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Sample records for coronary intervention-related periaortitis

  1. Pericardial and thoracic peri-aortic adipose tissues contribute to systemic inflammation and calcified coronary atherosclerosis independent of body fat composition, anthropometric measures and traditional cardiovascular risks

    International Nuclear Information System (INIS)

    Yun, Chun-Ho; Lin, Tin-Yu; Wu, Yih-Jer; Liu, Chuan-Chuan; Kuo, Jen-Yuan; Yeh, Hung-I.; Yang, Fei-Shih; Chen, Su-Chiu; Hou, Charles Jia-Yin; Bezerra, Hiram G.; Hung, Chung-Lieh; Cury, Ricardo C.

    2012-01-01

    Background: Coronary atherosclerosis has traditionally been proposed to be associated with several cardiovascular risk factors and anthropometric measures. However, clinical data regarding the independent value of visceral adipose tissue in addition to such traditional predictors remains obscure. Materials and methods: We subsequently studied 719 subjects (age: 48.1 ± 8.3 years, 25% females) who underwent multidetector computed tomography (MDCT) for coronary calcium score (CCS) quantification. Baseline demographic data and anthropometric measures were taken with simultaneous body fat composition estimated. Visceral adipose tissue of pericardial and thoracic peri-aortic fat was quantified by MDCT using TeraRecon Aquarius workstation (San Mateo, CA). Traditional cardiovascular risk stratification was calculated by metabolic (NCEP ATP III) and Framingham (FRS) scores and high-sensitivity CRP (Hs-CRP) was taken to represent systemic inflammation. The independent value of visceral adipose tissue to systemic inflammation and CCS was assessed by utilizing multivariable regression analysis. Results: Of all subjects enrolled in this study, the mean values for pericardial and peri-aortic adipose tissue were 74.23 ± 27.51 and 7.23 ± 3.69 ml, respectively. Higher visceral fat quartile groups were associated with graded increase of risks for cardiovascular diseases. Both adipose burdens strongly correlated with anthropometric measures including waist circumference, body weight and body mass index (all p < 0.001). In addition, both visceral amount correlates well with ATP and FRS scores, all lipid profiles and systemic inflammation marker in terms of Hs-CRP (all p < 0.001). After adjustment for baseline variables, both visceral fat were independently related to Hs-CRP levels (all p < 0.05), but only pericardial fat exerted independent role in coronary calcium deposit. Conclusion: Both visceral adipose tissues strongly correlated with systemic inflammation beyond traditional

  2. Thoracic periaortal fibrosis and Ormond's disease

    International Nuclear Information System (INIS)

    Kacl, G.M.; Bino, M.; Salomon, F.; Risti, B.; Marincek, B.

    1995-01-01

    Two cases of thoracic periaortal fibrosis as a manifestation of retroperitoneal fibrosis (Ormond's disease) are shown on CT and MRI. Thoracic periaortal fibrosis can result in an inflammatory aneurysmo with chronic dissection. Manifestation of thoracic periaortal fibrosis may typically occur intermittently over decades. (orig.) [de

  3. Periaortic lymphoma in a cat

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    Laura Bree

    2017-09-01

    Full Text Available Case summary A 14-year-old neutered male Siamese cat was presented with a 3 month history of lethargy, inappetence, dehydration, hindlimb ataxia and intermittent proprioceptive deficits in the hindlimbs. Physical examination revealed low body condition score (1.75/5, pallor and bilateral basilar grade II/VI systolic heart murmur. Neurological examination revealed hindlimb ataxia, severe atrophy of the hindlimb musculature, intermittent hindlimb proprioceptive deficits and normoreflexia. Clinicopathological investigations revealed non-regenerative anaemia (haematocrit 0.17 l/l; reference interval [RI] 0.24–0.45 l/l and increased feline pancreatic lipase concentration (Spec fPL test [IDEXX] 8.3 μg/l; RI 0.1–3.5 μg/l. Feline leukaemia virus antigen and feline immunodeficiency virus antibody tests were negative. Thoracic and abdominal imaging revealed a soft tissue structure in the area of the thoracoabdominal aorta. CT confirmed a periaortic contrast-enhancing mass extending from the level of T9–L2, with associated intervertebral infiltration at the level of T11–T12. Post-mortem examination confirmed the presence of a solid, white, multinodular, well-demarcated mass encircling the aorta extending from T9–L2. Based on histopathology and immunohistochemistry, a diagnosis of B-cell lymphoma was made. Lymphoma was also identified histopathologically within the kidneys and spleen. Evidence of mild Wallerian degeneration was present within the spinal cord, indicating compression at the level of the periaortic mass. Relevance and novel information To our knowledge, this is the first report of periaortic lymphoma in the cat. Although periaortic tumours are exceptionally rare in veterinary medicine, lymphoma should be considered as a differential in cats.

  4. Functional Characterization of Preadipocytes Derived from Human Periaortic Adipose Tissue

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    Diana Vargas

    2017-01-01

    Full Text Available Adipose tissue can affect the metabolic control of the cardiovascular system, and its anatomic location can affect the vascular function differently. In this study, biochemical and phenotypical characteristics of adipose tissue from periaortic fat were evaluated. Periaortic and subcutaneous adipose tissues were obtained from areas surrounding the ascending aorta and sternotomy incision, respectively. Adipose tissues were collected from patients undergoing myocardial revascularization or mitral valve replacement surgery. Morphological studies with hematoxylin/eosin and immunohistochemical assay were performed in situ to quantify adipokine expression. To analyze adipogenic capacity, adipokine expression, and the levels of thermogenic proteins, adipocyte precursor cells were isolated from periaortic and subcutaneous adipose tissues and induced to differentiation. The precursors of adipocytes from the periaortic tissue accumulated less triglycerides than those from the subcutaneous tissue after differentiation and were smaller than those from subcutaneous adipose tissue. The levels of proteins involved in thermogenesis and energy expenditure increased significantly in periaortic adipose tissue. Additionally, the expression levels of adipokines that affect carbohydrate metabolism, such as FGF21, increased significantly in mature adipocytes induced from periaortic adipose tissue. These results demonstrate that precursors of periaortic adipose tissue in humans may affect cardiovascular events and might serve as a target for preventing vascular diseases.

  5. Chronic periaortitis and antiphospholipid syndrome: is there a link?

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    Liliana Carneiro

    2016-06-01

    Full Text Available Chronic periaortitis (CP is a rare fibro-inflammatory disease characterized by periaortic fibrosis and/or aortic aneurysms formation, mostly localized in retroperitoneum and occasionally in the mediastinum. Recent studies have shown its common association with autoimmune diseases, therefore autoimmunity has been proposed as a contributing factor. Herein, we describe the second case in the literature of CP associated with antiphospholipid syndrome. A 64-year-old man with history of open surgery for inflammatory thoracic aneurysm and recurrent deep vein thrombosis was referred for abdominal pain and weight loss in the last 6 months. Further investigation revealed elevated acute-phase reactant levels, positive antiphospholipid autoantibodies, radiological and histological evidence of periaortic fibrosis and inflammation causing abdominal aneurysm and ureteral obstruction. Diagnosis of CP and antiphospholipid syndrome were made and steroid therapy was implemented with clinical and radiological improvement. The present report further supports the potentially immune-mediated origin of CP, highlighting its possible linkage with antiphospholipid syndrome.

  6. The Differential Diagnosis of Two Cases of Chronic Periaortitis

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    Takao Kato

    2013-01-01

    Full Text Available The imaging features of chronic periaortitis resemble those of infected aneurysms. Two illustrative cases of chronic periaortitis, in which the etiologies were caused by IgG4-related disease, are presented. The first case involved a 68-year-old man who presented with vague discomfort in his lower abdomen. The second case was a 42-year-old man who presented with a fever of 38°C and persistent, vague chest discomfort. Both cases demonstrated an increased amount of connective tissue around the aorta in computed tomography images and low intensity in the T2-weighed sequence and high intensity in the diffusion-weighed sequence, suggesting the presence of inflammation, in the magnetic resonance imaging. Negative blood cultures, elevated IgG4 levels, and pathological findings confirmed the diagnosis as chronic periaortitis due to IgG4-related disease. This is a newly recognized syndrome of unknown etiology, characterized by a fibroinflammatory condition, tumefactive lesions, and a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells. Both cases were successfully treated with corticosteroids. Infected aneurysms need to be carefully differentiated from this syndrome in view of the similar imaging features.

  7. Mycoplasma hominis periaortic abscess following heart-lung transplantation.

    Science.gov (United States)

    Hagiya, Hideharu; Yoshida, Hisao; Yamamoto, Norihisa; Kimura, Keigo; Ueda, Akiko; Nishi, Isao; Akeda, Yukihiro; Tomono, Kazunori

    2017-06-01

    We report the first case of Mycoplasma hominis periaortic abscess after heart-lung transplantation. The absence of sternal wound infection delayed the diagnosis, but the patient successfully recovered with debridement surgeries and long-term antibiotic therapy. Owing to the difficulty in detection and the intrinsic resistance to beta-lactams, M. hominis infections are prone to being misdiagnosed and undertreated. M. hominis should be suspected in cases where conventional microbiological identification and treatment approaches fail. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Comparison of the kidney dose between supine and prone position for pelvic and periaortic irradiation

    International Nuclear Information System (INIS)

    Mison, Chun; Haejin, Kang; Juree, Kim; Heesuk, Ryu; Hyunsoo, Shin

    1996-01-01

    We compared the doses received by the kidney in supine and prone positions for pelvic and periaortic irradiation. Kidney locations were verified by CT images taken with patients in the same position as during the treatment. Due to the shift of the kidney anteriorly during prone position, treatment in supine position delivered a much lower dose to most of the kidney than treatment in the prone position. Therefore, for periaortic irradiation treatment, the supine position should be considered to minimize the dose to the kidneys, even though the prone position with a belly board can reduce the dose to the small bowel

  9. A simple technique to reduce small bowel toxicity when irradiating the periaortic area

    International Nuclear Information System (INIS)

    Hernandez, J.C.; Fine, B.; Herman, T.S.; Rothenberg, M.; Nicol, N.

    1996-01-01

    Purpose/Objective: Patients receiving periaortic radiation are normally treated in the supine position. We decided to evaluate whether positioning the patient prone on a modified 'belly-board' can reduce the volume of small bowel within the lateral fields in patients receiving four field periaortic radiation. Materials and Methods: Sixteen consecutive women with gynecologic primaries underwent simulation of the periaortic area using a four-field set up (AP, PA, Lats). The fields extended from the top of the L1 vertebral body to the bottom of L5 and had a mean length of 16.2 cm. The AP and PA fields had a width of 8 cm (centered on the midline of the vertebral bodies) while the right and left lateral fields had a width of 4 cm (2 cm anterior and 2 cm posterior to the anterior margin of the vertebral bodies) and did not include the spinal cord. Following oral ingestion of small bowel contrast, simulation films were obtained in the supine position and in the prone position on a modified 'belly-board' (with the pelvic opening extended superiorly to the superior abdomen). It was hypothesized that the prone position on a modified 'belly-board' would allow the abdominal small bowel to fall by gravity away from the periaortic area. We measured the volume of small bowel irradiated through the lateral fields for both the supine and prone-in-belly-board positions using the method described by Gallagher et al. Results: The volume of small bowel included within the lateral fields in the supine position ranged from 164 to 359.5 cc 3 (mean 285 cc 3 ) while placement in the prone-in-bellyboard position reduced the volume of small bowel within the lateral fields to a range of 35-152 cc 3 (mean 86 cc 3 ), an overall reduction of approximately 70% in the volume of small bowel included within lateral fields. Conclusion: The use of lateral fields in the prone-in-bellyboard position allows for significant small bowel sparing through the lateral component of a four-field periaortic set

  10. The relationship of periaortic fat thickness and cardiovascular risk factors in children with Turner syndrome.

    Science.gov (United States)

    Akyürek, Nesibe; Atabek, Mehmet Emre; Eklioglu, Beray Selver; Alp, Hayrullah

    2015-06-01

    Children with Turner syndrome (TS) have a broad range of later health problems, including an increased risk of cardiovascular morbidity and mortality. The aim of this study was to evaluate the relationship between periaortic fat thickness (PAFT) and metabolic and cardiovascular profiles in children with TS. Twenty-nine TS and 29 healthy children and adolescents were enrolled in the study. Anthropometric measurements, pubertal staging, and blood pressure measurements were performed. Fasting serum glucose, insulin, and lipid profile were measured. Periaortic fat thickness was measured using an echocardiography method, which has not previously been applied in children with TS. No difference was found between TS and control subject (CS) in age, weight, waist/hip ratio, HDL cholesterol and LDL cholesterol levels. However, in TS subjects, total cholesterol (p = 0.045) was greater than that in controls. It was determined that 13.7 % (N: 4) of TS subjects had dyslipidemia. Mean fasting glucose, fasting insulin, QUICK-I, HOMA, and FGIR index were similar in TS and in CS, whereas 17.2 % (N: 5) of TS subjects had insulin resistance (IR) and 13.7 % (N: 4) had impaired glucose tolerance. Six subjects (20.6 %) were diagnosed as hypertensive. Periaortic fat thickness was significantly higher in the TS group (p children with TS, PAFT was positively correlated with fasting insulin, body mass index, and diastolic blood pressure. Our results provide additional evidence for the presence of subclinical cardiovascular disease in TS. In addition to existing methods, we recommend the measurement of periaortic fat thickness in children with TS to reveal the presence of early atherosclerosis.

  11. Periaortic haemangiosarcoma in an African wild dog (Lycaon pictus : clinical communication

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    A. Newell-Fugate

    2009-05-01

    Full Text Available A 9-year-old apparently healthy male African wild dog (Lycaon pictus was found dead in its enclosure at the De Wildt Cheetah and Wildlife Centre. Necropsy revealed a pericardium distended by approximately 250mℓ of thick blood. A soft, red, lobulated mass was attached to the periaortic fat between the level of the aortic valves and the pericardial reflection. Histologically, the mass was consistent with a haemangiosarcoma. Other findings in the heart included mild to moderate ventricular hypertrophy and moderate, acute perivascular myocardial necrosis. Sudden death was attributed to acute heart failure precipitated by cardiac tamponade.

  12. Inflammatory state of periaortic adipose tissue in mice under obesogenic dietary regimens

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    Laureane Nunes Masi

    2016-12-01

    Full Text Available High-fat diet or high-sugar diet causes obesity and a chronic low-grade inflammation that leads to the development of diabetes and cardiovascular diseases. Inflammation of the surrounding fat of thoracic aorta namely periaortic adipose tissue (PAAT has been associated with increased prevalence of vascular diseases in obesity. C57Bl/6 male mice (12 weeks of age fed a whole grain-based commercial diet (WGD, refined carbohydrate diet (RCD, refined carbohydrate diet plus sweetened condensed milk ad libitum (RCD + CM or high-fat diet (HFD for eight weeks were studied. Serum fatty acid (FA composition was evaluated by gas chromatography. The cellularity (as indicated by DNA and protein contents and the inflammatory state (as indicated by the contents of TNF-α, IL-6, IL-1β, IL-10, VCAM-1, ICAM-1, leptin and adiponectin measured by ELISA of the PAAT and thoracic aorta (TA were evaluated. Both obesogenic regimens (RCD + CM and HFD increased the content of total fatty acids (FA in serum and the cellularity of the PAAT compared to WGD. RCD + CM increased serum monounsaturated fatty acid (MUFA levels and HFD increased serum saturated fatty acid (SFA levels compared to WGD. RCD (one of the diets used as control and RCD + CM increased the levels of TNF-α, IL-1β, IL-10 and VCAM-1 in the PAAT compared to WGD. Mice fed with HFD showed decreased contents of TNF-α, VCAM-1 and IL-10 in the PAAT compared to animals fed RCD. The RCD raised the levels of SFA in serum, cellularity and inflammatory state in the PAAT compared to WGD. In conclusion, the effects of obesogenic dietary regimens on PAAT can be interpreted differently when the results are compared with WGD or RCD. We found marked changes in the PAAT and no significant modifications in TA indicating this adipose tissue as the major starting point of vascular diseases.

  13. Usefulness of {sup 18}F FDG PET/CT in evaluating disease activity at different times in a patient with chronic periaortitis

    Energy Technology Data Exchange (ETDEWEB)

    Treglia, Giorgio; Stefanelli, Antonella; Mattoli, Maria Vittoria; Leccisotti, Lucia; Muoio, Barbara [Catholic Univ. of the Sacred Heart, Rome (Italy); Bertagna, Francesco [Univ. of Brescia, Brescia (Italy)

    2012-03-15

    We report the case of a 53 year old man with a chronic periaortitis (CP) in whom Fluorine 18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been useful in assessing the disease extent at diagnosis, in evaluating the treatment response, in diagnosing the relapse, and in monitoring the disease activity during follow up. This case highlights the usefulness of FDG PET/CT at different times in patients with CP. CP is a rare inflammatory disorder that affects the abdominal aorta and the retroperitoneum. Imaging procedures are essential to diagnose and monitor the disease course. Ultrasonography may be used as first line screening test, and is particularly useful to monitor patients with hydronephrosis and aortic aneurysms. However, CT or magnetic resonance imaging (MRI) of the abdomen are currently considered the investigations of choice to diagnose CP. In active CP, the periaortic mass usually enhances on CT and MRI. Both these methods can be used to monitor the disease course of CP and to evaluate response to treatment. A note of caution: signs of vasculitis seen on MRI and CT may persist for some time, despite achievement of clinical remission. A further limitation of abdominal CT and MRI is that neither technique can detect vasculitis in vessels other than the abdominal aorta, which has been described in 43% of patients with CP. FDG PET/CT has been proposed as useful tool in inflammatory diseases, such as aortitis, because metabolic changes assessed by FDG PET/CT usually precede morphological changes assessed by conventional imaging methods. Our case highlights the usefulness of FDG PET/CT at different times in patients with CP. This method may be useful in assessing disease activity and extent at diagnosis, in evaluating the treatment response, in diagnosing the relapse, and in monitoring the disease during follow up.

  14. Integral diagnosis of coronary atherosclerosis by coronary multidetector computed tomography and by invasive coronary angiography

    International Nuclear Information System (INIS)

    Llerena Rojas, Luis Roberto; Llerena Rojas, Lorenzo D; Mendoza Rodriguez, Vladimir

    2013-01-01

    Coronary angiography by multidetector computed tomography (CMDCT) visualizes the wall and lumen of coronary arteries. Invasive coronary angiography (INVCA) only visualizes the arterial lumen but with better resolution

  15. Coronary heart disease

    Science.gov (United States)

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... buildup of plaque in the arteries to your heart. This may also be called hardening of the ...

  16. Coronary artery aneurysms

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    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.

  17. Indications for coronary angiography

    International Nuclear Information System (INIS)

    Kaltenbach, M.; Vallbracht, C.

    1985-01-01

    Today selective coronary angiography, introduced by Sones in 1957, is used as clinical routine for diagnosing morphological changes in the coronary arteries. Hitherto, more recent techniques such as digital subtraction angiography cannot provide comparable information. Strict criteria for its indication depending on possible therapeutic consequences, have to be applied, although the risk is low with a letality of 0.01 to 0.05 percent. Radionuclear investigations can be used as additional tool in selected cases. The careful indication for coronary angiography usually implies the possible need for coronary bypass graft surgery of balloon angioplasty. (orig./MG) [de

  18. Large coronary intramural hematomas

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels

    2015-01-01

    Isolated spontaneous coronary intramural hematoma is a unique subset of spontaneous coronary artery dissection that is characterized by a hemorrhage limited to the medial-adventitial layers, causing subsequent hematoma formation without visible intimal flaps. It is an infrequent and serious...... diagnostics and treatment strategy. Coronary intramural hematomas can also occur iatrogenically, as a complication to percutaneous coronary intervention (PCI). Coronary angiography (CAG) has limited diagnostic value in the absence of intimal dissections, and lesions are often angiographically ambiguous....... Intravascular ultrasound (IVUS) is an important diagnostic tool in establishing the correct diagnosis, as it provides a complete vessel wall assessment, and enables morphometric information regarding the magnitude and severity of the underlying hematoma. Due to the rarity of this clinical scenario...

  19. [Endarterectomy of the coronary arteries].

    Science.gov (United States)

    Fischer, V; Simkovic, I; Holoman, M; Verchvodko, P; Janotík, P; Galbánek, J; Hulman, M; Kostelnicák, J; Jurco, R; Slezák, J

    1992-02-01

    The authors analyze 50 patients with endarterectomy of the coronary arteries during the periods of 1972-1974 and 1988-1990. The results of endarterectomy of the right and left coronary artery provide evidence of its justification in indicated cases whereby contrary to some departments the results of endarterectomy of the left coronary artery are comparable with endarterectomy of the right coronary artery.

  20. Selective coronary scintigraphy

    International Nuclear Information System (INIS)

    Gambini, D.-J.

    1975-01-01

    Isotopic techniques occupy a leading place amongst examinations practicable on coronary patients because of their reliability and the safety and simplicity of their use. The present work reviews the possible applications of selective coronary scintigraphy in pathology. After a brief discussion on scintigraphy, isotopic techniques for myocardium research, coronarography and other methods to study local myocardium perfusion the theoretical bases for the use of the exploration are studied, the techniques and methods employed are reported and the results discussed. Coronary scintigraphy consists of selective injection in the two coronary arteries previously catheterized during a coronarography, of two different populations of microspheres labelled with two physically short-lived indicators: 15μ 99m Tc-labelled serumalbumin microspheres, 10 to 15μ In-labelled siderophiline microspheres. Various studies have shown the complete harmlessness of the exploration when certain precautions are taken regarding the size and number of the spheres. The microspheres disperse into the downstream arterial territory proportionally to the number of capillaries present in the different parts of the irrigated region, and are temporarily stopped in the precapillaries. The preparation of the different images needed to interpret the Face and OAG examination for the left coronary, then for the right coronary, is carried out at the end of the coronarography and lasts about 45 minutes. It is also possible by selective injection in the aorta-coronary bridges to judge their functional condition by observation of the regions they irrigate. 56 patients of the Necker hospital cardiological clinic have been examined [fr

  1. Congenital coronary artery fistula

    International Nuclear Information System (INIS)

    Oh, Yeon Hee; Kim, Hong; Zeon, Seoc Kil; Suh, Soo Jhi

    1986-01-01

    Congenital coronary artery fistula (CCAF) is communication of a coronary artery or its main branch with one of the atria or ventricles, the coronary sinus, the superior vena cava, or the pulmonary artery. In Korean peoples, only 4 cases of the CCAF were reported as rare as worldwide and authors want to report another case of CCAF, confirmed by operation. 10-year-old girl shows a fistula between sinus node artery of the right coronary artery and right atrium on root aortogram with left-to-right shunt and Qp/Qs=1.58, in which simple ligation of the sinus node artery from right coronary artery was performed. All of the 5 Korean CCAF (4 were previously reported and 1 of authors) were originated from right coronary artery, and of which 4 were opening into right ventricle and 1 of authors were into right atrium. Associated cardiac anomaly was noted in only 1 case as single coronary artery. Ages were from 9 months of age to 10 years old and no adult left case were found. 3 were female and 2 were male patients.

  2. Coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Dewey, Marc [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

    2009-07-01

    Coronary CT angiography has attained increasing scientific attention at academic institutions and has become a highly accurate diagnostic modality. Extending this knowledge into a practice setting is the purpose of 'Coronary CT Angiography'. This book will assist you in integrating cardiac CT into your daily practice, while also giving an overview of the current technical status and applications. The specific features of scanners from all four main vendors are also presented providing an objective overview of noninvasive coronary angiography using CT. (orig.)

  3. Acute Coronary Syndrome

    Science.gov (United States)

    ... heart cells are dying. An electrocardiogram (ECG or EKG) can diagnose an acute coronary syndrome by measuring ... Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  4. Coronary artery fistula

    Science.gov (United States)

    ... PA: Elsevier Saunders; 2015:chap 84. Friedman AH, Silverman NH. Congenital anomalies of the coronary arteries. In: ... provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  5. 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......), and to characterize and quantify subclinical atherosclerosis in their relatives. Furthermore, the aim was to explore the impact of common genetic risk variants on the age of onset, familial clustering and disease severity. In study I, 143 patients with early- onset CAD were recruited from the Western Denmark Heart...... 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...

  6. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar

    2014-01-01

    BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit...... a negative Poisson's ratio. Commercially available coronary stents have isotropic properties, whereas the vascular system of the body shows anisotropic characteristics. This results in a mismatch between anisotropic-isotropic properties of the stent and arterial wall, and this in turn is not favorable...... for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic design...

  7. Acute coronary syndrome

    Science.gov (United States)

    ... Have plenty of fruits, veggies, whole grains, and lean meats. Try to limit foods high in cholesterol ... et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary ...

  8. Coronary hemodynamics in vasospastic angina

    International Nuclear Information System (INIS)

    Matsumura, Kentaro; Kubota, Shinobu; Serizawa, Takashi; Nakase, Emiko; Kawai, Ichiro; Saito, Takayuki

    1991-01-01

    To evaluate the coronary circulation and myocardial perfusion dynamics, we performed left coronary digital subtraction angiography (DSA) in 35 patients with vasospastic angina. The left coronary circulation time (CCT) measured from the proximal left coronary artery to the coronary sinus was 5.77±0.86 sec, and the left epicardial conducting artery transmission time (CAT) measured from the proximal left coronary artery to the apical area was 2.65±0.82 sec in normal controls. The CCT and CAT were significantly prolonged in patients with vasospastic angina, indicating that the coronary peripheral vascular resistance is probably greater after the cessation of nitrates and Ca ++ -antagonists. After the intracoronary injection of ergonovine malate, the CCT was slightly shortened, but the apical T 1/2 was significantly prolonged in patients with vasospastic angina. This suggested that coronary vasospasm is present not only in the epicardial arteries but also in coronary arteries with peripheral resistance. These phenomena were not observed in normal controls. We performed left coronary DSA after conventional left coronary cineangiography. When the CCT exceeded 6.7 sec, we considered that the coronary circulation was significantly impaired. We concluded that the coronary DSA is very useful for evaluating abnormal coronary circulation in patients with vasospastic angina during myocardial perfusion. (author)

  9. Coronary tortuosity: a long and winding road.

    NARCIS (Netherlands)

    Zegers, E.S.; Meursing, B.T.J.; Oude Ophuis, A.J.M.

    2007-01-01

    Coronary tortuosity is a phenomenon often encountered by cardiologists performing coronary angiography. The aetiology and clinical importance of coronary tortuosity are still unclear. Coronary tortuosity without fixed atherosclerotic stenosis in patients with angina pectoris and an abnormal exercise

  10. 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.

  11. Calcified Plaque of Coronary Artery: Factors Influencing Overestimation of Coronary Artery Stenosis on Coronary CT Angiography

    International Nuclear Information System (INIS)

    Kim, Mok Hee; Kim, Yun Hyeon; Choi, Song; Seon, Hyun Ju; Jeong, Gwang Woo; Park, Jin Gyoon; Kang, Heoung Keun; Ko, Joon Seok

    2010-01-01

    To assess the influence of calcified plaque characteristics on the overestimation of coronary arterial stenosis on a coronary CT angiography (CCTA). The study included 271 coronary arteries with calcified plaques identified by CCTA, and based on 928 coronary arteries from 232 patients who underwent both CCTA and invasive coronary angiography (ICA). Individual coronary arteries were classified into two groups by agreement based on the degree of stenosis from each CCTA and ICA: 1) group A includes patients with concordant CCTA and ICA results and, 2) group B includes patients with an overestimation of CCTA compared to ICA. Parameters including total calcium score, calcium score of an individual coronary artery, calcium burden number of an individual coronary artery, and the density of each calcified plaque (calcium score / number of calcium burden) for each individual coronary artery were compared between the two groups. Of the 271 coronary arteries, 164 (60.5%) were overestimated on CCTA. The left anterior descending artery (LAD) had a significantly low rate of overestimation (47.1%) compared to the other coronary arteries (p=0.001). No significant differences for total calcium score, calcium score of individual coronary artery, and the density of each calcified plaque from individual coronary arteries between two groups was observed. However, a decreasing tendency for the rate of overestimation on CCTA was observed with an increase in calcium burden of individual coronary arteries (p<0.05). The evaluation of coronary arteries suggests that the degree of coronary arterial stenosis had a tendency to be overestimated by calcified plaques on CCTA. However, the rate of overestimation for the degree of coronary arterial stenosis by calcified plaques was not significantly influenced by total calcium score, calcium score of individual coronary artery, and density of each calcified plaque

  12. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    Muinck, Ebo Derk de

    1994-01-01

    In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

  13. Nuclear cardiology and coronary surgery

    DEFF Research Database (Denmark)

    Eckardt, R.; Andersen, L.I.; Hesse, B.

    2008-01-01

    Rising age, repeated percutaneous coronary revascularizations, and co-morbidity such as overweight, diabetes, and hypertension, characterize a change over the last 20-30 years in coronary patients referred to coronary artery bypass grafting (CABG). This patient group represents a great part of to...

  14. 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.

  15. 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

  16. 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.)

  17. [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.

  18. Coronary MR angiography: current status

    International Nuclear Information System (INIS)

    Danias, P.G.; Manning, W.J.

    2000-01-01

    Since first described in the early 1990s, coronary magnetic resonance angiography (MRA) has evolved as a promising noninvasive modality for imaging of the coronary arteries and evaluation of coronary artery disease. Despite technical limitations, coronary MRA has established value for imaging of anomalous coronary arteries and assessment of bypass graft patency. Current research focuses on the development of optimal respiratory compensation strategies, improved spatial and temporal resolution and faster acquisition of image data. The accurate detection of stenoses and assessment of the severity of coronary atherosclerosis is presently being evaluated with large multi-center studies. With further technique enhancements and more clinical experience, coronary MRA is likely to become the dominant noninvasive modality in clinical cardiology. (orig.) [de

  19. CT coronary angiography vs. invasive coronary angiography in CHD

    Directory of Open Access Journals (Sweden)

    Anja Hagen

    2012-04-01

    Full Text Available Scientific background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive computed tomography (CT coronary angiography are used in the diagnosis of coronary heart disease (CHD. Research questions: The present report aims to evaluate the clinical efficacy, diagnostic accuracy, prognostic value cost-effectiveness as well as the ethical, social and legal implications of CT coronary angiography versus invasive coronary angiography in the diagnosis of CHD. Methods: A systematic literature search was conducted in electronic data bases (MEDLINE, EMBASE etc. in October 2010 and was completed with a manual search. The literature search was restricted to articles published from 2006 in German or English. Two independent reviewers were involved in the selection of the relevant publications. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography as the reference standard and on diagnostic studies with intracoronary pressure measurement as the reference standard. Study results were combined in a meta-analysis with 95 % confidence intervals (CI. Additionally, data on radiation doses from current non-systematic reviews were taken into account. A health economic evaluation was performed by modelling from the social perspective with clinical assumptions derived from the meta-analysis and economic assumptions derived from contemporary German sources. Data on special indications (bypass or in-stent-restenosis were not included in the evaluation. Only data obtained using CT scanners with at least 64 slices were considered. Results: No studies were found regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Overall, 15 systematic reviews with data from 44 diagnostic studies using invasive coronary angiography as the reference standard (identification of obstructive

  20. Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2014-01-01

    Full Text Available Coronary computed tomography angiography (CCTA has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques.

  1. Percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Przybojewski, J.Z.; Weich, H.F.H.

    1984-01-01

    The purpose of this article is to review PTCA, percutaneous transluminal coronary angioplasty, which can be considered to be a truly revolutionary and fairly simple invasive form of intervention to atherosclerotic obstruction. The 'epidemic' of IHD, ischaemic heart disease, in the Republic of South Africa calls for the employment of this technique, which has already been carried out in a few teaching hospitals in this country. Very recently, modified balloon dilatation catheters have been used percutaneously in the non-operative transluminal correction of congenital coarctation of the aorta in infants and children, congenital pulmonary value stenosis, and hypoplasia and stenosis of the pulmonary arteries. It has also been employed for PTCA and for the simultaneous occlusion of coronary-bronchial artery anastomosis using a detachable balloon. The isotopes thallium 201 and technetium 99 were also used in scintiscanning

  2. Meniscotibial (coronary) ligament tears

    International Nuclear Information System (INIS)

    El-Khoury, G.Y.; Usta, H.Y.; Berger, R.A.

    1984-01-01

    Preservation of the meniscus whenever possible is essential in maintaining knee stability and preventing premature osteoarthritis. Peripheral meniscal tears are the most amenable to surgical repair. This study evaluates the peripheral attachments of the medial meniscus and focuses on a specific tear limited to the meniscotibial ligament (coronary ligament). The diagnosis is made arthrographically when the medial meniscus floats above the tibial plateau without separating completely from the capsule. The lateral meniscus is rarely involved in this type of injury. (orig.)

  3. Coffee consumption and coronary calcification - The Rotterdam Coronary Calcification Study

    NARCIS (Netherlands)

    van Woudenbergh, Geertruida J.; Vliegenthart, Rozemarijn; van Rooij, Frank J. A.; Hofman, Albert; Oudkerk, Matthijs; Witteman, Jacqueline C. M.; Geleijnse, Johanna M.

    Background-The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. Methods and Results-The study involved 1570 older men and women without coronary heart disease who participated in the

  4. Coffee consumption and coronary calcification: The Rotterdam coronary calcification study

    NARCIS (Netherlands)

    G.J. van Woudenbergh (Geertruida); R. Vliegenthart (Rozemarijn); F.J.A. van Rooij (Frank); A. Hofman (Albert); M. Oudkerk (Matthijs); J.C.M. Witteman (Jacqueline); J.M. Geleijnse (Marianne)

    2008-01-01

    textabstractBACKGROUND - The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. METHODS AND RESULTS - The study involved 1570 older men and women without coronary heart disease who

  5. Coffee Consumption and Coronary Calcification: The Rotterdam Coronary Calcification Study

    NARCIS (Netherlands)

    Woudenbergh, van G.J.; Vliegenthart, R.; Rooij, van F.J.A.; Hofman, A.; Oudkerk, M.; Witteman, J.C.M.; Geleijnse, J.M.

    2008-01-01

    Background¿ The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. Methods and Results¿ The study involved 1570 older men and women without coronary heart disease who participated in the

  6. [Developments in percutaneous coronary intervention and coronary stents].

    Science.gov (United States)

    Simsek, C; Daemen, J; Zijlstra, F

    2014-01-01

    In The Netherlands, more than 30.000 patients undergo a percutaneous coronary intervention every year, during which a coronary stent implantation will be performed in 90% of the cases. It is estimated that more than 5 million coronary stent implantations will be performed worldwide this year. While these numbers are impressive, however, coronary stents still have as a limitation the possibility of stent thrombosis. This has been and is an important stimulus for the development of both coronary stents, from a bare metal stent via a drug eluting stent to the present-day development of bio-absorbable stents, and anti-platelet drugs,from acenocoumarol to thieropyridines. The possibility of shortening the period of use of this powerful medication by developing new kinds of non-thrombogenic stents would, for example, make it possible to achieve significant reductions in subsequent bleeding during (dental) procedures.

  7. A rare anomaly: Double right coronary artery

    Directory of Open Access Journals (Sweden)

    Dursun Çayan Akkoyun

    2013-01-01

    Full Text Available Coronary artery anomalies are rare anomalies. Theseare usually asymptomatic and are discovered incidentally.Double right coronary artery (RCA is a rare coronaryartery anomaly. Although there is controversy aboutidentification and classification of double RCA, it is oftena benign condition, but it can be complicated by atherosclerosisand can lead to serious conditions such asmyocardial infarction (MI and may be accompanied byother anomalies. In our case, double RCA were detectedin coronary angiography for acute anterior MI, and in thenext session successful percutaneous coronary interventionwas performed.Key words: Coronary anomaly, coronary angiography,coronary stenosis

  8. Current status of hybrid coronary revascularization.

    Science.gov (United States)

    Jaik, Nikhil P; Umakanthan, Ramanan; Leacche, Marzia; Solenkova, Natalia; Balaguer, Jorge M; Hoff, Steven J; Ball, Stephen K; Zhao, David X; Byrne, John G

    2011-10-01

    Hybrid coronary revascularization combines coronary artery bypass surgery with percutaneous coronary intervention techniques to treat coronary artery disease. The potential benefits of such a technique are to offer the patients the best available treatments for coronary artery disease while minimizing the risks of the surgery. Hybrid coronary revascularization has resulted in the establishment of new 'hybrid operating suites', which incorporate and integrate the capabilities of a cardiac surgery operating room with that of an interventional cardiology laboratory. Hybrid coronary revascularization has greatly augmented teamwork and cooperation between both fields and has demonstrated encouraging as well as good initial outcomes.

  9. Non-invasive assessment of coronary calcification

    International Nuclear Information System (INIS)

    Vliegenthart, Rozemarijn; Oei, Hok-Hay S.; Hofman, Albert; Oudkerk, Matthijs; Witteman, Jackqueline C. M.

