Kemal Esref; Sari, Cenk; Bilen, Emine; Akcay, Murat; Bozkurt, Engin

    2014-08-01

    Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement.

  20. [Left-ventricular function and physical exertion tolerance in patients with myocardial infarction with isolated lesion of the coronary arteries].

    Science.gov (United States)

    Golikov, A P; Levshunov, S P; Belozerov, G E

    1989-01-01

    Myocardial infarction area and left-ventricular myocardial contractility, determined by sectoral scanning, and exercise tolerance were assessed in 47 myocardial infarction patients with isolated coronary arterial lesions. The area under myocardial infarction was shown to be dependent on the site of the atherosclerotic process rather than the degree of stenosis in patients with isolated coronary arterial lesions. A relationship was established between the incidence of complications developing in the acute phase of infarction and the degree of stenosis. The disease was complicated more frequently in patients with coronary arterial occlusion as compared to those with severe coronary-arterial stenosis. High stress tolerance, irrespective of the site of myocardial infarction, is an evidence of great functional potentials in this category of patients.

  1. How to manage hypertension with atherosclerotic renal artery stenosis?

    Science.gov (United States)

    Ricco, Jean-Baptiste; Belmonte, Romain; Illuminati, Guilio; Barral, Xavier; Schneider, Fabrice; Chavent, Bertrand

    2017-04-01

    The management of atherosclerotic renal artery stenosis (ARAS) in patients with hypertension has been the topic of great controversy. Major contemporary clinical trials such as the Cardiovascular Outcomes for Renal Artery lesions (CORAL) and Angioplasty and Stenting for Renal Atherosclerotic lesions (ASTRAL) have failed to show significant benefit of revascularization over medical management in controlling blood pressure and preserving renal function. We present here the implications and limitations of these trials and formulate recommendations for management of ARAS.

  2. Levels of plasma RANTES and MMP-9 and their correlation to coronary artery stenosis in patients with coronary heart disease%冠心病患者血浆RANTES及MMP-9水平及与冠状动脉狭窄的相关性研究

    Institute of Scientific and Technical Information of China (English)

    徐娅楠; 赵亚珍; 浦奎

    2011-01-01

    Objective To investigate the levels of plasma regulated on activation normal T cell expressed and secreted ( RANTES ) and matrix metalloproteinase-9 ( MMP-9 ) and their correlation to coronary artery stenosis in patients with coronary heart disease ( CHD ). Methods The hospitalized patients with CHD ( n =64) were chosen, a-mong them 26 with unstable angina ( UA group ),16 with acute myocardial infarction ( AMI group ),and 22 with stable angina ( SA group ). At the same time 20 cases with normal coronary angiography ( CAG ) were chosen as the control group. The levels of plasma MMP-9 and RANTES were detected, compared and analyzed by using enzyme-linked immu-nosorbent assay ( ELISA ). Results The levels of plasma MMP-9 and RANTES were significantly higher in UA group and AMI group than those in SA group and control group ( P <0. 01 ),higher in AMI group than those in UA group ( P <0. 05 ) ,and higher in SA group than those in control group without statistical significance ( P >0. 05 ). The concentration of plasma RANTES was greatly correlated to MMP-9 among UA group, AMI group and SA group ( r =0.794,P < 0.01 ),plasma RANTES concentration was greatly correlated to Gensini score ( r =0. 874,P <0.01 ),and Gensini score was greatly correlated to plasma MMP-9 concentration ( r =0.716,P <0. 01 ). Conclusion The expressions of RANTES and MMP-9 increase in the plasma of patients with acute coronary syndrome and are correlated to the degree of coronary artery stenosis.%目的 探讨冠心病患者血浆调节正常T细胞表达和分泌的细胞因子(RANTES)及基质金属蛋白酶-9(MMP-9)的水平及与冠状动脉狭窄的相关性.方法 选取住院的冠心病患者64例,其中不稳定性心绞痛患者26例(UA组)及急性心肌梗死患者16例(AMI组),稳定性心绞痛患者22例(SA组),同期冠状动脉造影正常的20例患者作为对照组.采用酶联免疫吸附法测定各组血浆MMP-9及RANTES含量,并进行对比分析.结果 血浆MMP-9

  3. Clinical analysis of 132 patients with atherosclerotic renal artery stenosis

    Institute of Scientific and Technical Information of China (English)

    徐红

    2006-01-01

    Objective To evaluate the prognostic result of renal function on atherosclerotic renal artery stenosis (ARAS) patients after revascularization and medication therapy. Methods The clinical data of 132 AEIAS patients diagnosed by renal angiography were analysed. For comparing the differences of glomenilar filtration rate (GFR) be-

  4. Angioplasty and stent treatment of transplant renal artery stenosis.

    Science.gov (United States)

    Del Pozo, Maitane; Martí, Jordi; Guirado, Lluís; Facundo, Carme; Canal, Cristina; de la Torre, Pablo; Ballarín, José; Díaz, Joan M

    2012-07-17

    Transplant renal artery stenosis is a major complication that requires a therapeutic approach involving surgery or angioplasty. The aim of this study was to analyse the evolution of renal transplant patients with renal allograft artery stenosis treated by angioplasty and stent placement. Thirteen patients were diagnosed with transplant renal artery stenosis. Clinical suspicion was based on deterioration of renal function and/or poorly controlled hypertension with compatible Doppler ultrasound findings. The diagnosis was confirmed by arteriography, performing an angioplasty with stent placement during the same operation. A progressive improvement in renal function was observed during the first 3 months after the angioplasty, and renal function then remained stable over 2 years. In addition, blood pressure improved during the first 2 years, and as a consequence there was no need to increase the average number of anti-hypertensive drugs administered (2.5 drugs per patient). In conclusion, angioplasty with stent placement is a safe and effective procedure for the treatment of transplant renal artery stenosis.

  5. Elevated NT-proBNP and coronary calcium score in relation to coronary artery disease in asymptomatic type 2 diabetic patients with elevated urinary albumin excretion rate

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Hansen, Peter R; Persson, Frederik;

    2011-01-01

    Elevated plasma N-terminal (NT)-proBNP levels and coronary calcium score (CCS) not only predicts myocardial ischaemia and coronary artery stenosis but also adverse cardiovascular events and mortality in type 2 diabetic patients with an increased urinary albumin excretion rate (UAER), whereas low...

  6. Coronary CT angiography: IVUS image fusion for quantitative plaque and stenosis analyses

    Science.gov (United States)

    Marquering, Henk A.; Dijkstra, Jouke; Besnehard, Quentin J. A.; Duthé, Julien P. M.; Schuijf, Joanne D.; Bax, Jeroen J.; Reiber, Johan H. C.

    2008-03-01

    Rationale and Objective: Due to the limited temporal and spatial resolution, coronary CT angiographic image quality is not optimal for robust and accurate stenosis quantification, and plaque differentiation and quantification. By combining the high-resolution IVUS images with CT images, a detailed representation of the coronary arteries can be provided in the CT images. Methods: The two vessel data sets are matched using three steps. First, vessel segments are matched using anatomical landmarks. Second, the landmarks are aligned in cross-sectional vessel images. Third, the semi-automatically detected IVUS lumen contours are matched to the CTA data, using manual interaction and automatic registration methods. Results: The IVUS-CTA fusion tool facilitates the unique combined view of the high-resolution IVUS segmentation of the outer vessel wall and lumen-intima transitions on the CT images. The cylindrical projection of the CMPR image decreases the analysis time with 50 percent. The automatic registration of the cross-vessel views decreases the analyses time with 85 percent. Conclusions: The fusion of IVUS images and their segmentation results with coronary CT angiographic images provide a detailed view of the lumen and vessel wall of coronary arteries. The automatic fusion tool makes such a registration feasible for the development and validation of analysis tools.

  7. Multimodality imaging of coronary artery bypass grafts

    NARCIS (Netherlands)

    Salm, Liesbeth Pauline

    2006-01-01

    This thesis describes multiple imaging modalities to examine coronary artery bypass grafts, and the research which was performed to further develop noninvasive imaging techniques to detect stenoses in native coronary arteries and bypass grafts in patients who experienced recurrent chest pain after

  8. Multimodality imaging of coronary artery bypass grafts

    NARCIS (Netherlands)

    Salm, Liesbeth Pauline

    2006-01-01

    This thesis describes multiple imaging modalities to examine coronary artery bypass grafts, and the research which was performed to further develop noninvasive imaging techniques to detect stenoses in native coronary arteries and bypass grafts in patients who experienced recurrent chest pain after c

  9. Ostial left main coronary stenosis in a frequent flyer.

    LENUS (Irish Health Repository)

    O'Sullivan, John F

    2009-05-15

    A 52 year old gentleman presented with chest pain, after a long distance flight from India; he had made long haul flights every 2 weeks over the last 5 years as part of his job. His ECG revealed T wave inversion in leads V1-3. Cardiac biomarkers including troponin were negative; we proceeded to exercise stress testing (EST). This revealed 2 mm ST depression at 2 min of the standard Bruce protocol, associated with chest pain. He was taken immediately to the coronary catheterization laboratory; engagement of the left main caused pressure damping with 6 French, then 5 French diagnostic Judkins left 4 catheters. An ostial left main stenosis was seen; the right and left coronary trees otherwise had no significant stenoses. He had normal LV function. He underwent inpatient CABG 7 days later.

  10. Coronary artery calcium score: current status

    Science.gov (United States)

    Neves, Priscilla Ornellas; Andrade, Joalbo; Monção, Henry

    2017-01-01

    The coronary artery calcium score plays an Important role In cardiovascular risk stratification, showing a significant association with the medium- or long-term occurrence of major cardiovascular events. Here, we discuss the following: protocols for the acquisition and quantification of the coronary artery calcium score by multidetector computed tomography; the role of the coronary artery calcium score in coronary risk stratification and its comparison with other clinical scores; its indications, interpretation, and prognosis in asymptomatic patients; and its use in patients who are symptomatic or have diabetes. PMID:28670030

  11. 血管内超声评价国产瑞舒伐他汀对冠状动脉轻中度狭窄病变的影响%Effects of domestic rosuvastatin on coronary plaque in patients with mild-to-moderate coronary artery stenosis as evaluated by virtual histology-intravascular ultrasound

    Institute of Scientific and Technical Information of China (English)

    杨海波; 赵晓燕; 赵荫涛; 张金盈; 李凌

    2012-01-01

    目的 应用虚拟组织学-血管内超声(VH-IVUS)评价国产瑞舒伐他汀对急性冠脉综合征患者冠状动脉轻中度狭窄病变斑块进展及成分的影响.方法 选择经冠状动脉造影(CAG)和VHIVUS检查无需介入治疗的冠脉轻中度狭窄病变患者83例,分为试验组42例和对照组41例,试验组给予国产瑞舒伐他汀(瑞旨10 mg,每晚1次),对照组给予进口瑞舒伐他汀(可定10 mg,每晚1次),治疗6个月后复查血脂、CAG及VH-IVUS,比较两组间血脂变化、定量冠脉造影分析靶病变处直径狭窄(DS)变化,VH-IVUS分析靶病变处斑块负荷、最小管腔面积(MLA)和斑块成分变化.结果 瑞舒伐他汀干预6个月后,VH-IVUS分析显示,两组患者斑块坏死核心比例比治疗前明显减少(试验组:14.8%±7.0%比22.6%±7.5%,P<0.05,对照组:14.9%±7.1%比23.1% ±7.7%,P<0.05)、纤维组织比例明显增加(试验组:51.5%±9.9%比44.5%±9.7%,P< 0.05,对照组:51.4%±10.1%比44.3%±9.8%,P<0.05),两组患者血脂水平明显改善(P<0.05),而DS、斑块负荷、MLA、纤维脂质组织比例、钙化组织比例无明显变化(P>0.05).结论 国产瑞舒伐他汀治疗冠脉轻中度狭窄病变可稳定斑块,并延缓斑块进一步发展.%Objective To evaluate the effects of domestic rosuvastatin tablets on coronary plaque in the patients with mild-to-moderate coronary artery stenosis through virtual histology-intravascular ultrasound (VH-IVUS).Methods Eighty-three patients with mild-to-moderate coronary artery stenosis of acute coronary syndrome( ACS)were enrolled and randomized into test group (domestic rosuvastatin,10 mg/day,n =42) or control group ( CRESTOR,10 mg/day,n =41 ).The serum lipid levels,diameter stenosis (DS)on quantitative coronary angiography (QCA),MLA (minimal lumen area),plaque burden and component of target lesion on VH-IVUS were evaluated at baseline and at 6-month follow-up.Results After 6 months,the levels of

  12. Spontaneous Coronary Artery Dissection with Cardiac Tamponade.

    Science.gov (United States)

    Goh, Anne C H; Lundstrom, Robert J

    2015-10-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.

  13. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS): prevalence and outcome

    NARCIS (Netherlands)

    Compter, A.; Hoeven, E.J. van der; Worp, H.B. van der; Vos, J.A.; Weimar, C.; Rueckert, C.M.; Kappelle, L.J.; Algra, A.; Schonewille, W.J.; Leeuw, F.E. de

    2015-01-01

    We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT an

  14. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS) : prevalence and outcome

    NARCIS (Netherlands)

    Compter, Annette; van der Hoeven, Erik J R J; van der Worp, H. Bart; Vos, Jan Albert; Weimar, Christian; Rueckert, Christina M.; Kappelle, L. Jaap; Algra, Ale; Schonewille, Wouter J.; Vergouwen, MD

    2015-01-01

    We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT an

  15. Coronary artery anomalies in Turner Syndrome

    DEFF Research Database (Denmark)

    Viuff, Mette H; Trolle, Christian; Wen, Jan;

    2016-01-01

    BACKGROUND: Congenital heart disease, primarily involving the left-sided structures, is often seen in patients with Turner Syndrome. Moreover, a few case reports have indicated that coronary anomalies may be more prevalent in Turner Syndrome than in the normal population. We therefore set out...... to systematically investigate coronary arterial anatomy by computed tomographic coronary angiography (coronary CTA) in Turner Syndrome patients. METHODS: Fifty consecutive women with Turner Syndrome (mean age 47 years [17-71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. RESULTS......: Coronary anomaly was more frequent in patients with Turner Syndrome than in healthy controls [20% vs. 4% (p = 0.043)]. Nine out of ten abnormal cases had an anomalous left coronary artery anatomy (absent left main trunk, n = 7; circumflex artery originating from the right aortic sinus, n = 2). One case had...

  16. Computer-aided stenosis detection at coronary CT angiography: effect on performance of readers with different experience levels

    Energy Technology Data Exchange (ETDEWEB)

    Thilo, Christian [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Herzzentrum Augsburg-Schwaben, Department of Cardiology, Klinikum Augsburg, Augsburg (Germany); Gebregziabher, Mulugeta [Medical University of South Carolina, Department of Biostatistics, Bioinformatics and Epidemiology, Charleston, SC (United States); Meinel, Felix G.; Arnoldi, Elisabeth M. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich (Germany); Goldenberg, Roman [Rcadia Medical Imaging, Haifa (Israel); Nance, John W.; Soma, Lashonda D.; Ebersberger, Ullrich; Blanke, Philip; Coursey, Richard L. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Rosenblum, Michael A.; Zwerner, Peter L. [Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States)

    2014-10-15

    To evaluate the effect of a computer-aided detection (CAD) algorithm for coronary CT angiography (cCTA) on the performance of readers with different experience levels. We studied 50 patients (18 women, 58 ± 11 years) who had undergone cCTA and quantitative coronary angiography (QCA). Eight observers with varying experience levels evaluated all studies for ≥50 % coronary artery stenosis. After 3 months, the same observers re-evaluated all studies, this time guided by a CAD system. Their performance with and without the CAD system (sensitivity, specificity, positive predictive value and negative predictive value) was assessed using the Likelihood Ratio Χ{sup 2} test both at the per-patient and per-vessel levels. The sensitivity of the CAD system alone for stenosis detection was 71 % per-vessel and 100 % per-patient. There were 54 false positive (FP) findings within 199 analyzed vessels, most of them associated with non-obstructive (<50 %) lesions. With CAD, one (out of three, 33 %) inexperienced reader's per-patient sensitivity and negative predictive value significantly improved from 79 % to 100 % (P = 0.046) and from 90 % to 100 % (P = 0.034), respectively. Other readers' performance indices showed no statistically significant change. Our results suggest that CAD can improve some inexperienced readers' sensitivity for diagnosing coronary artery stenosis at cCTA. (orig.)

  17. Molecular imaging of plaques in coronary arteries with PET and SPECT

    Institute of Scientific and Technical Information of China (English)

    Zhong-Hua SUN; Hairil Rashmizal; Lei XU

    2014-01-01

    Coronary artery disease remains a major cause of mortality. Presence of atherosclerotic plaques in the coronary artery is responsible for lu-men stenosis which is often used as an indicator for determining the severity of coronary artery disease. However, the degree of coronary lumen stenosis is not often related to compromising myocardial blood flow, as most of the cardiac events that are caused by atherosclerotic plaques are the result of vulnerable plaques which are prone to rupture. Thus, identification of vulnerable plaques in coronary arteries has become increas-ingly important to assist identify patients with high cardiovascular risks. Molecular imaging with use of positron emission tomography (PET) and single photon emission computed tomography (SPECT) has fulfilled this goal by providing functional information about plaque activity which enables accurate assessment of plaque stability. This review article provides an overview of diagnostic applications of molecular imaging tech-niques in the detection of plaques in coronary arteries with PET and SPECT. New radiopharmaceuticals used in the molecular imaging of coro-nary plaques and diagnostic applications of integrated PET/CT and PET/MRI in coronary plaques are also discussed.

  18. Spontaneous Coronary Artery Dissection: Case Report Review of the Literature

    Directory of Open Access Journals (Sweden)

    Kemal Karaağaç

    2013-03-01

    Full Text Available Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome with a high risk of mortality. The clinical presentation is similar to the atherosclerotic coronary artery disease. The diagnosis is usually made by coronary angiography. Spontaneous coronary artery dissection is more common in women than men. Fast and accurate diagnosis and treatment of spontaneous coronary artery dissection patients improves survival. Therapeutic options include surgery, percutaneous coronary intervention and medical therapy.

  19. Single Coronary Artery with Anomalous Origin of the Right Coronary Artery from the Distal Portion of Left Circumflex Artery: A Very Rare Case

    Directory of Open Access Journals (Sweden)

    MohammadReza Pourbehi

    2015-10-01

    Full Text Available Congenital anomalies of coronary arteries, albeit rare, may be significant contributors to angina pectoris, hemodynamic abnormalities, and sudden cardiac death. A 47-year-old man referred to us with atypical chest pain. Electrocardiography demonstrated no significant ischemic changes, but cardiac troponin I test was positive. The patient underwent coronary angiography, which revealed a single coronary artery from the left Valsalva sinus. In addition, the left anterior descending (LAD and the left circumflex (LCx arteries were in normal position with significant stenosis in the mid-portion of the LAD and the distal portion of the LCx. A large branch originated from the distal portion of the LCx and tapered toward the proximal portion as the right coronary artery (RCA. This is a rare coronary anomaly that has no ischemic result. Coronary lesions were the cause of the patient’s angina pectoris. Angioplasty and stenting of the LAD and LCx was done, and medical therapy (Clopidogrel, Aspirin, Atorvastatin, and Metoprolol was continued. The patient was asymptomatic at 8 months’ follow-up.

  20. Resting {sup 123}I-BMIPP scintigraphy for detection of organic coronary stenosis and therapeutic outcome in patients with chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Yamabe, Hiroshi; Fujiwara, Sei; Rin, Kouten; Ando, Makoto; Yokoyama, Mitsuhiro [Kobe Univ. (Japan). School of Medicine; Sakamoto, Takaaki; Ishida, Toshiharu; Itagane, Hiroshi; Mori, Takao

    2000-06-01

    Resting {sup 123}I-BMIPP scintigraphy can detect coronary artery disease based on persistent abnormality of myocardial fatty acid metabolism after transient ischemia. The present study aimed to determine the value of resting {sup 123}I-BMIPP scintigraphy in diagnosing coronary artery disease and predicting the therapeutic outcome in patients with chest pain symptom. Five hospitals participated in this study, and scintigraphic and angiographic studies were performed in 104 patients without myocardial infarction. Twenty of them had non-coronary artery disease (chest pain syndrome), 26 had stable effort angina, 35 had unstable angina with organic coronary lesions, and 23 had vasospastic angina without significant organic stenosis. Overall sensitivity for diagnosing angina pectoris (stable, unstable and vasospastic) was 45%, and overall specificity for excluding non-coronary artery disease was 80%. The incidence of positive {sup 123}I-BMIPP was 54% among patients with organic coronary stenosis (50% in stable angina and 61% in unstable angina with organic stenosis), but it was low (22%) in vasospastic angina without organic stenosis. Patients with advanced coronary stenosis and multi-vessel disease were found to have a higher incidence of positive {sup 123}I-BMIPP. A positive {sup 123}I-BMIPP result was correlated with a higher rate of subsequent intervention therapy (catheter intervention or CABG) than a negative result (48% versus 27%, p=0.03 at one month; and 63% versus 35%, p=0.008 at one year). Resting {sup 123}I-BMIPP scintigraphy was valuable in detecting advanced coronary lesions in angina patients associated with a high incidence of subsequent intervention therapy. (author)

  1. Coronary artery anatomy of the goat.

    Science.gov (United States)

    Lipovetsky, G; Fenoglio, J J; Gieger, M; Srinivasan, M R; Dobelle, W H

    1983-05-01

    The coronary arteries of the goat heart were studied using angiographic techniques and molds of the coronary vessel trees. Blood supplies to the left and right ventricles, interventricular septum, atrioventricular node, and apex of the caprine heart were studied. The goat possesses a left dominant pattern of coronary supply with relatively uniform coronary anatomy and may provide a good large animal model for testing cardiovascular assist devices.

  2. 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.

  3. Acute upregulation of COX-2 by renal artery stenosis

    DEFF Research Database (Denmark)

    Mann, Birgitte; Hartner, A; Jensen, B L

    2001-01-01

    This study aimed to characterize the influence of acute renal artery stenosis on cyclooxygenase-2 (COX-2) and renin expression in the juxtaglomerular apparatus. For this purpose, male Sprague-Dawley rats received a left renal artery clip, and COX-2 mRNA, COX-2 immunoreactivity, plasma renin...... causal relationship between the changes of COX-2 and of renin expression, clipped rats were treated with the COX-2 blocker celecoxib (40 mg. kg(-1). day(-1)). This treatment, however, did not change renin mRNA either in the clipped or in the contralateral intact kidney. Our findings indicate that renal...... artery stenosis causes ipsilaterally an acute upregulation and contralaterally a downregulation of juxtaglomerular COX-2 expression. The lacking effect of celecoxib on renin gene expression does not support the concept of a direct mediator function of COX-2-derived prostaglandins in the control of renin...

  4. Acute upregulation of COX-2 by renal artery stenosis

    DEFF Research Database (Denmark)

    Mann, Birgitte; Hartner, A; Jensen, B L

    2001-01-01

    This study aimed to characterize the influence of acute renal artery stenosis on cyclooxygenase-2 (COX-2) and renin expression in the juxtaglomerular apparatus. For this purpose, male Sprague-Dawley rats received a left renal artery clip, and COX-2 mRNA, COX-2 immunoreactivity, plasma renin...... activity, and renin mRNA levels were determined. COX-2 mRNA and COX-2 immunoreactivity in the macula densa region in the clipped kidneys increased as early as 6 h after clipping and reached a maximal expression 1-2 days after clipping. Although values for plasma renin activity were elevated markedly at all...... artery stenosis causes ipsilaterally an acute upregulation and contralaterally a downregulation of juxtaglomerular COX-2 expression. The lacking effect of celecoxib on renin gene expression does not support the concept of a direct mediator function of COX-2-derived prostaglandins in the control of renin...

  5. Percutaneous transluminal angioplasty of the left subclavian artery to prevent or treat the coronary-subclavian steal syndrome.

    Science.gov (United States)

    Marques, K M; Ernst, S M; Mast, E G; Bal, E T; Suttorp, M J; Plokker, H W

    1996-09-15

    A hemodynamic significant left subclavian artery stenosis or occlusion proximal to the origin of the left internal mammary artery (LIMA) can result in an impaired or reversed flow through the LIMA and the coronary artery to which it has been anastomosed. In this study, we report on our immediate and long-term follow-up results in 31 consecutive patients who underwent percutaneous transluminal coronary angioplasty of the left subclavian artery shortly before or after coronary artery bypass grafting with use of the LIMA.

  6. Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing

    NARCIS (Netherlands)

    I. Cho (Iksung); Ó Hartaigh, B. (Bríain); H. Gransar (Heidi); V. Valenti (Valentina); F.Y. Lin (Fay); S. Achenbach (Stephan); D.S. Berman (Daniel); M.J. Budoff (Matthew); T.Q. Callister (Tracy); M. Al-Mallah (Mouaz); F. Cademartiri (Filippo); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); A.M. Dunning (Alison); A. Delago (Augustin); T.C. Villines (Todd); M. Hadamitzky (Martin); J. Hausleiter (Jörg); J. Leipsic (Jonathon); L.J. Shaw (Leslee); P.A. Kaufmann (Philipp); R.C. Cury (Ricardo); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); E. Maffei (Erica); G.L. Raff (Gilbert); G. Pontone (Gianluca); D. Andreini (Daniele); H.-J. Chang (Hyuk-Jae); J.K. Min (James)

    2017-01-01

    textabstractBackground and aims: Coronary artery calcium (CAC) scoring is a predictor of future adverse clinical events, and a surrogate measure of overall coronary artery plaque burden. Coronary computed tomographic angiography (CCTA) is a contrast-enhanced method that allows for visualization of p

  7. Risk stratification of coronary artery disease in asymptomatic diabetic subjects using multidetector computed tomography.

    Science.gov (United States)

    Shimabukuro, Michio; Saito, Taro; Higa, Toru; Nakamura, Keita; Masuzaki, Hiroaki; Sata, Masataka

    2015-01-01

    Patients with type 2 diabetes mellitus (T2DM) show a greater risk for coronary artery disease (CAD), but the risk stratification in asymptomatic CAD patients has not been established. This study investigated the prevalence and severity for asymptomatic CAD and predictors in T2DM patients. In a multiclinic group, diabetic patients (320 men, 186 women) without known symptoms suggestive of CAD were recruited for multidetector computed tomography (MDCT). Patients were categorized according to severity of coronary atherosclerosis: Grade 1 (normal findings), Grade 2 (mild atherosclerosis without significant stenosis), Grade 3 (moderate stenosis/atherosclerosis, 50-74% stenosis), Grade 4 (moderate stenosis/atherosclerosis, 75-89% stenosis), Grade 5 (severe stenosis/atherosclerosis, ≥90% stenosis). The trend for severity grade of CAD was slightly higher in men than women (P=0.054). For critical lesions (combined Grades 3-5), the prevalence was almost equal (men 44% vs. women 37%; P=0.113). Multivariate models showed that in men, HbA1c≥7.4%, dyslipidemia, duration of diabetes, retinopathy, and other type of cardiovascular diseases were predictors of critical lesions and in women, duration of diabetes and retinopathy were predictors. The prevalence and severity of asymptomatic CAD are comparably high in men and women with T2DM. Risk stratification by using MDCT might be useful to predict asymptomatic coronary lesions requiring coronary revascularization.

  8. Is carotid artery disease responsible for perioperative strokes after coronary artery bypass surgery?

    Science.gov (United States)

    Li, Yuebing; Castaldo, John; Van der Heyden, Jan; Plokker, Herbert W M

    2010-12-01

    The coronary and extracranial carotid vascular beds are often simultaneously affected by significant atherosclerotic disease, and stroke is one of the potential major complications of coronary artery surgery. As a result, there is no shortage of reports in the vascular surgery literature describing simultaneous coronary and carotid artery revascularizations. Generally, these reports have found this combination of operations safe, but have stopped short of proving that it is necessary. Intuitively, simultaneous carotid endarterectomy and coronary artery bypass surgery could be justified if most perioperative strokes were the result of a significant carotid stenosis, either directly or indirectly. At first glance this appears to be a fairly straightforward issue; however, much of the evidence on both sides of the argument is circumstantial. One significant problem in analyzing outcome by choice of treatment in patients presenting with both coronary and carotid disease is the multiple potential causes of stroke in coronary bypass patients, which include hemorrhage and atheroemboli from aortic atheromas during clamping. But this controversial subject is now open to discussion, and our debaters have been given the challenge to clarify the evidence to justify their claims. Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  9. Exertion and acute coronary artery injury.

    Science.gov (United States)

    Black, A; Black, M M; Gensini, G

    1975-12-01

    Twelve cases of myocardial infarction as related to strenuous exertion are presented with the pathological findings in several of these cases. Three cases with coronary arteriography are also presented. The pathology of coronary arteriosclerotic plaques and the vulnerability to acute injury is reviewed and discussed. It is concluded that strenuous exertion can cause acute injury to coronary artery plaques due to the unusual stressful whip-like action to which coronary arteries are subject. These injuries may initiate as cracks in the plaques or subintimal hemorrhages and proceed to coronary occlusion and ultimate myocardial infarction. With this concept in mind we use the term of "crack in the plaque" (Black's Crack in the Plaque) to account for the sudden appearance of clinical coronary artery disease appearing during or shortly after exertion, or other stressful situations in patients without previous existing evidence of clinical coronary artery disease. This could also account for exacerbation of symptoms or death occurring after exertion in previously quiescent asymptomatic known coronary artery disease subjects. This concept may explain some of the puzzling features of coronary disease.

  10. Relationship of ascending aorta elasticity and severity of coronary artery stenosis in patients with essential hypertension%高血压病患者升主动脉弹性功能与冠状动脉狭窄程度的相关性

    Institute of Scientific and Technical Information of China (English)

    赵云峰; 郭杨; 张洁; 杨庆祥; 赵波

    2011-01-01

    目的 探讨原发性高血压病(EH)患者升主动脉弹性功能与冠状动脉病变狭窄程度的关系.方法 对107例EH患者进行冠状动脉造影,分为高血压伴冠心病组(A组,56例)和高血压非冠心病组(B组,51例),应用多普勒组织成像技术测定升主动脉弹性功能,并与Leaman冠状动脉病变评分作相关分析.结果 A组升主动脉扩张性、升主动脉前壁S波的速度均明显低于非冠心病组(P<0.01),且与Leaman冠状动脉病变评分呈负相关.A组升主动脉僵硬度指数明显高于非冠心病组(P<0.01),且与Leaman冠状动脉病变评分呈正相关.结论 升主动脉弹性功能可以作为冠状动脉病变严重程度的重要预测因子之一.%Objective To study the relationship of ascending aorta elasticity and severity of coronary artery stenosis in patients with essential hypertension (EH). Methods On the basis of coronary angiography, 107 EH patients were divided into two groups of A[56 cases, EH combined with coronary heart disease(CHD)] and B(51 cases,EH without CHD). The ascending aorta elasticity was evaluated by Doppler tissue imaging. The relationship between ascending aorta elasticity and Leaman coronary artery score (LCAS) were assessed. Results Aortic distensibility and S velocity of anterior wall of ascending aorta were remarkably lower in group A than those in group B(P<0. 01), which was negatively correlated to LCAS. Aortic stiffness index was higher in group A than that in group B(P<0. 01),which was positively correlated to LCAS. Conclusion Ascending aorta elasticity may be taken as one of the indicators for predicting the severity of severity of coronary artery stenosis in patients with EH.