    2004-01-01

    Electron-beam tomography (EBT) and multi-detector computed tomography (MDCT) enable the noninvasive assessment of coronary calcification. The amount of coronary calcification, as detected by EBT, has a close relation with the amount of coronary atherosclerosis, which is the substrate for the occurrence of myocardial infarction and sudden cardiac death. Calcification of the coronary arteries can be seen as a cumulative measure of life-time exposure to cardiovascular risk factors. Several studies have shown that the amount of coronary calcification is associated with the risk of coronary heart disease. Therefore, coronary calcification is a promising method for non-invasive detection of asymptomatic subjects at high risk of developing coronary heart disease. Whether measurement of coronary calcification also increases the predictive power of coronary events based on cardiovascular risk factors is topic of current research

  10. Diagnosing coronary artery disease after a positive coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nissen, L; Winther, S; Westra, J

    2018-01-01

    Aims: Perfusion scans after coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD) may reduce unnecessary invasive coronary angiographies (ICAs). However, the diagnostic accuracy of perfusion scans after primary CCTA is unknown. The aim...

  11. Vessel dilatation in coronary angiograms

    International Nuclear Information System (INIS)

    Hinterauer, L.; Goebel, N.

    1983-01-01

    Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment. (orig.) [de

  12. Vessel dilatation in coronary angiograms

    Energy Technology Data Exchange (ETDEWEB)

    Hinterauer, L.; Goebel, N.

    1983-11-01

    Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment.

  13. Management of coronary artery disease

    Science.gov (United States)

    Safri, Z.

    2018-03-01

    Coronary Artery Disease (CAD) is associated with significant morbidity and mortality, therefore it’s important to early and accurate detection and appropriate management. Diagnosis of CAD include clinical examination, noninvasive techniques such as biochemical testing, a resting ECG, possibly ambulatory ECG monitoring, resting echocardiography, chest X-ray in selected patients; and catheterization. Managements of CAD patients include lifestyle modification, control of CAD risk factors, pharmacologic therapy, and patient education. Revascularization consists of percutaneous coronary angioplasty and coronary artery bypass grafting. Cardiac rehabilitation should be considered in all patients with CAD. This comprehensive review highlights strategies of management in patients with CAD.

  14. PLACENTAL GROWTH FACTOR AND CORONARY NEOANGIOGENESIS IN CORONARY HEART DISEASE

    Directory of Open Access Journals (Sweden)

    M. V. Tulikov

    2013-01-01

    Full Text Available Neoangiogenesis in coronary heart disease is a protective reaction aimed to improve ischemic myocardial perfusion, by increasing the number and size of arterial collaterals. Placental growth factor (PlGF is one of the key peptides regulating angiogenic processes in atherosclerosis. In particular, a number of investigators have shown that injection of recombinant PlGF into the system or regional blood flow can stimulate neoangiogenesis. On the other hand, there is evidence confirming the involvement of PlGF in the progression of atherosclerosis and in the development of acute coronary syndrome. In this connection, the problem of investigating the efficiency and safety of possible use of PlGF preparations, as well as its place in the diagnosis of coronary heart disease and acute coronary syndrome remains urgent

  15. Coronary angiography using synchrotron radiation

    International Nuclear Information System (INIS)

    Akatsuka, Takao; Hiranaka, Yukio; Takeda, Tohru; Hyodo, Kazuyuki.

    1990-01-01

    Invasive coronary angiography is the imaging technique of choice for diagnosis of ischemic heart disease. Recently, the application of synchrotron radiation in coronary angiography has been investigated in the world, with the aim of developing the noninvasive technique for visualizing the heart. In this article, backgrounds and present situation of coronary angiography using synchrotron radiation are reviewed. Firstly, visual imaging techniques of the cardiovascular system are discussed in terms of angiography and digital subtraction angiography (DSA). Conventional temporal, energy, and hybrid subtraction modes used in DSA are referred to. Secondly, the application of synchrotron radiation is presented, focusing on the property of synchrotron radiation and K-edge subtraction angiography. Two kinds of synchrotron radiation beam methods are outlined. Interpretation of image data and various subtraction procedures remain unestablished. There is much to be done before coronary angiography using synchrotron radiation comes into a clinical practice. (N.K.)

  16. Depression following acute coronary syndrome

    DEFF Research Database (Denmark)

    Joergensen, Terese Sara Hoej; Maartensson, Solvej; Ibfelt, Else Helene

    2016-01-01

    PURPOSE: Depression is common following acute coronary syndrome, and thus, it is important to provide knowledge to improve prevention and detection of depression in this patient group. The objectives of this study were to examine: (1) whether indicators of stressors and coping resources were risk...... factors for developing depression early and later after an acute coronary syndrome and (2) whether prior depression modified these associations. METHODS: The study was a register-based cohort study, which includes 87,118 patients with a first time diagnosis of acute coronary syndrome during the period...... 2001-2009 in Denmark. Cox regression models were used to analyse hazard ratios (HRs) for depression. RESULTS: 1.5 and 9.5 % develop early (≤30 days) and later (31 days-2 years) depression after the acute coronary syndrome. Among all patients with depression, 69.2 % had first onset depression, while 30...

  17. Coronary Computed Tomography Angiography (CTA)

    Science.gov (United States)

    ... coronary arteries, may also be administered as a tablet or spray underneath your tongue. While lying on ... the scanner at one time such as with MRI. If an intravenous contrast material is used, you ...

  18. Pronounced Coronary Arteriosclerosis in Cirrhosis

    DEFF Research Database (Denmark)

    Danielsen, Karen V; Wiese, Signe; Hove, Jens

    2018-01-01

    factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died......BACKGROUND: The relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT...... and women: 136 vs. 0 HU; p alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p 

  19. 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.

  20. Physiologic assessment of coronary artery fistula

    International Nuclear Information System (INIS)

    Gupta, N.C.; Beauvais, J.

    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

  1. Correlation between coronary computed tomographic angiography and fractional flow reserve

    DEFF Research Database (Denmark)

    Kristensen, Thomas Skaarup; Engstrøm, Thomas; Kelbæk, Henning

    2010-01-01

    Coronary CT angiography (CCTA) has become an important modality to evaluate the presence of coronary artery disease. Coronary artery stenosis of intermediate severity remains a therapeutic dilemma. Measurement of fractional flow reserve (FFR) during coronary angiography is the most established...

  2. The minimum coronary artery diameter in which coronary spasm can be identified by synchrotron radiation coronary angiography

    International Nuclear Information System (INIS)

    Matsushita, Shonosuke; Hyodo, Kazuyuki; Imazuru, Tomohiro; Tokunaga, Chiho; Sato, Fujio; Enomoto, Yoshiharu; Hiramatsu, Yuji; Sakakibara, Yuzuru

    2008-01-01

    Background: Coronary vasospasm is defined as a temporary, intense narrowing of the coronary conduit artery. It brings about ischemic chest pain and becomes one of the causes of myocardial infarction. Coronary spasms are divided into two categories. One is the coronary spasm of the conduit artery and the other is the coronary microvascular spasm. Although coronary spasms are diagnosed with the images of coronary angiography, microvascular spasms cannot be diagnosed because of the limitations of conventional angiographic systems. However, synchrotron radiation coronary angiography (SRCA) can identify coronary arteries down to 100 μm in diameter in the beating heart and 50 μm in arrested heart. Aim: The purpose of this study was to confirm whether microvascular spasms could be identified or not using SRCA, and then down that size identification was possible. Methods: The Langendorff perfusion system with isolated rat hearts was employed. Krebs-Henseleit solution (KH solution) was used as a perfusate. 10 mM of 4-aminopyridine (4-AP: a voltage-gated potassium channel blocker; spasm inducer) was added to the KH solution and maintained for 5 min. SRCA was performed at pre-, during and 10 min after cessation of the KH solution with 4-AP. Coronary spasms were defined as a temporal 75% reduction of coronary arterial diameter. Results and conclusion: Multiple sizes of coronary arteries showed coronary spasms. The minimum stenosed coronary artery size was 100 μm. Since coronary microvascular spasms are seen in the arterioles (50-400 μm), coronary microvascular spasms may be diagnosed with the use of synchrotron radiation coronary angiography

  3. Coronary artery anomalies in Turner Syndrome.

    Science.gov (United States)

    Viuff, Mette H; Trolle, Christian; Wen, Jan; Jensen, Jesper M; Nørgaard, Bjarne L; Gutmark, Ephraim J; Gutmark-Little, Iris; Mortensen, Kristian H; Gravholt, Claus Højbjerg; Andersen, Niels H

    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. Fifty consecutive women with Turner Syndrome (mean age 47 years [17-71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. 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 a tubular origin of the right coronary artery above the aortic sinus. There was no correlation between the presence of coronary arterial anomalies and karyotype, bicuspid aortic valve, or other congenital heart defects. Coronary anomalies are highly prevalent in Turner Syndrome. The left coronary artery is predominantly affected, with an absent left main coronary artery being the most common anomaly. No hemodynamically relevant coronary anomalies were found. Copyright © 2016 Society of Cardiovascular Computed Tomography. All rights reserved.

  4. 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

  5. Coronary ostium occlusion by coronary cusp displacement in Williams syndrome.

    Science.gov (United States)

    Shiohama, Tadashi; Fujii, Katsunori; Ebata, Ryota; Funabashi, Nobusada; Matsumiya, Goro; Saito, Yuko Kazato; Takechi, Fumie; Yonemori, Yoko; Nakatani, Yukio; Shimojo, Naoki

    2016-06-01

    Williams syndrome is a contiguous gene deletion syndrome resulting from a heterozygous deletion on chromosome 7q11.23, and is characterized by distinctive facial features and supravalvular aortic stenosis (SVAS). This syndrome rarely presents unpredictable cardiac death, and yet, as illustrated in the present case, it is still not possible to predict it, even on close monitoring. We herein describe the case of a 6-year-old Japanese girl with Williams syndrome, who had sudden cardiac collapse due to cardiac infarction after pharyngitis. Cardiac failure followed a critical course that did not respond to catecholamine support or heart rest with extracardiac mechanical support. Although marked coronary stenosis was not present, the left coronary cusp abnormally adhered to the aortic wall, which may synergistically cause coronary ostium occlusion with SVAS. Altered hemodynamic state, even that caused by the common cold, may lead to critical myocardial events in Williams syndrome with SVAS. © 2015 Japan Pediatric Society.

  6. NEUROTICISM PROFILE IN CORONARY HEART DISEASE

    OpenAIRE

    Bhargava, S. C.; Sharma, S. N.; Agarwal, B. V.

    1980-01-01

    SUMMARY Thirty seven cases of coronary heart disease and 30 normal healthy controls were administered Hindi version of MHQ. The coronary heart disease patients scored significantly higher on total neuroticism, free-floating anxiety and somatic anxiety subscales of MHQ.

  7. Coronary artery with aberrant origin malignant right

    International Nuclear Information System (INIS)

    Ozcan, E.; Bozlar, U.; Demirkol, S.; Saglam, M.

    2012-01-01

    Full text: Introduction: Congenital anomalies of the coronary arteries is a major cause of sudden death, especially in young patients. Objectives and tasks: In this study we aim to present a young patient with chest pain who had malignant right coronary artery (RCA) with aberrant origin. Materials and methods: 24-year-old man who applied cardiology clinic for chest pain and palpitations especially after exercise, was referred to our clinic for coronary computed tomography (CT) angiography to evaluate coronary artery anomalies. Results: In CT angiography; we detected aberrant RCA with origin of tubularly part of ascendant aorta with a malignant course between aorta and pulmonary artery. Left main coronary artery, left anterior descending and circumflex artery had normal origin and course. Conclusion: Coronary artery with malignant course may cause sudden death especially after exercise. Coronary CT angiography has an important role in diagnosis of congenital coronary artery anomalies, with high resolution multiplanner reformatted images

  8. Coronary spasm induced by dipyridamole

    International Nuclear Information System (INIS)

    Wartski, M.; Caussin, C.; Lancelin, B.

    2001-01-01

    A 59 years old man was admitted at hospital for recurrent instable angina 1 month after coronary artery bypass surgery. Coronary artery disease started with a transmural antero-septo-apical myocardial infarction without thrombolysis and a percutaneous angioplasty with endo-prothesis on proximal left anterior descendant artery (LAD) is performed Because of recurrent rest angina and subacute stent thrombosis, a coronary artery bypass surgery (CABG) is performed with anastomosis of the left internal thoracic artery on LAD. The patient is admitted for recurrent rest angina one month after CABG. On ECG performed during chest pain, a ST-T segment elevation occurred on inferior leads. Coronary angiography showed no significant stenosis on endo-prothesis and no bypass graft dysfunction. Dipyridamole scintigraphy was realized. 2 minutes after the beginning of Dipyridamole infusion, a ST-T elevation occurred on inferior leads and two marked antero-septal and inferior defects were noticed on myocardial scintigraphy. Images at rest showed a clear improvement in the anterior wall and the inferior wall became normally perfused Patient was treated with anti-spastic drugs and a new coronarography with methyl-ergotamine test was performed inducing chest pain, ST-T elevation on inferior leads and tri-truncular coronary spasm. Patient's treatment was then modified with introduction of Nifedipine. The patient did not experienced new recurrent chest pain and remained totally asymptomatic few months later. (authors)

  9. Detection of coronary calcification in ultrafast CT compared to coronary angiography

    International Nuclear Information System (INIS)

    Koesling, S.; Hoffmann, U.; Rother, T.; Lieberenz, S.; Heywang-Koebrunner, S.H.; Schulz, H.G.

    1994-01-01

    The angiographical findings of 24 patients with coronary artery disease were compared with qualitative and quantitative detection of coronary calcification by ultrafast CT. Doubts concerning the capabilities of the ultrafast CT for a screening of coronary artery disease arise when the results of one third false positive and fase negative findings are considered. Variations in the quantification of coronary calcification were too great to allow a realistic assessment of the degree of stenosis of the coronary arteries. (orig.) [de

  10. HUMAN CORONARY ARTERIES- A STUDY BASED ON GROSS ANATOMY AND CORONARY CAST

    Directory of Open Access Journals (Sweden)

    Vijayamma K. N

    2018-01-01

    Full Text Available BACKGROUND Present study is an attempt to throw light upon the coronary arterial pattern, variations in arterial distribution and extent of intercoronary anastomosis and arterial preponderance in different age groups. MATERIALS AND METHODS Total of 115 hearts were made use for this study. Ninety hearts were dissected for the gross anatomical study of coronary arteries and 25 hearts including three fetal hearts were used for the coronary cast study. The right and left coronary arteries were traced from aortic sinus along the atrioventricular groove to the area of its termination. The atrial ventricular and septal branches were traced and looked for anastomosis. Coronary casts were prepared by injecting coloured liquid latex through the coronary ostia and the branching pattern and anastomosis were studied. The coronary arterial pattern, extent of distribution of its branches, arterial preponderance and variations were observed. RESULTS It was found that 73 % cases of SA nodal branch arise from right coronary artery and 27 % from circumflex branch of left coronary artery. SA node has dual blood supply from both coronary arteries in 4% cases. Right coronary preponderance was observed in 83% of cases and left coronary preponderance in 11 % cases, and balanced supply in 6% cases. Coronary cast was helpful to understand the branching pattern of vessels, and the anastomosis of small capillaries. It was also seen that all 11 % of left preponderance were seen in male hearts and all of the 31 female hearts dissected were right preponderant. CONCLUSION Coronary arteries are called end arteries functionally. Right coronary artery originates from anterior aortic sinus in all cases except one which takes origin from posterior left aortic sinus along with left coronary artery. Right coronary preponderance is observed in 83% cases. Left coronary artery branching pattern shows variability. Left coronary preponderance was observed in 11% and all cases are male

  11. Progress in genetics of coronary artery disease

    African Journals Online (AJOL)

    Radwa Gamal

    To the Editor. Coronary Heart Disease (CHD) is the leading cause of mortality and morbidity worldwide [1] and it is a result of coronary artery disease (CAD). Coronary artery disease refers to the build-up of atherosclerotic plaque in the blood vessels that supply oxygen and nutrients to the heart. Progressive infiltration of the ...

  12. Coronary CT in Acute Cardiac Care

    NARCIS (Netherlands)

    A. Dedic (Admir)

    2016-01-01

    markdownabstractCoronary CT angiography is a well-established diagnostic modality for stable angina pectoris. It provides an angiographic, non-invasive alternative for the diagnosis of coronary artery disease, exceeding in the ability to exclude important coronary artery disease. Having the ability

  13. 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.

  14. Homocysteine and coronary heart disease

    DEFF Research Database (Denmark)

    Clarke, Robert; Bennett, Derrick A; Parish, Sarah

    2012-01-01

    Moderately elevated blood levels of homocysteine are weakly correlated with coronary heart disease (CHD) risk, but causality remains uncertain. When folate levels are low, the TT genotype of the common C677T polymorphism (rs1801133) of the methylene tetrahydrofolate reductase gene (MTHFR) appreci......Moderately elevated blood levels of homocysteine are weakly correlated with coronary heart disease (CHD) risk, but causality remains uncertain. When folate levels are low, the TT genotype of the common C677T polymorphism (rs1801133) of the methylene tetrahydrofolate reductase gene (MTHFR...

  15. A comparison of hybrid coronary revascularization and off-pump coronary revascularization.

    Science.gov (United States)

    Umakanthan, Ramanan; Leacche, Marzia; Gallion, Anna H; Byrne, John G

    2013-04-01

    Minimally invasive approaches to treat vascular disease have been accruing significant popularity over the last several decades. Due to progressive advances in technology, a variety of techniques are being now utilized in the field of cardiovascular surgery. The objectives of minimally invasive techniques are to curtail operative trauma and minimize perioperative morbidity without decreasing the quality of the treatment. The standard surgical approach for the treatment of coronary artery disease has traditionally been coronary artery bypass grafting surgery via median sternotomy. Off-pump coronary artery bypass grafting surgery offers a less invasive alternative and enables coronary revascularization to be performed without cardiopulmonary bypass. Hybrid coronary revascularization offers an even less invasive option in which minimally invasive direct coronary artery bypass can be combined with percutaneous coronary intervention. In this article, the authors review a recent publication comparing hybrid coronary revascularization and off-pump coronary artery bypass grafting surgery.

  16. Coronary Heart Disease and Exercises

    Directory of Open Access Journals (Sweden)

    Tolga SAKA

    2016-06-01

    Full Text Available Coronary heart disease is a chronic process, of which the progression can rapidly change the functional capacity of patients. In CAD patients, the quality of life can be improved with an appropriate exercise prescription. This article explains how a safe exercise program for CAD patients can be prescribed.

  17. 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.

  18. Influence of psychological and coronary parameters on coronary patient rehospitalization

    Directory of Open Access Journals (Sweden)

    Nikolić Gordana

    2010-01-01

    Full Text Available Introduction. Psychological reactions are often comorbid with coronary risk factors and could be important for a six-month outcome. Objective. Determination of anxiety level, depression and aggression, persistence of risk health behaviour, stress life events, and coronary risk factors after coronary event and a predictive value of those parameters for six-month rehospitalization. Methods. In the group with Angina Pectoris (E1=30 and the group with Acute Myocardial Infarction (E2=33, there were applied, at baseline and after 6 months, the following: Semistructured Clinical Interview based on ICD-10, for depressive episode and anxiety disorder, Hamilton Anxiety Scale (HAMA, Hamilton Depression Scale (HAMD, KON-6 sigma Scale for aggression, Holms-Rahe Scale (H-R for stress events and Questionnaire for risk behaviour: alcohol consumption, smoking, lack of physical activity. Group differences were assessed by t-test and chi-square test, p<0.05, regression analysis for assessing initial variables, a predictive value for six month rehospitalization. Results. After acute coronary event, the anxiety and depression levels were mild and aggression was low in E1 and mild in E2. Stress event score was significantly higher in E2 (H-R=115.18 than in E1 (H-R=72.20, p<0.05. After 6 months, the results were the same except for a significantly lower stress event score in E1 (H-R=49.48, and in E2 (H-R=91.65, but still significantly higher than in E1. Coronary parameters were reduced, smokers' rate was increased in E1. Alcohol consumption, hypercholesterolaemia and hereditary tendency were predictive for six- month rehospitalization. Conclusion. After acute cardiac event, hospitalized coronary patients had a mild anxiety, depression and aggression level as well as after six months. The infarct patients had experienced more stress life events in the previous year than the angina patients. Risk health behaviour did not change in the following six months, with the

  19. Coronary artery calcification in Kawasaki disease

    International Nuclear Information System (INIS)

    Ino, T.; Shimazaki, S.; Akimoto, K.; Park, I.; Nishimoto, K.; Yabuta, K.; Tanaka, A.

    1990-01-01

    To evaluate the angiographic features of coronary lesions in Kawasaki disease with coronary artery calcification, cinefluoroscopy and cineangiography were retrospectively reviewed in 116 patients who had undergone coronary angiography between 1982 and 1989. Angiographic abnormalities of coronary arteries were demonstrated in 55 of 116 patients. In 5 (9.1%) of the 55 patients, 9 with calcification were identified by cinefluoroscopy and chest X-ray. Eight of the 9 calcified lesions showed a circular or ring-shape configuration. Coronary angiography revealed a total occlusion of the right coronary artery with collateral circulation from the distal left coronary artery in 2 patients and a severe stenosis of the right coronary artery in 2 patients, in whom anticoagulant therapy had not been continued during the follow-up periods. The remaining patient in whom anticoagulant therapy had been continued had bilateral aneurysms but no significant stenosis. These results indicate that a ring-shape calcification on chest X-ray in 2 patients with a history of Kawasaki disease may suggest an involvement by coronary artery stenosis even when anticoagulant drugs had been given. Therefore, coronary angiography should be performed to evaluate the stenotic lesions if this type of calcification is found by routine radiographic examination. (orig.)

  20. Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Joseph Chiha

    2017-03-01

    Conclusion: There is a significant relationship between coronary artery tortuosity and gender. Women with severe tortuosity are more likely to have normal coronary arteries or less severe disease than men despite presenting with chest pain.

  1. Recent activation of the plaque immune response in coronary lesions underlying acute coronary syndromes

    NARCIS (Netherlands)

    van der Wal, A. C.; Piek, J. J.; de Boer, O. J.; Koch, K. T.; Teeling, P.; van der Loos, C. M.; Becker, A. E.

    1998-01-01

    OBJECTIVE: To discriminate between chronic inflammation and acute activation of the plaque immune response in culprit lesions of patients with acute coronary syndromes. DESIGN: Retrospective study. SETTING: Tertiary referral centre. SUBJECTS: 71 patients having coronary atherectomy were classified

  2. Coronary anomalies: what the radiologist should know*

    Science.gov (United States)

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

    2015-01-01

    Coronary anomalies comprise a diverse group of malformations, some of them asymptomatic with a benign course, and the others related to symptoms as chest pain and sudden death. Such anomalies may be classified as follows: 1) anomalies of origination and course; 2) anomalies of intrinsic coronary arterial anatomy; 3) anomalies of coronary termination. The origin and the proximal course of anomalous coronary arteries are the main prognostic factors, and interarterial course or a coronary artery is considered to be malignant due its association with increased risk of sudden death. Coronary computed tomography angiography has become the reference method for such an assessment as it detects not only anomalies in origination of these arteries, but also its course in relation to other mediastinal structures, which plays a relevant role in the definition of the therapeutic management. Finally, it is essential for radiologists to recognize and characterize such anomalies. PMID:26379322

  3. Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes

    DEFF Research Database (Denmark)

    Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita

    2013-01-01

    The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations.......The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations....

  4. Coronary artery anomalies in adults: imaging at dual source CT coronary angiography

    International Nuclear Information System (INIS)

    Laspas, Fotios; Roussakis, Arkadios; Mourmouris, Christos; Kritikos, Nikolaos; Efthimiadou, Roxani; Andreou, John

    2013-01-01

    Congenital abnormalities of the coronary arteries have an incidence of 1%, and most of these are benign. However, a small number are associated with myocardial ischaemia and sudden death. Various imaging modalities are available for coronary artery assessment. Recently, multi-detector CT has emerged as an accurate diagnostic tool for defining coronary artery anomalies. The purpose of this pictorial essay is to review the dual source CT appearance of congenital anomalies of the coronary arteries in adults.

  5. MRI in coronary artery disease

    International Nuclear Information System (INIS)

    Barkhausen, Joerg; Hunold, Peter; Waltering, Kai-Uwe

    2004-01-01

    Diagnosis of coronary artery disease (CAD) is a major challenge for medical imaging, because CAD is the leading cause of death in developed nations. Several non-invasive tests are used in clinical routine for the detection of CAD. However, due to limited sensitivity and specificity, the reliable diagnosis as well as the exclusion of CAD can only be established by catheter angiography. In patients with known CAD, therapeutic decisions require accurate information on myocardial function, ischemia and viability. Recently, magnetic resonance (MR) imaging has emerged as a non-invasive cardiac imaging technique that provides information on cardiac morphology, cardiac function, myocardial viability, and coronary morphology. This review discusses technical aspects and the clinical impact of different MR techniques. (orig.)

  6. Left main percutaneous coronary intervention.

    Science.gov (United States)

    Teirstein, Paul S; Price, Matthew J

    2012-10-23

    The introduction of drug-eluting stents and advances in catheter techniques have led to increasing acceptance of percutaneous coronary intervention (PCI) as a viable alternative to coronary artery bypass graft (CABG) for unprotected left main disease. Current guidelines state that it is reasonable to consider unprotected left main PCI in patients with low to intermediate anatomic complexity who are at increased surgical risk. Data from randomized trials involving patients who are candidates for either treatment strategy provide novel insight into the relative safety and efficacy of PCI for this lesion subset. Herein, we review the current data comparing PCI with CABG for left main disease, summarize recent guideline recommendations, and provide an update on technical considerations that may optimize clinical outcomes in left main PCI. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  7. Nanomedicine in coronary artery disease.

    Science.gov (United States)

    Ambesh, Paurush; Campia, Umberto; Obiagwu, Chukwudi; Bansal, Rashika; Shetty, Vijay; Hollander, Gerald; Shani, Jacob

    Nanomedicine is one of the most promising therapeutic modalities researchers are working on. It involves development of drugs and devices that work at the nanoscale (10-9m). Coronary artery disease (CAD) is responsible for more than a third of all deaths in age group >35 years. With such a huge burden of mortality, CAD is one of the diseases where nanomedicine is being employed for preventive and therapeutic interventions. Nanomedicine can effectively deliver focused drug payload at sites of local plaque formation. Non-invasive strategies include thwarting angiogenesis, intra-arterial thrombosis and local inflammation. Invasive strategies following percutaneous coronary intervention (PCI) include anti-restenosis and healing enhancement. However, before practical application becomes widespread, many challenges need to be dealt with. These include manufacturing at the nanoscale, direct nanomaterial cellular toxicity and visualization. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  8. Diagnosis and therapy of coronary artery disease: Second edition

    International Nuclear Information System (INIS)

    Cohn, P.F.

    1985-01-01

    This book contains 18 selections. Some of the titles are: Nuclear cardiology; Diagnosis of acute myocardial infarction; Therapy of angina pectoris; Psychosocial aspects of coronary artery disease; Nonatherosclerotic coronary artery disease; and The epidemiology of coronary artery disease

  9. Bivalirudin in percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Sam J Lehman

    2006-12-01

    Full Text Available Sam J Lehman, Derek P ChewDepartment of Medicine, Flinders University, South Australia, AustraliaAbstract: Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI and acute coronary syndrome (ACS. Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use of bivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY trial are discussed. Keywords: bivalirudin, direct thrombin inhibitor, acute coronary syndrome, percutaneous coronary intervention

  10. Congenital Heart Defects and Coronary Anatomy

    OpenAIRE

    Mawson, John B.

    2002-01-01

    Coronary artery anomalies are a well recognized feature of many cardiac malformations and have been catalogued in a number of reviews. This overview concentrates on 1) the interplay between congenital heart defects and coronary morphogenesis, examining how some of the embryology fits with the experiments of nature encountered in clinical practice; and 2) the influence of coronary anatomy on patient management. This overview uses, as examples, pulmonary atresia with intact ventricular septum, ...

  11. Behavior patterns and coronary heart disease

    Science.gov (United States)

    Townsend, J. C.; Cronin, J. P.

    1975-01-01

    The relationships between two behavioral patterns, cardiac risk factors, and coronary heart disease are investigated. Risk factors used in the analysis were family history of coronary disease, smoking, cholesterol, obesity, systotic blood pressure, diastolic blood pressure, blood sugar, uric acid, erythrocyte sedimentation rate, and white blood unit. It was found that conventional, non-behavioral pattern risk factors alone were not significantly related to coronary heart disease.

  12. Coronary physiology assessment in the catheterization laboratory

    OpenAIRE

    Díez-delhoyo, Felipe; Gutiérrez-Ibañes, Enrique; Loughlin, Gerard; Sanz-Ruiz, Ricardo; Vázquez-Álvarez, María Eugenia; Sarnago-Cebada, Fernando; Angulo-Llanos, Rocío; Casado-Plasencia, Ana; Elízaga, Jaime; Fernández Avilés Diáz, Francisco

    2015-01-01

    Physicians cannot rely solely on the angiographic appearance of epicardial coronary artery stenosis when evaluating patients with myocardial ischemia. Instead, sound knowledge of coronary vascular physiology and of the methods currently available for its characterization can improve the diagnostic and prognostic accuracy of invasive assessment of the coronary circulation, and help improve clinical decision-making. In this article we summarize the current methods available for a thorough asses...

  13. Role of endothelial function in coronary slow-flow phenomenon with angiographically normal coronaries

    Directory of Open Access Journals (Sweden)

    Srikanth Nathani

    2016-01-01

    Conclusion: Coronary slow flow phenomenon is a marker of atherosclerosis (as documented by carotid intima media thickness and our study has also shown that endothelial function is significantly impaired in patients with coronary slow flow (as documented by impaired endothelial dependent vasodilatation than that of patients with normal epicardial coronaries with normal flow.

  14. Model of the coronary circulation based on pressure dependence of coronary resistance and compliance

    NARCIS (Netherlands)

    Bruinsma, P.; Arts, T.; Dankelman, J.; Spaan, J. A.

    1988-01-01

    The effect of pressure-dependent changes in vascular volume, resistance and capacitance in the coronary micro-circulation, has been studied by a distributed mathematical model of the coronary micro-vasculature in the left ventricular wall. The model does not include regulation of coronary blood flow

  15. Interesting images: Multiple coronary artery aneurysms.

    Science.gov (United States)

    Howard, Jonathon M; Viswanath, Omar; Armas, Alfredo; Santana, Orlando; Rosen, Gerald P

    2017-01-01

    We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field.

  16. Coronary artery dissection following chest trauma

    Directory of Open Access Journals (Sweden)

    Manoj K Agarwala

    2016-01-01

    Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

  17. [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.

  18. Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions

    DEFF Research Database (Denmark)

    Gaur, Sara; Øvrehus, Kristian Altern; Dey, Damini

    2016-01-01

    AIMS: Coronary plaque characteristics are associated with ischaemia. Differences in plaque volumes and composition may explain the discordance between coronary stenosis severity and ischaemia. We evaluated the association between coronary stenosis severity, plaque characteristics, coronary computed...... tomography angiography (CTA)-derived fractional flow reserve (FFRCT), and lesion-specific ischaemia identified by FFR in a substudy of the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). METHODS AND RESULTS: Coronary CTA stenosis, plaque volumes, FFRCT, and FFR were assessed...

  19. Multiple giant coronary aneurysms arising from coronary istula to the pulmonary artery revealed in aorta CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Eun Ju; Lee, Ki Nam [Dept. of Radiology, Dong A University Hospital, Dong-A University College of Medicine, Busan (Korea, Republic of); Lee, Jong Min [Dept. of Radiology, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

    2015-12-15

    Coronary fistula is a rare coronary abnormality through which blood drains into the cardiac chamber, great vessel or other vessels. In addition, giant aneurysm arising from coronary fistula is rare pathologic manifestation. Herein, we presented a rare case of multiple giant coronary artery aneurysms arising from coronary to pulmonary artery fistula in a 79-year-old woman presenting with sudden loss of consciousness. The aneurysms were detected using thoracic computed tomography angiography and consequently confirmed by invasive coronary angiography.

  20. Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Xiangfei Wang

    2014-01-01

    Full Text Available Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.

  1. Moderators of Coronary Vasomotion during Mental Stress in Coronary Artery Disease Patients: Stress Reactivity, Serum Lipoproteins, and Severity of Atherosclerosis

    National Research Council Canada - National Science Library

    Howell, Robert H

    1996-01-01

    Impaired coronary artery vasomotion in response to behavioral triggers such as mental stress may be an important pathophysiological process involved in acute manifestations of coronary artery disease...

  2. Evaluation of the restenosis of coronary artery after percutaneous transluminal coronary angioplasty by three-dimensional coronary magnetic resonance angiography

    International Nuclear Information System (INIS)

    Arisaka, Hiraku

    2000-01-01

    Coronary magnetic resonance angiography (MRA) has been recently brought into clinical use, however, there has not been reports on the comparison with MRA and conventional contrast coronary angiography (CAG) in the detection of the localization and characteristics of coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA). To assess the restenosis of coronary artery after PTCA, this study compared three-dimensional (3D) coronary MRA and CAG. One hundred three patients (76 males and 27 females, average age of 64.6±9.3 years old) were performed coronary MRA at 3-6 months after PTCA. The right coronary artery (RCA) group consist of 21 patients, the left anterior descending branch (LAD) 63 patients and the left circumflex branch (LCX) 19 patients. Coronary MRA was performed with the patients in supine position on a 1.5 T whole body scanner (MAGNETOM VISION, Siemens AG, Germany) using body array coil. The imaging technique used a 3-D gradient echo sequence with respiratory gating and fat suppression. The slice thickness was 2 mm, slab thickness 32 mm, a field of view of 300 mm and a matrix of 128 x 256. Other parameters were an echo time of 2.7 ms and a repetition time of 600 to 1100 msec. The measurement time of 1 imaging slab took 15 to 20 minutes depending on the patient's heart rate. The coronary arteries were reconstructed from the 3-D data set using a multiplanar reconstruction (MPR) technique. According to previous coronary MRA studies, a significant stenosis with a luminal reduction of ≥50% was assumed if a marked signal reduction or signal loss of a vessel segment was visible. In CAG, 57 of 103 patients showed restenosis. In coronary MRA, 37 of 103 patients demonstrated restenosis. The sensitivity, specificity, positive and negative predictive values were 64.9%, 100%, 100% and 69.6%, respectively. Predictive accuracy was 79.6%. Three-dimensional coronary MRA is useful in a noninvasive diagnostic method to evaluate the coronary

  3. Single coronary artery; extremely rare coronary anomaly successfully treated surgically in young adult male.

    LENUS (Irish Health Repository)

    Shah, A R

    2010-05-01

    Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.

  4. COVERED STENTS IN IATROGENIC CORONARY ARTERY FISTULA; A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Masoud Poormoghaddas

    2010-11-01

    Full Text Available Abstract    BACKGROUND: Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major cardiac vessels, mostly congenital but some of them are acquired as a consequence of coronary artery perforation.    CASE PRESENTATION: We report a case of cavity spilling coronary artery perforation during percutaneous coronary intervention 7 years ago. Because of continuing symptoms and risk of developing heart failure and pulmonary hypertension we were ought to treat this iatrogenically formed coronary artery fistula. We used stent graft implantation to treat it with acceptable results.    CONCLUSION: Beside their application as a rescue for acute coronary artery perforations, stent grafts can be used with acceptable results in iatrogenically acquired coronary artery coronary artery fistula      Keywords: Coronary artery perforation, Coronary artery fistula, Stent graft.

  5. The mechanism of directional coronary atherectomy

    NARCIS (Netherlands)

    V.A.W.M. Umans (Victor); E. Haine; J. Renkin; P.J. de Feyter (Pim); W. Wijns (William); P.W.J.C. Serruys (Patrick)

    1993-01-01

    textabstractAn attempt was made to assess the mechanism of directional coronary atherectomy using different methods of analysis. Quantitative coronary angiography was used as the gold standard to assess the immediate results of atherectomy, and a comparative quantitative analysis of atherectomy and

  6. Noninvasive Diagnostic Technique in Stenotic Coronary Atherosclerosis

    Directory of Open Access Journals (Sweden)

    A. Yu. Vasilyev

    2005-01-01

    Full Text Available Objective: to determine the sensitivity and specificity of combined stress echocardiography (EchoCG using dipyri-damole and dobutamine in diagnosing and defining the extent of stenotic coronary lesions in coronary heart disease (CHD in a group of critically ill patients who are unable to perform a physical exercise.Materials and methods: the study included 57 male patients with suspected acute coronary syndrome who underwent stress EchoCG using dipyridamole in high doses in combination with dobutamine, as well as coronary angiography.Results: stress EchoCG could bring up to the diagnostic criteria in all the patients, of whom 9 patients were found at coronary angiography to have no coronary lesion, 34 and 14 patients had one- and many-vessel lesions, respectively. The sensitivity and specificity of combined stress EchoCG were significantly higher than those of EchoCG used in the diagnosis of CHD.Conclusion: stress EchoCG using dipyridamole in combination with dobutamine is a highly informative safe noninvasive technique for diagnosing CHD, its helps to identify patients with atypical acute coronary syndrome and to form a group of patients to be subject to urgent coronarography and angiosurgical intervention. The pattern of segmental contractile disorders at the height of exercise during combined stress Echo-CG makes it possible to define the site of stenotic coronary atherosclerosis with 97.3% sensitivity and to diagnose many-vessel lesion with 100% sensitivity and 100%specificity.