  11. Correlation study between the level of serum leptin and the degree of coronary stenosis in patients wit coronary artery disease%冠心病患者血清瘦素水平与冠状动脉狭窄程度的相关性研究

    Institute of Scientific and Technical Information of China (English)

    孔庆瑞; 郭战利

    2010-01-01

    目的 探讨冠心病患者血清瘦素水平与冠状动脉狭窄程度的相关性.方法 选择经冠状动脉造影证实的稳定型心绞痛住院患者20例(稳定型心绞痛组)、不稳定型心绞痛住院患者26例(不稳定型心绞痛组),测定血清瘦素水平,并与20例虽有类似心绞痛症状,但经冠状动脉造影检查未见冠状动脉病变者(对照组)进行比较,分析血清瘦素水平与冠状动脉狭窄程度之间的关系.结果 不稳定型心绞痛组血清瘦素水平[(10.39±8.09)μg/L]显著高于稳定型心绞痛组[(7.65±4.46)μgL]及对照组[(3.93±2.66)μg/L](P0.05).不稳定型心绞痛组血清瘦素水平与Gensini积分及TIMI分级呈显著正相关(r值分别为0.654、0.542,P<0.05);稳定型心绞痛组血清瘦素水平与Gensini积分及TIMI分级也呈显著正相关(r值分别为0.466、0.518,P<0.05).结论 稳定型心绞痛和不稳定型心绞痛患者血清瘦素水平明显升高,且不稳定型心绞痛患者较稳定型心绞痛患者血清瘦素水平高.血清瘦素水平与冠状动脉病变严重程度呈正相关,与冠心病心肌缺血的范围、病变支数、冠状动脉末稍血流情况呈正相关.%Objective To study the relationship between the level of serum leptin and the degree of coronary stenosis in patients with coronary artery disease and evaluate their correlations. Methods Twenty patients with stable angina pectoris (stable angina pectoris group ), 26 patients with unstable angina pectoris (unstable angina pectoris group ), and 20 patients with symptom of angina pectoris but without coronary artery disease (control group) were involved in this study, all of whom were diagnosed by coronary arteriography.The levels of serum leptin in the three groups were detected. Results The level of serum leptin in unstable angina pectoris group [(10.39 ± 8.09) μg/L] was significantly higher than that in stable angina pectoris group [(7.65 ±4.46) μg/L] and control group[(3.93 ±2

  12. Effects of non Newtonian spiral blood flow through arterial stenosis

    Science.gov (United States)

    Hasan, Md. Mahmudul; Maruf, Mahbub Alam; Ali, Mohammad

    2016-07-01

    The spiral component of blood flow has both beneficial and detrimental effects in human circulatory system. A numerical investigation is carried out to analyze the effect of spiral blood flow through an axisymmetric three dimensional artery having 75% stenosis at the center. Blood is assumed as a Non-Newtonian fluid. Standard k-ω model is used for the simulation with the Reynolds number of 1000. A parabolic velocity profile with spiral flow is used as inlet boundary condition. The peak values of all velocity components are found just after stenosis. But total pressure gradually decreases at downstream. Spiral flow of blood has significant effects on tangential component of velocity. However, the effect is mild for radial and axial velocity components. The peak value of wall shear stress is at the stenosis zone and decreases rapidly in downstream. The effect of spiral flow is significant for turbulent kinetic energy. Detailed investigation and relevant pathological issues are delineated throughout the paper.

  13. 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.

  14. Renal angioplasty for atherosclerotic renal artery stenosis: Cardiologist′s perspective

    Directory of Open Access Journals (Sweden)

    A S Gulati

    2013-01-01

    Full Text Available Atherosclerotic renal artery stenosis (ARAS is frequently associated with concomitant coronary and peripheral arterial disease with a significant impact on cardiovascular morbidity and mortality. Renal angioplasty of ARAS is more challenging because of increased incidence of technical failures, complications, and restenosis; while there is barely perceptible control of hypertension and only marginal improvement in renal function. This is because most of the patient population in recent randomized trials had unmanifested or clinically silent renovascular disease. Manifestations of RAS should be looked for and incorporated in the management plan particularly before deciding for revascularization. In the absence of clinical manifestation like renovascular hypertension, ischemic nephropathy, left ventricular failure, or unstable coronary syndromes; mere presence of RAS is analogous to presence of concomitant peripheral arterial disease which increases risk of adverse coronary events. Dormant-RAS in the absence of any manifestations can be managed with masterly inactivity. Chronological sequence of events and clinical condition of the patient help in decision making by identifying progressive renovascular disease. Selecting patients for renal artery stenting who actually will benefit from revascularization shall also decrease the unnecessary complications inherent with any interventional procedure. The present review is an attempt to analyze the current view on the diagnostic and management issues more specifically about the need and rationale behind angioplasty.

  15. [Pediatric case of congenital coronary artery fistula; surgical result and late changes in coronary artery aneurysm].

    Science.gov (United States)

    Sugawara, Masaaki; Oguma, Fumiaki; Hirahara, Hiroyuki

    2014-07-01

    Congenital coronary artery fistula is an uncommon heart anomaly involving the coronary arteries. We report here a case of a 4-year-old boy who had a coronary fistula from the right coronary artery to the right ventricle, with a coronary aneurysm. He was asymptomatic, but the calculated ratio of pulmonary blood flow to systemic blood flow was shown to be high [pulmonary flow (Qp)/systemic flow(Qs)=1.78]. The coronary angiography showed that the right coronary artery was dilated beginning at the ostium and had an aneurysm at the acute marginal portion. A large spherical aneurysm approximately 20 mm in diameter was found to have been connected with coronary fistula opening into the right ventricle. Surgical repair by closure of the fistula under direct vision, partial resection and suture closure of the aneurysm was performed. Plication of the proximal portion of the right coronary artery was not performed, and the diffusely dilated artery was left untouched. After this operation, he recovered well under anticoagulant treatment with warfarin and aspirin. Postoperative angiography was performed 17 months after the surgery to evaluate morphological changes in the coronary artery. The angiography confirmed the closure of the fistula and the regression of coronary artery dilatation.

  16. Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Ahmet Karabulut

    2015-10-01

    Full Text Available Significant left main coronary artery (LMCA stenosis is not rare and reported 3 to 10% of patients undergoing coronary angiography. Unprotected LMCA intervention is a still clinical challenge and surgery is still going to be a traditional management method in many cardiac centers. With a presentation of drug eluting stent (DES, extensive use of IVUS and skilled operators, number of such interventions increased rapidly which lead to change in recommendation in the guidelines regarding LMCA procedures in the stable angina (Class 2a recommendation for ostial and shaft lesion and class 2b recommendation for distal bifurcation lesion. However, there was not clear consensus about the management of unprotected LMCA lesion associated with acute myocardial infarction (MI with a LMCA culprit lesion itself or distinct culprit lesion of other major coronary arteries. Surgery could be preferred as an obligatory management strategy even in the high risk patients. With this review, we aimed to demonstrate treatment strategies of LMCA disease associated with acute coronary syndrome, particularly acute myocardial infarction (MI. In addition, we presented a short case series with LMCA lesion and ST elevated acute MI in which culprit lesion placed either in the left anterior descending artery or circumflex artery. We reviewed the current medical literature and propose simple algorithm for management.

  17. Is there an indication for computed tomography and magnetic resonance imaging in the evaluation of coronary artery bypass grafts?

    NARCIS (Netherlands)

    Dikkers, R.; van der Zaag-Loonen HJ, [No Value; Willems, T.P.; Post, W.J.; Oudkerk, M.

    2009-01-01

    This meta-analysis evaluates the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for bypass graft occlusion and stenosis detection compared with coronary angiography in post-coronary artery bypass graft patients. The indication for noninvasive

  18. There an Indication for Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Coronary Artery Bypass Grafts?

    NARCIS (Netherlands)

    Dikkers, R.; van der Zaag-Loonen, H. J.; Willems, T. P.; Post, W. J.; Oudkerk, M.

    2009-01-01

    This meta-analysis evaluates tire diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for bypass graft occlusion and stenosis detection compared with coronary angiography in post-coronary artery bypass graft patients. The indication for noninvasive

  19. [Single coronary artery and right aortic arch].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Coronary anomalies are mostly asymptomatic and diagnosed incidentally during coronary angiography or echocardiography. However, they must be taken into account in the differential diagnosis of angina, dyspnea, syncope, acute myocardial infarction or sudden death in young patients. The case is presented of two rare anomalies, single coronary artery originating from right sinus of Valsalva and right aortic arch, in a 65 year-old patient with atherosclerotic coronary artery disease treated percutaneously. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  20. Relationship of blood cholesterol and apoprotein B levels to angiographically defined coronary artery disease in young males.

    Science.gov (United States)

    McGill, D A; Talsma, P; Ardlie, N G

    1993-03-01

    Coronary heart disease is mainly caused by the effects of obstruction to blood flow in the coronary arteries from discrete mural lesions that encroach into the lumen and usually occur in arteries that are involved by atherosclerosis. Even though the level of certain lipoproteins is indisputably related to the degree of this atherosclerotic involvement of the coronary arteries, the question of whether lipoproteins are also associated with the obstructive lesions remains uncertain. This study addressed the question in 53 males (age, 44.6 +/- 4.9 y) with premature coronary heart disease and angiographically proven coronary artery disease. The cholesterol, triglyceride, high-density lipoprotein, apoprotein B, and apoprotein A-I levels were compared by linear correlation to semiquantitative angiographic measures of coronary artery disease severity (coronary stenosis score and mean coronary stenosis score), the extent of mural involvement (coronary atheromatous score and mean coronary atheromatous score), and also the number of normal coronary artery segments, an alternative severity score (Jenkins), and left ventricular function score. Age, past and present cholesterol, low-density lipoprotein cholesterol, and apoprotein B levels correlated directly with the extent of disease (r = 0.27, 0.46, 0.29, 0.26, 0.35, respectively, P Multiple regression analysis was undertaken with lipoproteins and age as independent variables and angiographic scores as dependent variables; the apoprotein B level was the most predictive of the extent of coronary artery disease (P variables entered into the regression model, only age was independently predictive of the severity of angiographic coronary artery disease. Apoprotein B levels are not predictive of coronary artery disease severity but do predict independently the extent of involvement of coronary atherosclerosis defined angiographically.

  1. 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...

  2. COMPLEX CORONARY PATTERN AFFECTING THE SURGICAL OUTCOME OF ARTERIAL SWITCH OPERATION

    Directory of Open Access Journals (Sweden)

    Amit

    2015-12-01

    Full Text Available BACKGROUND Arterial switch operation (ASO has become the procedure of choice for the transposition of great arteries as well as for Taussig-Bing anomaly. Relocation of coronary arteries remains a technical problem in anatomic correction of the transposed great arteries. The present prospective study is designed to analyse the effect of coronary artery pattern on surgical outcome of arterial switch operation. METHOD From August 2014 to November 2015, total 60 patients underwent ASO. The patients are divided in three groups. Group-A 21 patients with d-TGA with intact ventricle septum (d-TGA intact IVS, in Group-B 33 patients d-TGA with ventricular septal defect (d-TGA, VSD, and in Group C 6 Taussig Bing anomaly. The coronary pattern and outcome is analyzed. RESULTS The overall mortality related to coronary pattern was 5%. The 2 patients died due to Intramural coronary artery leading to post-operative ventricular dysfunction, another patient with single retro pulmonary coronary artery died secondary to low coronary implant leading to kinking in coronary artery and myocardial dysfunction. On 12 monthly follow up, one of the Patients in group A had right pulmonary artery stenosis with gradient of 30 mm of Hg. Another patient in group B had supravalvular gradient of 20 mm of Hg. CONCLUSION The ASO for TGA and Taussig-Bing anomaly has low early and late mortality. However, the mortality is still seen in the patients with Intramural coronary artery and in the patient with single coronary artery with retro pulmonary course.

  3. Association of Low Serum Concentration of Bilirubin with Increased Risk of Coronary Artery Disease

    Science.gov (United States)

    1994-01-01

    bilirubin with increased risk of coronary artery dises . Toronto, Ontario M5G 2C4, Canada Cliii Chem 1994,40:18-23. Fax 416-481-2899 10 CLINICAL...performed for abnor- according to the maximum coronary stenosis at angiog- mal repolarization, decreased thallium uptake, cardiac raphy: < 10% (no...g AD-A276 272... 08/17/93 Association of Low Serum Concentration of Bilirubin IN-House with Increased Risk of Coronary Artery Disease PE 62202F

  4. Evaluation of computer-assisted quantification of carotid artery stenosis.

    Science.gov (United States)

    Biermann, Christina; Tsiflikas, Ilias; Thomas, Christoph; Kasperek, Bernadette; Heuschmid, Martin; Claussen, Claus D

    2012-04-01

    The purpose of this study was to evaluate the influence of advanced software assistance on the assessment of carotid artery stenosis; particularly, the inter-observer variability of readers with different level of experience is to be investigated. Forty patients with suspected carotid artery stenosis received head and neck dual-energy CT angiography as part of their pre-interventional workup. Four blinded readers with different levels of experience performed standard imaging interpretation. At least 1 day later, they performed quantification using an advanced vessel analysis software including automatic dual-energy bone and hard plaque removal, automatic and semiautomatic vessel segmentation, as well as creation of curved planar reformation. Results were evaluated for the reproducibility of stenosis quantification of different readers by calculating the kappa and correlation values. Consensus reading of the two most experienced readers was used as the standard of reference. For standard imaging interpretation, experienced readers reached very good (k = 0.85) and good (k = 0.78) inter-observer variability. Inexperienced readers achieved moderate (k = 0.6) and fair (k = 0.24) results. Sensitivity values 80%, 91%, 83%, 77% and specificity values 100%, 84%, 82%, 53% were achieved for significant area stenosis >70%. For grading using advanced vessel analysis software, all readers achieved good inter-observer variability (k = 0.77, 0.72, 0.71, and 0.77). Specificity values of 97%, 95%, 95%, 93% and sensitivity values of 84%, 78%, 86%, 92% were achieved. In conclusion, when supported by advanced vessel analysis software, experienced readers are able to achieve good reproducibility. Even inexperienced readers are able to achieve good results in the assessment of carotid artery stenosis when using advanced vessel analysis software.

  5. Effect of Diltiazem on Coronary Artery Flow and Myocardial Perfusion in Patients With Isolated Coronary Artery Ectasia and Either Stable Angina Pectoris or Positive Myocardial Ischemic Stress Test.

    Science.gov (United States)

    Ozcan, Ozgur Ulas; Atmaca, Yusuf; Goksuluk, Huseyin; Akbulut, Irem Muge; Ozyuncu, Nil; Ersoy, Nedret; Erol, Cetin

    2015-10-15

    Isolated coronary artery ectasia (CAE) may be associated with stable or unstable coronary events despite the absence of epicardial coronary stenosis. Impaired coronary flow dynamics and myocardial perfusion have been demonstrated in stable patients with ectatic coronary arteries. We aimed to assess whether epicardial flow and tissue-level perfusion would be improved by diltiazem in myocardial regions subtended by the ectatic coronary arteries in patients with isolated CAE. A total of 60 patients with isolated CAE were identified of 9,780 patients who underwent elective coronary angiography. Patients were randomized to 5 mg of intracoronary diltiazem or saline. Coronary blood flow of the microvascular network was assessed using myocardial blush grade (MBG) technique. The thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (TFC) were used to assess epicardial coronary flow. MBG (from 2.4 to 2.6, p = 0.02), TIMI flow grades (from 2.4 to 2.8, p flow grade; and from 35 to 33, p = 0.43 for TFC). Diltiazem provided amelioration of the altered coronary flow dynamics, which was suggested as the pathophysiological influence of CAE. In conclusion, the favorable effects of the diltiazem on myocardial perfusion were observed at both epicardial and tissue levels.

  6. The Aberrant Coronary Artery - The Management Approach.

    Science.gov (United States)

    King, Nina-Marie; Tian, David D; Munkholm-Larsen, Stine; Buttar, Sana N; Chow, Vincent; Yan, Tristan

    2017-07-03

    An aberrant coronary artery is a rare clinical occurrence with an incidence of 0.05-1.2%. Often it is an incidental finding detected on coronary angiography or at autopsy. However, symptomatic patients can experience angina, arrhythmia, sudden death or non-specific symptoms such as dyspnoea and syncope. At present, there are no guidelines or dedicated studies assessing the treatment of an aberrant coronary artery leaving management options for these patients controversial. Selected international cardiothoracic surgeons were surveyed electronically in November 2016 to determine whether consensus exists on different management aspects for patients with an aberrant coronary artery arising from the contralateral sinus with an interarterial course. For asymptomatic patients with either an aberrant left main coronary artery (ALMCA) arising from the contralateral sinus or an aberrant right main coronary artery (ARMCA) arising from the contralateral sinus, there was no consensus on surgical correction of the anomaly. If myocardial ischaemia was demonstrated on either coronary angiography with fractional flow reserve measurements and/or stress myocardial perfusion scan, surgical correction was the consensus between the surveyed surgeons. If surgery was deemed appropriate, coronary artery bypass surgery utilising the internal mammary artery was marginally preferred by the respondents in patients with an ALMCA whilst unroofing of the coronary ostium was preferred in patients with an ARMCA. Although no consensus was reached, a large proportion of respondents would not treat a patient over the age of 30 years differently compared to those under 30 years old. For symptomatic patients or if myocardial ischaemia is demonstrated on either coronary angiography with fractional flow reserve measurements and/or stress myocardial perfusion scan, surgical correction is indicated. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the

  7. Quantification of myocardial perfusion using cardiac magnetic resonance imaging correlates significantly to rubidium-82 positron emission tomography in patients with severe coronary artery disease

    DEFF Research Database (Denmark)

    Qayyum, Abbas A; Hasbak, Philip; Larsson, Henrik B W

    2014-01-01

    INTRODUCTION: Aim was to compare absolute myocardial perfusion using cardiac magnetic resonance imaging (CMRI) based on Tikhonov's procedure of deconvolution and rubidium-82 positron emission tomography (Rb-82 PET). MATERIALS AND METHODS: Fourteen patients with coronary artery stenosis underwent ...

  8. Stents in Renal Artery Bifurcation Stenosis: A Case Report

    Directory of Open Access Journals (Sweden)

    Polytimi Leonardou

    2011-01-01

    Full Text Available A 39-year-old patient presented with poorly controlled hypertension, and she was referred to renal angiogram and potential renal angioplasty. Renal angiogram showed a bifurcation lesion of the right renal artery. A guide wire was used to cross the upper branch, while the lower branch was protected by another same-type guide wire through the same introducer. Two thin monorail balloons were used to dilate the two branches; however, despite balloon dilatation, the stenosis of the vessels persisted. The “kissing balloon” technique was then attempted by simultaneously inflating both branches using the same balloons, but more than a 70% residual stenosis persisted in each branch. Two stents were finally placed in a “kissing” way through the main renal artery. The imaging and clinical results were good, without any procedure-related complications. Three years clinical followup was also good, without any reason for further interventional approach.

  9. Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and long-term results

    OpenAIRE

    Kolh, Philippe; Comté, Laetitia; Tchana-Sato, Vincent; Honoré, Charles; Kerzmann, Arnaud; Mauer, M.; Limet, Raymond

    2006-01-01

    Aims To assess risk factors for early and late outcome after concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). Methods and results Records of all 311 consecutive patients having concurrent CEA and CABG from 1989 to 2002 were reviewed, and follow-up obtained (100% complete). In the group (mean age 67 years; 74% males), 62% had triple-vessel disease, 57% unstable angina, 31% left main coronary stenosis, 19% congestive heart failure, and 35% either a history of ...

  10. Clinical features of renal artery stenosis in elderly patients

    Institute of Scientific and Technical Information of China (English)

    TANG Ri-ning; LIU Bi-cheng; REN li-qun; WANG Yan-li; MA Gen-shan

    2007-01-01

    @@ Together with an increasingly aging world population there is also an increasing prevalence of atherosclerosis. Renal artery stenosis (RAS) is one of the systemic manifestations of atherosclerosis. Its incidence is about 15%-35%.1 RAS accounts for 5%-27% of all patients with end-stage renal disease (ESRD).2 Patients with renal dysfunction resulting from RAS are at risk of death from cardiovascular disease and ESRD.3

  11. Renal artery stenosis presenting as crescendo angina pectoris.

    Science.gov (United States)

    Tami, L F; McElderry, M W; al-Adli, N M; Rubin, M; Condos, W R

    1995-07-01

    The coexistence of different clinical syndromes due to atherosclerosis in different organs is not rare and emphasizes the diffuse nature of this vascular process. Although renovascular disease may cause hypertension and/or renal insufficiency, it may also occur in the absence of the usual clinical markers that suggest renovascular hypertension. We report a patient with stable coronary anatomy who presented with crescendo angina pectoris. Diagnosis of renovascular hypertension was made by screening renal angiography at the time of the cardiac catheterization. Renal artery stenting resulted in stabilization of the coronary syndrome and obviated the need for further coronary intervention. To our knowledge, this is the first case of renovascular hypertension precipitating an unstable coronary syndrome in a patient with documented stable coronary anatomy. Review of the literature supports that patients undergoing cardiac catheterization are a high risk population for renovascular disease, particularly in the presence of other predictive factors such as documented coronary artery disease, older age, female gender, congestive heart failure, peripheral vascular disease, renal insufficiency, and smoking. Firm recommendations for routine screening renal angiography in patients undergoing peripheral or coronary angiography will need further studies.

  12. 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

  13. NON-INVASIVE IMAGING OF CORONARY ARTERY WITH 16-SLICE SPIRAL COMPUTED TOMOGRAPHY

    Institute of Scientific and Technical Information of China (English)

    Zhu-hua Zhang; Wen-bin Mou; Li-Ren Zhang; Wen-ling Zhu; Chao Ni; Hua Ren; Hong-quan Yu; Qi Miao; Qi Fang; Zheng-yu Jin; Dong-jing Li; Song-bai Lin; Shu-yang Zhang; Ling-yan Kong; Yun Wang; Lin-hui Wang; Wen-min Zhao

    2004-01-01

    Objective To evaluate the value of 16-slice spiral CT in the demonstration of coronary artery and in the diagnose of coronary artery stenosis.Methods Plain and enhanced CT scans were performed with a 16-slice CT scanner (Sensation 16, Siemens, Germany)in 230 patients with suspected coronary heart disease (CHD). Parameters of the plain scan were: 120 kV, 133 mA, slice collimation 16 mm×1.5 mm, rotation time 0.42 seconds, increment 1.5 mm, and slice width 3 mm. Parameters of the enhanced scan were: 120 kV, 500 mA, slice collimation 16 mm×0.75 mm, rotation time 0.42 seconds, increment 0.5 mm, and slice width 1 mm. Enhanced CT scan was performed with a rapid intravenous injection of 100 mL iothalamate meglumine (Ultravist)(370 mgI/mL) or Omnipaque (350mgI/mL) and 30 mL 0.9% NaC1 chaser bolus at a flow rate of 3.5 mL/s. Calcium scoring with plain scan images and two and three dimensional reconstruction with enhanced scan images were made in all cases,among which 30 cases underwent conventional coronary angiography. Demonstration of coronary arteries and their stenosis were evaluated and the factors that might influence the image quality were analyzed.Results Coronary calcium scores were calculated and coronary artery was demonstrated in our study. In the evaluation of image quality with volume rendering technique (VRT) images, 78.3% of the images were of the first class, 12.2% the second class, and 9.6% the third class. Multi-planar reconstruction (MPR) and maximal intensity projection (MIP) were better than VRT in the demonstration of small branches. The image quality was related to the heart rate, with or without arrhythmia,and breath-hold ability of patients. Comparative study of the stenosis of coronary arteries in 30 cases showed that the sensitivity and specificity of 16-slice coronary CT angiography (CTA) to diagnose significant stenosis were 95.8% and 94.8% respectively.Conclusion As a non-invasive and quick method, 16-slice coronary CTA is sensitive and

  14. Spontaneous Coronary Artery Dissection: The Phantom Menace

    Science.gov (United States)

    Spinthakis, Nikolaos; Abdulkareem, Nada; Farag, Mohamed; Gorog, Diana A.

    2016-01-01

    We present a case of a 66-year-old lady with chest pain, without dynamic 12-lead electrocardiographic (ECG) changes and normal serial troponin. Coronary angiography revealed a linear filing defect in the first obtuse marginal branch of the circumflex artery indicating coronary artery dissection, with superadded thrombus. She was managed medically with dual antiplatelet therapy and has responded well. Spontaneous coronary artery dissection (SCAD) is a rare cause of cardiac chest pain, which can be missed without coronary angiography. Unlike most other lesions in patients with unstable symptoms, where coronary intervention with stenting is recommended, patients with SCAD generally fare better with conservative measures than with intervention, unless there is hemodynamic instability. PMID:28197295

  15. [Is there a role for asymptomatic carotid artery stenosis screening?].

    Science.gov (United States)

    Heldenberg, Eitan; Bass, Arie

    2014-08-01

    Screening for asymptomatic carotid artery stenosis (CAS) is highly controversial Many surgeons routinely screen their patients for carotid disease prior to major operations, yet the benefit of such practice was never demonstrated. The treatment of symptomatic patients has not changed much during the last twenty years, since the publication of the North American Symptomatic Carotid Endarterectomy Trial (NASCET). However, in contrast, the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST) failed to get the same acceptance among the multidisciplinary group treating CAS.The prevalence of asymptomatic 60-99% carotid artery stenosis among the general population is about 1%. Neither ACAS nor ACST showed that stenosis severity was associated with increasing stroke risk. The 'realpolitik' is that mass interventions in asymptomatic patients will probably only ever prevent about 1% of all strokes. This is even truer regarding patients scheduLed for major operation, in which the incidence of stroke is less than 1%. Moreover the current evidence in the literature suggests that the best medicaL treatment (BMT) results in 0.5% strokes per year, better than resuLts which can be offered by surgery. According to the current evidence, it seems that asymptomatic carotid artery screening should be discontinued, since it is a major waste of resources.

  16. 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.

  17. Coronary pressure and flow relationships in humans: phasic analysis of normal and pathological vessels and the implications for stenosis assessment: a report from the Iberian–Dutch–English (IDEAL) collaborators

    Science.gov (United States)

    Nijjer, Sukhjinder S.; de Waard, Guus A.; Sen, Sayan; van de Hoef, Tim P.; Petraco, Ricardo; Echavarría-Pinto, Mauro; van Lavieren, Martijn A.; Meuwissen, Martijn; Danad, Ibrahim; Knaapen, Paul; Escaned, Javier; Piek, Jan J.; Davies, Justin E.; van Royen, Niels

    2016-01-01

    Background Our understanding of human coronary physiological behaviour is derived from animal models. We sought to describe physiological behaviour across a large collection of invasive pressure and flow velocity measurements, to provide a better understanding of the relationships between these physiological parameters and to evaluate the rationale for resting stenosis assessment. Methods and results Five hundred and sixty-seven simultaneous intracoronary pressure and flow velocity assessments from 301 patients were analysed for coronary flow velocity, trans-stenotic pressure gradient (TG), and microvascular resistance (MVR). Measurements were made during baseline and hyperaemic conditions. The whole cardiac cycle and the diastolic wave-free period were assessed. Stenoses were assessed according to fractional flow reserve (FFR) and quantitative coronary angiography DS%. With progressive worsening of stenoses, from unobstructed angiographic normal vessels to those with FFR ≤ 0.50, hyperaemic flow falls significantly from 45 to 19 cm/s, Ptrend stenosis severity and was consistent across all strata of stenosis (Ptrend > 0.05 for all). Trans-stenotic pressure gradient rose with stenosis severity for both rest and hyperaemic measures (Ptrend stenosis severity under resting conditions (Ptrend stenosis severity, TG rises. However, while hyperaemic flow falls significantly, resting coronary flow is maintained by compensatory reduction of MVR, demonstrating coronary auto-regulation. These data support the translation of coronary physiological concepts derived from animals to patients with coronary artery disease and furthermore, suggest that resting pressure indices can be used to detect the haemodynamic significance of coronary artery stenoses. PMID:26612582

  18. 老年冠心病患者冠状动脉狭窄程度与血清胆红素水平的相关性%Relationship between serum level of bilirubin and extent of coronary artery stenosis in aged patients with coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    张晓艳; 安映红; 魏璇; 李明阳

    2012-01-01

    Objective: To investigate relationship between serum level of bilirubin and extent of coronary artery stenosis in aged patients with cardiovascular diseases and its significance. Methods: A total of 264 aged patients with coronary heart disease (CHD) underwent coronary angiography and measurement of serum level of bilirubin. According to results of coronary angiography, patients were divided into normal control group (n= 68) and CHD group (n = 196), and CHD group was further divided into mild group (n = 66), moderate group (n = 64) and severe group (n = 66). Results: One-factor ANOVA analysis indicated compared with normal control group, the serum levels of total bilirubin [ (20. 52 ± 6. 12) μmol/L vs. (18. 07 ± 5. 81)μmol/L vs. (14. 22 ± 5. 19) mol/L vs. (15. 63 ± 6. 30) μmol/L] and indirect bilirubin [ (18. 80 ± 5. 21) μmol/L vs. (15. 46 ± 6. 71)μmol/L vs. (11. 63 ± 3. 42) μmol/L vs. (13. 37 + 4. 35) μmol/L] significantly decreased in mild CHD group, moderate CHD group and severe CHD group (P<0. 05~<0. 01); the multiple linear regression analysis indicated that serum levels of total bilirubin and indirect bilirubin were significant negative correlations with scores of coronary artery stenosis (partial correlation coefficients were -8. 976 and -2. 492 respectively, P<0. 05). Conclusion: Level of bilirubin is closely related with incidence, development and severity of cardiovascular diseases in aged patients, total and indirect bilirubin can be used for good indicators for predicting severity and range of lesions in coronary artery disease.%目的:探讨老年心血管病患者的冠脉狭窄程度与血清胆红素水平的关系及意义.方法:对264例老年冠心病患者行冠脉造影并测定血清胆红素水平.依据冠脉造影结果,患者被分为正常对照组(68例)和冠心病组(196例),其中冠心病组又分为轻度组(66例)、中度组(64例)和重度组(66例).结果:单因素方差分析显示,与正常对照组比较,冠

  19. 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...

  20. Left Circumflex Coronary Artery Fistula Connected to the Right Bronchial Artery Associated with Bronchiectasis: Multidetector CT and Coronary Angiography Findings

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Kyung Jin; Choo, Ki Seok [Dept. of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2013-04-15

    Coronary to bronchial artery fistula is a rare vascular anomaly secondary to enlargement of pre-existing vascular anastomosis between the coronary and bronchial arteries. This occurs when there is a constant disturbance of the pressure equilibrium involving either coronary or broncho-pulmonary disorder. Localized bronchiectasis is the most common related condition in patients with a coronary to bronchial artery fistula. Herein, we report on a case of a large left circumflex coronary artery to right bronchial artery fistula associated with bronchiectasis.

  1. Woven coronary artery: a case report and review of literature.

    Science.gov (United States)

    Kursaklioglu, Hurkan; Iyisoy, Atila; Celik, Turgay

    2006-10-26

    Woven coronary artery is an extremely rare and clearly undefined coronary malformation. Up to now, very few cases have been reported. In this anomaly, epicardial coronary artery are branched into thin channels at any segment of the coronary artery and then these longitudinal twisted thin channels merge again as the main coronary lumen. This anomaly is regarded as a benign condition since there is completely normal blood flow after the distal segment of the abnormal coronary artery. In this case report, we present a 48-year-old male patient with a woven coronary artery anomaly in the circumflex artery and who had been followed up for 5 years.

  2. The Fermi paradox and coronary artery disease

    National Research Council Canada - National Science Library

    Gottlieb, Ilan; Lima, Ronaldo Souza Leão

    2014-01-01

    ..., led Fermi to ask the famous question: "Where is everybody?" Fermi was confronted with a paradox that involved probability, scale, and evidence. Coronary artery disease (CAD) presents a similar challenge. The pathophysiological importance of nonobstructive CAD is well known, as two-thirds of acute coronary syndromes (ACS) originate...

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

    Science.gov (United States)

    Arslan, Uğur; Türkoğlu, Sedat; Balcioğlu, Serhat; Tavil, Yusuf; Karakan, Tarkan; Cengel, Atiye

    2007-09-01

    To demonstrate whether there is a relationship between the presence of nonalcoholic fatty liver disease (NAFLD) and the presence and extent of coronary artery disease (CAD). Ninety-two consecutive patients who planned to undergo coronary angiographies (CAG) without known CAD, other than findings of acute coronary syndrome, were enrolled in this study. Abdominal ultrasonography was performed before the CAG to detect NAFLD. CAD was defined as a stenosis of at least 50% in at least one major coronary artery. The extent of CAD was measured according to the number of major coronary artery/arteries affected by CAD. All the risk factors for CAD were included in a binary logistic regression model. Forward, backward, or step-wise selections were not used. P<0.05 was accepted as being significant. Sixty-five of the 92 patients (70.7%) were detected, by abdominal ultrasonography, to have fatty liver and 43 patients out of 92 (46.7%) were detected, by CAG, to have significant CAD. 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): 6.73 (1.14-39.61); P=0.035]; this was despite factoring in the other risk factors for CAD and the components of metabolic syndrome. NAFLD was more commonly found in patients as the extent of CAD increased (P=0.001). The presence of NAFLD is independently associated with the presence and extent of CAD. Future studies are needed to explain the mechanisms of this relationship.

  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. [Morphofunctional correlation in congenital anomalies of the coronary arteries. I. Coronary artery fistulas].