  7. Multislice CT imaging of anomalous coronary arteries

    International Nuclear Information System (INIS)

    Shi Heshui; Aschoff, Andrik J.; Brambs, Hans-Juergen; Hoffmann, Martin H.K.

    2004-01-01

    The purpose of the present study was to evaluate the role of 16 multislice computed tomography (MSCT) to identify the origin of anomalous coronary arteries and to confirm their anatomic course in relation to the great vessels. Accuracy of coronary artery disease (CAD) detection was a secondary aim and was tested with conventional angiograms (CA) serving as standard of reference. Two hundred and forty-two consecutive patients referred for noninvasive coronary CT imaging were reviewed for the study. Sixteen patients (6.6%) with anomalous coronary arteries were detected and included as the study group. MSCT and CA images were analyzed in a blinded fashion for accuracy of anomalous artery origin and path detection. Results were compared in a secondary consensus evaluation. Accuracy ratios to detect CAD with MSCT in all vessels were calculated. Coronary anomalies for all 16 patients were correctly displayed on MSCT. CA alone achieved correct identification of the abnormality in only 53% (P=0.016). Sensitivity and specificity of MSCT to detect significantly stenosed vessels was 90 and 92%. 16-MSCT is accurate to delineate abnormally branching coronary arteries and allows sufficiently accurate detection of obstructive coronary artery disease in distal branches. It should therefore be considered as a prime non-invasive imaging tool for suspected coronary anomalies. (orig.)

  8. Aneurysmal coronary artery disease: An overview

    Science.gov (United States)

    ElGuindy, Mohamed S.

    Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease. PMID:29564347

  9. [Minimally invasive coronary artery surgery].

    Science.gov (United States)

    Zalaquett, R; Howard, M; Irarrázaval, M J; Morán, S; Maturana, G; Becker, P; Medel, J; Sacco, C; Lema, G; Canessa, R; Cruz, F

    1999-01-01

    There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) on a beating heart through a minimally invasive access to the chest cavity. To report the experience with minimally invasive coronary artery surgery. Analysis of 11 patients aged 48 to 79 years old with single vessel disease that, between 1996 and 1997, had a LIMA graft to the LAD performed through a minimally invasive left anterior mediastinotomy, without cardiopulmonary bypass. A 6 to 10 cm left parasternal incision was done. The LIMA to the LAD anastomosis was done after pharmacological heart rate and blood pressure control and a period of ischemic pre conditioning. Graft patency was confirmed intraoperatively by standard Doppler techniques. Patients were followed for a mean of 11.6 months (7-15 months). All patients were extubated in the operating room and transferred out of the intensive care unit on the next morning. Seven patients were discharged on the third postoperative day. Duplex scanning confirmed graft patency in all patients before discharge; in two patients, it was confirmed additionally by arteriography. There was no hospital mortality, no perioperative myocardial infarction and no bleeding problems. After follow up, ten patients were free of angina, in functional class I and pleased with the surgical and cosmetic results. One patient developed atypical angina on the seventh postoperative month and a selective arteriography confirmed stenosis of the anastomosis. A successful angioplasty of the original LAD lesion was carried out. A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopulmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required to define its role in the treatment of coronary artery disease.

  10. Single Coronary Artery with Aortic Regurgitation

    International Nuclear Information System (INIS)

    Katsetos, Manny C.; Toce, Dale T.

    2003-01-01

    An isolated single coronary artery can be associated with normal life expectancy; however, patients are at an increased risk of sudden death. A case is reported of a 54-year-old man with several months of chest pressure with activity. On exercise Sestamibi stress testing, the patient developed a hypotensive response with no symptoms and minimal electrocardiographic changes. Nuclear scanning demonstrated reversible septal and lateral perfusion defects consistent with severe ischemia. Coronary angiography revealed a single coronary artery with the right coronary artery arising from the left main. There were high-grade stenotic lesions in the left anterior descending and circumflex arteries with only moderate atherosclerotic disease in the right coronary artery. An aortogram showed 2-3+ aortic regurgitation, with an ejection fraction of 45% on ventriculography. The patient underwent four-vessel revascularization and aortic valve replacement and did well postoperatively

  11. Updates in management of coronary artery disease

    International Nuclear Information System (INIS)

    Yang, Dong Heon; Chae, Shung Chull

    2005-01-01

    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

  12. 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.

  13. Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Koung Mi; Choi, Sang Il; Chun, Eun Ju; Kim, Jeong A; Youn, Tae Jin; Choi, Dong Ju [Seoul National University Bundang Hospital, Sungnam (Korea, Republic of)

    2012-01-15

    We aimed to describe the imaging findings of multidetector CT coronary angiography (MDCTA) in cases of vasospastic angina (VA) and to determine the accuracy of MDCTA in the identification of VA as compared with invasive coronary angiography with an ergonovine provocation test (CAG with an EG test). Fifty-three patients with clinically suspected VA were enrolled in this study. Two radiologists analyzed the stenosis degree, presence or absence of plaque, plaque composition, and a remodeling index of the related-segment in CAG with an EG test, which were used as a gold standard. We evaluated the diagnostic performances of MDCTA by comparing the MDCTA findings with those of CAG with an EG test. Among the 25 patients with positive CAG with an EG test, all 12 patients with significant stenosis showed no definite plaque with the negative arterial remodeling. Of the six patients with insignificant stenosis, three (50%) had non-calcified plaque (NCP), two (33%) had mixed plaque, and one (17%) had calcified plaque. When the criteria for significant stenosis with negative remodeling but no definite evidence of plaque as a characteristic finding of MDCTA were used, results showed sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) of 48%, 100%, 100%, and 68%, respectively. Significant stenosis with negative remodeling, but no definite evidence of plaque, is the characteristic finding on MDCTA of VA. Cardiac MDCTA shows good diagnostic performance with high specificity and PPV as compared with CAG with an EG test.

  14. Spontaneous coronary dissection: case report

    OpenAIRE

    Couto, Gustavo J. Ventura; Deslandes, Alexandre de O.; Santos, Paulo César de Souza; Cruz, Alexandre de Araújo; Saraiva, Roberto Santos

    2007-01-01

    O objetivo do trabalho é demonstrar o caso de um homem de 62 anos, com quadro de dissecção coronariana espontânea, localizada em 1/3 inicial de coronária circunflexa esquerda, tratado cirurgicamente com revascularização miocárdica. A operação realizada com sucesso demonstra, nesse caso, ser o único meio possível de cura.The purpose of the paper is to demonstrate the case of a 62-year-old man, with spontaneous coronary dissection of the left circumflex artery, treated surgically by myocardial ...

  15. Diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Pfisterer, M.; Gordon, D.; Battler, A.; Ashburn, W.; Froelicher, V.; Kantonsspital Basel

    1979-01-01

    In order to compare the three non-invasive exercise tests Ecg, Thallium myocardial perfusion imaging and radionuclide angiography in the diagnosis of coronary artery disease, the results of these tests in a consecutive series of 30 patients and 14 controls were analyzed. In all 88 symptom-limited exercise tests a significantly higher double product (heart rate x systolic blood pressure, mm Hg/min) was reached on a treadmill test (for Ecg and Thallium scintigraphy) as compared to the supine bicycle ergometer exercise (for radionuclide angiography): 243.1 +- 61.1 vs. 215.2 +- 46.5 x 10 2 (p [de

  16. Determining the proportion of coronary segments assessable on 16-slice CT coronary angiography: a brief report

    International Nuclear Information System (INIS)

    Soon, K. H.; Cox, N.; Eccleston, D.; Lim, Y.; Chaitowitz, I.; Bell, K. W.; Kelly, A-M.

    2007-01-01

    Computed tomography coronary angiography (CT-CA) is becoming a popular non-invasive coronary imaging method. We aimed to determine the proportion of coronary segments assessable on a 16-slice CT in comparison with conventional selective coronary angiography (SCA). We identified all patients who had both 16-slice CT-CA and recent SCA (less than 12 months) from March 2004 to July 2005. Two CT reporters blinded to SCA independently classified coronary segment assessability on CT-CA. A cardiologist blinded to CT findings classified assess-ability of coronary segments on SCA. Data were analysed using descriptive statistics and proportion of agreement. Ninety-five study pairs were included in the analysis. Of those, 1161 coronary segments were deemed assessable on SCA and 1103 segments (95%) were also assessable on CT-CA. Nonassessable segments on CT-CA were predominantly in the distal segments and branches of coronary arteries. Reasons for nonassessability were small calibre (48.3%), motion artefacts (20.7%) and poorly reconstructed segments (22.4%). The 16-slice CT was able to assess a high proportion of but not all coronary segments. Nonassessable segments were predominantly distal segments or branches of coronary arteries. Motion artefacts due to heart-rate changes, small calibre and poorly reconstructed images were main causes of nonassessability on 16-slice CT-CA

  17. [Development of an automated processing method to detect coronary motion for coronary magnetic resonance angiography].

    Science.gov (United States)

    Asou, Hiroya; Imada, N; Sato, T

    2010-06-20

    On coronary MR angiography (CMRA), cardiac motions worsen the image quality. To improve the image quality, detection of cardiac especially for individual coronary motion is very important. Usually, scan delay and duration were determined manually by the operator. We developed a new evaluation method to calculate static time of individual coronary artery. At first, coronary cine MRI was taken at the level of about 3 cm below the aortic valve (80 images/R-R). Chronological change of the signals were evaluated with Fourier transformation of each pixel of the images were done. Noise reduction with subtraction process and extraction process were done. To extract higher motion such as coronary arteries, morphological filter process and labeling process were added. Using these imaging processes, individual coronary motion was extracted and individual coronary static time was calculated automatically. We compared the images with ordinary manual method and new automated method in 10 healthy volunteers. Coronary static times were calculated with our method. Calculated coronary static time was shorter than that of ordinary manual method. And scan time became about 10% longer than that of ordinary method. Image qualities were improved in our method. Our automated detection method for coronary static time with chronological Fourier transformation has a potential to improve the image quality of CMRA and easy processing.

  18. Coronary blood flow and coronary stenosis correlations in ischemic heart patients

    International Nuclear Information System (INIS)

    Manukov, I.

    2003-01-01

    The aim of the study is the assessment of the methodology for the C-TIMI frame count by Gibson for easy and fast determination of the coronary blood flow during a selective coronary angiography. 75 patient have been studied with one-branch affection of the coronary arteries. The criteria for exclusion are: myocardial hypertrophy, valve lesions, myocardial infarction and dyslipidemia. Depending of the characteristics of the coronary stenotic changes, the patients have been divided into two groups: 1) Patients with 'ordinary' stenosis of the coronary artery and 2) Patients with 'complex' stenosis. The severity of the stenotic changes in percents is the same for the two groups - 78%±13% vs 81±12%, respectively. In the first group a pronounced correlation is observed between the severity of the coronary stenosis and the slowing of the coronary blood flow. The 'threshold' stenotic level is 89%. In the second group the lowest value of the coronary stenosis is 73% (p>0.01 vs group 1). No correlation is observed between the severity of the coronary stenosis and the slowing of the coronary blood flow. A conclusion is made that the Gibson method for the assessment of the blood flow is convenient for the daily practice not only for the assessment of the significance of the coronary changes, but also for fast analysis of the achieved reconstruction of the coronary arteries after angioplasty. Additional studies of the significance of the different signs of 'complexity' of the coronary stenosis for the slowing of the blood flow are necessary

  19. Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography.

    Science.gov (United States)

    Nakanishi, Rine; Baskaran, Lohendran; Gransar, Heidi; Budoff, Matthew J; Achenbach, Stephan; Al-Mallah, Mouaz; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J W; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Cury, Ricardo; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Kaufmann, Philipp A; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J; Villines, Todd C; Dunning, Allison; Marques, Hugo; Pontone, Gianluca; Andreini, Daniele; Rubinshtein, Ronen; Bax, Jeroen; Jones, Erica; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y; Min, James K; Berman, Daniel S

    2017-08-01

    Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events. © 2017 American Heart Association, Inc.

  20. Coronary CT angiography: Diagnostic value and clinical challenges.

    Science.gov (United States)

    Sabarudin, Akmal; Sun, Zhonghua

    2013-12-26

    Coronary computed tomography (CT) angiography has been increasingly used in the diagnosis of coronary artery disease due to improved spatial and temporal resolution with high diagnostic value being reported when compared to invasive coronary angiography. Diagnostic performance of coronary CT angiography has been significantly improved with the technological developments in multislice CT scanners from the early generation of 4-slice CT to the latest 320- slice CT scanners. Despite the promising diagnostic value, coronary CT angiography is still limited in some areas, such as inferior temporal resolution, motion-related artifacts and high false positive results due to severe calcification. The aim of this review is to present an overview of the technical developments of multislice CT and diagnostic value of coronary CT angiography in coronary artery disease based on different generations of multislice CT scanners. Prognostic value of coronary CT angiography in coronary artery disease is also discussed, while limitations and challenges of coronary CT angiography are highlighted.

  1. The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hvelplund, Anders; Jeger, Raban; Osterwalder, Remo

    2011-01-01

    To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device.......To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device....

  2. [Multiple coronary arteriovenous fistulae. Hazard or predetermination?].

    Science.gov (United States)

    Rangel, Alberto; Muñoz-Castellanos, Luis; Solorio, Sergio

    2003-01-01

    The authors present the clinical cases of three adult patients (49, 53 and 61 year-old), with rheumatic cardiac valvulopathy, and bilateral coronary arteriovenous fistulae draining in the main pulmonary artery. Based on documental investigation, the authors speculate about the predeterminate origin of coronary arteriovenous fistulae. At first glance, it seems obvious that congenital cardiopathies occur at random, i.e., embryonic development deviate or stops due to unknown reasons, originating the persistence of lacunar blood spaces prior to the development of coronary arteries cords. There are two factors involved in the genesis of congenital malformations: a genomic preexisting factor and the presence of an environmental precipitating factor, i.e., isolated pulmonary valve atresia or left ventricular hypoplastic syndrome, with mitral and aortic valve stenosis, can predispose development of coronary arteriovenous fistulae. Recently, the question has been raised whether there is a relation of coronary arteries fistulae with: ethnic groups, hereditary gigantism, autoimmune diseases, such as polymyositis, hereditary hemorrhagic telangiectasia, and apical hypertrophic myocardiopathy. Coronary arteriovenous fistulae, as well as some congenital cardiopathies, could be due to chromosome alterations or might be related to hereditary diseases, such as hemorrhagic telangiectasia, induced by a disturbed genetic program. Although, there is no concrete evidence that a genetic factor is related to the development of coronary arteriovenous fistulae, there are signs that suggest that such a possibility could be investigated.

  3. Frequency and importance of radiologically visible coronary scleroses

    International Nuclear Information System (INIS)

    Hoyer, B.

    1981-01-01

    The importance of radiologically visible coronary sceleroses for an early diagnosing of coronary heart disease was investigated. In 3 mixed collectives of patients with and without coronary heart diseases who had had a coronary angiography were examined retrospectively for coronary sclerosis (group I: standard films, group II: old X-ray findings, group III: fluoroscopy before beginning coronary angiography). In the retrospective evaluation, the sensitivity to the recognition of coronary heart disease was low. With prospective examination by means of fluoroscopy, coronary calcification could be proven in 37.66% of the patients with coronary diseases (sensitivity); the specificity (no coronary calcification in persons without coronary disease) was 99%. The duration and extent of a calcification do not show a definite influence on the severity of the disease. Several coronary scleroses in one or several vessels mostly indicate a vascular disease. Coronary scleroses are not necessarily located in the same point as coronary stenoses: in 85.5% of the patients with coronary sclerosis of the left truncus, haemodynamically important stenoses were found only in following vascular regions. Considering the high specificity of coronary scleroses in the fluoroscopic picture and the high sensitivity under favourable conditions, this method seems to be suitable as a screening method for early recognition of coronary heart diseases in the asymptomatic stage. A proven coronary sclerosis should in any case be the cause for continuing the search for a coronary heart disease. The radiation exposure during fluoroscopy of coronary sclerosis is low if the adjustment is correct, it takes little time, the patient is not put to discomfort. (orig./MG) [de

  4. [Comparison of 64 MDCT coronary CTA and coronary angiography in the detection of coronary artery stenosis in low risk patients with stable angina and acute coronary syndrome].

    Science.gov (United States)

    Cazalas, G; Sarran, A; Amabile, N; Chaumoitre, K; Marciano-Chagnaud, S; Jacquier, A; Paganelli, F; Panuel, M

    2009-09-01

    To determine the accuracy of 64 MDCT coronary CTA (CCTA) compared to coronary angiography in low risk patients with stable angina and acute coronary syndrome and determine the number of significant coronary artery stenoses ( 50%) in these patients. Materials and methods. Fifty-five patients underwent CCTA using a 32 MDCT unit with z flying focus allowing the acquisition of 64 slices of 0.6 mm thickness as well as coronary angiography (gold standard). Nine patients were excluded due to prior coronary artery bypass surgery (n=4), insufficient breath hold (n=3), calcium scoring>1000 (n=1) and delay between both examinations over 4 months (n=1). Forty-six patients: 27 males and 19 females were included. CCTA results were compared to coronary angiography per segment and artery with threshold detection of stenoses 50%. The degree of correlation between both examinations was performed using a regression analysis with a Pearson correlation coefficient<0.05 considered significant. The overall accuracy of CCTA was 90%; limitations related to the presence of calcifications, motion artifacts or insufficient vessel opacification. The correlation for all analyzed segments was 96.4%. Thirty-eight of 50 significant stenoses seen on coronary angiography were correctly detected on CCTA. Sensitivity, specificity, PPVC and NPV for detection of stenoses 50% were 76%, 98.3%, 80.3% and 97.7% respectively. Evaluation per segment had a NPV of 96.8% (interventricular and diagonal segments) to 100% (main trunk). Our results for specificity and NPV are similar to reports from the literature. This suggests that CCTA in this clinical setting may replace coronary angiography.

  5. 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......, and 5% versus 2% (2 . 25, 0 . 93-5 . 48, p= 0 . 073) for stroke. Interpretation The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease....

  6. Subclinical Coronary Plaque Burden in Asymptomatic Relatives of Patients With Documented Premature Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Jensen, Jesper Møller; Bøtker, Hans Erik

    Introduction: A family history of premature coronary artery disease (CAD) is a well-known risk factor for adverse coronary events with age of onset being inversely related to the degree of heritability. Hypothesis: We hypothesized that asymptomatic first degree relatives, of patients with premature...... CAD, suffer a high burden of subclinical coronary atherosclerosis. Methods: First degree relatives, aged 30-65 years, of patients with a documented coronary revascularization procedure before the age of 40 years, were invited to participate in the study. Participants were matched by age, sex...... and absence of a family history, with patients referred for coronary CT angiography (CTA) because of atypical angina or non-anginal chest pain. A pooled blinded analysis was performed. The main outcome measure was the number of plaque-affected coronary segments. Results: 88 relatives and 88 symptomatic...

  7. Non-obstructive coronary artery disease assessed by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nielsen, L.; Bøtker, H. E.; Sorensen, H.

    2015-01-01

    Introduction: Coronary CT angiography (CTA) detects non-obstructive coronary artery disease (CAD) that may not be recognized by functional testing, but the prognostic impact is not well understood. This study aimed to compare the risk of myocardial infarction (MI) and all-cause mortality...... in patients without or with non-obstructive and obstructive CAD assessed by coronary CTA. Methods: Consecutive patients without known coronary artery disease (CAD) and with chest pain who underwent coronary CTA (>64-detector row) between January 2007 and December 2012 in the 10 centers participating...... in the Western Denmark Cardiac Computed Tomography Registry were included. The endpoints were 3-year MI or all-cause mortality. The coronary CTA result was defined as normal (0% luminal stenosis), non-obstructive CAD (1%-49% luminal stenosis) or obstructive CAD (>50% luminal stenosis; 1-vessel, 2-vessel, or 3...

  8. Coronary CT: clinical indications and future directions

    International Nuclear Information System (INIS)

    Nomura, Cesar H.; Serpa, Bruna S.; Kay, Fernando U.; Szarf, Gilberto; Passos, Rodrigo B.; Neto, Roberto S.; Chate, Rodigo C.; Funar, Marcelo B.; Cury, Roberto C.

    2011-01-01

    Multidetector computed tomography (MDCT) has started its implementation in cardiology with calcium quantification of coronary plaques in the study without contrast, using the calcium score, demonstrating an important independent predictor of future cardiac events. The examination with intravenous contrast, coronary angiography, appeared later as a noninvasive method for evaluation of anatomy and obstructive coronary disease, characterizing the degree of stenosis and the presence of non calcified atherosclerotic plaques, assessing not only the lumen, but also the vessel wall. With the advent of new machines with more detectors and higher temporal resolution has been a reduction in radiation dose and the possibility of new applications. (author)

  9. Morphometry of the coronary ostia and the structure of coronary arteries in the shorthair domestic cat

    Science.gov (United States)

    Barszcz, Karolina; Kupczyńska, Marta; Klećkowska-Nawrot, Joanna; Janeczek, Maciej; Goździewska-Harłajczuk, Karolina; Dzierzęcka, Małgorzata; Janczyk, Paweł

    2017-01-01

    The aim of this study was to measure the area of the coronary ostia, assess their localization in the coronary sinuses and to determine the morphology of the stem of the left and right coronary arteries in the domestic shorthair cat. The study was conducted on 100 hearts of domestic shorthair cats of both sexes, aged 2–18 years, with an average body weight of 4.05 kg. A morphometric analysis of the coronary ostia was carried out on 52 hearts. The remaining 48 hearts were injected with a casting material in order to carry out a morphological assessment of the left and right coronary arteries. In all the studied animals, the surface of the left coronary artery ostium was larger than the surface of the right coronary artery ostium. There were four types of the left main coronary artery: type I (23 animals, 49%)–double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch, which in turn gave off the septal branch), type II (12 animals, 26%)–double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch without the septal branch), type III (11 animals, 23%)–triple-branched left main stem (giving off the left circumflex branch, interventricular branch and the septal branch, type IV (1 animal, 2%)–double-branched left main stem (giving off the interventricular paraconal branch and the left circumflex branch, which in turn gave off the septal branch). The left coronary artery ostium is greater than the right one. There is considerable diversity in the branches of proximal segment of the left coronary artery, while the right coronary artery is more conservative. These results can be useful in defining the optimal strategies in the endovascular procedures involving the coronary arteries or the aortic valve in the domestic shorthair cat. PMID:29020103

  10. Morphometry of the coronary ostia and the structure of coronary arteries in the shorthair domestic cat.

    Directory of Open Access Journals (Sweden)

    Karolina Barszcz

    Full Text Available The aim of this study was to measure the area of the coronary ostia, assess their localization in the coronary sinuses and to determine the morphology of the stem of the left and right coronary arteries in the domestic shorthair cat. The study was conducted on 100 hearts of domestic shorthair cats of both sexes, aged 2-18 years, with an average body weight of 4.05 kg. A morphometric analysis of the coronary ostia was carried out on 52 hearts. The remaining 48 hearts were injected with a casting material in order to carry out a morphological assessment of the left and right coronary arteries. In all the studied animals, the surface of the left coronary artery ostium was larger than the surface of the right coronary artery ostium. There were four types of the left main coronary artery: type I (23 animals, 49%-double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch, which in turn gave off the septal branch, type II (12 animals, 26%-double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch without the septal branch, type III (11 animals, 23%-triple-branched left main stem (giving off the left circumflex branch, interventricular branch and the septal branch, type IV (1 animal, 2%-double-branched left main stem (giving off the interventricular paraconal branch and the left circumflex branch, which in turn gave off the septal branch. The left coronary artery ostium is greater than the right one. There is considerable diversity in the branches of proximal segment of the left coronary artery, while the right coronary artery is more conservative. These results can be useful in defining the optimal strategies in the endovascular procedures involving the coronary arteries or the aortic valve in the domestic shorthair cat.

  11. Persistence of recruitable coronary collaterals in the absence of coronary vasospasm in a patient with variant angina

    International Nuclear Information System (INIS)

    Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide

    1998-01-01

    Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries.

  12. Persistence of Recruitable Coronary Collaterals in the Absence of Coronary Vasospasm in a Patient with Variant Angina

    International Nuclear Information System (INIS)

    Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide

    1998-01-01

    Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries

  13. 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.

  14. A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram

    Science.gov (United States)

    Yang, YoungSoon; Jin, Dong Gyu; Jang, Il Mi; Jang, YoungHee; Na, Hae Ri; Kim, SanYun

    2010-01-01

    Background Under certain conditions, exertional headaches may reflect coronary ischemia. Case Report A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. Conclusions A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test. PMID:20607049

  15. Acute Thrombotic Coronary Occlusion in a Patient with Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Beganu Elena

    2017-09-01

    Full Text Available Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accelerated atherosclerosis development. The following article presents the case of a 64-year-old female patient diagnosed with anterior ST-segment elevation myocardial infarction. The patient underwent primary percutaneous coronary intervention, which revealed the absence of the right coronary artery and separated origins of the left anterior descending artery and the left circumflex artery from the aorta.

  16. Depression in Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Nasser Safaie

    2012-09-01

    Full Text Available Introduction: Depression is one of the Common psychological disorders. From the cognitive point of view, the unhealthy attitudes increase the severity of the depression. The aim of this study was to investigate depression and unhealthy attitudes in coronary patients hospitalized at Tabriz Shahid Madani Heart Center. Methods: One hundred twenty eight hospitalized patients having myocardial Infarctions were studied regarding unhealthy attitudes, severity of depression and demographic data. Results: The study showed a significant relation between unhealthy attitudes, BDI (Beck Depression Inventory and severe depression. Moreover, a significant relation existed between gender and depression (P=0.0001. In addition, the level of education increased the intensity of unhealthy attitudes (P=0.0001. Several researches in both outside and inside Iran support the idea. Conclusion: Based on present study and more other investigations, it can be suggested to provide the necessary elements and parameters such as antidepressant medication, psychologists, complementary treatment for coping with negative mood and its unwanted consequences.

  17. 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...... identified. Furthermore, a total of 202 independent signals in 109 loci have achieved a false discovery rate (qgenetic risk scores that can improve risk prediction beyond conventional 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...

  18. Exercise Benefits Coronary Heart Disease.

    Science.gov (United States)

    Wang, Lei; Ai, Dongmei; Zhang, Ning

    2017-01-01

    Coronary heart disease (CHD) is a group of diseases that include: no symptoms, angina, myocardial infarction, ischemia cardiomyopathy and sudden cardiac death. And it results from multiple risks factors consisting of invariable factors (e.g. age, gender, etc.) and variable factors (e.g. dyslipidemia, hypertension, diabetes, smoking, etc.). Meanwhile, CHD could cause impact not only localized in the heart, but also on pulmonary function, whole-body skeletal muscle function, activity ability, psychological status, etc. Nowadays, CHD has been the leading cause of death in the world. However, many clinical researches showed that exercise training plays an important role in cardiac rehabilitation and can bring a lot of benefits for CHD patients.

  19. Radiation-induced coronary artery disease

    International Nuclear Information System (INIS)

    Dunsmore, L.D.; LoPonte, M.A.; Dunsmore, R.A.

    1986-01-01

    This report describes three patients who developed myocardial infarction at an untimely age, 4 to 12 years after radiation therapy for Hodgkin's disease. These cases lend credence to the cause and effect relation of such therapy to coronary artery disease

  20. Congenital Absence of Left Circumflex Coronary Artery

    Directory of Open Access Journals (Sweden)

    Zahra Ansari

    2009-09-01

    Full Text Available Congenital absence of left circumflex artery is a rare congenitalanomaly of the coronary arteries. The prevalence of theanomaly in different studies ranges from 0.6% to 1.3%. Ofthese, 80% are benign and asymptomatic and 20% are clinicallyimportant. We report a 56-year-old man presented withacute resting chest pain who was diagnosed as having acuteanterolateral infarction accompanied by electrocardiographicchanges and elevated cardiac enzymes. Coronary angiographyin different views was conducted, however, no left circumflexartery was found. The territory supplied by the artery had beenperfused by the super dominant right coronary artery. Therewas no left circumflex coronary artery with anomalous origin.Sever stenosis of left anterior ascending artery superimposedto the absent left circumflex artery was presented as acute anterolateralinfarction. Although absence of the artery is mostlyconsidered as a benign condition, atherosclerotic lesions maybe more important in such cases because of diminished compensatingmechanisms.

  1. CORONARY ARTERY FISTULA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    MZ Chowdhury

    2007-01-01

    Full Text Available The prevalence of congenital abnormalities of coronary artery is about 2% of general population. Of these abnormalities 5% were related to coronary artery fistulae (CAF. We report a case of 66 year old diabetic woman who presented with retrosternal chest pain. Her chest pain was associated with exercise and progressively deteriorated over the last 6 months. Electrocardiography showed right bundle branch block and Echo Color Doppler revealed hypo kinetic lateral wall. Coronary angiogram detected nothing abnormal except an aberrant tortuous branch of left circumflex. CT scan revealed a calcified sac medial to the descended thoracic aorta. A contrast enhancement was also done. All these imaging impressions were suggestive of coronary-to-pulmonary fistula. Ibrahim Med. Coll. J. 2007; 1(1: 32-33

  2. Image quality in coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Precht, Helle; Gerke, Oke; Thygesen, Jesper

    2018-01-01

    Background Computed tomography (CT) technology is rapidly evolving and software solution developed to optimize image quality and/or lower radiation dose. Purpose To investigate the influence of adaptive statistical iterative reconstruction (ASIR) at different radiation doses in coronary CT...

  3. Cardiovascular risk scores for coronary atherosclerosis.

    Science.gov (United States)

    Yalcin, Murat; Kardesoglu, Ejder; Aparci, Mustafa; Isilak, Zafer; Uz, Omer; Yiginer, Omer; Ozmen, Namik; Cingozbay, Bekir Yilmaz; Uzun, Mehmet; Cebeci, Bekir Sitki

    2012-10-01

    The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease. In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modified Framingham Risk Score (MFRS), the Prospective Cardiovascular Münster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis.The FRS had better predictive value than the other scores.

  4. Myocardial perfusion studies in coronary diseases

    International Nuclear Information System (INIS)

    Mut, Fernando

    1994-01-01

    For detecting in precocious form a coronary disease is necessary to apply a diagnostic techniques. The main considerations to be indicated in the present work are: physiological considerations, myocardial perfusion studies with radiotracers such as Talio 201, 99mTc, MIBI, 99mTc-Teboroxima, 99mTc-Fosfinas, instrumentation for obtain good images,proceedings protocols, studies interpretation, standards, SPECT, anomalies standards, coronary diseases

  5. Development of Coronary Pulse Wave Velocity: New Pathophysiological Insight Into Coronary Artery Disease.

    Science.gov (United States)

    Harbaoui, Brahim; Courand, Pierre-Yves; Cividjian, Andrei; Lantelme, Pierre

    2017-02-02

    Although aortic stiffness assessed by pulse wave velocity (PWV) is a strong predictor of coronary artery disease, the significance of local coronary stiffness has never been tackled. The first objective of this study was to describe a method of measuring coronary PWV (CoPWV) invasively and to describe its determinants. The second objective was to assess both CoPWV and aortic PWV in patients presenting with acute coronary syndromes or stable coronary artery disease. In 53 patients, CoPWV was measured from the delay in pressure wave and distance traveled as a pressure wire was withdrawn from the distal to the proximal coronary segment. Similarly, aortic PWV was measured invasively when the wire was pulled across the ascending aorta; carotid-femoral PWV was also measured noninvasively using the SphygmoCor system (AtCor Medical). Mean CoPWV was 10.3±6.1 m/s. Determinants of increased CoPWV were fractional flow reserve, diastolic blood pressure, and previous stent implantation in the recorded artery. CoPWV was lower in patients with acute coronary syndromes versus stable coronary artery disease (7.6±3 versus 11.5±6.4 m/s; P=0.02), and this persisted after adjustment for confounders. In contrast, aortic stiffness, assessed by aortic and carotid-femoral PWV, did not differ significantly. CoPWV seems associated with acute coronary events more closely than aortic PWV. High coronary compliance, whether per se or because it leads to a distal shift in compliance mismatch, may expose vulnerable plaques to high cyclic stretch. CoPWV is a new tool to assess local compliance at the coronary level; it paves the way for a new field of research. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  6. The Physics of Coronary Blood Flow

    CERN Document Server

    Zamir, M

    2005-01-01

    Coronary blood flow is blood flow to the heart for its own metabolic needs. In the most common form of heart disease there is a disruption in this flow because of obstructive disease in the vessels that carry the flow. The subject of coronary blood flow is therefore associated mostly with the pathophysiology of this disease, rarely with dynamics or physics. Yet, the system responsible for coronary blood flow, namely the "coronary circulation," is a highly sophisticated dynamical system in which the dynamics and physics of the flow are as important as the integrity of the conducting vessels. While an obstruction in the conducting vessels is a fairly obvious and clearly visible cause of disruption in coronary blood flow, any discord in the complex dynamics of the system can cause an equally grave, though less conspicuous, disruption in the flow. This book is devoted specifically to the dynamics and physics of coronary blood flow. While relevance to the clinical and pathophysiological issues is clearly maintaine...

  7. 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.

  8. Coronary triglyceride deposition in contemporary advanced diabetics.

    Science.gov (United States)

    Ikeda, Yoshihiko; Zaima, Nobuhiro; Hirano, Ken-ichi; Mano, Masayuki; Kobayashi, Kunihisa; Yamada, Sohsuke; Yamaguchi, Satoshi; Suzuki, Akira; Kanzaki, Hideaki; Hamasaki, Toshimitsu; Kotani, Jun-ichi; Kato, Seiya; Nagasaka, Hironori; Setou, Mitsutoshi; Ishibashi-Ueda, Hatsue

    2014-07-01

    It is of importance to clarify pathophysiology of diabetic heart diseases such as heart failure and coronary artery disease. We reported a novel clinical phenotype called triglyceride deposit cardiomyovasculopathy (TGCV), showing aberrant TG accumulation in both coronary arteries and myocardium, in a cardiac transplant recipient. Here, we examined autopsied diabetics for TG deposition in cardiovasculature. Consecutive series of hearts from advanced diabetes mellitus (DM) subjects (DM group: DMG, n = 20) and those from age- and sex-matched non-diabetic controls (non DM group: NDMG, n = 20) were examined. The diagnostic criteria of 'advanced DM' was made based on 2014 Clinical Practice Recommendations proposed by the American Diabetes Association. The mean duration of DM was 15.8 years. All DMG suffered from heart diseases including coronary artery diseases and 14 subjects had multi-vessel disease. Tissue TG contents were measured biochemically. Coronary arterial TG contents was significantly higher in DMG compared with NDMG. Spatial distribution of TG in transverse sections of coronary arteries showed TG deposition mainly in smooth muscle cells by Imaging Mass Spectrometry. Abundant TG deposition in coronary artery might be associated with advanced DM. © 2014 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.

  9. Localization strategy for magnetic resonance coronary angiography

    International Nuclear Information System (INIS)

    Cheng Liuquan; Gao Yuangui; Sun Wei; Sheng Fugeng; Cai Youquan

    2003-01-01

    Objective: To develop a localization strategy for magnetic resonance coronary angiography (MRCA). Methods: In 89 subjects, the standard 4-chamber view and long-axis view of left and right ventricle were acquired using Fast-Imaging-Employing-Steady-State-Acquisition (FIESTA) sequence in CINE mode, and the trigger-delay time for mid-diastolic phase was determined. Coronary vessels including right coronary artery (RCA), left main (LM), left anterior descending (LAD), and left circumflex (LCX) were localized and imaged using 3- dimensional fat-suppressed FIESTA sequence during end-expiration. The reproducibility of the localization strategy was evaluated by taking the standard of coronary segmentation system recommended by American Heart Association. Results: Eighty-six subjects completed the examination with full respiratory co-operation and the indication ratio was 96.63%. Nine planes were optimized as the standard to target the main branches of coronary arteries, and a comprehensive reproducibility reached 100% in demonstrating the proximal and middle segment of RCA (AHA-18, 19), LM (AHA-1, 2), proximal and middle segment of LAD (AHA-3, 5, 7), and proximal LCX (AHA-10). The reproducibility for the demonstration of distal segments of LAD, LCX, and RCA (AHA-9, 14, 21) was 94.19%, 72.09%, and 96.51%, respectively. Conclusion: This is a simple and practical localization strategy for MRCA. It could image the proximal and middle segments of the coronary arteries with good reproducibility, which indicates the potential for clinical application

  10. Very late coronary spasm inducing acute myocardial infarction in a heart transplant recipient.

    Science.gov (United States)

    Santoro, Francesco; Lopizzo, Agostino; Centola, Antonio; Cuculo, Andrea; Ruggiero, Antonio; Di Biase, Matteo; Brunetti, Natale Daniele

    2016-12-01

    : We report coronary angio findings of very late (10-year) coronary spasm inducing acute myocardial infarction with typical chest pain in a heart transplant recipient. Coronary spasm was promptly relieved by intra-coronary infusion of nitrates.