    Science.gov (United States)

    Rangel-Abundis, A; Muñoz-Castellanos, L; Marín, G; Chávez Pérez, E; Badui, E

    1994-01-01

    In order to explain the congenital coronary arteries malformations, the authors review the recent concepts on the coronary artery morphogenesis, based in the findings that in the human embryo, these arteries evolve from three sources: 1) endothelial aortic buds, 2) cavitary cellular groups from pericardial origin and with angiogenic character, which migrate to the cardiac zones where the coronary arteries will be distributed, and 3) the intramyocardial sinusoids. The anatomic and histologic cardiac alterations will be reflected in modifications of the coronary artery pattern. The coronary artery fistulae are formed by the persistence of the sponge structure of the myocardial wall, present in the early ontogenic steps of the cardiac development; such fistulae alter the normal functions of the coronary vascular tree and are capable to cause angina pectoris to the patient through diverse mechanisms: absence of capillarization, steal phenomenon aggravated by the altered coronary arteries properties when aneurysm or vascular channels are developed. The authors suggest a classification of the congenital coronary arteries anomalies: I. Anomalous origin in the sinus of Valsalva (anomalous and ectopic origin), II. Malformations of the coronary branches (in number, distribution and wall anomalies) and III. Anomalous connection of the coronary arteries: fistulae and persistence of the intramyocardial sinusoids isolated or communicated to left and right ventricles. The latter are frequently associated with aortic or pulmonary valve atresia. They do not cause myocardial ischemia and are formed secondary to the intracavitary elevated pressure which maintained the persistence, dilatation and communication of the ventricular chambers with such sinusoids and coronary arteries in the case of pulmonary valve atresia and with coronary veins in the case of aortic valve atresia.

  6. Single coronary artery anomaly: the left main coronary artery originating from the proximal segment of right coronary artery

    Institute of Scientific and Technical Information of China (English)

    ZHU Jun; QIN Xu-guang; WU Qing-yu; XIONG Wei-guo; LU Chun-peng; WANG Rong-feng

    2011-01-01

    This case report we presented is that the anomalous left main coronary artery (LMCA) originates from the proximal segment of right coronary artery. In order to confirm the origin and course of the anomalous LMCA, a multi-slice computed tomography (MSCT) of the heart was performed on a 64-slice machine (Philips 64 Slice, Philips, USA) after 6 months of coronary angiography operation. The results showed that the anomalous LMCA originates from the proximal segment of right coronary artery, lies posteriorly to the aorta before taking acute sharply to go between the aorta and left atrium. It was classified as R-Ⅱ P subtype according to Lipton's classification. It is a rare case in the clinical practice.

  7. 不同糖耐量冠心病患者血清内脂素水平与冠状动脉狭窄程度的关系%Relationship between serum visfatin level and coronary artery stenosis in patients with different glucose tolerance

    Institute of Scientific and Technical Information of China (English)

    王淑萍; 徐新生; 孙学清; 聂艳; 吕娜; 王少婷; 侯宁宁

    2011-01-01

    目的 比较血清内脂素(visfatin)在不同糖耐量水平冠心病患者和正常个体中的表达情况,评价血清内脂素水平与冠状动脉狭窄程度的关系.方法 经冠状动脉造影确诊冠心病患者85例,按1999年世界卫生组织糖尿病诊断标准分为冠心病正常糖耐量组(CHD)34例、冠心病合并糖调节异常组(CIG)25例、冠心病合并2型糖尿病组(CDM)26例,选择健康志愿者30名(冠状动脉CT血管造影阴性)作为正常对照组(CON).检测受试者人体测量学指标及糖、脂代谢指标;应用Gemini冠状动脉评分系统对冠状动脉狭窄程度进行评估;用SPSS 12.0统计软件包进行统计学分析.结果 与CON组比较,CHD、CIG及CDM组血清内脂素水平均显著增高(均P<0.05);与CHD组相比较,CIG和CDM组血清内脂素水平均显著增高(均P<0.05);内脂素水平与Gesini冠状动脉病变积分呈正相关(r=0.669,P<0.01);内脂素与腰围、腰臀比、甘油三酯呈正相关(r=0.200,P=0.032;r=0.185,P=0.047;r=0.321,P<0.01),与高密度脂蛋白胆固醇(HDL-C)呈负相关(r-0.354,P<0.01),多元回归分析显示,腰围、甘油三酯水平为影响内脂素水平的主要因素.结论 (1)血清内脂素水平较好地反映冠状动脉病变的严重程度,检测内脂素水平有助于冠心病的早期诊断.(2)在合并2型糖尿病及糖调节异常的冠心病患者中,血清内脂素表达显著增高,与临床糖尿病患者更重的冠状动脉病变相符合.(3)腰围、甘油三酯水平为影响血清内脂素水平的主要因素,提示内脂素水平与腹型肥胖密切相关.%Objective To investigate the relationship between serum visfatin level and coronary artery stenosis.Methods Based on coronary angiography,85 patients were diagnosed as coronary heart disease.According to oral glucose tolerance test,these patients were divided into 3 groups,34 patients with normal glucose tolerance(CHD group),25 with impaired glucose regulation(CIG group),and 26

  8. Waveform patterns and peak reversed velocity in vertebral arteries predict severe subclavian artery stenosis and occlusion.

    Science.gov (United States)

    Chen, Shun-Ping; Hu, Yuan-Ping

    2015-05-01

    This study investigated the value of analyzing spectral Doppler waveform patterns and measuring the peak reversed velocity (PRV) of the vertebral artery (VA) in predicting proximal severe subclavian artery (SA) stenosis and occlusion. Fifty-one patients with proximal SA stenosis were studied retrospectively. Based on the depth of the mid-systolic notch, the Doppler waveforms of the ipsilateral VA were divided into five subtypes (type I, n = 8; type II, n = 8; type III, n = 6; type IV, n = 13; and type V, n = 16). PRV was also measured. PRV receiver operating characteristic curves were constructed to obtain the best cutoff value for predicting severe SA stenosis or complete SA occlusion. The results indicated that both VA Doppler waveform and PRV were associated with the degree of SA stenosis (p waveform in the VA had similar accuracy in predicting SA occlusion (84.3%, 43/51). PRV was more accurate than VA waveforms in predicting severe SA stenosis (98%, 50/51 vs. 94.1%, 48/51). However, no significant differences between the two methods in predicting severe SA stenosis were observed (p = 0.84). Thus, with severe obstruction of the SA, typical Doppler waveform patterns of the VA could be observed. PRV is a helpful criterion in predicting severe stenosis and occlusion of the SA.

  9. Effects of vascular structures on the pressure drop in stenotic coronary arteries

    Science.gov (United States)

    Kim, Jaerim; Choi, Haecheon; Kweon, Jihoon; Kim, Young-Hak; Yang, Dong Hyun; Kim, Namkug

    2016-11-01

    A stenosis, which is a narrowing of a blood vessel, of the coronary arteries restricts the flow to the heart and it may lead to sudden cardiac death. Therefore, the accurate determination of the severity of a stenosis is a critical issue. Due to the convenience of visual assessments, geometric parameters such as the diameter stenosis and area stenosis have been used, but the decision based on them sometimes under- or overestimates the functional severity of a stenosis, i.e., pressure drop. In this study, patient-specific models that have similar area stenosis but different pressure drops are considered, and their geometries are reconstructed from the coronary computed tomography angiography (CCTA). Both steady and pulsatile inflows are considered for the simulations. Comparison between two models that have a bifurcation right after a stenosis shows that the parent to daughter vessel angle results in different secondary flow patterns and wall shear stress distributions which affect the pressure downstream. Thus, the structural features of the lower and upper parts of a stenosis significantly affect the pressure drop. Supported by 20152020105600.

  10. Coronary flow reserve evaluated by {sup 201}Tl myocardial perfusion SPECT after coronary artery bypass grafting (CABG) for angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Ishino, Yoichi; Nakata, Hajime [Univ. of Occupational and Environmental Health, Kitakyusyu, Fukuoka (Japan)

    2000-11-01

    We compared the flow reserves of the coronary bypass vessels between arterial and venous grafts by {sup 201}Tl myocardial perfusion SPECT on the patients with angina pectoris who had no past history of myocardial infarction or intervention therapy such as PTCA. Thirty two patients had undergone a total of 70 bypass grafts and 66 of them were proved to be patent at postoperative CAG. Reversible defects were observed in 6 of 40 segments (15.0%) covered by patent venous grafts, and in 11 of 26 segments (42.3%) by patent arterial grafts. The rate of postoperative reversible defects was higher in the areas grafted by artery but this had no relation with the severity of coronary artery stenosis before CABG. This reversible defect is most likely to be caused by the character of artery graft itself and this should not be considered to highly suggest the restenosis or occlusion of the graft vessel. (author)

  11. Evaluation of semi-automatic arterial stenosis quantification

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez Hoyos, M. [CREATIS Research Unit, CNRS, INSERM, INSA, Lyon (France); Universite Claude Bernard Lyon 1, 69 - Villeurbanne (France). INSA; Univ. de los Andes, Bogota (Colombia). Grupo de Ingenieria Biomedica; Serfaty, J.M.; Douek, P.C. [CREATIS Research Unit, CNRS, INSERM, INSA, Lyon (France); Universite Claude Bernard Lyon 1, 69 - Villeurbanne (France). INSA; Hopital Cardiovasculaire et Pneumologique L. Pradel, Bron (France). Dept. de Radiologie; Maghiar, A. [Hopital Cardiovasculaire et Pneumologique L. Pradel, Bron (France). Dept. de Radiologie; Mansard, C.; Orkisz, M.; Magnin, I. [CREATIS Research Unit, CNRS, INSERM, INSA, Lyon (France); Universite Claude Bernard Lyon 1, 69 - Villeurbanne (France). INSA

    2006-11-15

    Object: To assess the accuracy and reproducibility of semi-automatic vessel axis extraction and stenosis quantification in 3D contrast-enhanced Magnetic Resonance Angiography (CE-MRA) of the carotid arteries (CA). Materials and methods: A total of 25 MRA datasets was used: 5 phantoms with known stenoses, and 20 patients (40 CAs) drawn from a multicenter trial database. Maracas software extracted vessel centerlines and quantified the stenoses, based on boundary detection in planes perpendicular to the centerline. Centerline accuracy was visually scored. Semi-automatic measurements were compared with: (1) theoretical phantom morphometric values, and (2) stenosis degrees evaluated by two independent radiologists. Results: Exploitable centerlines were obtained in 97% of CA and in all phantoms. In phantoms, the software achieved a better agreement with theoretic stenosis degrees (weighted kappa {kappa}{sub W} = 0.91) than the radiologists ({kappa}{sub W} = 0.69). In patients, agreement between software and radiologists varied from {kappa}{sub W} =0.67 to 0.90. In both, Maracas was substantially more reproducible than the readers. Mean operating time was within 1 min/ CA. Conclusion: Maracas software generates accurate 3D centerlines of vascular segments with minimum user intervention. Semi-automatic quantification of CA stenosis is also accurate, except in very severe stenoses that cannot be segmented. It substantially reduces the inter-observer variability. (orig.)

  12. 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...

  13. Follow-up of combined intervention for patients with both renal and cerebral artery stenosis

    Institute of Scientific and Technical Information of China (English)

    BIAN Xiao-xi; SUN Yu-heng

    2006-01-01

    @@ Renal artery stenosis (RAS) is a frequently overlooked clinical entity that can cause uncontrolled hypertension and lead to a progressive deterioration of renal function.1 We observed 20 patients with RAS complicated with cerebral artery stenosis (CAS), who underwent cerebral and renal artery angiography and combined intervening treatment. Clinical follow-up was performed for more than 3 years.

  14. EVALUATION OF CAROTID ARTERY STENOSIS IN STROKE/TRANSIENT ISCHAEMIC ATTACK

    OpenAIRE

    Nambakam Tanuja; Naveen Kumar; Girish P.

    2015-01-01

    BACKGROUND : Stroke remains the second leading cause of death worldwide, after ischaemic heart disease. Patients with carotid artery stenosis are at higher risk of development of stroke. Carotid atherosclerosis occurs in patients with atheros clerotic risk factors like diabetes mellitus, hypertension, smoking and hyperlipidemia. Carotid artery stenosis can be assessed by means of noninvasive high - resolution B - mode ultrasonography of the carotid arteries. ...

  15. Three-dimensional speckle tracking imaging for reviewing myocardial strain parameter changes in patients with different severity coronary artery stenosis%三维斑点追踪成像评价冠脉不同程度狭窄心肌整体应变参数变化

    Institute of Scientific and Technical Information of China (English)

    李丹; 刘梅; 牛海燕; 段雅琦; 黄晓玲; 王建华

    2016-01-01

    Objective To review the global myocardial strain by applying three-dimensional speckle tracking imaging (3D-STI) in patients with different severity coronary artery stenosis.Methods The patients with suspected coronary heart disease (CHD,n=63) were chosen from Dec. 2013 to May. 2014. According to the outcomes of coronary angiography (CAG), the patients were divided into control group (without coronary artery stenosis,n=10), mild stenosis group (mild group, stenosis rate ≤50%,n=9), moderate stenosis group (moderate group, 50%75%,n=34). The global myocardial strain parameters were obtained by applying 3D-STI, including global long axis strain (GLS), global radial strain (GRS), global circumferential strain (GCS) and global area strain (GAS) of left ventricular systolic peak. The difference in global myocardial strain parameters of different severity coronary artery stenosis was compared.Results All myocardial strain parameters decreased significantly in severe group compared with other groups. GLS, GRS and GAS decreased significantly in moderate group compared with control group, and GAS decreased significantly in moderate group compared with mild group. GAS decreased significantly in mild group compared with control group (P<0.05).Conclusion 3D-STI can be taken as an effective detective method for reviewing global left ventricular systolic function in CHD patients without ventricular wall motion. GAS is a parameter with the highest sensitivity and repeatability. As the increase of coronary artery stenosis severity, the damage of myocardial strain will become heavier and GAS damage is the most significant.%目的:应用三维斑点追踪成像(three-dimensional speckle tracking imaging,3D-STI)技术评价冠脉不同程度狭窄心肌整体应变。方法收集2013年12月至2014年5月于北京军区总医院心内科住院,临床诊断疑似为冠心病患者共计63例,根据患者冠状动脉造影结果,按三支冠脉不同

  16. Aortic valve stenosis after previous coronary bypass: Transcatheter valve implantation or aortic valve replacement?

    Directory of Open Access Journals (Sweden)

    Jegaden Olivier

    2012-05-01

    Full Text Available Abstract We report a prospective comparison between transcatheter valve implantation (TAVI, n = 13 and surgical aortic valve replacement (AVR, n = 10 in patients with severe aortic valve stenosis and previous coronary bypass surgery (CABG. All patients had at least bilateral patent internal thoracic arteries bypass without indication of repeat revascularization. After a similar post-procedure outcome, despite one early death in TAVI group, the 1-year survival was 100% in surgical group and in transfemoral TAVI group, and 73% in transapical TAVI group. When previous CABG is the lone surgical risk factor, indications for a TAVI procedure have to be cautious, specially if transfemoral approach is not possible.

  17. [Short and long-term results of endovascular treatment of bifurcational coronary stenosis].

    Science.gov (United States)

    Shugushev, Z Kh; Movsesiants, M Iu; Maksimkin, D A; Baranovich, V Iu; Faĭbushevich, A G; Stefanov, S A; Tarichko, Iu V

    2010-01-01

    Short and long-term results of endovascular treatment of true bifurcational coronary stenosis were analyzed in 229 patients. 68 patients received a "provisional-T" stenting on the first stage of the study. On the next stage 40 patients received the same "provisional-T" stenting, a total bifurcational stenting was conducted in 37 patients. Only coated stents were used. Independent risk factors of "provisional-T" stenting conversion to total bifurcational stenting were revealed. There were no differences between "provisional-T" and total bifurcational stenting considering the short-term treatment results. Long-term results (12-18 months) were analyzed in 70 patients. There were no restenosis of the main artery, whereas restenosis of the lateral branch was noticed in 5.5 and 2.94%, respectively, in the groups of "provisional-T" and total bifurcational stenting. Late thrombosis was registered in 1 case from the group of total bifurcational stenting.

  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. Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test

    NARCIS (Netherlands)

    J.M.P. Baptista da Silva (José); M. Arnese (Mariarosaria); J.R.T.C. Roelandt (Jos); P.M. Fioretti (Paolo); D.T.J. Keane (David); J. Escaned (Javier); C. di Mario (Carlo); P.W.J.C. Serruys (Patrick); H. Boersma (Eric)

    1994-01-01

    textabstractOBJECTIVES. The purpose of this study was to determine the predictive value of quantitative coronary angiography in the assessment of the functional significance of coronary stenosis as judged from the development of left ventricular wall motion abnormalities during dobutamine-atropine

  20. Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test

    NARCIS (Netherlands)

    J.M.P. Baptista da Silva (José); M. Arnese (Mariarosaria); J.R.T.C. Roelandt (Jos); P.M. Fioretti (Paolo); D.T.J. Keane (David); J. Escaned (Javier); C. di Mario (Carlo); P.W.J.C. Serruys (Patrick); H. Boersma (Eric)

    1994-01-01

    textabstractOBJECTIVES. The purpose of this study was to determine the predictive value of quantitative coronary angiography in the assessment of the functional significance of coronary stenosis as judged from the development of left ventricular wall motion abnormalities during dobutamine-atropine s

  1. Updates in management of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Heon; Chae, Shung Chull [Kyungpook National University Medical School, Daegu (Korea, Republic of)

    2005-02-15

    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed.

  2. Coronary artery abnormalities in Kawasaki disease - Comparison between CT and MR coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Woo; Goo, Hyun Woo [Dept. of Radiology and Research Inst. of Radiology, Univ. of Ulsan Coll. of Medicine, Asan Medical Center, Seoul (Korea, Republic of)], e-mail: hwoogoo@amc.seoul.kr

    2013-03-15

    Background: Although CT coronary angiography (CTCA) and MR coronary angiography (MRCA) are increasingly used in patients with Kawasaki disease, comparison of coronary artery assessability and diagnostic performance between the two imaging modalities has been rarely performed. Purpose: To investigate which imaging modality, CTCA or MRCA, is better for evaluating coronary artery abnormalities in patients with Kawasaki disease. Material and Methods: Between 2003 and 2011, 56 patients (38 boys/men; age range, 1-24 years) with Kawasaki disease underwent CTCA or MRCA (group A). Of these, 17 underwent both CTCA and MRCA (group B). Visibility of 11 coronary arterial segments in each patient was graded on a four-point scale. Coronary artery aneurysm, stenosis, and occlusion were evaluated by CTCA and MRCA, based on a reference standard obtained from cardiac catheterization, echocardiography, follow-up CTCA and MRCA, and clinical history. Coronary artery assessability and diagnostic performance were compared between CTCA and MRCA. Results: In per-segment analysis, more segments were assessable on CTCA than on MRCA in both groups. In per-patient analysis of group B, no significant difference in the assessability was found between CTCA (95.0%, 128.3/135 segments) and MRCA (92.4%, 124.8/135 segments) (P > 0.05). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CTCA vs. MRCA were 93.1% vs. 77.9% (P < 0.001), 99.2% vs. 99.7% (P = 0.65), 96.8% vs. 98.7% (P = 0.65), 98.2% vs. 94.1% (P < 0.001), and 98.0% vs. 94.9% (P = 0.008), respectively, in group A, and 91.8% vs. 70.4% (P < 0.001), 99.5% vs. 99.5% (P = 1.000), 98.5% vs. 98.0% (P = 1.000), 97.2% vs. 91.1% (P = 0.006), and 97.6% vs. 92.3% (P = 0.004), respectively, in group B. Conclusion: Although CTCA and MRCA show comparable assessability in per-patient analysis, CTCA shows higher diagnostic performance than MRCA for evaluating coronary artery abnormalities in patients with Kawasaki

  3. 药物洗脱支架与冠状动脉旁路移植术治疗无保护左主干病变的临床疗效对比%Clinic comparison of drug-eluting stent (DES) implantation and coronary artery bypass grafting (CABG) treatment for patients with unprotected left main coronary stenosis

    Institute of Scientific and Technical Information of China (English)

    刘幼文; 金光临; 杨建安; 王涓; 曾繁芳; 师姗姗; 曹高镇; 张雪; 王灵芝

    2012-01-01

    Objective: To evaluate the clinical efficacy of drug-eluting stent (DES) implantation and coronary artery bypass grafting (CABG) treatment for patients with unprotected left main coronary stenosis. Method:Two hundred and eighty-two patients with unprotected left main coronary stenosis underwent revascularization from October 2003 to September 2010, of which 143 by percutaneous coronary intervention with DES (DES group) and 139 by CABG (CABG groups). The incidences of major adverse cardiovascular and cerebrovascular events (MACCE) , which included any death, non fatal myocardial infarction, target vessel revascularization and cerebro vascular event during hospital and follow-up, were compared between 2 groups. Result:The success rate achieved in DES group was 100% , and there was 1 case occurred with non-fatal myocardial infarction, no case of death, cerebral vascular accident or need to repeat revascularization during hospitalization. The success rate achieved in CABG was 95. 7%, and there was 1 case occurred non-fatal acute myocardial infarction. No case needed with repeat revascularization, and 6 cases were dead during hospitalization. Hospital mortality was significantly higher in CABG group than DES group (4. 3% vs 0%, P<0. 05). MACCEs during hospitalization in CABG group was significantly higher than in DES group (5. 0% vs 0. 7%, P<0. 05). Patients were followed up clinically for a mean of (17 ± 8) months. Compared with CABG group, the rates of clinical angina recurrence (7. 8% vs 2. 7%) and repeat revascularization in DES group (7. 0% vs 1. 8%) tended to increase without statistically significant. The incidence of MACCEs was significantly higher in DES group than CABG group (14. 8% vs 7. 1%). If remove the cases of new lesions and lesion progressed, the 2 groups had no significant overall difference in incidence of MACCE (7. 8%vs7. 1%). Conclusion: DES is safe and effective in treating patients with unprotected left main coronary stenosis, and it might to be

  4. Numerical Simulation of Coronary Artery Bypass Graft with an Assistant Graft

    Institute of Scientific and Technical Information of China (English)

    WANG Wei; WANG Feng

    2014-01-01

    The conventional bypass design is to implant a graft on the stenosed host artery allowing blood to flow bypass the stenotic artery. However, restenosis is a challenging problem which finally results in reoperation. The purpose of this paper is to propose a new bypass graft design of coronary artery with an assistant graft for the treatment of coronary artery stenosis. An additional assistant graft was employed in the new design compared with the conventional ETS anastomosis. Numerical simulations were performed by means of finite volume method using computational fluid dynamics (CFD) solver. Results demonstrated that the new anastomoses model provided a more smooth flow at the distal ETS anastomosis without any stagnation point on anastomotic bed and vortex formation in the heel region. Oscillatory shear index (OSI) and time-averaged wall shear stress gradient (TAWSSG) at the artery bed of the distal ETS anastomosis were reduced. The coronary artery bypass graft with an assistant graft is feasible to improve the local hemodynamics and diminish the probability of restenosis in the treatment of coronary artery stenosis.

  5. Right ventricular ejection fraction during exercise in normal subjects and in coronary artery disease patients: assessment by multiple-gated equilibrium scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Maddahi, J.; Berman, D.S.; Matsuoka, D.T.; Waxman, A.D.; Forrester, J.S.; Swan, H.J.C.

    1980-07-01

    The response of right ventricular ejection fraction (RVEF) during exercise and its relationship to the location and extent of coronary artery disease are not fully understood. We have recently developed and validated a new method for scintigraphic evaluation of RVEF using rapid multiple-gated equilibrium scintigraphy and multiple right ventricular regions of interest. The technique has been applied during upright bicycle exercise in 10 normal subjects and 20 patients with coronary artery disease. Resting RVEF was not significantly different between the groups (0.49 +- 0.04 vs 0.47 +- 0.09, respectively, mean +- SD). In all 10 normal subjects RVEF rose (0.49 +- 0.04 to 0.66 +- 0.08, p < 0.01) at peak exercise. At peak exercise in coronary artery disease patients, the group RVEF remained unchanged (0.47 +- 0.09 to 0.50 +- 0.11, p = NS), but the individual responses varied. In the coronary artery disease patients, the relationship between RVEF response to exercise and exercise left ventricular function, septal motion and right coronary artery stenosis were studied. Significant statistical association was found only between exercise RVEF and right coronary artery stenosis. RVEF rose during exercise in seven of seven patients without right coronary artery stenosis (0.42 +- 0.06 to 0.58 +- 0.08, p = 0.001) and was unchanged or fell in 12 of 13 patients with right coronary artery stenosis (0.50 +- 0.09 to 0.45 +- 0.10, p = NS). We conclude that (1) in normal subjects RVEF increases during upright exercise and (2) although RVEF at rest is not necessarily affected by coronary artery disease, failure of RVEF to increase during exercise, in the absence of chronic obstructive pulmonary disease or valvular heart disease, may be related to the presence of significant right coronary artery stenosis.

  6. Left main coronary artery compression in pulmonary arterial hypertension

    DEFF Research Database (Denmark)

    Al-Badri, Kadhem Helo Abbas; Jensen, Jesper Møller; Christiansen, Evald H

    2015-01-01

    In patients with pulmonary arterial hypertension (PAH), chest pain is most likely due to right ventricular demand ischemia. We report a patient with idiopathic PAH who developed severe angina due to extrinsic compression of the left main coronary artery (LMCA) from a dilated pulmonary artery trunk....... The diagnosis was verified by electrocardiogram after exercise, coronary angiography including intravascular ultrasound, and cardiac multidetector computed tomography (MDCT). The origin of the LMCA was high in the left coronary sinus, facilitating extrinsic compression. The patient was successfully treated...... by percutaneous coronary intervention with stent implantation in the LMCA. Extrinsic compression of the LMCA is a severe and potentially fatal complication that should be considered in all patients with PAH and angina. MDCT is the method of choice for first-line diagnosis....

  7. [Pregnancy and coronary artery dissection].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  8. Calculation of the index of microcirculatory resistance without coronary wedge pressure measurement in the presence of epicardial stenosis.

    Science.gov (United States)

    Yong, Andy S; Layland, Jamie; Fearon, William F; Ho, Michael; Shah, Maulik G; Daniels, David; Whitbourn, Robert; Macisaac, Andrew; Kritharides, Leonard; Wilson, Andrew; Ng, Martin K

    2013-01-01

    This study sought to investigate a novel method to calculate the index of microcirculatory resistance (IMR) in the presence of significant epicardial stenosis without the need for balloon dilation to measure the coronary wedge pressure (P(w)). The IMR provides a quantitative measure of coronary microvasculature status. However, in the presence of significant epicardial stenosis, IMR calculation requires incorporation of the coronary fractional flow reserve (FFR(cor)), which requires balloon dilation within the coronary artery for P(w) measurement. A method to calculate IMR by estimating FFR(cor) from myocardial FFR (FFR(myo)), which does not require P(w) measurement, was developed from a derivation cohort of 50 patients from a single institution. This method to calculate IMR was then validated in a cohort of 72 patients from 2 other different institutions. Physiology measurements were obtained with a pressure-temperature sensor wire before coronary intervention in both cohorts. From the derivation cohort, a strong linear relationship was found between FFR(cor) and FFR(myo) (FFR(cor) = 1.34 × FFR(myo) - 0.32, r(2) = 0.87, p measured FFR(cor) (21.2 ± 12.9 U vs. 20.4 ± 13.6 U, p = 0.161). There was good correlation (r = 0.93, p measured IMR. The FFR(cor), and, by extension, microcirculatory resistance can be derived without the need for P(w). This method enables assessment of coronary microcirculatory status before or without balloon inflation, in the presence of epicardial stenosis. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. secondary Prevention of Coronary Events by Coronary Artery Bypass Surgery

    OpenAIRE

    2003-01-01

    Coronary artery bypass surgery has shown its superiority on other therapeutic options in specific but frequent indications such as left main lesions, multivessel disease with alteration of ventricular function, proximal lesions of the LAD, and multivessel diseases in diabetic patients. After reviewing the epidemiology of coronary artherosclerosis, we emphasize the efficacy of the surgical treatment compared to medical or interventional therapy for preventing ischemic events. The results deriv...

  10. 平板运动试验和动态心电图联合检查对评估冠状动脉狭窄程度的预测价值%The Predictive Value in the Assessment of the Degree of Coronary Artery Stenosis through the Joint Inspection of Exercise Treadmill Test and Dynamic Electrocardiogram

    Institute of Scientific and Technical Information of China (English)

    杜红梅

    2014-01-01

    目的:为了明确活动平板运动试验和动态心电图联合检测对冠状动脉病变的预测价值。方法:选取冠状动脉造影阳性且造影前3个月内做平板运动试验和动态心电图的患者165例,冠状动脉造影用通用直径法确定冠状动脉狭窄程度,并与平板运动试验和动态心电图的结果进行对比观察。结果:平板运动试验中ST段下移出现越早,ST段下移程度越大,持续时间越长,冠状动脉狭窄程度越重。冠状动脉造影阳性而平板运动试验阴性者,多为单支病变或者病变程度较轻;平板运动试验的敏感性为71.8%,特异性为80.5%,动态心电图的敏感性为63.7%,特异性为78.1%。结论:活动平板运动试验和动态心电图联合检测可提高冠心病诊断的准确性。%To define the predictive value of the joint detection of between exercise treadmill test and dynamic electrocardiogram in the diagnosis of coronary artery lesions.Method:165 patients who were found coronary angiography positive and did treadmill exercise test and dynamic electrocardiogram within 3 months before angiography were selected. Coronary angiography employed the general method of diameter to determine the degree of coronary artery stenosis whose results were compared with the results of exercise treadmill test and dynamic electrocardiogram.Result:In the exercise treadmill test,the sooner ST segment depression appeared ,the greater degree ST segment depression showed,the longer duration of ST segment depression lasted,the more severe coronary artery stenosis was. The patient who was found positive in coronary angiography and negative in exercise treadmill test was mostly single lesions or a lesser degree of lesions. The sensitivity of exercise treadmill test was 71.8%,and its specificity was 80.5%. The sensitivity of the dynamic electrocardiogram was 63.7%,and its specificity was 78.1%. Conclusion:The diagnostic accuracy of coronary heart

  11. Concomitant atherosclerotic disease detected by whole-body MR angiography in relation to coronary artery calcification in patients with coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Seng, K.; Schlosser, T.; Barkhausen, J.; Ladd, S.C. [Universitaetsklinikum Essen (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie; Breuckmann, F.; Geckeis, K.; Schmermund, A.; Erbel, R. [Universitaetsklinikum Essen (Germany). Abt. fuer Kardiologie, Westdeutsches Herzzentrum Essen; Budde, T.; Hoefs, C. [Krupp Krankenhaus, Essen (Germany). Abt. fuer Kardiologie

    2010-04-15

    Purpose: Patients with coronary artery disease (CAD) show a high prevalence for concomitant atherosclerotic peripheral arterial disease (PAD). On the other hand, PAD seems to be an additional risk factor for cardiac events. We evaluated the correlation between arterial pathologies as found in whole-body MR angiography and coronary artery calcification (CAC) detected by electron beam computed tomography (EBCT) and multislice CT (MSCT). Materials and Methods: Two hundred and twenty-eight patients (161 men; 67 women) with suspicion for CAD/known CAD underwent whole-body contrast-enhanced MR angiography (wb-ce-MRA) and EBCT/MSCT. An atherosclerosis index was calculated for each patient Index = sum {sub n=1}{sup 40}w{sub i} with w{sub i} being the grading of the stenosis of the i{sup ten} of 40 arteria segments (grade: 0 - no plaque; 1 - plaque - {<=} 50 % stenosis; 2 - > 50 % stenosis - {<=} 90 % stenosis; 3 - > 90 % stenosis - < 100 % stenosis; 4 - occlusion). Correlations between CAC and atherosclerosis index were performed. Results: Wb-ce MRA and CAC correlate only moderately in this population. An atherosclerosis index 8 renders a positive predictive value for a CAC 100 of 63.3 %. Conclusion: An atherosclerosis index as defined in this study does not fully correlate with the extent of CAD as revealed by catheter angiography or EBCT/MSCT, but it might theoretically mirror the increased risk by PAD. It thus might be a promising complementary parameter for the prediction of cardiac events. Future studies need to show its possible additional predictive impact.