  11. Relation of coronary vasoreactivity and coronary calcification in asymptomatic subjects with a family history of premature coronary artery disease

    International Nuclear Information System (INIS)

    Pirich, Christian; Leber, Alexander; Knez, Andreas; Bengel, Frank M.; Nekolla, Stephan G.; Schwaiger, Markus; Haberl, Ralph

    2004-01-01

    Electron-beam computed tomography (EBCT) allows non-invasive imaging of coronary calcification and has been promoted as a screening tool for coronary artery disease (CAD) in asymptomatic high-risk subjects. This study assessed the relation of coronary calcifications to alterations in coronary vascular reactivity by means of positron emission tomography (PET) in asymptomatic subjects with a familial history of premature CAD. Twenty-one subjects (mean age 51±10 years) underwent EBCT imaging for coronary calcifications expressed as the coronary calcium score (CCS according to Agatston) and rest/adenosine-stress nitrogen-13 ammonia PET with quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR). The mean CCS was 237±256 (median 146, range 0-915). The CCS was 100 units in 13. As defined by age-related thresholds, 15 subjects had an increased CCS (>75th percentile). Overall mean resting and stress MBF and CFR were 71±16 ml 100 g -1 min -1 , 218±54 ml 100 g -1 min -1 and 3.20±0.77, respectively. Three subjects with CCS ranging from 114 to 451 units had an abnormal CFR (<2.5). There was no relation between CCS and resting or stress MBF or CFR (r=0.17, 0.18 and 0.10, respectively). In asymptomatic subjects a pathological CCS was five times more prevalent than an abnormal CFR. The absence of any close relationship between CCS and CFR reflects the fact that quantitative myocardial perfusion imaging with PET characterises the dynamic process of vascular reactivity while EBCT is a measure of more stable calcified lesions in the arterial wall whose presence is closely related to age. (orig.)

  12. Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome.

    Directory of Open Access Journals (Sweden)

    Toshiki Kuno

    Full Text Available OBJECTIVE: This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS patients undergoing percutaneous coronary intervention (PCI. BACKGROUND: Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease. METHODS: Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group and those with left-dominant anatomy (LD group. RESULTS: The average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003. In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001. Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06-2.89; P = 0.030. CONCLUSION: Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.

  13. Noninvasive Coronary Angiography with 64-Channel Multidetector Computed Tomography in Patients with Acute Coronary Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ulimoen, G. R.; Gjoennaess, E.; Atar, D.; Dahl, T.; Stranden, E.; Sandbaek, G. (Dept. of Radiology, Dept. of Vascular Diagnosis and Research, and Division of Cardiology, Aker Univ. Hospital, Oslo (Norway))

    2008-12-15

    Background: Advances in computer tomography (CT) imaging technology in recent years have facilitated the possibility of noninvasive coronary angiography. Purpose: To compare the diagnostic accuracy of 64-channel multidetector computed tomography (MDCT) with conventional invasive coronary angiography (ICA) for the detection of significant coronary stenosis in patients with acute coronary syndrome (ACS). Material and Methods: MDCT was performed in 60 patients classified with non-ST-elevation infarction (NSTEMI) or unstable angina and scheduled for ICA within 3 days. The diagnostic accuracy of MDCT was evaluated using quantitative coronary angiography (QCA) as the gold standard. Results: 48 out of 60 patients had interpretable scans by both MDCT and ICA. On a segment-based analysis, 488 out of 665 segments with a diameter of =1.5 mm, as defined by QCA, were interpretable by MDCT. Sensitivity was 78%, specificity 87%, positive predictive value 47%, and negative predictive value 97% in detecting and excluding significant coronary stenosis, as defined with MDCT. On a per patient-based analysis, sensitivity was 89%, specificity 50%, positive predictive value 84%, and negative predictive value 60%. Conclusion: Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome.

  14. Noninvasive Coronary Angiography with 64-Channel Multidetector Computed Tomography in Patients with Acute Coronary Syndrome

    International Nuclear Information System (INIS)

    Ulimoen, G. R.; Gjoennaess, E.; Atar, D.; Dahl, T.; Stranden, E.; Sandbaek, G.

    2008-01-01

    Background: Advances in computer tomography (CT) imaging technology in recent years have facilitated the possibility of noninvasive coronary angiography. Purpose: To compare the diagnostic accuracy of 64-channel multidetector computed tomography (MDCT) with conventional invasive coronary angiography (ICA) for the detection of significant coronary stenosis in patients with acute coronary syndrome (ACS). Material and Methods: MDCT was performed in 60 patients classified with non-ST-elevation infarction (NSTEMI) or unstable angina and scheduled for ICA within 3 days. The diagnostic accuracy of MDCT was evaluated using quantitative coronary angiography (QCA) as the gold standard. Results: 48 out of 60 patients had interpretable scans by both MDCT and ICA. On a segment-based analysis, 488 out of 665 segments with a diameter of =1.5 mm, as defined by QCA, were interpretable by MDCT. Sensitivity was 78%, specificity 87%, positive predictive value 47%, and negative predictive value 97% in detecting and excluding significant coronary stenosis, as defined with MDCT. On a per patient-based analysis, sensitivity was 89%, specificity 50%, positive predictive value 84%, and negative predictive value 60%. Conclusion: Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome

  15. A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease

    NARCIS (Netherlands)

    E.J. Topol (Eric); F. Leya; C.A. Pinkerton; P.L. Whitlow (Patrick); B. Hofling; C.A. Simonton; R.R. Masden; P.W.J.C. Serruys (Patrick); M.B. Leon (Martin); D.O. Williams (David); S.B. King 3rd (Spencer); B. Daniel; D.B. Mark (Daniel); J.M. Isner; D.R. Holmes Jr (David); S.G. Ellis (Stephen); K.L. Lee (Kerry); G.P. Keeler; L.G. Berdan (Lisa); T. Hinohara; R.M. Califf (Robert)

    1993-01-01

    textabstractBACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with

  16. Inversion prepared coronary MR angiography: direct visualization of coronary blood flow

    International Nuclear Information System (INIS)

    Katoh, M.; Spuentrup, E.; Buecker, A.; Guenther, R.W.; Stuber, M.; Manning, W.J.; Botnar, R.M.

    2005-01-01

    Purpose: visualization of coronary blood flow by means of a slice-selective inversion pre-pulse in concert with bright-blood coronary MRA. Materials and methods: coronary magnetic resonance angiography (MRA) of the right coronary artery (RCA) was performed in eight healthy adult subjects on a 1.5 Tesla MR system (Gyroscan ACS-NT, Philips Medical Systems, Best, NL) using a free-breathing navigator-gated and cardiac-triggered 3D steady-state free-precession (SSFP) sequence with radial k-space sampling. Imaging was performed with and without a slice-selective inversion pre-pulse, which was positioned along the main axis of the coronary artery but perpendicular to the imaging volume. Objective image quality parameters such as SNR, CNR, maximal visible vessel length, and vessel border definition were analyzed. Results: in contrast to conventional bright-blood 3D coronary MRA, the selective inversion pre-pulse provided a direct measure of coronary blood flow. In addition, CNR between the RCA and right ventricular blood pool was increased and the vessels had a tendency towards better delineation. Blood SNR and CNR between right coronary blood and epicardial fat were comparable in both sequences. (orig.)

  17. Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver; Valenta, Ines; Schepis, Tiziano [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); Husmann, Lars; Scheffel, Hans; Desbiolles, Lotus; Leschka, Sebastian; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland)

    2008-06-15

    The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 {+-} 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 {+-} 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001). Similarly, obstructive lesions ({>=}50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis. (orig.)

  18. Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

    NARCIS (Netherlands)

    Amoroso, G; Van Boven, AJ; Crijns, HJGM

    Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

  19. Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report

    Directory of Open Access Journals (Sweden)

    Yakup Alsancak

    2015-01-01

    Full Text Available Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

  20. Factors influencing delay time and coronary arterial density during coronary angiography with DSCT

    International Nuclear Information System (INIS)

    Lijun Tang; Xiaomei Zhu; Yi Xu; Tongfu Yu; Hai Xu; Jinhua Tang; Dehang Wang; Dogra, Vikram

    2011-01-01

    Background: CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. Purpose: To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. Material and Methods: One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight x height/3600]1/2) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Results: Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 x HR + 1.902 x gender + 0.394 x TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 x HR-3.293 x weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Conclusion: Delay time is influenced by HR, gender and TCD. Coronary arterial density

  1. Factors influencing delay time and coronary arterial density during coronary angiography with DSCT.

    Science.gov (United States)

    Tang, Lijun; Zhu, Xiaomei; Xu, Yi; Yu, Tongfu; Xu, Hai; Tang, Jinhua; Dogra, Vikram; Wang, Dehang

    2011-02-01

    CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight × height/3600](1/2)) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 × HR + 1.902 × gender + 0.394 × TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 × HR-3.293 × weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Delay time is influenced by HR, gender and TCD. Coronary arterial density also changes with HR and weight. So HR, gender, TCD and

  2. Morphological study on coronary ostial and clinicoangiographic analysis of isolated coronary ostial stenosis

    International Nuclear Information System (INIS)

    Kanoh, Tatsuji

    2007-01-01

    A morphological study of coronary ostia was performed in 70 autopsied human hearts, with particular attention being focused on the funnel-shaped structure, aging changes, and relation to atherosclerosis. The following results were obtained: The ostium is particularly well-defined and forms a funnel-shaped structure. The structure is predominantly a double circular shape on the right and comet-shaped on the left. The funnel-shaped structure of coronary ostia is characterized by a longitudinal smooth muscle arrangement in the inner layer and circular one in the outer layer. Including overhang formation, coronary sclerosis of the ostium appears mainly on the upper margin of the funnel-shaped structure of the right ostium and at the upper right margin of the left. In ischemic heart disease, along with changes in coronary arteries themselves, changes in the ostia of these arteries should be paid close attention. Ostial stenosis of the coronary artery in the absence of distal vessel obstructions, isolated ostial stenosis, is a rare form of coronary artery disease. In a previous review of the international literature, the incidence of coronary ostial stenosis varied between 0.13% and 2.7%. Among 7,500 patients undergoing selective coronary cineangiography at Juntendo University Hospital and Juntendo Urayasu Hospital from 1975 to 1990, five women (0.07%) were diagnosed as having ''isolated coronary ostial stenosis'', of which the cause is unknown. Atherosclerosis, particularly early premature atherome, congenital coronary anomaly, fibro-muscular dysplasia, Takayasu's aortitis, humoral factors, spasm, and iatrogenic events have been considered as its causes. In contrast to usual atherosclerotic coronary artery disease, patients with isolated coronary ostial stenosis of unknown etiology were characterized as being middle-aged, premenopausal, slender females having few coronary risk factors, experiencing severe angina pector is with marked ischemic electrocardiogram changes

  3. Multiple Culprit Coronary Artery Thrombosis in a Patient with Coronary Ectasia

    Directory of Open Access Journals (Sweden)

    Bruno da Silva Matte

    2018-01-01

    Full Text Available We here report a case of ST-elevation myocardial infarction (STEMI due to simultaneous acute coronary artery occlusions of two major coronary arteries in a patient with coronary ectasia. The patient had been previously submitted to percutaneous coronary angioplasty with bare metal stent implantation in both culprit vessels. Very late stent thrombosis could be the cause of the first occlusion, triggering the event in the other vessel. In addition, concomitant embolic sources were not identified. Although routine aspiration thrombectomy in STEMI was not proven to be beneficial in randomized clinical trials, it was of great value in this case. We also discuss the relation between coronary ectasia, chronic inflammatory status, and increased platelet activity which may have caused plaque disruption in another already vulnerable vessel.

  4. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    Directory of Open Access Journals (Sweden)

    Parag Chevli

    2014-09-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50 and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement.

  5. Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography

    DEFF Research Database (Denmark)

    Westra, Jelmer; Tu, Shengxian; Winther, Simon

    2018-01-01

    BACKGROUND: Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire...... patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv......, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50...

  6. 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

    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.......01), hypertension (P=0.02), current smoking (Ppain characteristics or results from diagnostic stress testing...

  7. Role of coronary physiology in the contemporary management of coronary artery disease

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-01-01

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually “intermediate” in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications. PMID

  8. Role of coronary physiology in the contemporary management of coronary artery disease.

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-02-16

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually "intermediate" in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications.

  9. Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler

    DEFF Research Database (Denmark)

    Michelsen, Marie M; Peña, Adam; Mygind, Naja D

    2016-01-01

    the feasibility and factors associated with the quality of CFVR obtained in a large prospective study of women suspected of having microvascular disease. METHODS: Women with angina-like chest pain and no obstructive coronary artery disease on coronary angiography (

  10. Coronary vasodilatory action after a single dose of nicorandil

    NARCIS (Netherlands)

    H. Suryapranata (Harry); P.W.J.C. Serruys (Patrick); P.J. de Feyter (Pim); P.D. Verdouw (Pieter); P.G. Hugenholtz (Paul)

    1988-01-01

    textabstractCoronary hemodynamics and vasodilatory effects on major epicardial arteries were investigated after a single dose of nicorandil in 22 patients undergoing cardiac catheterization for suspected coronary artery disease. Nicorandil, 20 mg, was administered sublingually to 11 consecutive

  11. Diabetic retinopathy: A predictor of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Fawzia El Demerdash

    2012-06-01

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

  12. Clinical implications of glycometabolic disturbances in acute coronary

    NARCIS (Netherlands)

    Timmer, Jorik Rudolf

    2005-01-01

    Prevalence of glycometabolic disturbances in patients with a suspected acute coronary syndrome is high. One in three patients has signs of disturbed glucose metabolism and this condition is associated with previous or newly diagnosed coronary artery disease. Zie: Summary

  13. Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Wiberg, Sebastian; Van't Hof, Arnoud

    2015-01-01

    OBJECTIVES: This study sought to determine clinical, procedural, and treatment factors associated with acute stent thrombosis (AST) in the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial. BACKGROUND: Bivalirudin started during transport for primary percutaneous coronary...

  14. Carbon monoxide and coronary heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Scheidemandel, V

    1974-01-01

    Studies on the relationship between increased carboxyhemoglobin levels in the blood and coronary heart disease in smokers and city dwellers are reviewed. The evidence of myocardial infarction is significantly higher in smokers than in nonsmokers which is due, apart from nicotine which promotes coronary arteriosclerosis, to inhaled carbon monoxide which leads to increased carboxyhemoglobin levels and most likely plays a role in the risk of arteriosclerosis and the coronary heart disease. Apart from combining with hemoglobin, CO increases the circulation rate and the coronary blood flow, and reduces the coronary arteriovenous oxygen difference, which is indicative of a reduced rate of oxygen extraction by the myocardium against an increased myocardial oxygen demand. The reduction of the oxygen extraction correlates with the increased COHb level. Inhaled CO lowers the threshold of angina pectoris due to the reduced myocardial oxygen tension. Also, considerable reduction of the oxygen diffusion from the capillaries toward the mitochondria due to the combination of CO with myoglobin is observed. Chronically increased CO levels in the blood and tissues not only accelerate the development of arteriosclerosis, but also induce a process directly injurious to the myocardial metabolism. (Air Pollut. Abstr.)

  15. Recurrent post-partum coronary artery dissection

    Directory of Open Access Journals (Sweden)

    Resnic Frederic S

    2010-10-01

    Full Text Available Abstract Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.

  16. Visualization of the coronary arteries. 6

    International Nuclear Information System (INIS)

    Koch, M.; Von Schulthess, G.K.

    1991-01-01

    Since MRI is very sensitive to motion, flow and perfusion, in addition to its ability to depict detailed morphology, it has many excellent advantages as a tool for studying vascular structures. These include its noninvasive nature, excellent and to a large degree user adjustable contrast between flowing blood and cardiovascular structures, and the ability to produce direct images in any plane. The coronary arteries can be identified in their proximal parts when imaging is done using sections perpendicular to the aortic root, more distally located portions are detected inconsistently and should not be confounded with cardiac veins. With gradient-echo imaging and MR angiograpic (MRA) methods the coronaries can be visualized well, because their is a positive, rather than a negative vascular contrast as found in spin-echo (SE) images. With regard to coronary artery imaging, to date MRA does not challenge the primary role of conventional coronary angiography. Conventional angiograms have superior spatial resolution and are less sensitive to degradation by flow disturbances. Current MRA is a purely experimental procedure and MRI of the coronary vessels is a research endeavour. (author). 32 refs.; 7 figs

  17. The dynamics of the coronary collateral circulation.

    Science.gov (United States)

    Zimarino, Marco; D'Andreamatteo, Mariangela; Waksman, Ron; Epstein, Stephen E; De Caterina, Raffaele

    2014-04-01

    Coronary collaterals are present at birth, with wide interindividual variation in their functional capacity. These vessels protect jeopardized myocardium, and the number of collaterals and the extent of their coverage are associated with improved survival in patients with coronary heart disease. The collateral circulation is not a permanent set of structures, but undergoes dynamic changes with important consequences for cardioprotection. If a severe atherosclerotic lesion develops in an artery supplying tissue downstream of a total occlusion through collateral blood flow, pressure gradients across the collateral bed change. The result is that some of the collateral flow previously supplying the perfusion territory of the totally occluded artery is redirected to the perfusion territory of the donor artery, thus producing a 'collateral steal'. The collateral circulation can regress once antegrade flow in the main dependent artery is re-established, as occurs following the recanalization of a chronic total occlusion. The clinical benefits of coronary revascularization must be cautiously weighed against the risk of reducing the protective support derived from coronary collaterals. Consequently, pharmacological, gene-based, and cell-based therapeutic attempts have been made to enhance collateral function. Although such approaches have so far yielded no, or modest, beneficial results, the rapidly accruing data on coronary collateral circulation will hopefully lead to new effective therapeutic strategies.

  18. Patent Ductus Arteriosus Associated with Congenital Anomaly of Coronary Artery

    OpenAIRE

    Maleki, Majid; Azizian, Nassrin; Esmaeilzadeh, Maryam; Moradi, Bahieh

    2013-01-01

    We reported a case of patent ductus arteriosus (PDA) with congenital anomaly of coronary arteries as abnormal origin of right coronary artery (RCA) and left coronary artery (LCA) from a single ostium of the right coronary sinus. A 21-year-old man referred to our institution for evaluation of cardiac murmur. He has suffered from palpitation and atypical chest pain for three months. On physical examination, a continuous murmur was heard in the second left parasternal space. Transthoracic echoca...

  19. Prognostic value of coronary atherosclerosis progression evaluated by coronary CT angiography in patients with stable angina

    International Nuclear Information System (INIS)

    Gu, Hui; Gao, Yang; Hou, Zhihui; Lu, Bin; Schoepf, U.J.; Snyder, Alan N.; Duguay, Taylor M.; Wang, Ximing

    2018-01-01

    To investigate the progression of coronary atherosclerosis burden by coronary CT angiography (CCTA) and to demonstrate its association with the incidence of major adverse cardiac events (MACE). We retrospectively studied patients with stable angina who had undergone repeat CCTA due to recurrent or worsening symptoms. Lipid-rich, fibrous, calcified and total plaque burden as well as coronary diameter stenosis were quantitatively analysed. The incidence of MACE during follow-up was determined. The final cohort consisted of 268 patients (mean age 52.9 ± 9.8 years, 71 % male) with a mean follow-up period of 4.6 ± 0.9 years. Patients with lipid-rich, fibrous, calcified and total plaque burden (%) progression, as well as coronary diameter stenosis (%) progression had a significantly higher incidence of MACE than those without (all p < 0.05). The progression of lipid-rich plaque (HR = 1.601, p = 0.021), total plaque burden (HR = 2.979, p = 0.043) and coronary diameter stenosis (HR = 4.327, p <0.001) were independent predictors of MACE (all p < 0.05). Patients presenting with recurrent or worsening symptoms associated with coronary artery disease who have coronary atherosclerosis progression on CCTA are at an increased risk of future MACE. (orig.)

  20. Milrinone infusion: A therapeutic option in coronary vasospasm after primary percutaneous transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Singh Amarpal

    2009-01-01

    Full Text Available A 42-year-old male presented to the emergency department with acute chest pain. The electrocardiogram revealed inferior wall myocardial infarction. Emergency coronary angiography revealed total occlusion of the distal right coronary artery with thrombus. Patient was taken up for primary percutaneous coronary angioplasty with stenting of distal right coronary artery. Six hours following the procedure, the patient developed re-elevation of ST-segment in inferior leads of electrocardiogram and subsequent haemodynamic instability. Repeat coronary angiography revealed patent stent and coronary artery spasm in proximal part, which was relieved by intracoronary injection of nitroglycerine. After an hour, the patient re-developed symptoms of chest pain along with bradycardia, hypotension and ST segment elevation. Intravenous infusion of nitroglycerine did not improve the condition but produced persistent hypotension. Infusion of milrinone was then started. Over time, normalisation of electrocardiogram occurred. The patient was discharged in stable condition. This case suggests that milrinone may be effective in alleviating coronary artery spasm when the use of other agents fails

  1. Prognostic value of coronary atherosclerosis progression evaluated by coronary CT angiography in patients with stable angina

    Energy Technology Data Exchange (ETDEWEB)

    Gu, Hui [Shandong University, Department of CT, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong (China); Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Beijing (China); Gao, Yang; Hou, Zhihui; Lu, Bin [Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Beijing (China); Schoepf, U.J.; Snyder, Alan N.; Duguay, Taylor M. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Wang, Ximing [Shandong University, Department of CT, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong (China)

    2018-03-15

    To investigate the progression of coronary atherosclerosis burden by coronary CT angiography (CCTA) and to demonstrate its association with the incidence of major adverse cardiac events (MACE). We retrospectively studied patients with stable angina who had undergone repeat CCTA due to recurrent or worsening symptoms. Lipid-rich, fibrous, calcified and total plaque burden as well as coronary diameter stenosis were quantitatively analysed. The incidence of MACE during follow-up was determined. The final cohort consisted of 268 patients (mean age 52.9 ± 9.8 years, 71 % male) with a mean follow-up period of 4.6 ± 0.9 years. Patients with lipid-rich, fibrous, calcified and total plaque burden (%) progression, as well as coronary diameter stenosis (%) progression had a significantly higher incidence of MACE than those without (all p < 0.05). The progression of lipid-rich plaque (HR = 1.601, p = 0.021), total plaque burden (HR = 2.979, p = 0.043) and coronary diameter stenosis (HR = 4.327, p <0.001) were independent predictors of MACE (all p < 0.05). Patients presenting with recurrent or worsening symptoms associated with coronary artery disease who have coronary atherosclerosis progression on CCTA are at an increased risk of future MACE. (orig.)

  2. Lack of a relationship between serum ferritin levels and coronary atherosclerosis evaluated by coronary arteriography

    Directory of Open Access Journals (Sweden)

    W.C. Manfroi

    1999-03-01

    Full Text Available Many clinical and epidemiological studies have demonstrated the relationship between serum ferritin and ischemic heart disease. In the present study we evaluated the relationship between coronary heart disease (CHD and serum ferritin levels in patients submitted to coronary arteriography. We evaluated 307 patients (210 (68.7% males; median age: 60 years who were submitted to coronary angiography, measurement of serum ferritin and identification of clinical events of ischemic heart disease. Serum ferritin is reported as quartiles. Ninety-six patients (31.27% had normal coronary angiography (group 1 and 211 (68.73% had coronary heart disease (group 2. Of the patients with CHD, 61 (28.9% had serum ferritin levels higher than 194 ng/ml (4th quartile, as opposed to only 14 (14.58% of those without CHD (P = 0.0067. In the 2nd quartile, 39 patients (18.48% had CHD, while 35 patients (36.46% had normal coronary arteries (P = 0.00064. Multivariate analysis of the data showed that the difference between groups was not statistically significant (P = 0.33. We conclude that there is no independent relationship between coronary heart disease and increased levels of serum ferritin.

  3. Optimization of coronary attenuation in coronary computed tomography angiography using diluted contrast material.

    Science.gov (United States)

    Kawaguchi, Naoto; Kurata, Akira; Kido, Teruhito; Nishiyama, Yoshiko; Kido, Tomoyuki; Miyagawa, Masao; Ogimoto, Akiyoshi; Mochizuki, Teruhito

    2014-01-01

    The purpose of this study was to evaluate a personalized protocol with diluted contrast material (CM) for coronary computed tomography angiography (CTA). One hundred patients with suspected coronary artery disease underwent retrospective electrocardiogram-gated coronary CTA on a 256-slice multidetector-row CT scanner. In the diluted CM protocol (n=50), the optimal scan timing and CM dilution rate were determined by the timing bolus scan, with 20% CM dilution (5ml/s during 10s) being considered suitable to achieve the target arterial attenuation of 350 Hounsfield units (HU). In the body weight (BW)-adjusted protocol (n=50, 222mg iodine/kg), only the optimal scan timing was determined by the timing bolus scan. The injection rate and volume in the timing bolus scan and real scan were identical between the 2 protocols. We compared the means and variations in coronary attenuation between the 2 protocols. Coronary attenuation (mean±SD) in the diluted CM and BW-adjusted protocols was 346.1±23.9 HU and 298.8±45.2 HU, respectively. The diluted CM protocol provided significantly higher coronary attenuation and lower variance than did the BW-adjusted protocol (P<0.05, in each). The diluted CM protocol facilitates more uniform attenuation on coronary CTA in comparison with the BW-adjusted protocol.  

  4. The effect of blood cell count on coronary flow in patients with coronary slow flow phenomenon.

    Science.gov (United States)

    Soylu, Korhan; Gulel, Okan; Yucel, Huriye; Yuksel, Serkan; Aksan, Gokhan; Soylu, Ayşegül İdil; Demircan, Sabri; Yılmaz, Ozcan; Sahin, Mahmut

    2014-09-01

    The coronary slow flow phenomenon (CSFP) is a coronary artery disease with a benign course, but its pathological mechanisms are not yet fully understood.The purpose of this controlled study was to investigate the cellular content of blood in patients diagnosed with CSFP and the relationship of this with coronary flow rates. Selective coronary angiographies of 3368 patients were analyzed to assess Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) values. Seventy eight of them had CSFP, and their demographic and laboratory findings were compared with 61 patients with normal coronary flow. Patients' demographic characteristics were similar in both groups. Mean corrected TFC (cTFC) values were significantly elevated in CSFP patients (p<0.001). Furthermore, hematocrit and hemoglobin values, and eosinophil and basophil counts of the CSFP patients were significantly elevated compared to the values obtained in the control group (p=0.005, p=0.047, p=0.001 and p=0.002, respectively). The increase observed in hematocrit and eosinophil levels showed significant correlations with increased TFC values (r=0.288 and r=0.217, respectively). Significant changes have been observed in the cellular composition of blood in patients diagnosed with CSFP as compared to the patients with normal coronary blood flow. The increases in hematocrit levels and in the eosinophil and basophil counts may have direct or indirect effects on the rate of coronary blood flow.

  5. Coronary stent on coronary CT angiography: Assessment with model-based iterative reconstruction technique

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Chae; Kim, Yeo Koon; Chun, Eun Ju; Choi, Sang IL [Dept. of of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2016-05-15

    To assess the performance of model-based iterative reconstruction (MBIR) technique for evaluation of coronary artery stents on coronary CT angiography (CCTA). Twenty-two patients with coronary stent implantation who underwent CCTA were retrospectively enrolled for comparison of image quality between filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR) and MBIR. In each data set, image noise was measured as the standard deviation of the measured attenuation units within circular regions of interest in the ascending aorta (AA) and left main coronary artery (LM). To objectively assess the noise and blooming artifacts in coronary stent, we additionally measured the standard deviation of the measured attenuation and intra-luminal stent diameters of total 35 stents with dedicated software. All image noise measured in the AA (all p < 0.001), LM (p < 0.001, p = 0.001) and coronary stent (all p < 0.001) were significantly lower with MBIR in comparison to those with FBP or ASIR. Intraluminal stent diameter was significantly higher with MBIR, as compared with ASIR or FBP (p < 0.001, p = 0.001). MBIR can reduce image noise and blooming artifact from the stent, leading to better in-stent assessment in patients with coronary artery stent.

  6. Subacute narrowing of the left main coronary artery following directional atherectomy for proximal obstructive coronary artery disease

    NARCIS (Netherlands)

    Piek, J. J.; Koch, K. T.; van der Wal, A. C.; Becker, A. E.

    1997-01-01

    Directional atherectomy is an alternative device for treatment of highly eccentric or proximal coronary lesions considered less suitable for balloon angioplasty. We report a patient with exuberant neointimal proliferation, extending into the left main coronary artery, following directional

  7. Effect of coronary occlusion site on angiographic and clinical outcome in acute myocardial infarction patients treated with early coronary intervention

    NARCIS (Netherlands)

    Elsman, P; van't Hof, AWJ; Hoorntje, JCA; de Boer, MJ; Borm, GF; Suryapranata, H; Ottervanger, JP; Gosselink, AM; Zijlstra, F; Dambrink, Jan Hendrik Everwijn

    2006-01-01

    In acute myocardial infarction that is treated with thrombolysis, proximal coronary artery occlusion is associated with worse prognosis, irrespective of the infarcted artery. Primary percutaneous coronary intervention (PCI) is currently the treatment of choice for ST-segment elevation acute

  8. Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary Narrowings and multivessel disease

    NARCIS (Netherlands)

    Chamuleau, SAJ; Tio, RA; de Cock, CC; de Muinck, ED; Pijls, NHJ; van Eck-Smit, BLF; Koch, KT; Meuwissen, M; Dijkgraaf, MGW; Verberne, HJ; van Liebergen, RAM; Laarman, GJ; Tijssen, JGP; Piek, JJ; de Jong, A.

    2002-01-01

    OBJECTIVES This study aimed to investigate the roles of intracoronary derived coronary flow velocity reserve (CFVR) and myocardial perfusion scintigraphy (single photon emission computed tomography, or SPECT) for management of an intermediate lesion in patient, with multivessel coronary artery

  9. Rest period duration of the coronary arteries: Implications for magnetic resonance coronary angiography

    International Nuclear Information System (INIS)

    Shechter, Guy; Resar, Jon R.; McVeigh, Elliot R.

    2005-01-01

    Magnetic resonance (MR) and computed tomography coronary imaging is susceptible to artifacts caused by motion of the heart. The presence of rest periods during the cardiac and respiratory cycles suggests that images free of motion artifacts could be acquired. In this paper, we studied the rest period (RP) duration of the coronary arteries during a cardiac contraction and a tidal respiratory cycle. We also studied whether three MR motion correction methods could be used to increase the respiratory RP duration. Free breathing x-ray coronary angiograms were acquired in ten patients. The three-dimensional (3D) structure of the coronary arteries was reconstructed from a biplane acquisition using stereo reconstruction methods. The 3D motion of the arterial model was then recovered using an automatic motion tracking algorithm. The motion field was then decomposed into separate cardiac and respiratory components using a cardiac respiratory parametric model. For the proximal-to-middle segments of the right coronary artery (RCA), a cardiac RP (<1 mm 3D displacement) of 76±34 ms was measured at end systole (ES), and 65±42 ms in mid-diastole (MD). The cardiac RP was 80±25 ms at ES and 112±42 ms at MD for the proximal 5 cm of the left coronary tree. At end expiration, the respiratory RP (in percent of the respiratory period) was 26±8% for the RCA and 27±17% for the left coronary tree. Left coronary respiratory RP (<0.5 mm 3D displacement) increased with translation (32% of the respiratory period), rigid body (51%), and affine (79%) motion correction. The RCA respiratory RP using translational (27%) and rigid body (33%) motion correction were not statistically different from each other. Measurements of the cardiac and respiratory rest periods will improve our understanding of the temporal and spatial resolution constraints for coronary imaging

  10. Coronary artery atherosclerosis associated with shift work in chemical plant workers by using coronary CT angiography.

    Science.gov (United States)

    Kang, WonYang; Park, Won-Ju; Jang, Keun-Ho; Kim, Soo-Hyeon; Gwon, Do-Hyeong; Lim, Hyeong-Min; Ahn, Ji-Sung; Moon, Jai-Dong

    2016-08-01

    The aim of this study was to investigate whether shift work is related to elevated risk of coronary artery disease (CAD) by determining the coronary artery calcium (CAC) score and the presence of coronary artery stenosis by using coronary artery CT angiography (CCTA). In this study, 110 male workers participated and underwent a CCTA examination for CAC scoring, which represents coronary artery plaque, and were evaluated for luminal stenosis. All of the participants were working in the same chemical plant, of whom 70 worked day shifts and 40 worked rotating shifts. In a multivariate logistic regression analysis, including age, smoking status, alcohol consumption, regular exercise and waist circumference, shift work was associated with a 2.89-fold increase in the odds of developing coronary plaque compared with day work (OR, 2.89; 95% CI 1.07 to 7.82). The association between shift work and coronary plaque was strong after adjustment for age, low-density lipoprotein cholesterol, hypertension and diabetes mellitus (OR, 2.92; 95% CI 1.02 to 8.33). In addition, the number of years of shift work employment was associated with coronary plaque. However, no association was found between shift work and coronary artery stenosis. Shift work could induce CAD onset via the atherosclerotic process, and shift work employment duration was associated with an increased risk of atherosclerosis in male workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results

    Directory of Open Access Journals (Sweden)

    Umut Elboga

    2017-05-01

    Full Text Available Aim: Coronary artery disease (CAD is one of the most frequent causes of mortality and morbidity worldwide. Coronary angiography is the gold standard for the anatomical diagnosis of coronary artery stenosis. Myocardial Perfusion Scintigraphy (MPS is a non-invasive imaging modality used for the diagnosis of CAD. In this study, we aimed to compare the findings of MPS and coronary angiogram. Material and Method: Eighty-one patients (37 males, 44 females; mean age 55 ± 10.95 years with angina and detected perfusion defects on MPS were included in this study. All of the patients underwent coronary angiogram. A narrowing %u2265 50% was considered pathological on the coronary angiography. Results: Findings of the coronary angiogram and MPS were compared and found consistent in 51 (63% patients. A coronary narrowing < 50% was detected by coronary angiogram in 4 (5% of the remaining patients. Coronary angiogram was found to be normal in the remaining 26 patients (32% and these patients were evaluated as cardiac syndrome X (CSX known as microvascular angina (MA. Discussion: The findings showed that MPS is superior to coronary angiogram in the early diagnosis of myocardial perfusion disorders at the microvascular level. Therefore, we concluded that MPS should be the primary diagnostic tool to begin treatment before an anatomically large narrowing occurs in the coronaries.

  12. CASE REPORT ALCAPA: The Al Capone of coronary artery anomalies

    African Journals Online (AJOL)

    CT coronary angiography has the benefit of being non-invasive and will also demonstrate the origin of the left coronary artery from the pulmonary artery. Anomalous origin of the other coronary vessels may also be identified. The retrograde flow from the LCA to the pulmonary artery is well depicted on MRI and is seen as a ...

  13. Rivaroxaban in patients with a recent acute coronary syndrome

    DEFF Research Database (Denmark)

    Mega, Jessica L; Braunwald, Eugene; Wiviott, Stephen D

    2012-01-01

    Acute coronary syndromes arise from coronary atherosclerosis with superimposed thrombosis. Since factor Xa plays a central role in thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might improve cardiovascular outcomes in patients with a recent acute coronary syndrome....

  14. Coronary artery disease and symptoms of depression in a Kenyan ...

    African Journals Online (AJOL)

    Coronary artery disease and symptoms of depression in a Kenyan population. ... death. Little is known about the co-morbidity of heart disease and depression in Africa. Objective: To describe the prevalence of depression in Black Africans with and without. Coronary Artery Disease as documented on coronary angiography ...

  15. [Involvement of thrombophilia in coronary thrombosis].

    Science.gov (United States)

    Bal Dit Sollier, C; Drouet, L

    2017-12-01

    This review of thrombophilia and coronary thrombosis takes into account the "classical" thrombophilia commonly found in venous pathology and the conditions under which their research may be useful in certain forms of arterial thrombosis especially coronary thrombosis. In addition to the classical thrombophilia, exceptional thrombophilia are evoked, which are both factors of venous thrombosis but also arterial thrombosis. There are also thrombophilia that are more specific to the arterial system such as - homocystein which is potentially both a thrombosis factor but also an agent of arterial parietal lesion or - serotonin which is a factor of arterial spasm and especially coronary spasm. Finally, under the term thrombophilia, it is possible to include thrombophilic conditions, in particular cancers and inflammatory conditions. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Clinical application of magnetic resonance coronary angiography

    International Nuclear Information System (INIS)

    Murakami, Akihiko; Onoe, Teruyuki; Kodera, Akifumi; Ohtsuki, Tetsuya; Shiomi, Akio; Ida, Masaaki; Sawada, Takahisa

    1999-01-01

    We performed the magnetic resonance coronary angiography (MRCA) in the cases which underwent coronary angiography (CAG) and obtained images were compared. Lesion with significant constriction more than 75% on CAG were determined as abnormal findings on MRCA, however, lesions with about 50% constriction were as the normal findings. On the assessment of the re-constriction after PTCA, the changes in signal were found in about half of cases. This may come from the contribution of flexion lesions, the difficulty to assess moderate constriction after PTCA, etc. For the anomalous aortic origin of coronary artery, peripheral large vessels could be simultaneously imaged by MRCA and be also assessed among their clear spatial relationship. Although MRCA has some problems on the assessment for flexion or moderate constriction, these results suggested that MRCA is useful to clinical application as the non-invasive examination. (K.H.)