  12. Integration of a capacitive pressure sensing system into the outer catheter wall for coronary artery FFR measurements

    Science.gov (United States)

    Stam, Frank; Kuisma, Heikki; Gao, Feng; Saarilahti, Jaakko; Gomes Martins, David; Kärkkäinen, Anu; Marrinan, Brendan; Pintal, Sebastian

    2017-05-01

    The deadliest disease in the world is coronary artery disease (CAD), which is related to a narrowing (stenosis) of blood vessels due to fatty deposits, plaque, on the arterial walls. The level of stenosis in the coronary arteries can be assessed by Fractional Flow Reserve (FFR) measurements. This involves determining the ratio between the maximum achievable blood flow in a diseased coronary artery and the theoretical maximum flow in a normal coronary artery. The blood flow is represented by a pressure drop, thus a pressure wire or pressure sensor integrated in a catheter can be used to calculate the ratio between the coronary pressure distal to the stenosis and the normal coronary pressure. A 2 Fr (0.67mm) outer diameter catheter was used, which required a high level of microelectronics miniaturisation to fit a pressure sensing system into the outer wall. The catheter has an eccentric guidewire lumen with a diameter of 0.43mm, which implies that the thickest catheter wall section provides less than 210 microns height for flex assembly integration consisting of two dies, a capacitive MEMS pressure sensor and an ASIC. In order to achieve this a very thin circuit flex was used, and the two chips were thinned down to 75 microns and flip chip mounted face down on the flex. Many challenges were involved in obtaining a flex layout that could wrap into a small tube without getting the dies damaged, while still maintaining enough flexibility for the catheter to navigate the arterial system.

  13. 血管紧张素转换酶2基因9570A/G多态性与冠状动脉狭窄程度的相关分析%Association of angiotensin-converting enzyme 2 and gene polymorphism with the severity of coronary artery stenosis

    Institute of Scientific and Technical Information of China (English)

    张永; 张友亮; 吴士礼

    2012-01-01

    目的:探讨皖北地区汉族人群血管紧张素转换酶2(ACE2)基因9570A/G多态性与冠心病(CHD)患者冠状动脉狭窄程度的关系.方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测120例CHD患者ACE2基因多态性,并根据冠脉造影病变支数和Genisini积分进行基因型和等位基因频率分析比较.结果:在男性CHD组中,9570G基因型者冠状动脉病变支数和Genisini积分均多于9570A基因型者(P0.05).结论:ACE2基因9570A/G多态性与皖北地区汉族人群男性CHD冠脉狭窄程度具有一定关系,与女性无明显关系.%Objective:To explore the relationship between angiotensin-converting enzyme 2( ACE2) gene 9570A/G polymorphism and the severity of coronary artery stenosis in the Han population of northern Anhui province. Methods: The ACE2 gene polymorphism in 120 CHD patients was detected by means of polymerase chain reaction and restriction fragment length polymorphism; the frequency of genotype and allele were compared according to the number of coronary artery lesions and the dangerous scores. Results:The number of coronary artery lesions and Genisini scores in the male patients with G genotype were higher than those with A genotype in CHD group (P <0. 05 ); however, there was no statistical difference in female patients with CHD ( P > 0. 05 ). Conclusions: The ACE2 gene 9570A/G polymorphism might be associated with the severity of coronary artery straitness of CHD in male patients in the Han nationality of northern Anhui province; however, female patients might have no such correlation.

  14. Conjunctival-corneal melt in association with carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    Rosalind MK Stewart

    2008-10-01

    Full Text Available Rosalind MK Stewart1, Say Aun Quah1, Dan Q Nguyen2, Stephen B Kaye11Royal Liverpool University Hospital, Liverpool, UK; 2Bristol Eye Hospital, Bristol, UKPurpose: To report a case of severe conjunctival-corneal melt in association with carotid artery stenosis.Methods: Observational case report.Results: A 76-year-old man with a history of bilateral severe carotid artery occlusion and nonarteritic ischemic optic neuropathy developed a spontaneous bulbar conjunctival defect. Despite intensive lubrication, and attempts at surgical closure including an amniotic membrane patch graft, it progressed with subsequent adjacent corneal perforation. Thorough investigations revealed no underlying disease, except markedly delayed episcleral vessel filling on anterior segment fluorescein angiography.Conclusions: Neovascularisation is a known factor in the inhibition of ulceration. In light of the findings in this report, ocular ischemia should be considered as a cause or contributing factor in the differential diagnosis of conjunctival-corneal melt.Keywords: conjunctival melt, corneal melt, ocular ischemia, carotid artery stenosis

  15. Efficacy of magnetic resonance coronary angiography for evaluating coronary arterial lesions due to Kawasaki disease

    Energy Technology Data Exchange (ETDEWEB)

    Inaba, Rikako; Suzuki, Atsuko; Sato, Katsuhiko; Ono, Masae; Hosina, Kiyoshi; Furuyama, Tamio; Takemura, Atsusi; Korenaga, Tateo [Tokyo Teishin Hospital (Japan)

    2002-11-01

    To reduce the number of invasive X-ray coronary angiography (XCA) in patients with coronary arterial lesions (CAL) due to Kawasaki disease, we evaluated the efficacy of noninvasive magnetic resonance coronary angiography (MRCA). We preformed MRCA on 30 patients with Kawasaki disease (age 4 months to 37 years; medium 9 years) by SIEMENS MAGNETOM Symphony 1.5 T. MRCA with free respiration using navigator echo 3D fast low angle shot (3D-FLASH) was performed on 10 young children. Evaluation of MRCA was based on the findings of 2D echo cardiogram (30 patients) and XCA (14 patients). All 17 aneurysms (100%) were detected by MRCA; four out of five dilatations were detected by MRCA (80%), but a slight dilatation was not detected (i.e., appeared to be a normal coronary artery). We observed seven stenoses (100%) that were detected on XCA and one new stenosis on MRCA; both of two aortocoronary bypass graphs (one in each of two patients; 100%) were observed to be patent. These results demonstrated that MRCA was highly beneficial, first for detecting CAL after the acute phase even in young infants, second for reducing the number of XCA examination times for following up CAL, and third for screening of CAL in adults with a history of Kawasaki disease. (author)

  16. Spontaneous healing of spontaneous coronary artery dissection.

    Science.gov (United States)

    Almafragi, Amar; Convens, Carl; Heuvel, Paul Van Den

    2010-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. It should be suspected in every healthy young woman without cardiac risk factors, especially during the peripartum or postpartum periods. It is important to check for a history of drug abuse, collagen vascular disease or blunt trauma of the chest. Coronary angiography is essential for diagnosis and early management. We wonder whether thrombolysis might aggravate coronary dissection. All types of treatment (medical therapy, percutaneous intervention or surgery) improve the prognosis without affecting survival times if used appropriately according to the clinical stability and the angiographic features of the involved coronary arteries. Prompt recognition and targeted treatment improve outcomes. We report a case of SCAD in a young female free of traditional cardiovascular risk factors, who presented six hours after thrombolysis for ST elevation myocardial infarction. Coronary angiography showed a dissection of the left anterior descending and immediate branch. She had successful coronary artery bypass grafting, with complete healing of left anterior descending dissection.

  17. Effects of dipyridamole and aminophylline on hemodynamics, regional myocardial blood flow and thallium-201 washout in the setting of a critical coronary stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Granato, J.E.; Watson, D.D.; Belardinelli, L.; Cannon, J.M.; Beller, G.A. (Univ. of Virginia Health Sciences Center, Charlottesville (USA))

    1990-12-01

    Experiments were performed to characterize the interaction of intravenous dipyridamole and aminophylline on thallium-201 transport kinetics, regional myocardial blood flow and systemic hemodynamics in the presence of a critical coronary artery stenosis. In 12 dogs with a critical left anterior descending coronary artery stenosis, arterial pressure decreased from a mean value (+/- SEM) of 107 +/- 6 to 94 +/- 3 mm Hg and distal left anterior descending artery pressure decreased from 70 +/- 7 to 55 +/- 4 mm Hg after intravenous administration of dipyridamole. In the left anterior descending perfusion zone, the endocardial/epicardial flow ratio decreased from 0.70 to 0.36 and the intrinsic thallium washout rate was significantly prolonged. Intravenous aminophylline reversed the dipyridamole-induced systemic hypotension and transmural coronary steal and restored the thallium washout rate to baseline values. In six other dogs, aminophylline alone resulted in no alterations in systemic and coronary hemodynamics or regional myocardial blood flow. As expected, dipyridamole-induced vasodilation and coronary steal were prevented by aminophylline pretreatment. These data show that in a canine model of partial coronary stenosis, systemic hypotension, adverse regional flow effects and prolonged thallium-201 washout consequent to intravenously administered dipyridamole are promptly reversed by intravenous aminophylline administration. Aminophylline alone had no significant hemodynamic and coronary flow effects. This study provides further insight into the altered thallium kinetics occurring as a consequence of dipyridamole-induced vasodilation and suggests that the prompt reversal of symptoms and signs of ischemia with aminophylline in patients receiving intravenous dipyridamole for clinical imaging studies probably reflects the reversal of transmural coronary steal.

  18. Diagnosis of renal artery branch stenosis using captopril intervention scintirenography

    Energy Technology Data Exchange (ETDEWEB)

    Prakash, R.; Gupta, S.K. [Batra Hospitan, New Delhi (India). Depts. of Nuclear Medicine and Cardiology

    1996-08-01

    A case of renovascular hypertension in a young male is presented. The patient had a small size right kidney with reduced differential function on the baseline [99mTc]-DTPA renal study. Captopril intervention scintigraphy demonstrated a dramatic reduction in renal perfusion and cortical uptake in the upper and mid-poles of the affected kidney. Time-activity curves of the [99mTc]-DTPA studies using segmental regions of interest corroborated visual findings. The presence of renal artery branch stenosis was confirmed on renal angiography. 10 refs., 6 figs.

  19. Transient cortical blindness after coronary artery angiography.

    Science.gov (United States)

    Terlecki, Michał; Wojciechowska, Wiktoria; Rajzer, Marek; Jurczyszyn, Artur; Bazan-Socha, Stanisława; Bryniarski, Leszek; Czarnecka, Danuta

    2013-01-01

    Coronary angiography is the current gold standard for the diagnosis of ischemic heart disease and therefore the prevalence of percutaneous coronary procedures such as angiography and angioplasty is high. The occurrence of cerebral complications after coronary angiography and coronary angioplasty is low and it mainly includes transient ischemic attack and stroke. The prevalence of transient cortical blindness after X-ray contrast media is low and it is usually seen after cerebral angiography. Until now only a few cases of transient cortical blindness have been described after coronary artery angiography. Regarding the spread of coronary angiography worldwide and in Poland this complication is uniquely rare. A 32-year-old man with multiple extrasystolic ventricular arrhythmia suggesting Brugada syndrome diagnosis according to morphology of the left bundle branch block and with decreased left ventricular ejection fraction was admitted to the First Department of Cardiology and Hypertension, Medical College of the Jagiellonian University in Krakow. Coronary angiography was performed in order to exclude ischemic etiology of the observed abnormalities. No arteriosclerotic lesions were found in coronary arteries. Transient cortical blindness was observed directly after angiography which may have been caused by the neurotoxic effect of the used X-ray contrast medium. In ophthalmologic and neurologic examination as well as in the cerebral computed tomography scan no pathologies were found. Visual impairment disappeared totally within several hours.

  20. Angiographic coronary stenosis versus (15)O-water PET myocardial blood flow

    DEFF Research Database (Denmark)

    Thomassen, Anders; Braad, Poul-Erik; Johansen, Allan

    2013-01-01

    Purpose: To examine which of stress myocardial flow (MBF) and coronary flow reserve (CFR) determined by (15)-water-PET (PET) correspond most closely with diameter stenosis assessed by quantitative coronary angiography (QCA). Methods: Twenty-three patients with a C40% QCA stenosis underwent baseline...... and functional stenosis was poor, suggesting that the hemodynamic consequences of angiographically proven coronary stenoses should be examined by functional imaging like PET....... and adenosine stress PET. Baseline MBF measures were corrected for myocardial workload and stress MBF and CFR calculated in 17 standard AHA myocardial segments and reassigned to respective feeding vessels. If multiple stenoses, only the most severe stenosis was considered. Pearson’s correlation coefficients...

  1. [Acute coronary syndrome suspicion in patient with left coronary artery arising from right coronary sinus].

    Science.gov (United States)

    Kern, Adam; Górny, Jerzy; Rzeszowski, Bartłomiej; Witkowska, Ewa; Wasilewski, Grzegorz

    2013-01-01

    We present a case of 73 year-old patient who underwent coronary angiography due to suspicion of acute coronary syndrome without persistent ST segment elevation. The angiographic result showed no lesions that could cause recurrent chest pain,but it also revealed a seldom coronary artery abnormality - left coronary artery arising from right coronary sinus. Performed computed tomography of the chest confirmed the result of the coronarography. But apart from that it found the signs of neoplastic disease which was probably responsible for clinical presentation.

  2. Coronary heart disease risk assessment and characterization of coronary artery disease using coronary CT angiography: comparison of asymptomatic and symptomatic groups

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Y. [Department of Radiology, School of Medicine, Ewha Womans University, Seoul (Korea, Republic of); Kim, Y., E-mail: yookkim@ewha.ac.k [Department of Radiology, School of Medicine, Ewha Womans University, Seoul (Korea, Republic of); Chung, I.-M. [Division of Cardiology in Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul (Korea, Republic of); Ryu, J.; Park, H. [Department of Preventive Medicine, School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2010-08-15

    Aim: To evaluate the prevalence of coronary artery disease (CAD) in relation to risk of coronary heart disease (CHD) and assess plaque characteristics from coronary computed tomography (CT) angiography in asymptomatic and symptomatic patients. Materials and methods: Three hundred and ninety consecutive patients [asymptomatic group, n = 138; symptomatic group (atypical or non-anginal chest pain), n = 252] were retrospectively enrolled. They were subsequently classified into three CHD risk categories, based on the National Cholesterol Education Program guidelines, and 10 year risks of coronary events were calculated using Framingham risk score. CT was evaluated for stenosis, plaque composition, and coronary calcium scores. Results: CAD was observed in 42% of the asymptomatic group and 62% of the symptomatic group. In the former, the prevalence of CAD in low-, moderate- and high-risk subgroups was 21.4, 47.4 and 65%, respectively, and was 33.3, 74.4, and 72.4% in the symptomatic group. Framingham 10-year risks of coronary events were significantly higher in patients with CAD than in normal participants, and receiver operating characteristics curves showed that discriminatory power was poor in the asymptomatic group and symptomatic men, and good in symptomatic women. Of the participants in the asymptomatic group, 12% exhibited only non-calcified plaques and of the symptomatic group, 7% exhibited only non-calcified plaques. The coronary calcium score was significantly higher for significant stenosis than for non-significant stenosis in both groups. Conclusions: The prevalence of CAD was not negligible even in subgroups with low-to-moderate CHD risk. Additionally, the Framingham risk score was effective for predicting CAD only in symptomatic women. Coronary calcium scores correlated with significant stenosis; however, a sizeable percentage of both groups had only non-calcified plaques.

  3. On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients

    Directory of Open Access Journals (Sweden)

    Abbas Afrasiabirad

    2015-01-01

    Full Text Available Background: There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG in coronary high-risk patients in comparison with the conventional methods. Methods: In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003. Results: Preoperative patient characteristics revealed no significant differences between the two groups. The patients’ mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001. Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group. Conclusion: Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications.

  4. Correlation study on waist circumference-triglyceride (WT) index and coronary artery scores in patients with coronary heart disease.

    Science.gov (United States)

    Yang, R-F; Liu, X-Y; Lin, Z; Zhang, G

    2015-01-01

    Coronary disease is analyzed through common lipid profiles, but these analyses fail to account for residual risk due to abdominal weight and elevated TG levels. We aimed to investigate the relationship between the waist circumference × triglyceride index (WT index) and the Coronary Artery Score (CAS) in patients with coronary heart disease. 346 patients in our Cardiology Department were recruited from September 2007 to August 2011 and divided into two groups according to whether the patients presented with metabolic syndrome. We performed coronary angiography using the standard Judkins method. The severity of coronary artery stenosis and the CAS were calculated and analyzed with a computerized quantitative analysis system. The signs index, which includes the body mass index (BMI), waist circumference, hip circumference, waist-hip-ratio, and waist-height-ratio, the blood glucose and blood lipid index of all the patients were collected and used to calculate the WT index (waist circumference x triglyceride index. We performed a correlative analysis with age, gender, body mass index, blood glucose and blood lipid, blood pressure and other risk indicators of all patients as the dependent variables and the CAS as the independent variable. We show that the CAS is positively correlated to the WT index. Several lipid profiles and waist circumference were significantly associated with the CAS. The WT index is correlated to the CAS and is a good predictor for the development of coronary artery disease; it can be applied in the clinic for early intervention in populations at risk for coronary heart disease.