  17. Prophylactic antidepressant treatment following acute coronary syndrome

    DEFF Research Database (Denmark)

    Christiansen, Ole G; Madsen, Michael T; Simonsen, Erik

    2017-01-01

    Major depressive disorder is significantly increased in patients following acute coronary syndrome resulting in twofold increased mortality compared with patients without depression. The depression diagnosis is often missed leading to considerable undertreatment. This systematic review assesses...... the current evidence of primary prophylactic treatment of depression in patients after acute coronary syndrome. The study protocol was prospectively registered at PROSPERO (registration number CRD42015025587). A systematic review were conducted and reported according to Preferred Reporting Items...... for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, PsychINFO, CINAHL, and Cochran Library was searched. Two independent reviewers screened the records. The inclusion criteria were randomized controlled trials on adult patients with acute coronary syndrome treated prophylactically...

  18. Effect of darapladib on major coronary events after an acute coronary syndrome

    DEFF Research Database (Denmark)

    O'Donoghue, Michelle L; Braunwald, Eugene; White, Harvey D

    2014-01-01

    ]) at 868 sites in 36 countries. INTERVENTIONS: Patients were randomized to either once-daily darapladib (160 mg) or placebo on a background of guideline-recommended therapy. Patients were followed up for a median of 2.5 years between December 7, 2009, and December 6, 2013. MAIN OUTCOMES AND MEASURES......: The primary end point (major coronary events) was the composite of coronary heart disease (CHD) death, MI, or urgent coronary revascularization for myocardial ischemia. Kaplan-Meier event rates are reported at 3 years. RESULTS: During a median duration of 2.5 years, the primary end point occurred in 903...

  19. Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries

    International Nuclear Information System (INIS)

    Dewey, M.; Hamm, B.; Hoffmann, H.

    2006-01-01

    Purpose: to investigate the influence of sublingual glycerol trinitrate (1.2 mg, Nitrate [nitroglycerine], Nitrolingual N spray) on the coronary artery diameter on multislice computed tomography (MSCT) coronary angiography. Materials and methods: out of our database of patients who underwent MSCT (slice thickness of 0.5 mm, Aquilion, Toshiba) coronary angiography between July 2003 and November 2005 (950 patients) we retrospectively identified patients with follow-up examinations who received Nitrate for one examination while another examination was performed without Nitrate (10 patients). Another 10 patients who underwent two MSCT examinations with sublingual Nitrate administration were randomly selected from this database to serve as control group. For the resulting 40 MSCT examinations, blinded MSCT datasets were prepared, which were randomly evaluated by a reader blinded to the patient information and whether or not Nitrate had been given. The proximal coronary artery diameters were measured for the left main coronary artery (LMA), the left anterior descending coronary artery (LAD), the left circumflex coronary artery (LCX), and the right coronary artery (RCA) in all 40 datasets, resulting in altogether 160 measurements. Results: the proximal diameters of all four coronary arteries were significantly larger on the MSCT coronary angiograms obtained after sublingual administration of Nitrate compared with the examinations in the same 10 patients without Nitrate (p < 0.001). The average diameters without and with Nitrate for the LMA, LAD, LCX, and RCA were 4.3 ± 1.1 vs. 4.8 ± 0.9 mm (12% increase, p < 0.005), 3.0 ± 0.6 vs. 3.5 ± 0.5 mm (17% increase, p < 0.001), 2.7 ± 0.6 vs. 3.2 ± 0.7 mm (19% increase, p < 0.005), and 2.9 ± 0.9 vs. 3.5 ± 0.7 mm (21% increase, p < 0.005), respectively. In the control group of 10 patients who underwent two MSCT coronary angiographies after sublingual Nitrate, no significant difference in the proximal diameter of all four

  20. Optical coherence tomography following percutaneous coronary intervention with Excimer laser coronary atherectomy

    Energy Technology Data Exchange (ETDEWEB)

    Rawlins, John, E-mail: john.rawlins@doctors.net.uk; Talwar, Suneel; Green, Mark; O’Kane, Peter

    2014-01-15

    The indications for Excimer laser coronary atherectomy (ELCA) have been refined in modern interventional practice. With the expanding role for optical coherence tomography (OCT) providing high-resolution intra-coronary imaging, this article examines the appearance of the coronary lumen after ELCA. Each indication for ELCA is discussed and illustrated with a clinical case, followed by detailed analysis of the OCT imaging pre and post ELCA. The aim of the article is to provide information to interventional cardiologists to facilitate decision making during PCI, when ELCA has been used as part of the interventional strategy.

  1. Coronary angioplasty with second generation Monorail catheters.

    Science.gov (United States)

    Pande, A K; Meier, B; Urban, P; Villavicencio, R; de la Serna, F; Moles, V

    1991-07-01

    The Monorail system (Schneider) consists of a balloon catheter in which the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the length of the guiding catheter. It offers distinct advantages over conventional systems of coronary angioplasty. It facilitates contrast injections and permits rapid balloon exchanges. This system was used for coronary angioplasty in 273 unselected consecutive patients (age 59 +/- 10, mean 35 to 73 years). There were 216 patients (84%) undergoing single-vessel and 57 patients (16%) with multi-vessel coronary angioplasty. A total of 335 coronary stenoses were dilated, which included 35 total occlusions. The size of balloon used ranged from 2.0 to 4.25 mm (3.0 +/- 0.5 mm) and the severity of stenosis was 85 +/- 11%. Technical success was defined as a residual stenosis of less than 50% as determined angiographically. Clinical success was defined as technical success, and absence of a major inhospital complication defined as absence of myocardial infarction, lack of need for coronary arterial bypass surgery, and survival. The Monorail system was technically successful in 294/300 stenotic lesions (98%). It was clinically successful for 281 lesions (94%). Of the 35 total occlusions, technical success was obtained in 25 (71%). The residual stenosis of successful cases was 26 +/- 21%. The Monorail system was also successful in 5 patients with stenosis of more than 90% in whom conventional systems failed. The complications included acute occlusion causing acute myocardial infarction in 13 cases (5%), emergency coronary arterial bypass surgery in 1 patient (0.4%), and death in 4 patients (1.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Impact of Prediabetic Status on Coronary Atherosclerosis

    Science.gov (United States)

    Kurihara, Osamu; Takano, Masamichi; Yamamoto, Masanori; Shirakabe, Akihiro; Kimata, Nakahisa; Inami, Toru; Kobayashi, Nobuaki; Munakata, Ryo; Murakami, Daisuke; Inami, Shigenobu; Okamatsu, Kentaro; Ohba, Takayoshi; Ibuki, Chikao; Hata, Noritake; Seino, Yoshihiko; Mizuno, Kyoichi

    2013-01-01

    OBJECTIVE To determine if prediabetes is associated with atherosclerosis of coronary arteries, we evaluated the degree of coronary atherosclerosis in nondiabetic, prediabetic, and diabetic patients by using coronary angioscopy to identify plaque vulnerability based on yellow color intensity. RESEARCH DESIGN AND METHODS Sixty-seven patients with coronary artery disease (CAD) underwent angioscopic observation of multiple main-trunk coronary arteries. According to the American Diabetes Association guidelines, patients were divided into nondiabetic (n = 16), prediabetic (n = 28), and diabetic (n = 23) groups. Plaque color grade was defined as 1 (light yellow), 2 (yellow), or 3 (intense yellow) based on angioscopic findings. The number of yellow plaques (NYPs) per vessel and maximum yellow grade (MYG) were compared among the groups. RESULTS Mean NYP and MYG differed significantly between the groups (P = 0.01 and P = 0.047, respectively). These indexes were higher in prediabetic than in nondiabetic patients (P = 0.02 and P = 0.04, respectively), but similar in prediabetic and diabetic patients (P = 0.44 and P = 0.21, respectively). Diabetes and prediabetes were independent predictors of multiple yellow plaques (NYPs ≥2) in multivariate logistic regression analysis (odds ratio [OR] 10.8 [95% CI 2.09–55.6], P = 0.005; and OR 4.13 [95% CI 1.01–17.0], P = 0.049, respectively). CONCLUSIONS Coronary atherosclerosis and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable between prediabetic and diabetic patients. Slight or mild disorders in glucose metabolism, such as prediabetes, could be a risk factor for CAD, as is diabetes itself. PMID:23223344

  3. The value of coronary artery calcium score assessed by dual-source computed tomography coronary angiography for predicting presence and severity of coronary artery disease

    International Nuclear Information System (INIS)

    Almasi, Alireza; Pouraliakbar, Hamidreza; Sedghian, Ahmad; Karimi, Mohammad Ali; Firouzi, Ata; Tehrai, Mahmood

    2014-01-01

    Measuring coronary artery calcium score (CACS) using a dual-source CT scanner is recognized as a major indicator for assessing coronary artery disease. The present study aimed to validate the clinical significance of CACS in predicting coronary artery stenosis and its severity. This prospective study was conducted on 202 consecutive patients who underwent both conventional coronary angiography and dual-source (256-slice) computed tomography coronary angiography (CTA) for any reason in our cardiac imaging center from March to September 2013. CACS was measured by Agatston algorithm on non-enhanced CT. The severity of coronary artery disease was assessed by Gensini score on conventional angiography. There was a significant relationship between the number of diseased coronary vessels and mean calcium score, i.e. the mean calcium score was 202.25±450.06 in normal coronary status, 427.50±607.24 in single-vessel disease, 590.03±511.34 in two-vessel disease, and 953.35±1023.45 in three-vessel disease (p<0.001). There was a positive association between calcium score and Gensini score (r=0.636, p<0.001). In a linear regression model, calcium score was a strong determinant of the severity of coronary artery disease. Calcium scoring had an acceptable value for discriminating coronary disease from normal condition with optimal cutoff point of 350, yielding a sensitivity and specificity of 83% and 70%, respectively. Our study confirmed the strong relationship between the coronary artery calcium score and the presence and severity of stenosis in coronary arteries assessed by both the number of diseased coronary vessels and also by the Gnesini score

  4. Inflammation: a trigger for acute coronary syndrome

    International Nuclear Information System (INIS)

    SAGER, Hendrik B.; NAHRENDORF, Matthias

    2016-01-01

    Atherosclerosis is a chronic inflammatory disease of the vessel wall and a major cause of death worldwide. One of atherosclerosis’ most dreadful complications are acute coronary syndromes that comprise ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina. We now understand that inflammation substantially contributes to the initiation, progression, and destabilization of atherosclerosis. In this review, we will focus on the role of inflammatory leukocytes, which are the cellular protagonists of vascular inflammation, in triggering disease progression and, ultimately, the destabilization that causes acute coronary syndromes.

  5. Diagnostic value of the coronary CT scan

    International Nuclear Information System (INIS)

    Kiuchi, Sousuke

    1982-01-01

    Using high-resolution computed tomography, coronary scanning has been made to investigate the radiographical details of the middle and inner ear organs. Twenty patients with chronic otitis media, secondary cholesteatoma, sensorineural hearing loss, facial spasm, and suspected meningitis, were evaluated. In 26 of 40 ears in this series, the coronary scans sharply outlined almost all of the bony structures, and showed also the eardrum as a clearly defined soft tissue, but no abnormal radiographical findings were recognized. In the remaining ears with chronic otitis media, the scans were valuable in demonstration of mucosal thickening, granulation tissue, and destruction of the auditory ossicles. (author)

  6. Computed tomography versus invasive coronary angiography

    DEFF Research Database (Denmark)

    Napp, Adriane E.; Haase, Robert; Laule, Michael

    2017-01-01

    Objectives: More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate...... angiography (ICA) is the reference standard for detection of CAD.• Noninvasive computed tomography angiography excludes CAD with high sensitivity.• CT may effectively reduce the approximately 2 million negative ICAs in Europe.• DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest...

  7. Primary coronary angioplasty in a nonagenarian

    Directory of Open Access Journals (Sweden)

    Baracioli Luciano M.

    2002-01-01

    Full Text Available A woman aged 98 years entered the tertiary hospital service with a picture of acute myocardial infarction of the extensive anterior wall, which began 4 hours earlier. Due to the large myocardial risk area suggested by the electrocardiogram, the patient was taken to the hemodynamics laboratory for the performance of emergency coronary arteriography, which revealed occlusion in the proximal third of the anterior descending artery. Primary angioplasty followed by stent grafting was successfully performed. The patient had a satisfactory evolution (Killip I and was discharged from the hospital on the seventh postinfarction day. We discuss here aspects of thrombolysis and coronary percutaneous interventions in the aged.

  8. Association between diabetes and different components of coronary atherosclerotic plaque burden as measured by coronary multidetector computed tomography.

    Science.gov (United States)

    Yun, Chun-Ho; Schlett, Christopher L; Rogers, Ian S; Truong, Quynh A; Toepker, Michael; Donnelly, Patrick; Brady, Thomas J; Hoffmann, Udo; Bamberg, Fabian

    2009-08-01

    The aim of the study was to assess differences in the presence, extent, and composition of coronary atherosclerotic plaque burden as detected by coronary multidetector computed tomography (MDCT) between patients with and without diabetes mellitus. We compared coronary atherosclerotic plaques (any plaque, calcified [CAP], non-calcified [NCAP, and mixed plaque [MCAP

  9. Cyanotic Congenital Heart Disease The Coronary Arterial Circulation

    Science.gov (United States)

    Perloff, Joseph K

    2012-01-01

    Background: The coronary circulation in cyanotic congenital heart disease (CCHD) includes the extramural coronary arteries, basal coronary blood flow, flow reserve, the coronary microcirculation, and coronary atherogenesis. Methods: Coronary arteriograms were analyzed in 59 adults with CCHD. Dilated extramural coronaries were examined histologically in six patients. Basal coronary blood flow was determined with N-13 positron emission tomography in 14 patients and in 10 controls. Hyperemic flow was induced by intravenous dipyridamole pharmacologic stress. Immunostaining against SM alpha-actin permitted microcirculatory morphometric analysis. Non-fasting total cholesterols were retrieved in 279 patients divided into four groups: Group A---143 cyanotic unoperated, Group B---47 rendered acyanotic by reparative surgery, Group C---41 acyanotic unoperated, Group D---48 acyanotic before and after operation. Results: Extramural coronary arteries were mildly or moderately dilated to ectatic in 49/59 angiograms. Histologic examination disclosed loss of medial smooth muscle, increased medial collagen, and duplication of internal elastic lamina. Basal coronary flow was appreciably increased. Hyperemic flow was comparable to controls. Remodeling of the microcirculation was based upon coronary arteriolar length, volume and surface densities. Coronary atherosclerosis was absent in both the arteriograms and the necropsy specimens. Conclusions: Extramural coronary arteries in CCHD dilate in response to endothelial vasodilator substances supplemented by mural attenuation caused by medial abnormalities. Basal coronary flow was appreciably increased, but hyperemic flow was normal. Remodeling of the microcirculation was responsible for preservation of flow reserve. The coronaries were atheroma-free because of the salutory effects of hypocholesterolemia, hypoxemia, upregulated nitric oxide, low platelet counts, and hyperbilirubinrmia. PMID:22845810

  10. [Experimental evaluation of the role of the coronary sinus pressure in the regulation of coronary return volume via the coronary sinus. Surgical considerations in atrio-pulmonary diversion procedures].

    Science.gov (United States)

    Fantidis, P; Fernández Ruiz, M A; Madero Jarabo, R; Moreno Granados, F; Cordovilla Zurdo, G; Sanz Galeote, E

    1990-11-01

    In order to find out the validity of the vascular waterfall mechanism in coronary venous circulation, the role of coronary sinus pressure in the regulation of coronary return volume via the coronary sinus is studied in healthy animals. An experimental model of pressure regulation in the coronary sinus was prepared, and aortic pressure, EKG and the cardiac output (measured by thermodilution) were recorded. The return volume via the coronary sinus was measured at coronary sinus pressure of 10 or less, 15, 20, and 25 mmHg or more, for a total of 36 determinations. Increased coronary sinus pressure did not produce significant changes in aortic pressure, heart rate, cardiac index or coronary return volume via coronary sinus. When coronary sinus pressure was 25 mmHg or more, there was a significant decline in the average of coronary return volume via coronary sinus. Nevertheless, stepwise variant regression showed that the coronary sinus pressure per se does not condition the volume of coronary return via the coronary sinus. Our results suggest that in the healthy animals, the vascular waterfall mechanism in coronary venous circulation is not valid. Our results suggest that in the correction of congenital cardiac malformations using atriopulmonary anastomosis procedures, employing techniques that ensure coronary sinus drainage into the left atrium, in order to avoid the hemodynamic repercussions attributable to the vascular waterfall mechanism, is not justified.

  11. A rare cause of acute coronary syndrome: Kounis syndrome.

    Science.gov (United States)

    Almeida, João; Ferreira, Sara; Malheiro, Joana; Fonseca, Paulo; Caeiro, Daniel; Dias, Adelaide; Ribeiro, José; Gama, Vasco

    2016-12-01

    Kounis syndrome is an acute coronary syndrome in the context of a hypersensitivity reaction. The main pathophysiological mechanism appears to be coronary vasospasm. We report the case of a patient with a history of allergy to quinolones, who was given ciprofloxacin before an elective surgical procedure and during drug administration developed symptoms and electrocardiographic changes suggestive of ST-segment elevation acute coronary syndrome. The drug was suspended and coronary angiography excluded epicardial coronary disease. Two hours after withdrawal of the drug the symptoms and ST elevation had resolved completely. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. CT Determination of Fractional Flow Reserve in Coronary Lesions

    Directory of Open Access Journals (Sweden)

    Mester András

    2016-12-01

    Full Text Available Invasively determined fractional flow reserve (FFR represents the gold-standard method for the functional evaluation of coronary lesions. Coronary computed tomography angiography (CCTA provides characterization of the coronary anatomy, with important morphological information on the atherosclerotic plaques, but does not offer a hemodynamic evaluation of coronary artery lesions. CT evaluation of FFR (FFRCT is a new noninvasive diagnostic method, which provides anatomical and functional assessment of the whole coronary tree, based on computational techniques, with no more radiation or hyperemic agent administration compared with routine CCTA. Recent studies demonstrated the safety and accuracy of FFRCT and its therapeutic use and cost benefits in real-world clinical use.

  13. Dietary fiber and risk of coronary heart disease

    DEFF Research Database (Denmark)

    Pereira, Mark A; O'Reilly, Eilis; Augustsson, Katarina

    2004-01-01

    BACKGROUND: Few epidemiologic studies of dietary fiber intake and risk of coronary heart disease have compared fiber types (cereal, fruit, and vegetable) or included sex-specific results. The purpose of this study was to conduct a pooled analysis of dietary fiber and its subtypes and risk...... of coronary heart disease. METHODS: We analyzed the original data from 10 prospective cohort studies from the United States and Europe to estimate the association between dietary fiber intake and the risk of coronary heart disease. RESULTS: Over 6 to 10 years of follow-up, 5249 incident total coronary cases...... associated with risk of coronary heart disease....

  14. Imaging diagnosis of congenital heart disease with single coronary artery

    International Nuclear Information System (INIS)

    Zhu Ming; Li Yuhua; Zhong Yumin; Sun Aimin

    2003-01-01

    Objective: To report 56 cases of congenital heart disease with congenital single coronary artery and to evaluate the imaging diagnostic techniques. Methods: All 56 patients with congenital single coronary artery underwent angiocardiography. Contrast enhancement magnetic resonance angiography (CE MRA) was performed in 4 cases. 48 cases were confirmed by operation. Results: In these 56 cases, single left coronary artery was found in 44 cases and single right coronary artery was found in 12. Conclusion: Congenital heart disease with congenital single coronary artery is not rare and correct diagnosis is very important for surgery

  15. Epicardial fat volume is correlated with coronary lesion and its severity

    OpenAIRE

    Bo, Xiaohong; Ma, Likun; Fan, Jili; Jiang, Zhe; Zhou, Yuansong; Zhang, Lei; Li, Wanjun

    2015-01-01

    Objective: To evaluate the correlation of epicardial adipose tissue volume (EATV) with the coronary artery lesion and its severity. Methods: Inpatients with suspicious stable angina of coronary heart lesion were recruited. For patients with coronary artery lesions in CTA, further coronary angiography (CAG) was performed to evaluate the coronary artery lesion. Gensini scoring system was employed to assess the severity of coronary artery lesions. Results: Patients were classified as coronary he...

  16. The cristal (right superior septal) coronary artery and its relationship to anomalous left coronary origin

    International Nuclear Information System (INIS)

    Partridge, J.B.; Ridley, L.J.

    2011-01-01

    The cristal artery is an occasional finding, being visible in around 3% of coronary angiograms, arising from the proximal right coronary artery (RCA) and passing downwards and forwards through the muscle of the crista superventricularis. It supplies a variable volume of the superior interventricular septum, and can contribute to collateralization of the other septal vessels. When part or all of the left coronary artery (LCA) arises anomalously from the right coronary sinus, its passage to the left may be in the same pathway as a cristal artery, bearing a tell-tale septal vessel arising from its proximal segment. This helps to differentiate it from one that has a higher pathway, running between the great vessels, and which may have a greater correlation with sudden cardiac death.

  17. Intraarterial digital subtraction angiography after coronary bypass surgery - an alternative to coronary angiography

    International Nuclear Information System (INIS)

    Hauenstein, H.K.; Roeren, T.; Schlosser, V.; Urbani, B.

    1985-01-01

    Intraarterial digital subtraction angiography after coronary bypass surgery - an alternative to coronary angiography. Intraarterial DSA is a suitable method for early postoperative control of coronary artery bypass grafts. Small quantities of contrast media with low iodine content are injected into the aortic root. Investigations can be carried out with a routine fluoroscopic and digital equipment; additional cine-technique and analogue memory disc are not necessary. At an image rate of 3/s the bypass anastomoses can be exactly visualized in 75%, whereas diagnostic information was not sufficient in only 4% of all cases. The use of modern F-5-catheters and the nonselective injection make this method a less invasive alternative to coronary angiography. It is paticularly useful in evaluation of short- and long-term results. (orig.) [de

  18. Prognostic factors of male patients with acute coronary syndrome after percutaneous coronary intervention therapy

    International Nuclear Information System (INIS)

    Xu Peng; Zhang Gaofeng; Wu Xusheng; Qiao Qi; Yu Liqun

    2005-01-01

    Objective: To study the prognostic risk factors of male patients with coronary heart disease in stent placement era. Methods: One hundred and four patients were enrolled in this study (aged 64.9 ± 9.6 years) including 61 diagnosed as acute myocardial infarction, and 43 as unstable angina with followed up 11.9 ± 8.7 months. All factors including demographic factors, non-interventional work-up, associated clinical complications and results of coronary artery angiography reached a model of Logistic regression analysis. Results: Based on MACE (major adverse cardiac events), as quantitative factors, diseased proximal middle left anterior descending artery was a significant independent variable (P<0.05), and its coefficient was 22.00. Conclusions: Diseased proximal middle left anterior descending coronary artery is the prognostic factor of MACE in male patients with acute coronary syndrome. (authors)

  19. ACE INHIBITION ATTENUATES SYMPATHETIC CORONARY VASOCONSTRICTION IN PATIENTS WITH CORONARY-ARTERY DISEASE

    NARCIS (Netherlands)

    PERONDI, R; SAINO, A; TIO, RA; POMIDOSSI, G; GREGORINI, L; ALESSIO, P; MORGANTI, A; ZANCHETTI, A; MANCIA, G

    Background. In humans, angiotensin converting enzyme (ACE) inhibition attenuates the vasoconstriction induced by sympathetic stimulation in a number of peripheral districts. Whether this is also the case in the coronary circulation is unknown, however. Methods and Results. In nine normotensive

  20. Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease

    DEFF Research Database (Denmark)

    Kühl, J Tobias; Hove, Jens D; Kristensen, Thomas S

    2017-01-01

    OBJECTIVES: To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. DESIGN: The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using...... invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed. RESULTS: CCTA detects significant (>50...... 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....

  1. Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Hüche Nielsen, Lene; Bøtker, Hans Erik; Sørensen, Henrik T.

    2017-01-01

    Aims: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity. Methods and results: This cohort study......, and comorbidity. Conclusion: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden....... included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death...

  2. High-resolution coronary MR angiography for evaluation of patients with anomalous coronary arteries: visualization of the intramural segment

    Energy Technology Data Exchange (ETDEWEB)

    Biko, David M. [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Chung, Claudia; Chung, Taylor [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); Hitt, David M. [Philips Healthcare, Cleveland, OH (United States); Kurio, Gregory [UCSF Benioff Children' s Hospital Oakland, Department of Cardiology, Oakland, CA (United States); Reinhartz, Olaf [UCSF Benioff Children' s Hospital Oakland, Department of Cardiac Surgery, Oakland, CA (United States)

    2015-08-15

    Anomalous origin of the coronary artery from the contralateral coronary sinus is a rare coronary anomaly associated with sudden death. The inter-arterial course is most closely associated with sudden death, but it has been suggested that the presence of an intramural segment of a right anomalous coronary is associated with more symptoms and therefore may be an important criterion for intervention in these patients. To demonstrate that MR angiography can accurately determine the presence or absence of an intramural segment in an anomalous coronary artery. All studies of children who underwent MR angiography for the evaluation of an anomalous coronary artery were retrospectively reviewed by two pediatric radiologists in consensus. Criteria for an intramural anomalous coronary artery were the presence of a small or slit-like ostium and the relative smaller size of the proximal intramural portion of the coronary artery in relation to the more distal epicardial coronary artery. The anomalous coronary artery was classified as not intramural if these two findings were absent. These findings were correlated with operative reports confirming the presence or absence of an intramural segment. Twelve patients (86%) met MR angiography criteria for the presence of an intramural course. Only 2 patients (14%) met MR angiography criteria for a non-intramural course. When correlating with intraoperative findings, MR angiography was successful in distinguishing between intramural and non-intramural anomalous coronary arteries in all cases (P = 0.01). MR angiography may be able to reliably identify the intramural segment of an anomalous coronary artery in older children using the imaging criteria of a small or slit-like ostium and relative decrease in size of the proximal portion of the anomalous coronary artery compared to the distal portion of the anomalous coronary artery. Determining the presence of the intramural segment may help with surgical planning and may be an important

  3. Association between smoking habits and severity of coronary stenosis as assessed by coronary computed tomography angiography.

    Science.gov (United States)

    Yano, Masaya; Miura, Shin-Ichiro; Shiga, Yuhei; Miyase, Yuiko; Suematsu, Yasunori; Norimatsu, Kenji; Nakamura, Ayumi; Adachi, Sen; Nishikawa, Hiroaki; Saku, Keijiro

    2016-07-01

    Smoking promotes arteriosclerosis and is one of the most important coronary risk factors. However, few studies have investigated the association between smoking habits and the severity of coronary stenosis as assessed by coronary computed tomography angiography (CTA). We enrolled 416 patients [165/251 = smoker (past and current)/non-smoker)]. They had all undergone CTA and either were clinically suspected of having coronary artery disease (CAD) or had at least one cardiovascular risk factor. We divided the patients into smoking and non-smoking groups, and evaluated the presence of CAD, the number of significantly stenosed coronary vessels (VD), and the Gensini score as assessed by CTA in the two groups. The incidence of CAD, VD, the Gensini score, and coronary calcification score in the smoking group were all significantly greater than those in the non-smoking group (CAD, p = 0.009; VD, p = 0.003; Gensini score, p = 0.007; coronary calcification score, p = 0.01). Pack-year was significantly associated with VD and the Gensini score, and was strongly associated with multi-vessel disease (2- and 3-VD) (p < 0.05), whereas the duration of cessation in past smokers was not associated with VD or the Gensini score. Pack-year, but not the duration of cessation, may be the most important factor that was associated with the severity of coronary stenosis in terms of VD and the Gensini score.

  4. Severity of coronary artery disease in obese patients undergoing coronary angiography

    International Nuclear Information System (INIS)

    Javed, A.; Ali, J.; Kayani, A.M.

    2012-01-01

    Objective: To assess the relationship of severity of coronary artery disease with obesity in patients undergoing coronary angiography. Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC-NIHD), 1st February 2010 to 31st August 2010 Patients and Methods: The study population included 468 patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health (NIH) criteria as normal (BMI 21-24 kg/m2), overweight (BMI 25-29 kg/m2), obesity class I (BMI 30-34 kg/m2), obesity class II (BMI 35 to 39 kg/m2 and obesity class III (BMI 40 or above kg/m2). Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries (>50% for the left main coronary artery). We attempted to quantify the 'severity of CAD' by ascertaining the prevalence of High-Risk Coronary Anatomy (HRCA). Results: Insignificant difference was observed in traditional risk factors i.e. age, diabetes mellitus and smoking except hypertension and gender. Statistically significantly low prevalence of HRCA was encountered in the obese group (57.7%) as compared to normal/overweight group (75.8%) (p < 0.05). Conclusion: We conclude that obesity is associated with less severe coronary artery disease. (author)

  5. Acute occlusion of the coronary artery after transluminal balloon coronary angioplasty

    International Nuclear Information System (INIS)

    Savchenko, A.P.; Matchin, Yu.G.; Lyakishev, A.A.

    1995-01-01

    The research was aimed at elucidation of the relationship of the clinical and angiographic factors, on the one hand, and development of acute occlusion following transluminal balloon coronary angioplasty TBCA, on the other. TBCA was carried out in 162 patients. Eight (4.9 %) patients developed acute occlusion of the coronary artery, which was complicated by acute myocardial infarction in 50 % cases. 35 refs.; 4 tabs

  6. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography

    DEFF Research Database (Denmark)

    Jensen, Jesper Møller; Medina, Hector; Nørgaard, Bjarne Linde

    2012-01-01

    BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac...... increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P...

  7. Spontaneous Coronary Artery Dissection following Topical Hormone Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Alexander L. Pan

    2012-01-01

    Full Text Available Spontaneous coronary artery dissection is a rare condition, usually presenting as an acute coronary syndrome, and is often seen in states associated with high systemic estrogen levels such as pregnancy or oral contraceptive use. While topical hormonal replacement therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, there are no reported cases of spontaneous coronary dissection with topical hormonal replacement therapy. We describe a 53-year-old female who developed two spontaneous coronary dissections while on topical hormonal replacement therapy. The patient had no other risk factors for coronary dissection. After withdrawal from topical hormonal therapy, our patient has done well and has not had recurrent coronary artery dissections over a one-year follow-up period. The potential contributory role of topical hormonal therapy as a cause of spontaneous coronary dissection should be recognized.

  8. Imaging techniques in the diagnosis of coronary heart disease

    International Nuclear Information System (INIS)

    Frank, H.

    1997-01-01

    Coronary heart disease is the leading cause of death and disability worldwide. Coronary angiography makes it possible to visualize coronary artery stenosis and can be used for angioplasty and stent implantation; however, it does not allow the assessment of changes in myocardial microcirculation. The severity of an angiographically evaluated coronary stenosis does not always correspond to the extent of myocardial ischemia. Nonivasive techniques are needed to reexamine our reliance on coronary angiography and to explore the clinical value fo the physiological assessment of coronary artery stenoses. Such noninvasive techniques might become important tools in the future following an overal evaluation of coronary morphology, myocardial function and perfusion ascertained by all available methods. (orig.) [de

  9. Statistical significant change versus relevant or important change in (quasi) experimental design : some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research

    NARCIS (Netherlands)

    Middel, Berrie; van Sonderen, Eric

    2002-01-01

    This paper aims to identify problems in estimating and the interpretation of the magnitude of intervention-related change over time or responsiveness assessed with health outcome measures. Responsiveness is a problematic construct and there is no consensus on how to quantify the appropriate index to

  10. Congenital coronary-pulmonary artery fistula originating from right and left coronary artery

    Directory of Open Access Journals (Sweden)

    Ali Kemal Gür

    2013-12-01

    Full Text Available Coronary artery fistula (CAF is a rare congenital anomalywith an incidence of 1 in 50 000 live births. The fistula wasobserved at the right coronary artery in 53%, the left coronaryartery in 42% and both coronary artery in 5% of thecases. Echocardiography examination in a 46 year-oldwoman with the symptoms of chest pain, palpitation anddyspnea revealed a severe mitral valve insufficiency anda moderate to severe tricuspid valve insufficiency. A CAForiginating from the proximal part of the left anterior descendingartery (LAD and another fistula originating fromosteal part of the right coronary artery (RCA were detectedby coronary angiography. Both fistulas were draininginto the main pulmonary artery. The coronary artery fistulaclosed under cardiopulmonary by-pass. Mitral insufficiencyoriginated from the posterior leaflet was diagnosedintra-operative exploration, and thereafter it was repairedwith mitral annuloplasty including a quadrangular resectionand use of a 32 No St Jude mitral ring. Tricuspid valvewas repaired with Calangos Ring annuloplasty. Followingsix day hospital stay, the woman was discharged free ofany symptom.Key words: Dyspnea, double arteriovenous fistula, mitral and tricuspid insufficiency

  11. THE PLURAL LESION CORONARY AND CYTOKINES DISBALANCE IN PATIENTS WITH CORONARY ATHEROSCLEROSIS

    Directory of Open Access Journals (Sweden)

    Martynov AV

    2012-12-01

    Full Text Available The aim of the study was to examine the levels of the main pro-inflammatory and anti-inflammatory cytokines in patients with ischemic heart disease, and the study of the possible impact of persistent herpes virus infection plural lesion coronary arteries. A total of 57 patients (mean age 49,3 ± 3,7 years IHD s hemodynamically significant stenoses of the coronary vessels. Conducted virological examination, including the definition of hypertension HSV1, HSV2, HHV6, SMV, VZV and VEB immunofluorescent and cytokines ІL-1β, ІL-6 ІL-8, TNF by ELISA in serum. Found increased levels of proinflammatory cytokines ІL-1β, ІL-6 and FNPα of IHD patients who had hemodynamically significant stenoses of coronary vessels. ІL-6 level in patients with 2 or more significant coronary artery lesions exceeded the rate of patients with a damaged coronary artery in 1.67 TNFα, ІL-8 - 1.37 ІL-1β and 1.28 times respectively. In patients with plural coronary vascular damage was the most common combination of CMV, VEB and HHV6. Since CMV was detected in more than 60% of patients with injuries of two spacecraft and nearly 76% from three spacecraft, VEB was detected in 72% and 88%, respectively.

  12. The relationship between coronary stenosis severity and compression type coronary artery movement in acute myocardial infarction.

    Science.gov (United States)

    Chan, Kim H; Chawantanpipat, Chirapan; Gattorna, Tim; Chantadansuwan, Thamarath; Kirby, Adrienne; Madden, Ann; Keech, Anthony; Ng, Martin K C

    2010-04-01

    Acute myocardial infarction is thought to occur at sites of minor coronary stenosis. Recent data challenge this and also propose a role for coronary artery movement (CAM) in plaque instability. We examined the relationship between coronary stenosis severity, CAM pattern, and infarct-related lesions (IRLs) in acute myocardial infarction. We investigated 203 consecutive patients with ST-segment elevation myocardial infarction after successful fibrinolysis. Quantitative coronary angiography, CAM pattern, and extent score (atheroma burden) analysis was performed for each coronary artery segment. The IRL stenosis was at least moderate (>50%) and severe (>70%) in 78% and 31% of patients, respectively. Culprit arteries were associated with higher atheroma extent scores (25.2 vs 21.6, P 70% vs Compression CAM was also strongly associated with culprit segments (OR 3.4, 95% CI 2.6-4.5, P compression CAM and stenosis severity were strongly correlated, with the likelihood of a coronary segment having compression CAM progressively increasing with worsening stenosis (OR 56.4, 95% CI 37.9-83.8, P 70% vs relationship between stenosis severity and IRLs. Our study also raises the hypothesis that compression CAM may accelerate atherosclerosis and predispose to plaque vulnerability. Copyright 2010 Mosby, Inc. All rights reserved.

  13. Clinical perspective of coronary computed tomographic angiography in diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Chang, Hyuk-Jae; Chung, Namsik

    2011-01-01

    Since a 4-detector row coronary computed tomographic angiography (CCTA) was launched in 1998, CCTA has experienced rapid improvement of imaging qualities with the ongoing evolution of computed tomography (CT) technology. The diagnostic accuracy of CCTA to detect coronary artery stenosis is well established, whereas improvements are still needed to reduce the overestimation of coronary artery disease (CAD) and assess plaque composition. CCTA has been used to evaluate CAD in various clinical settings. For example, CCTA could be an efficient initial triage tool at emergency departments for patients with acute chest pain with low-to-intermediate risk because of its high negative predictive value. In patients with suspected CAD, CCTA could be a cost-effective alternative to myocardial perfusion imaging and exercise electrocardiogram for the initial coronary evaluation of patients with intermediate pre-test likelihood suspected CAD. However, in asymptomatic populations, there is a lack of studies that show an improved prognostic power of CCTA over other modalities. Therefore, the clinical use of CCTA to detect CAD for purposes of risk stratification in asymptomatic individuals should be discouraged. As CT technology evolves, CCTA will provide better quality coronary imaging and non-coronary information with lower radiation exposure. Future studies should cover these ongoing technical improvements and evaluate the prognostic power of CCTA in various clinical settings of CAD in large, well-designed, randomized trials. (author)

  14. Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Siqueira, Bruna Pinto; Guimaraes, Carolina Camargos Braichi; Cruz, David Filipe Silva; Guimaraes, Leiziane Assuncao Alves; Lima, Maicom Marcio Perigolo, E-mail: marciovlbarros@gmail.com [Faculdade de Saude e Ecologia Humana, Vespasiano, MG (Brazil); Nunes, Maria do Carmo Pereira [Universidade de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Siqueira, Maria Helena Albernaz [Hospital Materdei, Belo Horizonte, MG (Brazil)

    2015-07-15

    Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD), data on the prognostic value of this method in patients with no significant coronary obstruction are limited. Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting. Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes were non-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 - 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT was associated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes. Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients with suspected CAD, which may prove useful in the risk stratification of these patients. (author)

  15. Coronary plaque morphology on multi-modality imagining and periprocedural myocardial infarction after percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Akira Sato

    2016-06-01

    Full Text Available Percutaneous coronary intervention (PCI may be complicated by periprocedural myocardial infarction (PMI as manifested by elevated cardiac biomarkers such as creatine kinase (CK-MB or troponin T. The occurrence of PMI has been shown to be associated with worse short- and long-term clinical outcome. However, recent studies suggest that PMI defined by biomarker levels alone is a marker of atherosclerosis burden and procedural complexity but in most cases does not have independent prognostic significance. Diagnostic multi-modality imaging such as intravascular ultrasound, optical coherence tomography, coronary angioscopy, near-infrared spectroscopy, multidetector computed tomography, and magnetic resonance imaging can be used to closely investigate the atherosclerotic lesion in order to detect morphological markers of unstable and vulnerable plaques in the patients undergoing PCI. With the improvement of technical aspects of multimodality coronary imaging, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology and patients outcomes. There were numerous published data regarding the relationship between pre-PCI lesion subsets on multi-modality imaging and post-PCI biomarker levels. In this review, we discuss the relationship between coronary plaque morphology estimated by invasive or noninvasive coronary imaging and the occurrence of PMI. Furthermore, this review underlies that the value of the multimodality coronary imaging approach will become the gold standard for invasive or noninvasive prediction of PMI in clinical practice.

  16. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

    Science.gov (United States)

    Williams, Michelle C.; Hunter, Amanda; Shah, Anoop S.V.; Assi, Valentina; Lewis, Stephanie; Smith, Joel; Berry, Colin; Boon, Nicholas A.; Clark, Elizabeth; Flather, Marcus; Forbes, John; McLean, Scott; Roditi, Giles; van Beek, Edwin J.R.; Timmis, Adam D.; Newby, David E.

    2016-01-01

    Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) PMID:27081014

  17. Anatomical studies of the coronary system in elasmobranchs: II. Coronary arteries in hexanchoid, squaloid, and carcharhinoid sharks.

    Science.gov (United States)

    De Andrés, A V; Muñoz-Chápuli, R; Sans-Coma, V; García-Garrido, L

    1992-07-01

    Coronary artery anatomy was studied in 16 shark species belonging to 9 families of the orders Hexanchiformes, Squaliformes, and Carcharhiniformes. The study included 101 specimens and used an injection-corrosion technique that obtained internal casts of the main trunks and coronary arterial branches. The results showed 2 main patterns of coronary arterial arrangement: the dorsoventral coronary trunk pattern, shared by lamnoid and advanced carcharhinoid sharks, and the lateral coronary trunk pattern, shown by hexanchoid and squaloid sharks. Scyliorhinus and Galeus had intermediate arrangements of their vessels.

  18. Myocardial flow reserve is influenced by both coronary artery stenosis severity and coronary risk factors in patients with suspected coronary artery disease

    International Nuclear Information System (INIS)

    Tsukamoto, Takahiro; Naya, Masanao; Tsutsui, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Inubushi, Masayuki; Kuge, Yuji; Tamaki, Nagara

    2006-01-01

    Myocardial flow reserve (MFR) measurement has an important role in assessing the functional severity of coronary artery stenosis. However, a discrepancy between the anatomical severity of coronary artery stenosis and MFR is often observed. Such a discrepancy may be explained by coronary risk factors. In this study, we aimed to investigate the influence of coronary artery stenosis severity and risk factors on MFR. Seventy-four patients suspected to have coronary artery disease and seven age-matched healthy volunteers were enrolled. Myocardial blood flow (MBF) and MFR were measured using 15 O-labelled water PET. Regional MFR was calculated in regions with significant coronary artery stenosis (stenotic regions) and in regions without significant stenosis (remote regions). The contributions of coronary artery stenosis severity and coronary risk factors were assessed using univariate and multivariate analyses. In stenotic regions, MFR correlated inversely with coronary artery stenosis severity (r=-0.50, p<0.01). Univariate analysis did not show any significant difference in MFR between the patients with and the patients without each risk factor. In remote regions, however, MFR was significantly decreased in the diabetes and smoking groups (each p<0.05). By multivariate analysis, diabetes and smoking were independent predictors of MFR (each p<0.05). In the group with more than one risk factor, MFR was significantly lower (2.78±0.79) than in the other group (3.40±1.22, p<0.05). MFR is influenced not only by coronary stenosis severity but also by coronary risk factors. In particular, the influence of risk factors should be considered in regions without severe coronary stenosis. (orig.)

  19. Ethnic variations in acute coronary syndromes

    OpenAIRE

    Lanza, G A

    2004-01-01

    Although it is very likely that ethnic variations in the incidence and, possibly, clinical outcome of acute coronary artery disease events exist, the causes for such differences are many and difficult to address fully, given the complex interplay of contributing factors

  20. Functional Information in Coronary Artery Disease

    DEFF Research Database (Denmark)

    Kofoed, Klaus F; Sørgaard, Mathias H; Linde, Jesper J

    2017-01-01

    as an add-on to standard coronary CT angiography (CCTA), to identify regions of myocardial hypoperfusion, at rest and during adenosine stress. The principle of measurement is well-validated in animal experimental models, and CT myocardial perfusion imaging has a high degree of concordance with already...

  1. In-Vivo Assessment of Coronary Atherosclerosis

    NARCIS (Netherlands)

    G.A. Rodriguez-Granillo

    2006-01-01

    textabstractIntravascular ultrasound (IVUS) has emerged as a highly accurate tool for the serial assessment of the natural history of coronary atherosclerosis and to evaluate the effect of different conventional and emerging drug therapies on the progression of atherosclerosis. The

  2. Quantitative angiography after directional coronary atherectomy

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); V.A.W.M. Umans (Victor); B.H. Strauss (Bradley); R-J. van Suylen (Robert-Jan); M.J.B.M. van den Brand (Marcel); H. Suryapranata (Harry); P.J. de Feyter (Pim); J.R.T.C. Roelandt (Jos)

    1991-01-01

    textabstractOBJECTIVE: To assess by quantitative analysis the immediate angiographic results of directional coronary atherectomy. To compare the effects of successful atherectomy with those of successful balloon dilatation in a series of patients with matched lesions. DESIGN--Case series.

  3. Chest pain: Coronary CT in the ER

    NARCIS (Netherlands)

    E. Maffei (Erica); S. Seitun (Sara); A.I. Guaricci (Andrea); F. Cademartiri (Filippo)

    2016-01-01

    textabstractCardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD)

  4. Regression of coronary atherosclerosis by simvastatin

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Pedersen, Knud Erik

    2004-01-01

    BACKGROUND: Angiography of the coronary arteries reflects only changes in luminal dimensions. With intravascular ultrasound, cross-sectional images can be obtained and area measurements can be added to calculate volumes of the external elastic membrane (EEM), plaque plus media (P+M), and lumen. T...

  5. Genetically Determined Height and Coronary Artery Disease

    NARCIS (Netherlands)

    Nelson, Christopher P.; Hamby, Stephen E.; Saleheen, Danish; Hopewell, Jenna C.; Zeng, Lingyao; Assimes, Themistocles L.; Kanoni, Stavroula; Willenborg, Christina; Burgess, Stephen; Amouyel, Phillipe; Anand, Sonia; Blankenberg, Stefan; Boehm, Bernhard O.; Clarke, Robert J.; Collins, Rory; Dedoussis, George; Farrall, Martin; Franks, Paul W.; Groop, Leif; Hall, Alistair S.; Hamsten, Anders; Hengstenberg, Christian; Hovingh, G. Kees; Ingelsson, Erik; Kathiresan, Sekar; Kee, Frank; König, Inke R.; Kooner, Jaspal; Lehtimäki, Terho; März, Winifred; McPherson, Ruth; Metspalu, Andres; Nieminen, Markku S.; O'Donnell, Christopher J.; Palmer, Colin N. A.; Peters, Annette; Perola, Markus; Reilly, Muredach P.; Ripatti, Samuli; Roberts, Robert; Salomaa, Veikko; Shah, Svati H.; Schreiber, Stefan; Siegbahn, Agneta; Thorsteinsdottir, Unnur; Veronesi, Giovani; Wareham, Nicholas; Willer, Cristen J.; Zalloua, Pierre A.; Erdmann, Jeanette

    2015-01-01

    BACKGROUND The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease (CAD) are unclear. METHODS We used a genetic approach to investigate the association between height and CAD, using 180 height-associated genetic variants. We tested

  6. ANGINA PECTORIS AND NORMAL CORONARY ANGIOGRAPHY*

    African Journals Online (AJOL)

    A 14th patient, a woman aged 28, had angina pectoris with an abnormal cardiogram ... coronary arteries, and there was no cardiac muscle or valve pathology. ... depression of abnormal shape, werebdes~ribed as pn;'bably positive. Selective ...

  7. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Nilüfer Çetiner

    2014-01-01

    Full Text Available Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2–0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy.

  8. Post-mortem CT-coronary angiography

    DEFF Research Database (Denmark)

    Pøhlsgaard, Camilla; Leth, Peter Mygind

    2007-01-01

    post-mortem coronary angiography and computerized tomography.  We describe how to prepare and inject the contrast medium, and how to establish a CT-protocol that optimizes spatial resolution, low contrast resolution and noise level. Testing of the method on 6 hearts, showed that the lumen...

  9. Coronary involvement in Churg-Strauss syndrome.

    Science.gov (United States)

    Dendramis, Gregory; Paleologo, Claudia; Piraino, Davide; Arrotti, Salvatore; Assennato, Pasquale

    2015-01-01

    Systemic autoimmune diseases are themselves a relevant and independent risk factor for atherosclerosis and coronary ectasia. We describe a case of a 58-year-old Caucasian man who was admitted to our department for unstable angina. History of asthma, paranasal sinus abnormality, and peripheral eosinophilia given a high suspicion of Churg-Strauss syndrome (CSS). Diagnosis was performed with 5 of the 6 American College of Rheumatology criteria. The knowledge that CSS is often associated with significant coronary artery involvement and the persistence of chest pain led us to performing immediately a coronary angiography. Coronary angiography showed diffuse ectasic lesions, chronic occlusion of left anterior descending artery with homocoronary collateral circulation from left circumflex artery and subocclusive stenosis in the proximal tract of posterior descending artery. The early recognition of CSS, an aggressive invasive diagnostic approach, and an early appropriate therapy are important to prevent the progressive and permanent cardiac damage in these patients. In the setting of a multidisciplinary approach, careful cardiac assessment is an essential step in CSS, even in mildly symptomatic patients. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  10. Detecting asymptomatic coronary artery disease using routine ...

    African Journals Online (AJOL)

    ECG-monitored exercise testing has been proposed as a relatively inexpensive and effective means of screening for asymptomatic coronary artery disease in patients presenting for peripheral vascular surgery. Despite the fact that exercise thallium scintigraphy is also dependent on the patient's ability to exercise, using this ...

  11. Antioxidant vitamins and coronary heart disease risk

    DEFF Research Database (Denmark)

    Knekt, Paul; Ritz, John; Pereira, Mark A

    2004-01-01

    BACKGROUND: Epidemiologic studies have suggested a lower risk of coronary heart disease (CHD) at higher intakes of fruit, vegetables, and whole grain. Whether this association is due to antioxidant vitamins or some other factors remains unclear. OBJECTIVE: We studied the relation between the intake...

  12. Psychosocial factors in coronary heart disease

    Science.gov (United States)

    French, J. R. P., Jr.; Chaplan, R. D.

    1969-01-01

    The relationship between job satisfaction and coronary heart disease is explored for blue and white collar groups, different personalities and physiological risk factors. Differences found among administrators, engineers and scientists with regard to variables associated with heart disease are in terms of physiology, personality, reported job stress, and smoking.

  13. Smoking, Stress, and Coronary Heart Disease.

    Science.gov (United States)

    Epstein, Leonard H.; Perkins, Kenneth A.

    1988-01-01

    Focuses on the interrelation between stressors and smoking, and on its potential impact on coronary heart disease risk beyond that due to stressors or to smoking alone. Reviews evidence supporting the stress-smoking interrelationship, its relevance to the risk of heart disease, and mechanisms explaining why smokers smoke more during stress and why…

  14. Incidence and predictors of coronary stent thrombosis

    DEFF Research Database (Denmark)

    D'Ascenzo, Fabrizio; Bollati, Mario; Clementi, Fabrizio

    2013-01-01

    Stent thrombosis remains among the most feared complications of percutaneous coronary intervention (PCI) with stenting. However, data on its incidence and predictors are sparse and conflicting. We thus aimed to perform a collaborative systematic review on incidence and predictors of stent...

  15. Two new contrast media in coronary angiography

    International Nuclear Information System (INIS)

    Selin, K.; Bjoerk, L.

    1983-01-01

    Amipaque, ioxaglic acid and Isopaque Coronar 300 were compared in a double blind investigation of coronary angiography in patients with ischemic heart disease. Amipaque affected systolic blood pressure and ECG less than the other contrast media. Ioxaglic acid appeared to give more ST and T changes than Isopaque Coronar. (Auth.)

  16. Successful transcatheter closure of coronary artery fistula in a child with single coronary artery: a heavy load and a long road.

    Science.gov (United States)

    Phasalkar, Manjunath; Thakkar, Bhavesh; Poptani, Vishal

    2013-07-01

    Single coronary artery is an uncommon variation of the coronary circulation. After transposition of great arteries, coronary artery fistulas are the most common associated cardiac anomalies in these patients. Transcatheter closure of coronary artery fistula (CAF) involving single coronary artery is a challenging intervention. In the absence of contralateral coronary artery, a complex anatomy of the CAF and a large myocardial perfusion territory of the dominant circulation pose an additional risk during interventional procedure. We report our experience of a successful transcatheter closure of a coronary artery fistula in a patient with single coronary artery. Copyright © 2013 Wiley Periodicals, Inc.

  17. Breath-hold two-dimensional MR angiography of coronary arteries. Comparison with conventional coronary angiography in ten cases

    International Nuclear Information System (INIS)

    Li Liwei; Zhang Wanshi; Liu Chaozhong; Lu Xiaoyan; Xu Jiaxing

    1997-01-01

    Purpose: To assess the diagnostic value of two-dimensional coronary magnetic resonance (MR) angiography in patients evaluated for ischemic heart disease. Materials and methods: Ten patients who underwent selective cardiac catheterization with coronary MR angiography were evaluated with two-dimensional coronary MR angiography. Coronary MR angiography was performed with breath-hold fat-suppressed ECG-gated Turbo-FLASH with K-space segmentation using a 1.5 T imager. Results: The left main coronary artery, proximal left anterior descending artery, circumflex artery and right coronary artery were demonstrated in all cases. Continuous segments (mean) of left anterior descending, circumflex and right coronary arteries visualized on MRA were 6.72 +- 3.16 cm, 3.67 +- 4.81 cm and 7.93 +- 3.12 cm respectively. The overall sensitivity for detection of hemodynamically significant coronary artery lesion (≥50%) was 62.5% respectively. Conclusion: Breath-hold two-dimensional coronary MR angiography was useful in showing relatively long segments of the main coronary arteries and also has potential in depicting hemodynamically significant coronary artery lesions

  18. Safety and efficacy of angioplasty with intracoronary stenting in patients with unstable coronary syndromes. Comparison with stable coronary syndromes

    Directory of Open Access Journals (Sweden)

    Luís C. L. Correia

    2000-06-01

    Full Text Available OBJECTIVE: To assess safety and efficacy of coronary angioplasty with stent implantation in unstable coronary syndromes. METHODS: Retrospective analysis of in-hospital and late evolution of 74 patients with unstable coronary syndromes (unstable angina or infarction without elevation of the ST segment undergoing coronary angioplasty with stent placement. These 74 patients were compared with 31 patients with stable coronary syndromes (stable angina or stable silent ischemia undergoing the same procedure. RESULTS: No death and no need for revascularization of the culprit artery occurred in the in-hospital phase. The incidences of acute non-Q-wave myocardial infarction were 1.4% and 3.2% (p=0.6 in the unstable and stable coronary syndrome groups, respectively. In the late follow-up (11.2±7.5 months, the incidences of these events combined were 5.7% in the unstable coronary syndrome group and 6.9% (p=0.8 in the stable coronary syndrome group. In the multivariate analysis, the only variable with a tendency to significance as an event predictor was diabetes mellitus (p=0.07; OR=5.2; 95% CI=0.9-29.9. CONCLUSION: The in-hospital and late evolutions of patients with unstable coronary syndrome undergoing angioplasty with intracoronary stent implantation are similar to those of the stable coronary syndrome group, suggesting that this procedure is safe and efficacious when performed in unstable coronary syndrome patients.

  19. Single left coronary ostium and an anomalous prepulmonic right coronary artery in 2 dogs with congenital pulmonary valve stenosis.

    Science.gov (United States)

    Visser, Lance C; Scansen, Brian A; Schober, Karsten E

    2013-06-01

    A coronary artery anomaly characterized by the presence of a single left coronary ostium with absence of the right coronary ostium and an anomalous prepulmonic right coronary artery course was observed in two dogs with concurrent congenital pulmonary valve stenosis. This unique coronary artery anatomy is similar to the previously described single right coronary ostium with anomalous prepulmonic left coronary artery, the so-called type R2A anomaly, in that an anomalous coronary artery encircles the pulmonary valve annulus. Both dogs of this report, a boxer and an English bulldog, were of breeds known to be at risk for the type R2A anomaly. As such, veterinarians should be aware that the echocardiographic presence of a left coronary ostium in a dog with pulmonary valve stenosis does not exclude the possibility of a prepulmonic coronary artery anomaly that may enhance the risk of complications during balloon pulmonary valvuloplasty. A descriptive naming convention for coronary artery anomalies in dogs is also presented, which may be preferable to the older coding classification scheme. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. The Role of Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance in STEMI Patients with Normal Coronary Angiography

    Directory of Open Access Journals (Sweden)

    Beganu Elena

    2017-09-01

    Full Text Available Usually, the diagnosis of myocardial infarction based on patient symptoms, electrocardiogram (ECG changes, and cardiac enzymes, is not a challenge for cardiologists. The correlation between coronary anatomy and the ECG territories that present ischemic changes can help the clinician to estimate which coronary artery presents lesions upon performing a coronary angiogram. In certain situations, the diagnosis of myocardial infarction can be difficult due to the lack of correlations between the clinical and paraclinical examinations and the coronary angiogram. In some cases, patients with chest pain and ST-segment elevation on the ECG tracing present with a normal coronary angiography. In other cases, patients without important changes on the ECG can present critical lesions or even occlusions upon angiographic examination. The aim of this article is to highlight the role of noninvasive coronary magnetic resonance and multi-slice computed tomography in patients with ST-segment elevation myocardial infarction and normal coronary angiography.

  1. Treatment of Angina and Microvascular Coronary Dysfunction

    Science.gov (United States)

    Samim, Arang; Nugent, Lynn; Mehta, Puja K.; Shufelt, Chrisandra; Merz, C. Noel Bairey

    2014-01-01

    Opinion statement Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina, more commonly diagnosed in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease (CAD) on cardiac catheterization. Data from National Heart, Lung and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study has shown that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, or death. The gold standard diagnostic test for MCD is an invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test the endothelial dependent and independent, microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratifying patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce risk of adverse cardiac events, ameliorating symptoms to improve quality of life, and to decrease the morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor managment, including lifestyle counseling regarding smoking cessation, nutrition and physical activity should be initiated. Current pharmacotherapy for MCD can include the treatment of microvascular endothelial dysfunction (statins, angiotensin-converting enzyme inhibitor, low dose aspirin), as well as treatment for angina and myocardial ischemia (beta blockers, calcium channel blockers, nitrates, ranolazine). Additional symptom management techniques can include tri-cyclic medication, enhanced external counterpulsation, autogenic training, and spinal cord stimulation. While our current therapies are effective in the treatment

  2. [Coronary heart disease: epidemiologic-genetic aspects].

    Science.gov (United States)

    Epstein, F H

    1985-01-01

    Coronary heart disease and the risk factors which predispose to it aggregate in families. How much of this clustering of disease is "explained" by the familial resemblance in predisposing factors? The published reports which bear on this question fall into six distinct study designs: prospective studies, persons at high or low risk or persons with and without a positive family history as points of departure, case-control studies, studies of patients who had a coronary angiogram and studies in different ethnic groups. The findings of the 16 investigations reviewed suggest that there are as yet unidentified factors - genetic, environmental or both - which are responsible for familial clustering of coronary heart disease, apart from the three main risk factors (serum lipids, blood pressure, smoking) and diabetes. Future research must put greater emphasis on studies of families rather than individuals and on closer collaboration between epidemiologists and geneticists, in order to fill these gaps in knowledge. It is likely that the individual predisposition to coronary heart disease is due in part to genetic influences which remain to be discovered in the course of such studies. They would help in identifying susceptible person in the population with greater precision than is now possible. The "high-risk strategy" of coronary heart disease prevention will become more efficient as more specific and sensitive tests of disease prediction are developed. In the meantime, preventive programmes must be put into action on the basis of what is already known, on the level of both the high-risk and the community-wide mass strategy.

  3. Coronary In-Stent Restenosis: Assessment with Corrected Coronary Opacification Difference across Coronary Stents Measured with CT Angiography.

    Science.gov (United States)

    Gao, Yang; Lu, Bin; Hou, Zhi Hui; Yu, Fang Fang; Yin, Wei Hua; Wang, Zhi Qiang; Wu, Yong Jian; Mu, Chao Wei; Meinel, Felix G; McQuiston, Andrew D; Schoepf, U Joseph

    2015-05-01

    To determine whether changes in coronary opacification normalized to the aorta (corrected coronary opacification [CCO]) across stents can help identify in-stent restenosis (ISR) severity with use of invasive coronary angiography as the standard of reference. This study was approved by the institutional review board, and the requirement to obtain informed consent was waived. The authors retrospectively analyzed 106 patients (88 men, 18 women; mean age, 59.6 years ± 10.4; age range, 36-84 years) who had previously undergone stent implantation within 3 months of coronary computed tomographic (CT) angiography. Attenuation values in the coronary lumen were measured proximal and distal to the stents and normalized to the descending aorta. The CCO difference across the stent was compared with the severity of ISR. One-way analysis of variance least significant difference was used for comparison. A total of 141 stents were assessed. Seventy-six stents were normally patent, 18 had ISR of less than 50%, 28 had ISR of 50%-99%, and 19 were fully occluded. The median CCO differences in the four groups were 0.078, 0.163, 0.346, and 0.606, respectively. There was no significant difference between stents with an ISR of at least 50% and those with total occlusion (P = .056), although the other groups had significant differences at pairwise comparison (P stents smaller than 3 mm in diameter, the median CCO differences in the four groups were 0.086, 0.136, 0.390, and 0.471, respectively. The CCO differences across normal stents and stents with ISR of less than 50% were significantly less than those across stents with an ISR of at least 50% and those with total occlusion (P stents with no ISR and those with an ISR of less than 50% (P = .821) and between stents with an ISR of at least 50% and those with an ISR of 100% (P = .836). The CCO difference across coronary stents is related to ISR severity in obstructive ISR in stents smaller than 3 mm in diameter. © RSNA, 2014.

  4. Coronary anomalies in Pakistani children with tetralogy of fallot

    International Nuclear Information System (INIS)

    Hussain, I.; Patel, N.

    2010-01-01

    To determine coronary artery anomalies in tetralogy of Fallot in Pakistani children as seen on angiography. Study Design: Case series. Place and Duration of Study: The National Institute of Cardiovascular Diseases, Karachi, Pakistan from July 2006 to July 2007. Methodology: Children under 15 years of age with echocardiographic diagnosis of tetralogy of Fallot were included in the study. All patients had pre-operative cardiac catheterization and angiography. Coronary arteries were studied with a nonselective aortic root angiogram in standard cranially tilted left anterior oblique view. The frequency of a normal and an anomalous coronary was determined. Results: Of the 83 patients, 78% were male and had a mean age of 8.9 years. Their mean weight was 14.3 kilograms. Seventy six (91.6%) had a normal coronary anatomy while 7 (8.4%) patients had anomalous coronary arteries. Among the patients with coronary anomalies, the commonest was a single origin coronary artery in 04 (57.14%) cases. Three (42.86%) had an anomalous origin of left anterior descending artery from the right coronary artery. Conclusion: Coronary artery anomalies were detected in 8.4% of the cases with tetralogy of Fallot. Single origin coronary artery anomaly was the commonest anomaly. (author)

  5. Effects of exercise training on coronary transport capacity

    International Nuclear Information System (INIS)

    Laughlin, M.H.

    1985-01-01

    Coronary transport capacity was estimated in eight sedentary control and eight exercise-trained anesthetized dogs by determining the differences between base line and the highest coronary blood flow and permeability-surface area product (PS) obtained during maximal adenosine vasodilation with coronary perfusion pressure constant. The anterior descending branch of the left coronary artery was cannulated and pump- perfused under constant-pressure conditions (approximately equal to 100 Torr) while aortic, central venous, and coronary perfusion pressures, heart rate, electrocardiogram, and coronary flow were monitored. Myocardial extraction and PS of 51 Cr-labeled ethylenediaminetetraacetic acid were determined with the single-injection indicator-diffusion method. The efficacy of the 16 +/- 1 wk exercise training program was shown by significant increases in the succinate dehydrogenase activities of the gastrocnemius, gluteus medialis, and long head of triceps brachii muscles. There were no differences between control and trained dogs for either resting coronary blood flow or PS. During maximal vasodilation with adenosine, the trained dogs had significantly lower perfusion pressures with constant flow and, with constant-pressure vasodilation, greater coronary blood flow and PS. It is concluded that exercise training in dogs induces an increased coronary transport capacity that includes increases in coronary blood flow capacity (26% of control) and capillary diffusion capacity (82% of control)

  6. Posttraumatic Stress Disorder Disturbs Coronary Tone and Its Regulatory Mechanisms.

    Science.gov (United States)

    Lazuko, Svetlana S; Kuzhel, Olga P; Belyaeva, Lyudmila E; Manukhina, Eugenia B; Fred Downey, H; Tseilikman, Olga B; Komelkova, Maria V; Tseilikman, Vadim E

    2018-01-01

    Posttraumatic stress disorder (PTSD) is associated with myocardial injury, but changes in coronary regulatory mechanisms in PTSD have not been investigated. This study evaluated the effect of PTSD-inducing stress on coronary tone and its regulation by nitric oxide (NO) and voltage-gated K + channels. PTSD was induced by exposing rats to predator stress, 15 min daily for 10 days, followed by 14 stress-free days. Presence of PTSD was confirmed by the elevated plus-maze test. Coronary tone was evaluated from changes in coronary perfusion pressure of Langendorff isolated hearts. Predator stress induced significant decreases in coronary tone of isolated hearts and in blood pressure of intact rats. L-NAME, a non-selective NO synthase (NOS) inhibitor, but not S-MT, a selective iNOS inhibitor, and increased coronary tone of control rats. In PTSD rats, both L-NAME and S-MT increased coronary tone. Therefore, the stress-induced coronary vasodilation resulted from NO overproduction by both iNOS and eNOS. NOS induction was apparently due to systemic inflammation as evidenced by increased serum interleukin-1β and C-reactive protein in PTSD rats. Decreased corticosterone in PTSD rats may have contributed to inflammation and its effect on coronary tone. PTSD was also associated with voltage-gated K + channel dysfunction, which would have also reduced coronary tone.

  7. [Surgical angioplasty of the left main coronary artery].

    Science.gov (United States)

    Vranes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Velimirović, Dusan; Djukić, Petar

    2010-01-01

    The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

  8. Complex Coronary Hemodynamics - Simple Analog Modelling as an Educational Tool.

    Science.gov (United States)

    Parikh, Gaurav R; Peter, Elvis; Kakouros, Nikolaos

    2017-01-01

    Invasive coronary angiography remains the cornerstone for evaluation of coronary stenoses despite there being a poor correlation between luminal loss assessment by coronary luminography and myocardial ischemia. This is especially true for coronary lesions deemed moderate by visual assessment. Coronary pressure-derived fractional flow reserve (FFR) has emerged as the gold standard for the evaluation of hemodynamic significance of coronary artery stenosis, which is cost effective and leads to improved patient outcomes. There are, however, several limitations to the use of FFR including the evaluation of serial stenoses. In this article, we discuss the electronic-hydraulic analogy and the utility of simple electrical modelling to mimic the coronary circulation and coronary stenoses. We exemplify the effect of tandem coronary lesions on the FFR by modelling of a patient with sequential disease segments and complex anatomy. We believe that such computational modelling can serve as a powerful educational tool to help clinicians better understand the complexity of coronary hemodynamics and improve patient care.

  9. Hemodynamic analysis of sequential graft from right coronary system to left coronary system.

    Science.gov (United States)

    Wang, Wenxin; Mao, Boyan; Wang, Haoran; Geng, Xueying; Zhao, Xi; Zhang, Huixia; Xie, Jinsheng; Zhao, Zhou; Lian, Bo; Liu, Youjun

    2016-12-28

    Sequential and single grafting are two surgical procedures of coronary artery bypass grafting. However, it remains unclear if the sequential graft can be used between the right and left coronary artery system. The purpose of this paper is to clarify the possibility of right coronary artery system anastomosis to left coronary system. A patient-specific 3D model was first reconstructed based on coronary computed tomography angiography (CCTA) images. Two different grafts, the normal multi-graft (Model 1) and the novel multi-graft (Model 2), were then implemented on this patient-specific model using virtual surgery techniques. In Model 1, the single graft was anastomosed to right coronary artery (RCA) and the sequential graft was adopted to anastomose left anterior descending (LAD) and left circumflex artery (LCX). While in Model 2, the single graft was anastomosed to LAD and the sequential graft was adopted to anastomose RCA and LCX. A zero-dimensional/three-dimensional (0D/3D) coupling method was used to realize the multi-scale simulation of both the pre-operative and two post-operative models. Flow rates in the coronary artery and grafts were obtained. The hemodynamic parameters were also showed, including wall shear stress (WSS) and oscillatory shear index (OSI). The area of low WSS and OSI in Model 1 was much less than that in Model 2. Model 1 shows optimistic hemodynamic modifications which may enhance the long-term patency of grafts. The anterior segments of sequential graft have better long-term patency than the posterior segments. With rational spatial position of the heart vessels, the last anastomosis of sequential graft should be connected to the main branch.

  10. Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Meier Pascal

    2012-06-01

    Full Text Available Abstract Background The benefit of the coronary collateral circulation (natural bypass network on survival is well established. However, data derived from smaller studies indicates that coronary collaterals may increase the risk for restenosis after percutaneous coronary interventions. The purpose of this systematic review and meta-analysis of observational studies was to explore the impact of the collateral circulation on the risk for restenosis. Methods We searched the MEDLINE, EMBASE and ISI Web of Science databases (2001 to 15 July 2011. Random effects models were used to calculate summary risk ratios (RR for restenosis. The primary endpoint was angiographic restenosis > 50%. Results A total of 7 studies enrolling 1,425 subjects were integrated in this analysis. On average across studies, the presence of a good collateralization was predictive for restenosis (risk ratio (RR 1.40 (95% CI 1.09 to 1.80; P = 0.009. This risk ratio was consistent in the subgroup analyses where collateralization was assessed with intracoronary pressure measurements (RR 1.37 (95% CI 1.03 to 1.83; P = 0.038 versus visual assessment (RR 1.41 (95% CI 1.00 to 1.99; P = 0.049. For the subgroup of patients with stable coronary artery disease (CAD, the RR for restenosis with 'good collaterals' was 1.64 (95% CI 1.14 to 2.35 compared to 'poor collaterals' (P = 0.008. For patients with acute myocardial infarction, however, the RR for restenosis with 'good collateralization' was only 1.23 (95% CI 0.89 to 1.69; P = 0.212. Conclusions The risk of restenosis after percutaneous coronary intervention (PCI is increased in patients with good coronary collateralization. Assessment of the coronary collateral circulation before PCI may be useful for risk stratification and for the choice of antiproliferative measures (drug-eluting stent instead bare-metal stent, cilostazol.

  11. CMR diagnosis of coronary graft fistula

    Directory of Open Access Journals (Sweden)

    Bengt Johansson

    2014-01-01

    Full Text Available The patient is a 54-year old man with a previous history of cerebral aqueduct stenosis and hydrocephalus resulting in malignant hypertension who had surgery for permanent ventriculo-peritoneal shunt. At age 41, he had coronary artery bypass graft (CABG surgery with the right internal mammary artery anastomosed to the posterior descending artery and a saphenous vein graft to the first obtuse marginal branch. The patient was recently admitted with pneumonia that rapidly deteriorated and he went in respiratory failure requiring mechanical ventilation. A thoracic CT investigation showed massive bilateral pulmonary infiltrates, pulmonary artery embolism and a large vein graft aneurysm with a maximal diameter of 40 mm (Figure 1 A-B. The management course was complicated with prolonged respiratory failure, persistent infection, despite negative cultures and extended hospital stay. After 50 days of slow recovery the patient was discharged with a need for home oxygen therapy. Ten days later, he was re-admitted with chest pain requiring admission to the coronary care unit where severe pulmonary hypertension was diagnosed with Doppler echocardiography. Troponin-T was mildly elevated, 1,3 ug/L (ref <0,01, CRP was 50 mg/L and chest X-ray showed bilateral lung infiltrates and wide pulmonary vessels. At this point a systo-diastolic murmur was heard at the left lower sternal edge. With a view of potential coronary reintervention and to evaluate the pulmonary hypertension, a coronary angiogram and a pulmonary artery cathetherisation were performed. This showed a new stenosis in the left anterior descending coronary artery and the pulmonary catheterisation showed a “step-up” in oxygen saturation in the pulmonary artery, suggesting a left-to-right shunt. The vein graft aneurysm did not contribute to the coronary circulation. A cardiovascular magnetic resonance scan revealed a communication between the vein graft aneurysm and the left branch pulmonary artery

  12. Prevalence of Congenital Coronary Artery Anomalies and Variants in 2697 Consecutive Patients Using 64-Detector Row Coronary CTAngiography

    International Nuclear Information System (INIS)

    Shabestari, Abbas Arjmand; Akhlaghpoor, Shahram; Tayebivaljozi, Reza; Fattahi Masrour, Farzaneh

    2012-01-01

    Coronary artery anomalies are not common, but could be very serious. This study determines the frequency of coronary anomalies and normal variants by multi-detector-row computed tomography (MDCT). The results of cardiac MDCT study in 2697 consecutive patients were analyzed retrospectively. Acquisition was performed by a 64-detector row CT machine. Imaging results were assessed by experienced radiologists. Myocardial bridging was by far the most frequent coronary variant (n = 576, 21.3%). Eighty-three subjects (3.1%) showed other coronary anomalies and variants. Anomalies of origination and course of the left main coronary artery (LMCA) were detected in 1.09% of the subjects. The frequency of these anomalies in the right coronary artery (RCA), left circumflex artery (LCx), left anterior descending artery (LAD), posterior descending artery (PDA) and obtuse marginal (OM) artery were 1.24%, 0.33%, 0.1%, 0.07% and 0.03%, respectively. The single coronary pattern was seen in 0.18% and coronary fistulas in 0.07%. Based on the fact that coronary CT-angiography using MDCT can display different coronary anomalies, this study shows similar results to other reports on the subject. Future advances in the performance of CT machines will further improve the quality of CT-based cardiac imaging

  13. Percutaneous brachial artery catheterization for coronary angiography and percutaneous coronary interventions (pci): an encouraging experience of 100 cases

    International Nuclear Information System (INIS)

    Islam, Z.U.; Maken, G.R.; Saif, M.; Khattak, Z.A.