  5. Thoracic Sympathectomy for Severe Refractory Multivessel Coronary Artery Spasm.

    Science.gov (United States)

    Cardona-Guarache, Ricardo; Pozen, Jonah; Jahangiri, Arehzo; Koneru, Jayanthi; Shepard, Richard; Roberts, Charlotte; Abbate, Antonio; Cassano, Anthony

    2016-01-01

    Coronary artery spasm is a rare but potentially fatal disease. Herein, we report a case of recurrent ST-segment myocardial infarctions and ventricular fibrillation complicating severe multivessel coronary artery spasm successfully treated with bilateral thoracic surgical sympathectomy.

  6. Coronary Artery Dissection: Not Just a Heart Attack

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More Coronary Artery Dissection: Not Just a Heart Attack Updated:Oct 4, ... cannot reach the heart muscle. Spontaneous coronary artery dissection (SCAD) is an uncommon occurrence, but because it ...

  7. Evaluation of coronary arterial stenotic lesion with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Handa, Satoshi [Wakayama Medical Coll. (Japan)

    2002-09-01

    Although coronary arteriography (CAG) is an invasive method, it is widely used to diagnose the ischemic heart disease (IHD). Magnetic resonance imaging (MRI) is a noninvasive method and could be useful as a screening method for IHD. As coronary artery (CA) can be depicted as high intensity with a new pulse sequence of MRI, segmented k-space turboFLASH (STFL), we contrived a means to visualize CA and investigated the usefulness of this method to diagnose the stenotic lesion of CA. We compared the image quality of CA with body coil and spine surface coil in 24 normal volunteers using MRI. The quality was better with surface coil than with body coil. With surface coil, the segment no.1, no.2, no.5, no.6 of CA were visualized in all cases and the segment no.3, no.7, no.11 were in more than 70% of the cases. We investigated the figure of depicting the stenotic lesion with STFL method in 33 angina pectoris patients with more than 50% stenosis of CA in segment no.1, no.2, no.3, no.5, no.6, no.7, no.11 (41 lesions). The figures of depicting the stenotic lesion of CA were divided into three patterns as follows, the abruption of signal intensity of CA, the narrowing of signal intensity, the focal decreased signal intensity. The severe stenotic lesion (more than 90% stenosis) was showed as an abruption of signal intensity, and mild stenotic lesion (50% stenosis) was showed as a narrowing of signal intensity or focal decreased signal intensity. The sensitivity and specificity of MRI in diagnosing the stenotic lesions were calculated in consequent 27 angina pectoris patients having more than 25% stenosis in the segment no.1, no.2, no.3, no.5, no.6, no.7, no.11 of CA. The CAG study was analyzed accordingly to the American Heart Association CA stenosis classification, and in MRI the segments were classified into normal, abruption of signal intensity, narrowing of signal intensity and focal decreased signal intensity. When the abruption of signal intensity was recognized in MRI

  8. Relationship between coronary arterial remodeling and clinical presentation

    Institute of Scientific and Technical Information of China (English)

    杨震坤; 沈卫峰; 张大东

    2003-01-01

    Objective To examine the relationship between coronary arterial remodeling and clinical presentation. Methods A total of 34 patients with acute (10 with recent myocardial infarction and 24 with unstable angina) and 26 with stable (8 with old myocardial infarction and 18 with stable angina) coronary syndrome underwent intravascular ultrasound (IVUS) before intervention. Target lesions were classified as soft or hard plaques. Q uantitative measurements of cross-sectional area (CSA) of external elastic memb rane (EEM), lumen and plaque were performed at the lesion site and at the proxim al and distal reference sites. Remodeling index (RI) was expressed by the ratio of EEM CSA at the lesion site to the mean EEM CSA of both proximal and distal r eference sites. Positive remodeling was defined as RI>1.05 and negative remode ling as RI<0.95. Results Soft plaque was observed more frequently in acute than in stable coronary syndrome (59% vs 31%), whereas hard plaque was more common in stable coronary syndrome (69% vs 41%) (P=0.03). The EEM CSA (15.11±2.89 mm2 vs 13.25±3.10 mm2, P=0.019) and plaque CSA (10.83±2.62 mm2 vs 9.30±2.84 mm 2, P =0.035) were significantly greater at target lesions in patients with acute r ather than stable coronary syndrome, while lumen CSA and percent area stenosis w ere similar in both groups. RI was significantly higher (1.08±0.16 vs 0.95 ±0.14, P=0.002) and positive remodeling was more frequent in acute corona ry syndrome (53% vs 23%, P=0.019), whereas negative remodeling was more com mon in stable coronary syndrome (58% vs 24%, P=0.007). Conclusions The study indicates that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling .

  9. Coronary Anomaly and Coronary Artery Fistula as Cause of Angina Pectoris with Literature Review

    Science.gov (United States)

    Koneru, Jayanth; Samuel, Anish; Joshi, Meherwan; Hamden, Aiman; Shamoon, Fayez E.; Bikkina, Mahesh

    2011-01-01

    Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA), and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options. PMID:22937462

  10. Coronary Anomaly and Coronary Artery Fistula as Cause of Angina Pectoris with Literature Review

    Directory of Open Access Journals (Sweden)

    Jayanth Koneru

    2011-01-01

    Full Text Available Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA, and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

  11. Elevated NT-proBNP and coronary calcium score in relation to coronary artery disease in asymptomatic type 2 diabetic patients with elevated urinary albumin excretion rate

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Hansen, Peter R; Persson, Frederik;

    2011-01-01

    Elevated plasma N-terminal (NT)-proBNP levels and coronary calcium score (CCS) not only predicts myocardial ischaemia and coronary artery stenosis but also adverse cardiovascular events and mortality in type 2 diabetic patients with an increased urinary albumin excretion rate (UAER), whereas low...... levels are associated with low frequency of coronary artery disease (CAD) and good prognosis. The underlying causes of poor prognosis in patients with elevated NT-proBNP are not known; thus, we investigated the role of putative asymptomatic CAD in type 2 diabetic patients with UAER >30 mg/24 h...... and elevated P-NT-proBNP and/or CCS....

  12. Computed tomography imaging of early coronary artery lesions in stable individuals with multiple cardiovascular risk factors

    Directory of Open Access Journals (Sweden)

    Xi Yang

    2015-04-01

    Full Text Available OBJECTIVES: To investigate the prevalence, extent, severity, and features of coronary artery lesions in stable patients with multiple cardiovascular risk factors. METHODS: Seventy-seven patients with more than 3 cardiovascular risk factors were suspected of having coronary artery disease. Patients with high-risk factors and 39 controls with no risk factors were enrolled in the study. The related risk factors included hypertension, impaired glucose tolerance, dyslipidemia, smoking history, and overweight. The characteristics of coronary lesions were identified and evaluated by 64-slice coronary computed tomography angiography. RESULTS: The incidence of coronary atherosclerosis was higher in the high-risk group than in the no-risk group. The involved branches of the coronary artery, the diffusivity of the lesion, the degree of stenosis, and the nature of the plaques were significantly more severe in the high-risk group compared with the no-risk group (all p < 0.05. CONCLUSION: Among stable individuals with high-risk factors, early coronary artery lesions are common and severe. Computed tomography has promising value for the early screening of coronary lesions.

  13. THREE-DIMENSIONAL ULTRASOUND AND STENOSIS OF INTERNAL CAROTID ARTERY

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    Vojko Flis

    2003-12-01

    Full Text Available Background. Elucidation of the ultrasound structure of the atherosclerotic plaque in stenosis of internal carotid artery may have important implications for carotid surgery. This study compares the ability of computer derived 3D ultrasound gray scale volumetric measurements to diferentiate between ultrasonic structure of symptomatic and asymptomatic carotid plaque causing more than 70% stenosis.Methods. Eightysix internal carotid artery stenoses (70–99%, 45 symptomatic, 41 asymptomatic were imaged with 3D ultrasound to obtain the whole volume of the atherosclerotic plaque. Digitalized sonograms were computerized and normalized to the gray scale median (GSM of blood (0 and vessel adventitia (200. Plaque GSM was obtained for the whole volume by computing the volume ratio between echolucent and echogenic areas. The plaque heterogeneity was obtained by computing the density of echogenic areas per volume unit. Parametric t test was used for statistic analysis.Results. Minimum volume GSM ratio (determining echolucency was higher for asymptomatic plaque (0.6 – CI 0.48– 0.91 versus 0.3 – CI 0.21–0.75: p = 0.002. Greater GSM heterogeneity was present in symptomatic plaque (6.8 – CI 2.5– 18.3 versus 0.41 – CI 0.2–3.4;.p = 0.0001.Conclusions. Volume ultrasound imaging that enables objective assessment of whole ultrasonic plaque structure is more sensitive that single longitudinal view sonography for differentiating between ultrasonic structure of symptomatic and asymptomatic plaque.

  14. Influence of the amount of myocardium subtended to a coronary stenosis on the index of microcirculatory resistance. Implications for the invasive assessment of microcirculatory function in ischemic heart disease.

    Science.gov (United States)

    Echavarría-Pinto, Mauro; van de Hoef, Tim P; Nijjer, Sukhjinder; Gonzalo, Nieves; Nombela-Franco, Luis; Ibañez, Borja; Sen, Sayan; Petraco, Ricardo; Jimenez-Quevedo, Pilar; Nuñez-Gil, Ivan J; Cerrato, Enrico; Salinas, Pablo; Quirós, Alicia; Garcia-Garcia, Hector M; Fernandez-Ortiz, Antonio; Macaya, Carlos; Davies, Justin; Piek, Jan; Escaned, Javier

    2017-05-09

    The index of microcirculatory resistance (IMR) is growingly used to quantify microcirculatory function. However, in normal coronary arteries, resistance increases with the branching structure of the coronary tree, which suggest that IMR could be influenced by the amount of downstream myocardial mass (MM). We aimed to evaluate the influence of the amount of MM subtended to an intermediate stenosis on the IMR. IMR, fractional flow reserve and coronary flow reserve (CFR) were measured in 123 coronary arteries (102 patients) with intermediate stenosis. Jeopardized MM was estimated with the Myocardial Jeopardy Index (MJI). MM was inversely associated with IMR (R2=0.16, pcoronary stenosis is inversely associated with the IMR, while is not associated with the CFR.

  15. Prevalence and predictors of coronary artery disease in adults with Kawasaki disease.

    Science.gov (United States)

    Garg, Jalaj; Krishnamoorthy, Parasuram; Palaniswamy, Chandrasekar; Paudel, Rajiv; Chatterjee, Saurav; Ahmad, Hasan; Snyder, Christopher

    2015-08-01

    Accelerated coronary atherosclerosis in patients with Kawasaki disease, in conjunction with coronary artery aneurysm and stenosis that characterise this disease, are potential risk factors for developing coronary artery disease in young adults. We aimed to determine the prevalence and predictors of coronary artery disease in adult patients with Kawasaki disease. All patients aged 18-55 years of age diagnosed with Kawasaki disease were sampled from Nationwide Inpatient Sample database using International Classification of Diseases 9th revision (ICD 9 code 446.1) from 2009 to 2010. Demographics, prevalence of coronary artery disease, and other traditional risk factors in adult patients with Kawasaki disease were analysed using ICD 9 codes. The prevalence of Kawasaki disease among adults was 0.0005% (n=215) of all in-hospital admissions in United States. The mean age was 27.3 years with women (27.6 years) older than men (27.1 years). Traditional risk factors were hypertension (21%), hyperlipidaemia (15.6%), diabetes (11.5%), tobacco use (8.8%), and obesity (8.8%), with no significant difference between men and women. Coronary artery disease (32.4%), however, was more prevalent in men (44.7%) than in women (12.1%; p=0.03). In multivariate regression analysis, after adjusting for demographics and traditional risk factors, hypertension (OR=13.2, p=0.03) was an independent risk factor of coronary artery disease. There was increased preponderance of coronary artery disease in men with Kawasaki disease. On multivariate analysis, hypertension was found to be the only independent predictor of coronary artery disease in this population after adjusting for other risk factors.

  16. [Emergency coronary artery bypass grafting for acute coronary syndrome].

    Science.gov (United States)

    Yamaguchi, Atsushi; Murayama, Takanori

    2012-09-01

    Since the drug eluting stents appeared in Japan, the indication for percutaneous coronary intervention has become wide-spread for the treatment of coronary artery disease. In the past decade, 216 patients underwent emergency/urgent coronary artery bypass grafting (CABG) in our institution, while the annual numbers of both emergency and elective CABG cases have declined. On the contrary to the decreasing number, emergency CABG patients were significantly getting older with multiple co-morbidities. Thus, off-pump CABG is likely to be beneficial for preventing postoperative complications, leading to the decreased postoperative mortality. When emergency CABG patients developed refractory myocardial ischemia and unstable hemodynamics, a percutaneous cardiopulmonary support system was quickly applicable and useful for on-pump beating CABG achieving complete surgical revascularization. For keeping satisfactory hemodynamics during CABG, communication between cardiovascular surgeons, anesthesiologists, and perfusionists is most important.

  17. Non-Newtonian model study for blood flow through a tapered artery with a stenosis

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    Noreen Sher Akbar

    2016-03-01

    Full Text Available The blood flow through a tapered artery with a stenosis is analyzed, assuming the blood as tangent hyperbolic fluid model. The resulting nonlinear implicit system of partial differential equations is solved analytically with the help of perturbation method. The expressions for shear stress, velocity, flow rate, wall shear stress and longitudinal impedance are obtained. The variations of power law index m, Weissenberg number We, shape of stenosis n and stenosis size δ are discussed different type of tapered arteries.

  18. When stenting in renal artery stenosis? Update on pathophysiology of ischemic nephropathy and management strategies

    Directory of Open Access Journals (Sweden)

    Alessandro Zuccalà

    2013-11-01

    Full Text Available In recent years, decisions taken on the optimal management of patients with renal artery stenosis have triggered off controversy and debate among clinicians dealing with renovascular disease. The main reason underlying this ongoing controversy may be the heterogeneity of the clinical entities that are normally associated with the umbrella definition of renal artery stenosis. Indeed a causal link between the stenosis and its clinical consequences (i.e. hypertension, renal failure can often demonstrated in some entities, such as fibromuscular dysplasia, truncal stenosis or arterial stenosis in the transplanted kidney, which can be defined as pure renal artery stenosis. On the contrary, the entity generally called ostial stenosis is a disease of the abdominal aorta where it encroaches the ostium of the renal artery at the end of a long process involving the entire vascular tree. Patients affected by ostial stenosis also suffer from generalized atherosclerosis, and kidney damage is often caused by the atherosclerotic environment with the stenosis acting as an innocent bystander. This may account for the low rate of renal function recovery in subjects with ostial stenosis. In our view, keeping the different entities separate along with a careful understanding of the mechanisms underpinning renal damage, particularly the intrarenal activation of the renin angiotensin system which in turn induces renal inflammation and oxidative stress, may enable clinicians to make the right decisions in regard to revascularization.

  19. Prevalence of significant carotid artery stenosis in patients with transient ischaemic attack

    DEFF Research Database (Denmark)

    Rappeport, Yael; Simonsen, Lene; Christiansen, Hanne Hjertmann;

    2002-01-01

    Carotid artery stenosis is one of the risk factors for transient ischaemic attack (TIA) and stroke. The purpose of this study was to investigate the prevalence of carotid artery stenosis and the prevalence of candidates for carotid endarterectomy in a hospital-based cohort of TIA patients under 71...

  20. [A successful case of minimally invasive direct coronary artery bypass (MIDCAB) followed by PTCA].

    Science.gov (United States)

    Nishina, T; Matsuda, K; Nomoto, S; Nishimura, K; Koshiji, T; Sato, T; Ueyama, K; Nonaka, M; Ban, T

    1998-02-01

    A 70-year-old man who developed angina pectoris underwent cardiac catheterization, which showed total occlusion of the left anterior descending coronary artery (LAD), associated with 75% stenosis of the right coronary artery (RCA) and 90% stenosis of the small circumflex coronary artery (CX). The LAD received good collateral flow from the RCA. The patient was scheduled to undergo the MIDCAB for the LAD using the internal thoracic artery (ITA), combined with percutaneous transluminal coronary angioplasty (PTCA) for the RCA subsequently. A left anterior submammarian skin inci