    2013-01-01

    Objective: To evaluate the practicability and safety of the percutaneous transbrachial approach (TBA) for diagnostic coronary angiography and therapeutic percutaneous coronary interventions. Study Design: Quasi experimental study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) from March 2009 to May 2011. Patients and Methods: We collected data of 100 consecutive patients who underwent coronary catheterization by the percutaneous transbrachial approach. Transbrachial catheterization was performed only if the radial access failed or radial pulse was feeble. Study endpoints included successful brachial artery catheterization, vascular and neurological complications at access site and procedure success rate. Results: Mean age of the patients was 54 years (range 33-79 yrs) and 65(65%) were males and 35 (35%) were females. The right brachial artery was used in all of the cases. Procedural success was achieved in 100% of the patients. Coronary angiography was performed in 70 patients and percutaneous coronary interventions were done in 30 cases. Out of these 30 cases, PCI to left coronary arteries (LAD and LCX) were performed in 19 patients while 11 patients had PCI to right coronary artery (RCA). No case of vascular complications such as major access site bleeding, vascular perforation, brachial artery occlusion causing forearm ischemia, compartment syndrome, vascular spasm or failure to catheterize coronary arteries requiring alternate vascular access were observed. Conclusion: Brachial artery is a safe and easily accessible approach for coronary angiography and percutaneous coronary interventions. (author)

  14. Three-Dimensional Respiratory-Gated Coronary Mr Angiography with Reference to X-Ray Coronary Angiography

    International Nuclear Information System (INIS)

    Ikonen, A. E. J.; Manninen, H. I.; Vainio, P.; Vanninen, R. L.; Matsi, P. J.; Soimakallio, S.; Hirvonen, T.P.J.; Hartikainen, J.E.K.

    2003-01-01

    Purpose: To assess the clinical value of three-dimensional coronary MR angiography (CMRA) in the detection of significant coronary artery stenosis using conventional X-ray angiography as the standard reference. Material and Methods: Sixty-nine patients underwent X-ray coronary angiography and CMRA because of suspected or previously diagnosed coronary artery disease. MRI was performed with a 1.5-T whole body imaging system using ECG-triggered 3D gradient echo sequence with retrospective navigator echo respiratory gating and fat suppression. Results: A total of 276 coronary artery segments were analyzed. The X-ray coronary angiography was normal in 22 patients. Significant proximal stenoses (exceeding 50%) or occlusions were present in 102 coronary artery segments. In all, 120 stenoses or occlusions were identified in CMRA. Sixteen percent of the coronary artery segments had to be excluded because of poor image quality. The overall sensitivity and specificity for MRA for identification of significant stenosis were 75% and 62%, respectively. CMRA correctly detected 89% of patients with at least one vessel disease, but 6 patients with coronary artery disease would have been missed. Conclusions: Because of the high data exclusion and false-negative case rate, CMRA with retrospective navigator echo triggering is at present not suitable as a clinical screening method in coronary artery disease

  15. Detection of coronary calcium with electron beam tomography in coronary artery disease

    International Nuclear Information System (INIS)

    Haberl, R.; Knez, A.; Becker, A.; Becker, C.; Bruening, R.; Reiser, M.; Maass, A.; Steinbeck, G.

    1998-01-01

    Purpose: Coronary calcium is a powerful indicator of arteriosclerosis and can be detected very precisely with electron beam tomography. The method can be applied in patients with known coronary artery disease or in asymptomatic patients at risk of arteriosclerotic disease. Results: At the University of Munich we performed an EBT scan of the heart in 1100 patients within the last year. In 567 patients coronary angiography was performed also (±3 days). Confirming previous reports in the literature, we found a correlation of the calcium score with the age and gender of the patients. Severe coronary artery disease (stenoses ≥ 75%) was associated with significantly more calcium than less severe CAD. The calcium score did not discriminate between one-, two- and three-vessel disease. The site of calcification does not correlate with the localization of stenoses. Thirty-three percent of the patients with significant coronary artery disease showed a normal age-adjusted calcium score; a total of 8.1% of patients with severe stenoses did not reveal any coronary calcification (score =0). With asymptomatic patients there are only a few studies available. Soft plaques cannot be detected with EBT, but in most patients soft plaques occur together with hard plaques. Our results show that spiral CT of the newest generation may also be used for calcium screening. There was an excellent correlation of the calcium scores of EBT and spiral CT at all levels of calcification. Discussion: Coronary calcium is a sensitive marker of coronary artery disease. In the clinical setting EBT is indicated in patients with known coronary artery disease (to evaluate prognosis), in patients who are unable to perform a stress test, and in patients with atypical chest pain. However, lack of calcification may be associated with severe stenoses in a minority of patients. The clinical value in asymptomatic patients needs to be defined: Randomized studies are necessary. We see a possible indication in

  16. 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

  17. Gender differences in coronary plaque composition by coronary computed tomography angiography.

    Science.gov (United States)

    Blaha, Michael J; Nasir, Khurram; Rivera, Juan J; Choi, Eue-Keun; Chang, Sung-A; Yoon, Yeonyee E; Chun, Eun Ju; Choi, Sang-il; Agatston, Arthur; Blumenthal, Roger S; Chang, Hyuk-Jae

    2009-12-01

    Coronary computed tomography angiography allows the differentiation of non-calcified (NCAP), calcified (CAP), and mixed coronary artery plaques (MCAP). Although males are thought to have a higher prevalence of atherosclerosis for a given age, there are currently few data regarding age-adjusted sex differences in plaque morphology and composition. We studied 1015 consecutive asymptomatic South Korean patients (49+/-10 years, 64% men) who underwent 64-slice coronary computed tomography angiography during a routine health evaluation. Coronary plaque characteristics were analyzed on a per-segment basis according to the modified AHA classification. Plaques with more than 50% calcified tissue were classified as CAP, plaques with less than 50% calcified tissue were classified as MCAP, and plaques without calcium were classified as NCAP. Multiple regression analysis was used to describe the cross-sectional association between sex and plaque-type burden (>or=2 affected segments) after adjustment for age and other cardiovascular risk factors. There was a greater prevalence of coronary plaque among men (13 vs. 4%, PNCAP was similar across sex (2 vs. 1%, P = 0.28). After multivariable adjustment, men have six to seven times greater odds of having an increased burden of CAP and MCAP, whereas no sex difference was observed in the burden of NCAP. In this population of asymptomatic middle-aged Korean individuals, males had a significantly greater burden of MCAP and CAP. Future studies will determine whether these differences contribute to the accelerated cardiovascular risk observed in men.

  18. The effects of fenoldopam on coronary conduit blood flow after coronary artery bypass graft surgery.

    LENUS (Irish Health Repository)

    Halpenny, M

    2012-02-03

    OBJECTIVE: To quantify the effects of fenoldopam, 0.1 microg\\/kg\\/min, on left internal mammary artery (LIMA) and saphenous vein blood flow after coronary anastomosis. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: University teaching hospital, single institution. PARTICIPANTS: Thirty-one American Society of Anesthesiologists III patients undergoing elective coronary revascularization. INTERVENTIONS: A perivascular ultrasonic flow probe (Linton Instrumentation, Norfolk, UK) was placed around the LIMA and saphenous vein graft after coronary anastomosis. MEASUREMENTS AND MAIN RESULTS: Immediately before and at 5-minute intervals for 15 minutes after starting the infusion, blood flow was measured in the LIMA and one saphenous vein graft using a transit time ultrasonic flow probe. Heart rate, blood pressure, and central venous pressure were documented at these time points. Administration of fenoldopam, 0.1 microg\\/kg\\/min, did not alter heart rate or blood pressure. A small, nonsignificant increase in LIMA blood flow occurred during the 15-minute study period (30 +\\/- 12 to 35 +\\/- 10 mL\\/min) in patients who received fenoldopam. No significant changes occurred in the placebo group. CONCLUSIONS: The findings indicate that fenoldopam, 0.1 microg\\/kg\\/min, did not influence coronary conduit blood flow to a clinically significant extent. The small increase in LIMA blood flow may be of greater importance in high-risk patients or in the prevention of coronary arterial spasm.

  19. Correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium scan

    International Nuclear Information System (INIS)

    Lee, Sang Hoon; Hong, Yong Kook; Park, Sung Il; Lee, Hyang Mee; Choe, Kyu Ok

    1998-01-01

    To determine the correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium(EBT CAC) scan and to measure the difference in calcium score according to symptoms. Materials and Methods : Fifty-six patients underwent EBT CAC scanning and either coronary angiography or stress thallium 201 scanning or the treadmill test. When the results were positive, coronary artery obstructive disease(CAOD) was assumed to be present. The patients were divided into three groups : symptomatic CAOD,asymptomatic CAOD, and asymptomatic non- CAOD; those with a previous history of myocardial ischemia or who showed positive results in any of the three tests relating to typical symptoms of angina were assigned to the symptomatic group. Results : The number of cases assigned to group to group 1,2 and 3 was 19, 16 and 21, respectively; total CAC scores were 571 ± 751, 600 ± 726 293± 401, respectively. The difference in CAC score between asymptomatic CAOD and asymptomatic non- CAOD was not statistically significant(p=0.079) but in asymptomatic CAOD, the score tended to be higher. The CAC score was not different between symptomatic and asymptomatic CAOD(p>0.1). When the CAC threshold was 1, sensitivity was 89% and specificity was 14%;when the threshold was 200, sensitivity was 60% and specificity was 67%. Conclusion : When the EBT CAC score is high, further evaluation provides early evidence of coronary artery obstructive disease

  20. CT Coronary Angiography vs. Coronary Artery Calcium Scoring for the Occupational Assessment of Military Aircrew.

    Science.gov (United States)

    Parsons, Iain; Pavitt, Chris; Chamley, Rebecca; d'Arcy, Jo; Nicol, Ed

    2017-02-01

    To ensure flight safety military aircrew undergo regular clinical and occupational assessment. Coronary artery calcium scoring (CACS) has been established as an imaging modality to noninvasively assess coronary artery disease (CAD). CT coronary angiography (CTCA) potentially offers a more accurate assessment of CAD, but has not been formally assessed in military aircrew. This retrospective cohort study is designed to compare the theoretical differences in downstream investigations and occupational outcomes in aircrew with suspected CAD comparing CTCA with existing CACS pathways. A 2-yr retrospective cohort study of consecutive UK military patients who underwent a CTCA and CACS was undertaken. Patient demographics, CTCA and CACS results, and initial and final occupational restrictions were analyzed comparing current UK, Canadian, and U.S. pathways. There were 44 patients who underwent CACS and CTCA. The commonest indication for a CTCA was a positive exercise ECG. Increasing CACS, stenosis severity, and stenosis burden were associated with significantly greater likelihood of occupational restriction (P = occupational restrictions. Two patients with a calcium score ≤10 had at least 1 single vessel stenosis ≥50%. A CTCA pathway is potentially a better discriminator of CAD burden in aircrew when compared with CACS and may reduce downstream testing, allowing a more efficacious approach to CAD assessment in military aircrew.Parsons I, Pavitt C, Chamley R, d'Arcy J, Nicol E. CT coronary angiography vs. coronary artery calcium scoring for the occupational assessment of military aircrew. Aerosp Med Hum Perform. 2017; 88(2):76-81.

  1. The relationship between mean platelet volume and coronary collateral vessels in patients with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Gaurav Singhal

    2016-01-01

    Full Text Available Background: Elevated mean platelet volume (MPV has been proposed as a risk factor for coronary artery disease (CAD and is associated with poor clinical outcome in acute coronary syndrome (ACS. However, some studies have contradictory findings. Hence, we aimed to evaluate the association of MPV with the presence of coronary collateral vessel (CCV in patients with ACS. Objective: To find MPV value in ACS patients and to find the predictive value of MPV in the spectrum of CAD and to examine whether levels of MPV predict the presence of CCVs. Methods: A total of 180 patients with first ACS were included in the study. MPV was measured. All patients underwent coronary angiography to know disease severity and CCVs. The CCVs are graded according to the Rentrop scoring system and according to coronary angiography results; patients were divided into two groups as Group 1 (poor CCV and Group 2 (good CCV. Results: The MPV was 10.74 ± 2 fl in poor collateral group patients and 11.01 ± 1.7 fl in good collateral group (P = 0.421. The presence of CCV was not significantly associated with high levels of MPV. MPV value did not show any prediction of the spectrum of CAD. Conclusion: MPV on admission was not associated with the development of CCV positively in patients with ACS. Furthermore, it is not associated with a number of vessel involvements.

  2. Coronary artery disease confined to secondary branches of the left coronary system

    International Nuclear Information System (INIS)

    Iskandrian, A.S.; Klein, B.L.; Segal, B.L.; Kimbiris, D.; Bemis, C.E.

    1981-01-01

    Among 3,000 patients studied by coronary arteriography during a 4-year period, 31 patients (1%) had coronary artery disease limited to a diagonal branch of the left anterior descending (15 patients), marginal branch of the left circumflex (10 patients), or to both branches (6 patients). Ten patients had 50-69% and twenty-one had greater than or equal to 70% diameter narrowing. The suitability for grafting was noted in 20 patients as judged by the caliber and distribution of the diseased branches. Collaterals were noted in seven patients. Disease was present in 28 men and 3 women (age range 38-70 years). At least one major coronary risk factor was present in 27 patients. Angina was noted in 27 patients; prior myocardial infarction was noted in 5 patients by history and in 4 by ECG. The left ventriculogram was normal in 22 patients and showed mild segmental asynergy in 9; ejection fraction was normal in all. Exercise ECGs were positive in 12 of 25 patients; exercise 201thallium scans were positive in 13. All patients responded to medical therapy. In conclusion, among the population of patients who undergo catheterization, coronary branch disease is rare. The clinical findings are indistinguishable from patients with major coronary disease. Prognosis remains benign and patients respond to medical therapy

  3. Circumflex coronary artery with aberrant origin and atherosclerosis

    International Nuclear Information System (INIS)

    Ozcan, E.; Bozlar, U.; Celik, T.; Tasar, M.

    2012-01-01

    Full text: Introduction: Circumflex (Cx) coronary artery congenital anomaly is reported to be less than 1% incidence. Coronary arteries with aberrant origin are more likely to have atherosclerosis according to some published literatures. Objectives and tasks: In this study we aim to present computed tomography (CT) angiography findings of a patient, who has Cx artery with aberrant origin and atherosclerotic. Materials and methods: 57-year-old woman without any symptoms who has risk factors to atherosclerosis was referred to our clinic for coronary CT angiography. Results: In CT angiography; we detected Cx coronary artery with aberrant origin (right sinus of valsalva) and retroaortic course. Also we saw intimal irregularities and calcified plaque causing severe narrowing in the proximal segment of artery. Right coronary and left anterior descendant arteries had mild atherosclerosis. Conclusion: Coroner CT angiography, which allows multiplanar imaging with high resolution, is an effective diagnostic tool for coronary artery disease, like not only congenital anomalies but also acquired atherosclerotic disease

  4. Congenital heart disease with high origin of coronary artery

    International Nuclear Information System (INIS)

    Zhu Ming; Li Yuhua; Zhong Yumin

    2002-01-01

    Objective: To report 6 cases of congenital heart disease with high origin of coronary artery and to evaluate the imaging method for diagnosis of congenital high origin of coronary artery. Methods: Six patients with congenital high origin of coronary artery underwent angiocardiography, echocardiography, and 2 patients also underwent magnetic resonance examination. All 6 cases were confirmed by operation. Results: All 6 cases were congenital high origin of right coronary artery. Angiocardiography made correct diagnosis in all 6 cases; MRI made the correct diagnosis in 1 of the 2 cases; echocardiography made 1 correct diagnosis. Conclusion: Correct diagnosis of congenital high origin of coronary artery was very important for patients with congenital heart disease. Angiocardiography was a very reliable imaging method and MRI can play an important role in preoperative diagnosis of congenital high origin of coronary artery

  5. Coronary Heart Disease and Emotional Intelligence.

    Science.gov (United States)

    Vlachaki, Chrisanthy; Maridaki Kassotaki, Katerina

    2013-09-23

    Coronary Heart Disease (CHD) is associated with emotions, especially negative ones, namely anxiety and depression. Emotional Intelligence (EI) is a psychological model that consists of a variety of emotional skills. The aim of the present study was to examine the relation between different dimensions of Emotional Intelligence and coronary heart disease. A total of 300 participants were studied during a 3-year period in an attempt to partially replicate and further expand a previous study conducted in Greece among CHD patients, which indicated a strong association between certain dimensions of Emotional Intelligence and the incidence of CHD. All participants completed a self-report questionnaire, assessing several aspects of Emotional Intelligence. The results showed that there is a link between the regulation of emotions and the occurrence of CHD. The evidence reported in the present study makes stronger the claim that EI plays a significant role in the occurrence of CHD.

  6. Digital radiographic assessment of coronary flow reserve

    International Nuclear Information System (INIS)

    Vogel, R.A.

    1985-01-01

    A method for measuring relative changes in regional blood flow using digital radiographic enhancement of selective coronary arteriography. Coronary flow reserve is measured in individual arterial distributions using the washin ratio of contrast appearance time under baseline and hyperemic conditions. Information is quantitatively presented in functional (parametric) image format. These images, termed contrast medium appearance pictures (CMAP), depict the transit of contrast through the arterial, myocardial and early venous stages. This process can be divided into three general phases: data acquisition, CMAP formation and CMAP analysis. The technique has evolved over its development period from a cine film-based technology which required substantial processing time to a real-time digital radiographic technique

  7. Modern antiplatelet agents in coronary artery disease.

    LENUS (Irish Health Repository)

    Power, Rachel F

    2012-10-01

    Dual antiplatelet therapy is well recognized in the prevention of thrombotic complications of acute coronary syndrome and percutaneous coronary interventions. Despite clinical benefits of aspirin and clopidogrel therapy, a number of limitations curtail their efficacy: slow onset of action, variability in platelet inhibitory response and potential drug-drug interactions. Furthermore, the single platelet-activation pathway targeted by these agents allows continued platelet activation via other pathways, ensuring incomplete protection against ischemic events, thus, underscoring the need for alternate antiplatelet treatment strategies. A number of novel antiplatelet agents are currently in advance development and many have established superior effects on platelet inhibition, clinical outcomes and safety profile than clopidogrel in high-risk patients. The aim of this review is to provide an overview of the current status of P2Y12 receptor inhibition and PAR-1 antagonists in determining a future strategy for individualized antiplatelet therapy.

  8. [Absorbable coronary stents. New promising technology].

    Science.gov (United States)

    Erbel, Raimund; Böse, Dirk; Haude, Michael; Kordish, Igor; Churzidze, Sofia; Malyar, Nasser; Konorza, Thomas; Sack, Stefan

    2007-06-01

    Coronary stent implantation started in Germany 20 years ago. In the beginning, the progress was very slow and accelerated 10 years later. Meanwhile, coronary stent implantation is a standard procedure in interventional cardiology. From the beginning of permanent stent implantation, research started to provide temporary stenting of coronary arteries, first with catheter-based systems, later with stent-alone technology. Stents were produced from polymers or metal. The first polymer stent implantation failed except the Igaki-Tamai stent in Japan. Newly developed absorbable polymer stents seem to be very promising, as intravascular ultrasound (IVUS) and optical coherence tomography have demonstrated. Temporary metal stents were developed based on iron and magnesium. Currently, the iron stent is tested in peripheral arteries. The absorbable magnesium stent (Biotronik, Berlin, Germany) was tested in peripheral arteries below the knee and meanwhile in the multicenter international PROGRESS-AMS (Clinical Performance and Angiographic Results of Coronary Stenting with Absorbable Metal Stents) study. The first magnesium stent implantation was performed on July 30, 2004 after extended experimental testing in Essen. The magnesium stent behaved like a bare-metal stent with low recoil of 5-7%. The stent struts were absorbed when tested with IVUS. Stent struts were not visible by fluoroscopy or computed tomography (CT) as well as magnetic resonance imaging (MRI). That means, that the magnesium stent is invisible and therefore CT and MRI can be used for imaging of interventions. Only using micro-CT the stent struts were visible. The absorption process could be demonstrated in a patient 18 days after implantation due to suspected acute coronary syndrome, which was excluded. IVUS showed a nice open lumen. Stent struts were no longer visible, but replaced by tissue indicating the previous stent location. Coronary angiography after 4 months showed an ischemia-driven target lesion

  9. [Coronary stents: 30 years of medical progress].

    Science.gov (United States)

    Silvain, Johanne; Cayla, Guillaume; Collet, Jean-Philippe; Fargeot, Catherine; Montalescot, Gilles

    2014-03-01

    The history of interventional cardiology has been marked by several technologic revolutions since the late 1970s. The first key step was the use of inflatable balloon angioplasty as an alternative to CABG surgery for coronary revascularization, followed by intracoronary delivery of bare metal stent (BMS) and drug eluting stents (DES) to drastically reduce intracoronary restenosis observed with BMS. Improved stents platforms and polymers (absorbable or biocompatible) led to a dramatic reduction in the rate of late stent thrombosis. Self-expanding stents are now available to improve stent a position especially in acute myocardial infarction. The emergence of new fully bioabsorbable stents that can be combined with antiproliferative drugs is the ongoing revolution. A new generation of stents is continuously improving and likely to become the ideal stent for coronary revascularization in the near future. © 2014 médecine/sciences – Inserm.

  10. Intravascular photoacoustic imaging of human coronary atherosclerosis

    Science.gov (United States)

    Jansen, Krista; van der Steen, Antonius F. W.; Springeling, Geert; van Beusekom, Heleen M. M.; Oosterhuis, J. Wolter; van Soest, Gijs

    2011-03-01

    We demonstrate intravascular photoacoustic imaging of human coronary atherosclerotic plaque. We specifically imaged lipid content, a key factor in vulnerable plaques that may lead to myocardial infarction. An integrated intravascular photoacoustics (IVPA) and ultrasound (IVUS) catheter with an outer diameter of 1.25 mm was developed. The catheter comprises an angle-polished optical fiber adjacent to a 30 MHz single-element transducer. The ultrasonic transducer was optically isolated to eliminate artifacts in the PA image. We performed measurements on a cylindrical vessel phantom and isolated point targets to demonstrate its imaging performance. Axial and lateral point spread function widths were 110 μm and 550 μm, respectively, for PA and 89 μm and 420 μm for US. We imaged two fresh human coronary arteries, showing different stages of disease, ex vivo. Specific photoacoustic imaging of lipid content, is achieved by spectroscopic imaging at different wavelengths between 1180 and 1230 nm.

  11. Radial pseudoaneurysm following diagnostic coronary angiography

    Directory of Open Access Journals (Sweden)

    Shankar Laudari

    2015-06-01

    Full Text Available The radial artery access has gained popularity as a method of diagnostic coronary catheterization compared to femoral artery puncture in terms of vascular complications and early ambulation. However, very rare complication like radial artery pseudoaneurysm may occur following cardiac catheterization which may give rise to serious consequences. Here, we report a patient with radial pseudoaneurysm following diagnostic coronary angiography. Adequate and correct methodology of compression of radial artery following puncture for maintaining hemostasis is the key to prevention.DOI: http://dx.doi.org/10.3126/jcmsn.v10i3.12776 Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 48-50

  12. Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD

    DEFF Research Database (Denmark)

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

    2016-01-01

    and the endothelial-independent aspect of CMD assessed as a coronary flow velocity reserve (CFVR). METHODS: We included 339 women with chest pain suggestive of angina pectoris and a diagnostic invasive coronary angiogram without significant coronary artery stenosis (

  13. Directional atherectomy for treatment of restenosis within coronary stents: clinical, angiographic and histologic results

    NARCIS (Netherlands)

    B.H. Strauss (Bradley); V.A.W.M. Umans (Victor); R-J. van Suylen (Robert-Jan); P.J. de Feyter (Pim); J. Marco (Jean); G. Robertson; J. Renkin; G.R. Heyndrickx (Guy); V.D. Vuzevski (Vojislav); F.T.B. Bosman (Fré); P.W.J.C. Serruys (Patrick)

    1992-01-01

    textabstractAbstract OBJECTIVES: The safety and long-term results of directional coronary atherectomy in stented coronary arteries were determined. In addition, tissue studies were performed to characterize the development of restenosis. METHODS: Directional coronary atherectomy was performed in

  14. Coronary CT Angiography Derived Fractional Flow Reserve

    DEFF Research Database (Denmark)

    Nørgaard, Bjarne Linde; Jensen, Jesper Møller; Blanke, Philipp

    2017-01-01

    Purpose of Review: To summarize the scientific basis of CT derived fractional flow reserve (FFRCT) and present an updated review on the evidence from clinical trials and real-world observational data Recent Findings: In prospective multicenter studies of patients with stable coronary artery disea...... of patients with stable CAD. The optimal FFRCT testing interpretation strategy, as well as the relative cost-efficiency of FFRCT against standard noninvasive functional testing, need further investigation....

  15. Acute coronary syndrome in the elderly.

    Science.gov (United States)

    Shanmugasundaram, Madhan; Alpert, Joseph S

    2009-11-01

    The spectrum of acute coronary syndrome (ACS) including unstable angina, non-ST-elevation myocardial infarction and ST-elevation myocardial infarction accounts for increasing numbers of deaths among persons age > or = 65 years in the US. This is important given demographic changes involving falling birth rates and increasing life expectancy. Elderly patients are likely to benefit the most from treatment of ACS, even though community practice still demonstrates less use of cardiac medications as an early-invasive approach among this population.

  16. Cardiac Computed Tomography as an Imaging Modality in Coronary Anomalies.

    Science.gov (United States)

    Karliova, Irem; Fries, Peter; Schmidt, Jörg; Schneider, Ulrich; Shalabi, Ahmad; Schäfers, Hans-Joachim

    2018-01-01

    Coronary artery fistulae and coronary aneurysms are rare anomalies. When they become symptomatic, they require precise anatomic information to allow for planning of the therapeutic procedure. We report a case in which both fistulae and aneurysm were present. The required information could only be obtained by electrocardiogram-gated computed tomography with reformation. This imaging modality should be considered in every case of fistula or coronary aneurysm. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. False coronary dissection with the new Monorail angioplasty balloon catheter.

    Science.gov (United States)

    Esplugas, E; Cequier, A R; Sabaté, X; Jara, F

    1990-01-01

    During percutaneous transluminal coronary angioplasty, the appearance of persistent staining in the vessel by contrast media suggests coronary dissection. We report seven patients in whom a false image of severe coronary dissection was observed during angioplasty performed with the new Monorail balloon catheter. This image emerges at the moment of balloon inflation, is distally located to the balloon, and disappears with balloon catheter deflation. No complications were associated with the appearance of this image.

  18. A tomographic approach to intravenous coronary arteriography

    International Nuclear Information System (INIS)

    Ritman, E.L.; Bove, A.A.

    1986-01-01

    Coronary artery anatomy can be visualized using high speed, volume scanning X-ray CT. A single scan during a bolus injection of contrast medium provides image data for display of all angles of view of the opacified coronary arterial tree. Due to the tomographic nature of volume image data the superposition of contrast filled cardiac chambers, such as would occur in the levophase of an intravenous injection of contrast agent, can be eliminated. Data are presented which support these statements. The Dynamic Spatial Reconstructor (DSR) was used to scan a life-like radiologic phantom of an adult human thorax in which the left atrial and ventricular chambers and the major epicardial coronary arteries were opacified so as to simulate the levophase of an intravenous injection of contrast agent. A catheter filled with diluted contrast agent and with regions of luminal narrowing (i.e. 'stenoses') was advanced along a tract equivalent to a right ventricular catheterization. Ease of visualization of the catheter 'stenoses' and the accuracy with which they can be measured are presented. (Auth.)

  19. Contrast agent choice for intravenous coronary angiography

    International Nuclear Information System (INIS)

    Zeman, H.D.; Siddons, D.P.

    1989-01-01

    The screening of the general population for coronary artery disease would be practical if a method existed for visualizing the extent of occlusion after an intravenous injection of contrast agent. Measurements performed with monochromatic synchrotron radiation x-rays and an iodine containing contrast agent at the Stanford Synchrotron Radiation Laboratory have shown that such an intravenous angiography procedure would be possible with an adequately intense monochromatic x-ray source. Because of the size and cost of synchrotron radiation facilities it would be desirable to make the most efficient use of the intensity available, while reducing as much as possible the radiation dose experienced by the patient. By choosing contrast agents containing elements with a higher atomic number than iodine, it is possible to both improve the image quality and reduce the patient radiation dose, while using the same synchrotron source. By using Si monochromator crystals with a small mosaic spread, it is possible to increase the x-ray flux available for imaging by over an order of magnitude, without any changes in the storage ring or wiggler magnet. The most critical imaging task for intravenous coronary angiography utilizing synchrotron radiation x-rays is visualizing a coronary artery through the left ventricle or aorta which also contains a contrast agent. Calculations have been made of the signal to noise ratio expected for this imaging task for various contrast agents with atomic numbers between that of iodine and bismuth

  20. Anomalous Coronary Artery From the Opposite Sinus (ACAOS): Technical Challenges During Percutaneous Coronary Intervention.

    Science.gov (United States)

    Sinha, Santosh Kumar; Razi, Mahmodula; Mahrotra, Anupam; Aggarwal, Puneet; Singh, Anupam; Rekwal, Lokendra; Tripathi, Sunil; Abhishekh, Nishant Kumar; Krishna, Vinay

    2018-04-01

    Anomalies of the coronary arteries are reported in 1-2% of patients among diagnostic angiogram. Ectopic origin of right coronary artery (RCA) from opposite sinus is one of the most common and they are mainly benign, but at times may be malignant. We report a case of a 69-year-old male who underwent early invasive percutaneous coronary intervention for non-ST-segment elevation myocardial infarction (NSTEMI) where RCA arising from left sinus at the root of left main artery was culprit and various technical challenges were encountered while intervening in form of cannulation to tracking of hardwares. RCA was cannulated with floating wire technique using hockey stick guide catheter and revascularized by deployment of 3.5 × 38 mm Promus Premier Everolimus eluting stent (Boston Scientific, USA). To the best of our knowledge, this is the first ever report of ectopic RCA being revascularized by using hockey stick catheter.

  1. Acute Coronary Syndromes: From The Laboratory Markers To The Coronary Vessels

    Directory of Open Access Journals (Sweden)

    Palazzuoli Alberto

    2006-01-01

    Full Text Available A number of "interesting" risk markers have been proposed as providing prognostic information in acute coronary syndromes (ACS. Elevation in plasma inflammatory and necrosis biomarkers have been related to future cardiovascular events in individuals with or without prior myocardial infarction. Recently BNP and pro-BNP are entered in clinical practice to recognize patients at major risk, providing incremental information respect to the traditional markers. Together with these laboratory indexes, a few of promising laboratory markers once easily available, could become useful in identification of patients at high risk. Several studies evaluated many markers of platelet aggregation, endothelial dysfunction and vascular thrombosis, but it is not yet clear whether each of the proposed markers may provide incremental predictive information. We describe, following the most studies reported in literature, the laboratory markers with potential clinical and prognostic power that could early help physicians in the identifi cation of patients with impaired coronary disease and more narrowed coronary arteries.

  2. Increase in stenotic resistance following a brief coronary occlusion in the anesthetized open-chest dog.

    OpenAIRE

    Saito, Daiji; Yasuhara, Koichiro; Takeda, Hikaru; Hyodo, Tatuo; Yamada, Nobuyuki; Uchida, Toshiaki; Haraoka, Shoichi; Nagashima, Hideo

    1982-01-01

    Changes in the stenotic resistance of a coronary artery following brief coronary occlusion were studied in the anesthetized open-chest dog. A critical coronary stenosis was constructed by tying a thick string around the circumflex coronary artery (LCx) near its origin. The LCx was occluded for 5, 10, 15, 20 and 30 seconds with and without coronary stenosis then the reactive hyperemia was observed. In the absence of the stenosis, resistance of the segment of the large coronary artery remained ...

  3. Reverse 201Tl myocardial redistribution induced by coronary artery spasm

    International Nuclear Information System (INIS)

    Xiang Dingcheng; Yin Jilin; Gong Zhihua; Xie Zhenhong; Zhang Jinhe; Wen Yanfei; Yi Shaodong

    2010-01-01

    Objective: To investigate the mechanism of reverse redistribution (RR) on dipyridamole 201 Tl myocardial perfusion studies in the patients with coronary artery spasm. Methods: Twenty-six patients with coronary artery spasm and presented as RR on dipyridamole 201 Tl myocardial perfusion studies were enlisted as RR group, while other 16 patients with no coronary artery stenosis nor RR were enlisted as control group. Dipyridamole test was repeated during coronary angiography. Corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) were measured at RR related and non-RR related coronary arteries before and after dipyridamole infusion respectively. All of the data were analyzed by Student's t-test or χ 2 -test and correlation analysis. Results: Coronary artery angiography showed slower blood flow and lower myocardial perfusion in RR related vessels when compared with non-RR related vessels in RR group, but there was no significant difference among the main coronary arteries in control group. The perfusion defects of RR area at rest were positively related to slower blood velocity at corresponding coronary arteries (r = 0.79, t =10.18, P 0.05). Conclusion: RR is related to the decreased blood flow and myocardial perfusion induced by coronary artery spasm at rest, which may be improved by stress test such as intravenous dipyridamole infusion. (authors)

  4. [Magnetic resonance compatibility research for coronary mental stents].

    Science.gov (United States)

    Wang, Ying; Liu, Li; Wang, Shuo; Shang, Ruyao; Wang, Chunren

    2015-01-01

    The objective of this article is to research magnetic resonance compatibility for coronary mental stents, and to evaluate the magnetic resonance compatibility based on laboratory testing results. Coronary stents magnetic resonance compatibility test includes magnetically induced displacement force test, magnetically induced torque test, radio frequency induced heating and evaluation of MR image. By magnetic displacement force and torque values, temperature, and image distortion values to determine metal coronary stent demagnetization effect. The methods can be applied to test magnetic resonance compatibility for coronary mental stents and evaluate its demagnetization effect.

  5. Transesophageal echocardiography in the assessment of coronary arteries

    International Nuclear Information System (INIS)

    Adamek-Kosmider, A.; Kasprzak, J.; Kosmider, M.; Krzeminska-Pakula, M.

    1993-01-01

    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)

  6. Rationale of physical rehabilitation of patients with violation coronary circulation

    Directory of Open Access Journals (Sweden)

    Anvar Morad Pour Heidari Roudberi

    2013-09-01

    Full Text Available The aim of the study is to examine the risk factors that lead to the violation of the coronary circulation. Rationale for the use of physical rehabilitation to restore optimal hemodynamics in the myocardium. Considered views on the causes of the high mortality rate of the population of Ukraine of cardiovascular disease. It is shown that the main cause of death is coronary heart disease. Suggested that the major risk factors for coronary heart disease is high cholesterol, hypertension and obesity. Proposed to use exercise therapy, dosage walking, psychotherapy, autogenic training and diet therapy in rehabilitation program patients with impaired coronary circulation.

  7. Left main coronary artery disease: pathophysiology, diagnosis, and treatment.

    Science.gov (United States)

    Collet, Carlos; Capodanno, Davide; Onuma, Yoshinobu; Banning, Adrian; Stone, Gregg W; Taggart, David P; Sabik, Joseph; Serruys, Patrick W

    2018-06-01

    The advent of coronary angiography in the 1960s allowed for the risk stratification of patients with stable angina. Patients with unprotected left main coronary artery disease have an increased risk of death related to the large amount of myocardium supplied by this vessel. Although coronary angiography remains the preferred imaging modality for the evaluation of left main coronary artery stenosis, this technique has important limitations. Angiograms of the left main coronary artery segment can be difficult to interpret, and almost one-third of patients can be misclassified when fractional flow reserve is used as the reference. In patients with clinically significant unprotected left main coronary artery disease, surgical revascularization was shown to improve survival compared with medical therapy and has been regarded as the treatment of choice for unprotected left main coronary artery disease. Two large-scale clinical trials published in 2016 support the usefulness of catheter-based revascularization in selected patients with unprotected left main coronary artery disease. In this Review, we describe the pathophysiology of unprotected left main coronary artery disease, discuss diagnostic approaches in light of new noninvasive and invasive imaging techniques, and detail risk stratification models to aid the Heart Team in the decision-making process for determining the best revascularization strategy for these patients.

  8. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Tonino, Pim A L; De Bruyne, Bernard; Pijls, Nico H J

    2009-01-01

    of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes. METHODS: In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug......BACKGROUND: In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio...

  9. Cardiac computed tomography in patients with acute coronary syndrome

    International Nuclear Information System (INIS)

    Schlett, C.L.; Bamberg, F.

    2014-01-01

    Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

  10. Association between neutrophil/lymphocyte ratio and coronary collateral circulation

    Directory of Open Access Journals (Sweden)

    Mustafa Oylumlu

    2012-03-01

    Full Text Available Objectives: To investigate relation between neutrophil/lymphocyte ratio and coronary collateral flow.Material and methods: Eighty-two patients admittedDicle University Medical Faculty Hospital Cardiology Departmentwith diagnosis of coronary artery disease anddetected significant stenosis or occlusion at least one ofthe coronary arteries, were included to study. Age, sex,presence of diabetes mellitus and hypertension, acute/stable coronary disease, body mass index, neutrophil/lymphocyte ratio, white blood count, Rentrop scores andnumber of diseased vessel were recorded.Results: Well-developed coronary collateral circulationwas found in 33 of the patients. Forty-nine patients hadpoor coronary collateral circulation. Mean age, sex, bodymass index, presence of diabetes mellitus and hypertensionwere similar in two groups. Mean neutrophil/lymphocyteratio was lower in well-developed coronary collateralcirculation group than poor coronary collateral circulationgroup, but there was no significant differences (2.78 vs2.89, p=0.12.Conclusions: There was no association between neutron/hil lymphocyte ratio and coronary collateral circulationaccording to our data. J Clin Exp Invest 2012; 3(1:29-32

  11. Coronary arterio-venous fistula associated acute coronary syndrome: A case-report and review of literature

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    V.H. Contreras-Gutiérrez

    2017-01-01

    Full Text Available A 56-year-old woman with no medical history presented to the emergency department complaining of oppressive chest pain of three hours of duration triggered by walking. An electrocardiogram (ECG performed at hospital admission showed ST-segment depression and T-wave inversion in left precordial and inferior leads. Serum troponin I levels were above the normal values. Non ST-segment elevation acute coronary syndrome (NSTEACS was diagnosed and an invasive approach with a percutaneous coronary intervention was performed. No obstructive coronary lesions were observed. However a tortuous coronary fistula emerging from the left-anterior descending coronary artery to the pulmonary artery was observed. Coronary arterio-venous fistulas are present in 0.002% of the general population and in 0.25% of patients undergoing cardiac catheterization for any cause. Most of them are asymptomatic. Ischemic symptoms may develop but are infrequent in patients with no atherosclerotic disease.

  12. 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...... in CAD patients. The aim of this study was to examine the relationship among CFR, systolic and diastolic function, peripheral vascular function, and cardiopulmonary fitness in CAD patients. Methods and Results Forty patients with median left ventricular ejection fraction (LVEF) 49 (interquartile 46....... 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...

  13. CT coronary angiography versus conventional invasive coronary angiography. The view of the referring physician

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, Martin H. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Universitaetsspital Bern (Switzerland). Dept. fuer Diagnostische, Interventionelle und Paediatrische Radiologie; Zimmermann, E.; Hamm, B. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Dewey, M.

    2014-12-15

    Assessment of experience gained by local referring physicians with the procedure of coronary computed tomographic angiography (CCTA) in the everyday clinical routine. A 25-item questionnaire was sent to 179 physicians, who together had referred a total of 1986 patients for CCTA. They were asked about their experience to date with CCTA, the indications for coronary imaging, and their practice in referring patients for noninvasive CCTA or invasive catheter angiography. 53 questionnaires (30%) were assessable, corresponding to more than 72% of the patients referred. Of the referring physicians who responded, 94% saw a concrete advantage of CCTA in the treatment of patients, whereby 87% were 'satisfied' or 'very satisfied' with the reporting. For excluding coronary heart disease (CHD) where there was a low pre-test probability of disease, the physicians considered CCTA to be superior to conventional coronary diagnosis (4.2 on a scale of 1-5) and vice versa for acute coronary syndrome (1.6 of 5). The main reasons for unsuitability of CCTA for CT diagnosis were claustrophobia and the absence of a sinus rhythm. The level of exposure to radiation in CCTA was estimated correctly by only 42% of the referring physicians. 90% of the physicians reported that their patients evaluated their coronary CT overall as 'positive' or 'neutral', while 87% of the physicians whose patients had undergone both procedures reported that the patients had experienced CCTA as the less disagreeable of the two. CCTA is accepted by the referring physicians as an alternative imaging procedure for the exclusion of CHD and received a predominantly positive assessment from both the referring physicians and the patients.

  14. Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms

    Directory of Open Access Journals (Sweden)

    Dinesha Basavanna

    2017-01-01

    Full Text Available Aim: Spontaneous coronary artery dissection (SCAD is a rare cause of angina, myocardial infarction (MI, and sudden cardiac death (SCD and may frequently manifest as acute coronary syndrome (ACS. The diagnosis of SCAD relies on angiographic visualization of a radiolucent intimal flap. Therapeutic options include medical therapy, percutaneous coronary interventions, and bypass surgery. The aim of this study is to analyze the clinical profile, inhospital outcomes, management, and follow-up of patients with angiographic SCAD. Methods: About 19,676 diagnostic coronary angiograms (CAGs were reviewed retrospectively during a 2-year period; 64 patients had SCAD and were included in the study. Complete medical histories before and during the event as well as treatment regimens were obtained from patients' hospital files. Results: A total of 64 cases of SCAD were considered for the study within an age range of 25–70 years. Fifty-eight patients presented with ACS, two patients presented with unstable angina, one patient presented with rheumatic mitral stenosis in atrial fibrillation, one patient presented with non-ST-elevation myocardial infarction, one patient with dilated cardiomyopathy with left ventricular dysfunction, and one patient with effort. Out of 64 patients, four patients died and the average hospital stay is 3–5 days. Conclusion: SCAD occurs in 0.32% of patients undergoing CAG for evaluation of coronary artery disease. Majority of SCAD occurs in men. The left coronary artery is most commonly affected. The inhospital outcomes are good. Most of the patients with SCAD have good prognosis following optimal medical therapy.

  15. Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Francisco Flávio Costa Filho

    2015-11-01

    Full Text Available AbstractBackground:Guidelines recommend that in suspected stable coronary artery disease (CAD, a clinical (non-invasive evaluation should be performed before coronary angiography.Objective:We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.Methods:We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.Results:A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77, age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26, diabetes (OR, 2.01; CI 95%, 1.40 - 2.90, dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07, typical angina (OR, 2.92; CI 95%, 1.77 - 4.83 and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27.Conclusions:In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

  16. Topographic association of angioscopic yellow plaques with coronary atherosclerotic plaque: assessment with quantitative colorimetry in human coronary artery autopsy specimens.

    Science.gov (United States)

    Ishibashi, Fumiyuki; Lisauskas, Jennifer B; Kawamura, Akio; Waxman, Sergio

    2008-01-01

    Yellow plaques seen during coronary angioscopy are thought to be the surrogates for superficial intimal lipids in coronary plaque. Given diffuse and heterogeneous nature of atherosclerosis, yellow plaques in coronaries may be seen as several yellow spots on diffuse coronary plaque. We examined the topographic association of yellow plaques with coronary plaque. In 40 non-severely stenotic ex-vivo coronary segments (average length: 52.2 +/- 3.1 mm), yellow plaques were examined by angioscopy with quantitative colorimetry. The segments were cut perpendicular to the long axis of the vessel at 2 mm intervals, and 1045 slides with 5 microm thick tissue for whole segments were prepared. To construct the plaque surface, each tissue slice was considered to be representative of the adjacent 2 mm. The circumference of the lumen and the lumen border of plaque were measured in each slide, and the plaque surface region was constructed. Coronary plaque was in 37 (93%) of 40 segments, and consisted of a single mass [39.9 +/- 3.9 (0-100) mm, 311.3 +/- 47.4 (0.0-1336.2) mm2]. In 30 (75%) segments, multiple (2-9) yellow plaques were detected on a mass of coronary plaque. The number of yellow plaques correlated positively with coronary plaque surface area (r = 0.77, P colorimetry, some of them are associated with lipid cores underneath thin fibrous caps, may be used to assess the extent of coronary plaque. Further research using angioscopy could be of value to study the association of high-risk coronaries with acute coronary syndromes.

  17. Lumen and calcium characteristics within calcified coronary lesions. Comparison of computed tomography coronary angiography versus intravascular ultrasound

    OpenAIRE

    Noll, Dariusz; Kruk, Mariusz; Pręgowski, Jerzy; Kaczmarska, Edyta; Kryczka, Karolina; Pracoń, Radosław; Skwarek, Mirosław; Dzielińska, Zofia; Petryka, Joanna; Śpiewak, Mateusz; Lubiszewska, Barbara; Norwa-Otto, Bożena; Opolski, Maksymilian; Witkowski, Adam; Demkow, Marcin

    2013-01-01

    Introduction Computed tomography coronary angiography (CTCA) is a diagnostic method used for exclusion of coronary artery disease. However, lower accuracy of CTCA in assessment of calcified lesions is a significant factor impeding applicability of CTCA for assessment of coronary atherosclerosis. Aim To provide insight into lumen and calcium characteristics assessed with CTCA, we compared these parameters to the reference of intravascular ultrasound (IVUS). Material and methods Two hundred and...

  18. Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography

    Directory of Open Access Journals (Sweden)

    LaFramboise William A

    2012-12-01

    Full Text Available Abstract Background More than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no significant coronary lesions or do not require mechanical or surgical revascularization. Consequently, the ability to rule out clinically significant coronary artery disease (CAD using low cost, low risk tests of serum biomarkers in even a small percentage of patients with normal coronary arteries could be highly beneficial. Methods Serum from 359 symptomatic subjects referred for catheterization was interrogated for proteins involved in atherogenesis, atherosclerosis, and plaque vulnerability. Coronary angiography classified 150 patients without flow-limiting CAD who did not require percutaneous intervention (PCI while 209 required coronary revascularization (stents, angioplasty, or coronary artery bypass graft surgery. Continuous variables were compared across the two patient groups for each analyte including calculation of false discovery rate (FDR ≤ 1% and Q value (P value for statistical significance adjusted to ≤ 0.01. Results Significant differences were detected in circulating proteins from patients requiring revascularization including increased apolipoprotein B100 (APO-B100, C-reactive protein (CRP, fibrinogen, vascular cell adhesion molecule 1 (VCAM-1, myeloperoxidase (MPO, resistin, osteopontin, interleukin (IL-1β, IL-6, IL-10 and N-terminal fragment protein precursor brain natriuretic peptide (NT-pBNP and decreased apolipoprotein A1 (APO-A1. Biomarker classification signatures comprising up to 5 analytes were identified using a tunable scoring function trained against 239 samples and validated with 120 additional samples. A total of 14 overlapping signatures classified patients without significant coronary disease (38% to 59% specificity while maintaining 95% sensitivity for patients requiring

  19. Antithrombotic strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Son V Pham

    2010-09-01

    Full Text Available Son V Pham1, Phuong-Chi T Pham2, Phuong-Mai T Pham3, Jeffrey M Miller4, Phuong-Thu T Pham5, Phuong-Anh T Pham61Bay Pines VA Medical Center, Department of Cardiology, Bay Pines, FL, USA; 2Department of Medicine, Nephrology Division, UCLA-Olive View Medical Center, 3Department of Medicine, Greater Los Angeles VA Medical Center, 4Department of Medicine, Hematology-Oncology Division, UCLA-Olive View Medical Center, 5Department of Medicine, Nephrology Division, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 6Mercy General Hospital, Heart and Vascular Institute, Department of Cardiology, Sacramento, CA, USAAbstract: In patients undergoing percutaneous coronary intervention (PCI for acute coronary syndrome (ACS, both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings. While clopidogrel may be of little beneficial effect if administered immediately prior to PCI and may even increase major bleeding risk if coronary artery bypass grafting is anticipated, early discontinuation of the drug may result in insufficient antiplatelet coverage with thrombotic complications. Optimal and rapid inhibition of platelet activity to suppress ischemic and thrombotic events while minimizing bleeding complications is an important therapeutic goal in the management of patients undergoing percutaneous coronary intervention. In this article we present an overview of the literature on clinical trials evaluating the different aspects of antithrombotic therapy in patients

  20. Radial artery spasm occurred in transradial coronary intervention for coronary heart disease: its occurrence and predictors

    International Nuclear Information System (INIS)

    Zhong Jiming; Li Lang; Lu Yongguang; Zeng Shuyi

    2011-01-01

    Objective: To discuss the incidence and clinical predictors of radial artery spasm occurred in performing transradial coronary intervention for coronary heart disease. Methods: A total of 1020 patients, who underwent transradial coronary procedures for coronary heart disease during the period of May 2007 Jan 2010 in authors' hospital, were enrolled in this study. All clinical information and medication were recorded in detail. Arteriography via radial artery was performed in all patients. The diameter of the radial artery as well as the arterial anatomy, including arterial variations, were determined and observed, which was follow by coronary angiography or percutaneous coronary intervention. Multivariate Logistic regression analysis was adopted to evaluate the variables, such as clinical parameters, angiographic characteristics of the radial artery and procedure-related factors, in predicting the occurrence of radial artery spasm. Results: Radial artery spasm occurred in 209 (20.5%) patients. Multivariate Logistic regression analysis showed that the following eight factors were independently associated with the occurrence of radial artery spasm. These factors were as follows: female gender (OR=2.8, 95% CI 2.5-5.8; P=0.001), age (OR=0.68, 95% CI 0.60-0.92; P=0.003), smoking (OR=2.3, 95% CI 1.8-4.1; P=0.026), moderate-to-severe pain of forearm during radial artery cannulation (OR=3.0, 95% CI 2.3-4.8; P=0.006), radial artery anatomical abnormalities (OR=4.7, 95% CI 3.6-7.2; P=0.002), the ratio of radial artery diameter to patient's height (RAH) (OR=5.2, 95% CI 3.7-8.1; P=0.012), the ratio of radial artery diameter to outer diameter of the sheath (RAOD) (OR=5.8, 95% CI 4.2-6.9; P=0.006) and the number of catheter exchange (OR=2.3, 95% CI 1.4-4.3; P=0.038). Conclusion: Radial artery spasm occurred in performing transradial coronary intervention for coronary heart disease is frequently seen in clinical practice. Female gender, younger age, smoking, forearm pain during

  1. YKL-40 a new biomarker in patients with acute coronary syndrome or stable coronary artery disease

    DEFF Research Database (Denmark)

    Wang, Y.Z.; Ripa, R.S.; Johansen, J.S.

    2008-01-01

    Background. YKL-40 is involved in remodelling and angiogenesis in non-cardiac inflammatory diseases. Aim was to quantitate plasma YKL-40 in patients with ST-elevation myocardial infarction (STEMI) or stable chronic coronary artery disease (CAD), and YKL-40 gene activation in human myocardium....... Methods and results. We included 73 patients: I) 20 patients with STEMI; II) 28 patients with stable CAD; III) 15 CAD patients referred for coronary by-pass surgery. YKL-40 mRNA expression was measured in myocardium subtended by stenotic or occluded arteries and areas with no apparent disease; and IV) 10...

  2. Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq.

    Science.gov (United States)

    Mohammad, Ameen Mosa; Jehangeer, Hekmat Izzat; Shaikhow, Sabri Khalif

    2015-11-18

    Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. Given the lack of such studies in the country, this study examines the prevalence, associated cardiovascular risk factors, and coronary angiographic profile of the disease in Iraq. Data was collected from a total of 445 adult patients undergoing coronary angiography at Duhok Heart Center, Kurdistan in a period between March and September 2014. Patients were divided into PCAD (male 70 % compared to lesser obstruction. Premature coronary artery disease is alarming  in the country. Cardiovascular risk factors are clustered among them. But the angiographic profile and therapeutic options of PCAD are close to those reported from previous studies.

  3. MR measurement of coronary arterial blood flow velocity. Evaluation of age, stenosis and drugs as factors affecting coronary blood flow

    International Nuclear Information System (INIS)

    Taoka, Yoshiaki; Harada, Masafumi; Nishitani, Hiromu; Yukinaka, Michiko; Nomura, Masahiro

    1998-01-01

    Coronary arterial blood flow velocity was measured using MRI. Two types of phase contrast methods were used for the measurements, one of which exhibited good resolving power whereas the other provided more distinct images acquired while the subject patients held their breath. Before measuring coronary arterial blood flow velocity, accuracy of the two phase contrast methods was evaluated using a phantom. The results obtained with both methods largely agreed with the values obtained using the phantom. Using both methods, the patterns of coronary arterial blood flow over one cardiac cycle were essentially identical. A peak was noted in late systole or in early diastole in the right coronary artery, whereas in the left coronary artery, a peak was noted somewhat later in diastole. In healthy volunteers, no significant difference in the maximal flow velocity in the coronary arteries was found from one age group to another. Among patients with coronary arterial stenosis, coronary arterial blood flow velocity central to the area of stenosis was lower than that observed in the healthy volunteers. Coronary arterial blood flow velocity was observed to decrease after administration of isosorbide dinitrate and increased following administration of nifedipine. (author)

  4. Association of changes in health-related quality of life in coronary heart disease with coronary procedures and sociodemographic characteristics

    Directory of Open Access Journals (Sweden)

    Rollag Arnfinn

    2004-10-01

    Full Text Available Abstract Background Few studies have focused on the association between the sociodemographic characteristics of a patient with the change in health-related quality of life (HRQOL following invasive coronary procedures, and the results remain inconclusive. The objective of the present study was to measure the temporal changes in HRQOL of patients with coronary heart disease, and assess how these changes are associated with invasive coronary procedures and sociodemographic characteristics. Methods This was a prospective study of 254 patients with angina pectoris and 90 patients with acute coronary syndrome. HRQOL was assessed with the multi-item scales and summary components of the SF-36, both 6 weeks and 2 years after baseline hospitalization in 1998. Paired t-tests and multiple regression analyses were used to assess temporal changes in HRQOL and to identify the associated factors. Results Physical components of HRQOL had improved most during the 2 years following invasive coronary procedures. Our findings indicated that patients with angina pectoris who were younger, male, and more educated were most likely to increase their HRQOL following invasive coronary procedures. When adjusting for baseline HRQOL scores, invasive coronary procedures and sociodemographic characteristics did not explain temporal changes in patients with acute coronary syndrome, possibly due to higher comorbidity. Conclusion Sociodemographic characteristics should be taken into account when comparing and interpreting changes in HRQOL scores in patients with and without invasive coronary procedures.

  5. Intraoperative echocardiographic imaging of coronary arteries and graft anastomoses during coronary artery bypass grafting without cardiopulmonary bypass.

    Science.gov (United States)

    Suematsu, Y; Takamoto, S; Ohtsuka, T

    2001-12-01

    No accepted approach exists for the intraoperative evaluation of the quality of coronary arteries and the technical adequacy of graft anastomoses during coronary artery bypass grafting without cardiopulmonary bypass. We assessed the accuracy of high-frequency epicardial echocardiography and power Doppler imaging in evaluating coronary arteries during coronary artery bypass grafting without cardiopulmonary bypass. To validate measurements of coronary arteries and graft anastomoses by high-frequency epicardial echocardiography and power Doppler imaging, we compared luminal diameters determined by these methods with diameters determined histologically in a study of off-pump coronary artery bypass grafting in 20 dogs. Technical errors were deliberately created in 10 grafts (stenosis group). The results of these animal validation studies showed that the maximum luminal diameters of coronary arteries and graft anastomoses measured by high-frequency epicardial echocardiography (HEE) and power Doppler imaging (PDI) correlated well with the histologic measurements: HEE = 1.027 x Histologic measurements + 0.005 (P anastomoses were examined intraoperatively by high-frequency epicardial echocardiography and power Doppler imaging, and luminal diameters determined by power Doppler imaging were compared with those determined by postoperative coronary angiography. The results demonstrated that graft anastomosis by power Doppler imaging correlated well with the angiographic measurements: PDI = 1.018 x Angiographic measurements - 0.106 (P anastomoses and can detect technical errors and inadequacies during coronary artery bypass grafting without cardiopulmonary bypass.

  6. Statistical coronary motion models for 2D + t/3D registration of X-ray coronary angiography and CTA

    DEFF Research Database (Denmark)

    Baka, N.; Metz, C. T.; Schultz, C.

    2013-01-01

    Accurate alignment of intra-operative X-ray coronary angiography (XA) and pre-operative cardiac CT angiography (CTA) may improve procedural success rates of minimally invasive coronary interventions for patients with chronic total occlusions. It was previously shown that incorporating patient...... specific coronary motion extracted from 4D CTA increases the robustness of the alignment. However, pre-operative CTA is often acquired with gating at end-diastole, in which case patient specific motion is not available. For such cases, we investigate the possibility of using population based coronary...

  7. Acute coronary syndrome caused by coronary vasospasms associated with Churg-Strauss syndrome: effects of betamethasone therapy.

    Science.gov (United States)

    Suzuki, Yuji; Nishiyama, Osamu; Sakai, Toshiaki; Niiyama, Masanobu; Itoh, Tomonori; Nakamura, Motoyuki

    2014-01-01

    A 42-year-old woman with a history of aspirin-induced asthma was admitted with severe chest pain. Emergency coronary angiography revealed coronary artery spasms. The administration of vasodilators did not suppress the anginal symptoms, and the differential white blood cell count continued to show eosinophilia. The patient's symptoms of aspirin-induced asthma, eosinophilia and other allergic states led to the diagnosis of Churg-Strauss syndrome (CSS). After starting betamethasone therapy, the eosinophilia and cardiac symptoms rapidly disappeared. Although coronary vasospasms related to CSS are rare, the present case suggests that a differential white blood cell count should be obtained in patients with refractory coronary vasospasms.

  8. Cirsoid Aneurysm of Coronary Arteries Associated with Arterioventricular Fistula Evaluated by 64-Multidetector CT Coronary Angiography: Depiction of a Case

    International Nuclear Information System (INIS)

    Marrone, Gianluca; Mamone, Giuseppe; Milazzo, Mariapina; Caruso, Settimo; Baravoglia, Cesar Hernandez; Vitulo, Patrizio; Gridelli, Bruno; Luca, Angelo

    2009-01-01

    A female patient with severe pulmonary hypertension was admitted for lung transplant evaluation. As an incidental finding, the chest CT showed diffuse and dilated coronaries, not detected at previous echocardiography. A coronary CT angiography was then performed using a 64-multidetector computed tomography (MDCT) scanner to better evaluate the coronary tree. The images obtained after postprocessing demonstrated tremendously aneurysmatic and tortuous coronary arteries and the presence of a septal branch deepening into the myocardium and penetrating the right ventricle cavity, forming an abnormal arterioventricular fistula. A causal relation between the aneurysms and the fistula is suspected.

  9. Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Maffei, Erica; Seitun, Sara [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Nieman, Koen; Weustink, Annick C.; Mollet, Nico R. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Martini, Chiara [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Guaricci, Andrea Igoren [Azienda Ospedaliero-Universitaria di Foggia, Department of Cardiology, Foggia (Italy); Tedeschi, Carlo [Ospedale San Gennaro, Department of Cardiology, Naples (Italy); Berti, Elena; Grilli, Roberto [Regione Emilia-Romagna, Healthcare and Social Agency, Bologna (Italy); Messalli, Giancarlo [SDN Foundation, IRCCS, Naples (Italy); Cademartiri, Filippo [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Azienda Ospedaliero-Universitaria - Parma, Department of Radiology, Parma (Italy)

    2011-05-15

    To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). 147 diabetic (mean age: 65 {+-} 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 {+-} 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. Diabetics showed a higher number of diseased segments (4.1 {+-} 4.2 vs. 2.1 {+-} 3.0; p < 0.0001); a higher rate of CCS > 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS {<=} 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS {<=} 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics. (orig.)

  10. Systolic Compression of Epicardial Coronary and Intramural Arteries

    Science.gov (United States)

    Mohiddin, Saidi A.; Fananapazir, Lameh

    2002-01-01

    It has been suggested that systolic compression of epicardial coronary arteries is an important cause of myocardial ischemia and sudden death in children with hypertrophic cardiomyopathy. We examined the associations between sudden death, systolic coronary compression of intra- and epicardial arteries, myocardial perfusion abnormalities, and severity of hypertrophy in children with hypertrophic cardiomyopathy. We reviewed the angiograms from 57 children with hypertrophic cardiomyopathy for the presence of coronary and septal artery compression; coronary compression was present in 23 (40%). The left anterior descending artery was most often affected, and multiple sites were found in 4 children. Myocardial perfusion abnormalities were more frequently present in children with coronary compression than in those without (94% vs 47%, P = 0.002). Coronary compression was also associated with more severe septal hypertrophy and greater left ventricular outflow gradient. Septal branch compression was present in 65% of the children and was significantly associated with coronary compression, severity of septal hypertrophy, and outflow obstruction. Multivariate analysis showed that septal thickness and septal branch compression, but not coronary compression, were independent predictors of perfusion abnormalities. Coronary compression was not associated with symptom severity, ventricular tachycardia, or a worse prognosis. We conclude that compression of coronary arteries and their septal branches is common in children with hypertrophic cardiomyopathy and is related to the magnitude of left ventricular hypertrophy. Our findings suggest that coronary compression does not make an important contribution to myocardial ischemia in hypertrophic cardiomyopathy; however, left ventricular hypertrophy and compression of intramural arteries may contribute significantly. (Tex Heart Inst J 2002;29:290–8) PMID:12484613

  11. Effect of Heart Rate and Coronary Calcification on the Diagnostic Accuracy of the Dual-Source CT Coronary Angiography in Patients with Suspected Coronary Artery Disease

    International Nuclear Information System (INIS)

    Meng, Lingdong; Cui, Lianqun; Cheng, Yuntao; Wu, Xiaoyan; Tang, Yuansheng; Wang, Yong; Xu, Fayun

    2009-01-01

    To evaluate the diagnostic accuracy of a dual-source computed tomography (DSCT) coronary angiography, with a particular focus on the effect of heart rate and calcifications. One hundred and nine patients with suspected coronary disease were divided into 2 groups according to a mean heart rate ( 400). Next, the effect of heart rate and calcification on the accuracy of coronary artery stenosis detection was analyzed by using an invasive coronary angiography as a reference standard. Coronary segments of less than 1.5 mm in diameter in an American Heart Association (AHA) 15-segment model were independently assessed. The mean heart rate during the scan was 71.8 bpm, whereas the mean Agatston score was 226.5. Of the 1,588 segments examined, 1,533 (97%) were assessable. A total of 17 patients had calcium scores above 400 Agatston U, whereas 50 had heart rates ≥ 70 bpm. Overall the sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) for significant stenoses were: 95%, 91%, 65%, and 99% (by segment), respectively and 97%, 90%, 81%, and 91% (by artery), respectively (n = 475). Heart rate showed no significant impact on lesion detection; however, vessel calcification did show a significant impact on accuracy of assessment for coronary segments. The specificity, PPV and accuracy were 96%, 80%, and 96% (by segment), respectively for an Agatston score less than 100% and 99%, 96% and 98% (by artery). For an Agatston score of greater to or equal to 400 the specificity, PPV and accuracy were reduced to 79%, 55%, and 83% (by segment), respectively and to 79%, 69%, and 85% (by artery), respectively. The DSCT provides a high rate of accuracy for the detection of significant coronary artery disease, even in patients with high heart rates and evidence of coronary calcification. However, patients with severe coronary calcification (> 400 U) remain a challenge to diagnose

  12. Evaluation of hemodynamic significance of coronary fistulae. Diagnostic integration between coronary angiography and stress/rest myocardial scintigraphy

    International Nuclear Information System (INIS)

    Rubini, G.; Sebastiani, M.

    2000-01-01

    It is here reported on the importance of the integration of data obtained from digital coronary angiography and stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography in evaluationing the hemodynamic significance of coronary arteriovenous fistulae. Coronary fistulae were detected with coronary angiography in 9 patients. All patients underwent clinical examination, trans thoracic echocardiography, stress electrocardiogram and stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography. Stress/rest 99m Tc sestamibi myocardial perfusion single photon tomography and stress electrocardiogram showed stress-induced myocardial ischemia in 2 patients. The first patient with familial predisposition and risk factors for ischemic heart disease presented a mesocardic heart murmur on clinical examination. At stress ECG (125 Watt, 153 b/m max frequency 93%, arterial pressure 230 mmHg, max frequency pressure product 35200) ischemic alterations were recorded at the first minute of the second stage of the Bruce protocol. Coronary angiography detected a circumflex artery fistula in the coronary sinus. Stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography for the evaluation of stress/rest perfusion detected a reversible perfusion defect of the proximal portion of the posterolateral and lateral walls, thus confirming the hemodynamic importance of the flow through the fistula during stress cycloergometric testing. In the second patient familial predisposition to ischemic heart disease and previous inferior wall myocardial infarction and non-significant stress ECG, coronary angiography identified a seclusive stenosis of the right coronary artery and anomaly between the anterior interventricular artery and the left pulmonary artery. The presence of the contrast medium in the left pulmonary artery identified a flow from the left ventricle to the left pulmonary artery. Good angiographic results were obtained

  13. [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...

  14. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Hwan; Chun, Eun Ju; Kim, Yeo Koon; Yoo, Jin Young; Choi, Sang Il; Choi, Dong Ju [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-07-15

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

  15. 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.

  16. Quantification of coronary artery calcium on the basis of dual-energy coronary CT angiography.

    Science.gov (United States)

    Schwarz, Florian; Nance, John W; Ruzsics, Balazs; Bastarrika, Gorka; Sterzik, Alexander; Schoepf, U Joseph

    2012-09-01

    To evaluate the feasibility of using virtual noncontrast material-enhanced (VNC) computed tomographic (CT) series derived from dual-energy CT imaging studies for coronary artery calcium quantification. This HIPAA-compliant study was institutional review board approved; all patients provided written informed consent. Thirty-six patients prospectively underwent noncontrast-enhanced CT calcium scoring followed by coronary CT angiography performed in dual-energy mode. By using different reconstruction algorithms, three VNC series were generated and evaluated for noise and efficiency of virtual iodine removal. Two readers independently quantified calcium on VNC images and true noncontrast-enhanced conventional calcium scoring series. A leave-one-out cross validation was used to assess the accuracy of calcium score prediction from VNC series by means of linear regression. CT value histograms of the VNC series closely resembled the profile in the true noncontrast-enhanced series. There was excellent correlation between calcium volumes on the VNC series and true noncontrast-enhanced series on a per-patient (r = 0.94, P VNC series was excellent (r = 0.82). Multiethnic Study of Atherosclerosis rankings that were derived from the predicted calcium scores also showed excellent agreement (intraclass correlation coefficient = 0.909). Coronary artery calcium identification and quantification based on dual-energy coronary CT angiographic studies may obviate the need for dedicated CT calcium scoring studies. © RSNA, 2012

  17. Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery in Korea

    Directory of Open Access Journals (Sweden)

    Heeyoung Lee

    2016-12-01

    Full Text Available Background: Coronary angioplasty has been replacing coronary artery bypass grafting (CABG because of the relative advantage in terms of recovery time and noninvasiveness of the procedure. Compared to other Organization for Economic Cooperation and Development (OECD countries, Korea has experienced a rapid increase in coronary angioplasty volumes. Methods: We analyzed changes in procedure volumes of CABG and of percutaneous coronary intervention (PCI from three sources: the OECD Health Data, the National Health Insurance Service (NHIS surgery statistics, and the National Health Insurance claims data. Results: We found the ratio of procedure volume of PCI to that of CABG per 100,000 population was 19.12 in 2014, which was more than triple the OECD average of 5.92 for the same year. According to data from NHIS statistics, this ratio was an increase from 11.4 to 19.3 between 2006 and 2013. Conclusion: We found that Korea has a higher ratio of total procedure volumes of PCI with respect to CABG and also a more rapid increase of volumes of PCI than other countries. Prospective studies are required to determine whether this increase in absolute volumes of PCI is a natural response to a real medical need or representative of medical overuse.

  18. Coronary flow reserve/diastolic function relationship in angina-suffering patients with normal coronary angiography.

    Science.gov (United States)

    Anchisi, Chiara; Marti, Giuliano; Bellacosa, Ilaria; Mary, David; Vacca, Giovanni; Marino, Paolo; Grossini, Elena

    2017-05-01

    Coronary blood flow and diastolic function are well known to interfere with each other through mechanical and metabolic mechanisms. We aimed to assess the relationship between coronary flow reserve (CFR) and diastolic dysfunction in patients suffering from angina but with normal coronary angiography. In 16 patients with chest pain and angiographically normal coronary arteries, CFR was measured using transthoracic echo-Doppler by inducing hyperemia through dipyridamole infusion. Diastolic function (E/A, deceleration time, isovolumetric relaxation time [IVRT], propagation velocity [Vp]) and left ventricular mass were evaluated by means of two-dimensional transthoracic echocardiography. The patients were initially divided into two groups on the grounds of CFR only (ACFR: altered CFR, n = 9; NACFR: unaltered CFR, n = 7). Thereafter they were divided into four groups on the grounds of CFR and diastolic function (NN: normal; AA: altered CFR/diastole; AN: altered CFR/normal diastole; NA: normal CFR/altered diastole). Most of the subjects were scheduled in AA (n = 8) or NA (n = 5) groups, which were taken into consideration for further analysis. Patients were not different regarding various risk factors. ACFR and AA patients were older with normal body weight in comparison with NACFR and NA patients (P relationship between altered CFR and diastole.

  19. Three dimensional quantitative coronary angiography can detect reliably ischemic coronary lesions based on fractional flow reserve.

    Science.gov (United States)

    Chung, Woo-Young; Choi, Byoung-Joo; Lim, Seong-Hoon; Matsuo, Yoshiki; Lennon, Ryan J; Gulati, Rajiv; Sandhu, Gurpreet S; Holmes, David R; Rihal, Charanjit S; Lerman, Amir

    2015-06-01

    Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha'ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 ± 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm(2), %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.

  20. Multi-detector CT coronary angiographic findings of coronary-to-pulmonary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Seok; Park, Eun Ah; Lim, Ji Yeon; Lee, Whal [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Myongji Hospital, Seonam University College of Medicine, Goyang (Korea, Republic of)

    2017-01-15

    To evaluate multi-detector CT (MDCT) coronary angiographic findings of coronary-to-pulmonary artery fistula (CPAF). We retrospectively reviewed images of patients with CPAF from the coronary CT angiography (CCTA) database obtained with a 64-channel MDCT between January 2008 and March 2011. We analyzed the CCTA findings for feeding arteries, fistula, association with peripulmonary arterial aneurysms, and the presence of communication between the CPAF and bronchial arteries. Fifty-five of the 15042 (0.37%) patients were diagnosed with CPAFs. The feeding artery was single (n = 18) or multiple (n = 37). The fistula had a single drainage site (n = 54) or multiple drainage sites (n = 1). The mean diameter of the fistulous opening was 2.7 ± 1.4 mm. A peripulmonary arterial aneurysm was present in 24 (44%) patients. Communication between CPAF and bronchial arteries was present in eight (14.5%) patients. MDCT coronary angiography can provide comprehensive morphologic details on CPAF and may help in presurgical or preinterventional planning.

  1. Association of Dyslipidemia and Sex With Coronary Artery Calcium Assessed by Coronary Computed Tomography Angiography.

    Science.gov (United States)

    Asami, Masahiko; Yamaji, Kyohei; Aoki, Jiro; Tanimoto, Shuzou; Watanabe, Mika; Horiuchi, Yu; Furui, Koichi; Kato, Nahoko; Hara, Kazuhiro; Tanabe, Kengo

    2017-10-21

    Previous studies reporting that statin increases coronary artery calcium (CAC) were conducted exclusively on patients with statin as a prevention, regardless of the presence or absence of dyslipidemia. The impact of sex on CAC has not been fully evaluated. We aimed to determine the association of dyslipidemia and sex with CAC using 320-row multi-detector computed tomography (MDCT).Of the 356 consecutive patients who underwent coronary MDCT, 251 patients were enrolled, after excluding those with prior stenting and/or coronary bypass grafting or images showing motion artifacts. The primary outcome measures were the percent calcium volume (PCV) and percent atheroma volume (PAV) per coronary vessel.Multivariable analyses indicated that PCV was significantly higher in dyslipidemia patients without statins than in the subjects without dyslipidemia [partial regression coefficient (PRC): 2.59, 95% confidence interval (CI): 0.83 to 4.34, P = 0.004]. In contrast, PCV was similar in dyslipidemia patients taking statins and those without dyslipidemia (PRC: -1.09, 95% CI: -2.82 to 0.65, P = 0.22). There was no significant difference in PCV between men and women, although women exhibited a significantly lower PAV (PRC: -2.87, 95% CI: -4.54 to -1.20, P = 0.001).In low-risk patients, these results could be translated into hypotheses, which should be tested in future prospective studies. Furthermore, there was no significant difference in CAC between men and women, but women had lower PAV than men.

  2. Correlation between serum Hcy content and coronary atherosclerosis severity in patients with H-type hypertension and coronary heart disease

    Directory of Open Access Journals (Sweden)

    Xiao-Mei Li

    2017-03-01

    Full Text Available Objective: To analyze the correlation between serum Hcy content and coronary atherosclerosis severity in patients with H-type hypertension and coronary heart disease. Methods: 48 patients with H-type hypertension and coronary heart disease were selected as observation group, and 57 patients with normal hypertension and coronary heart disease were selected as control group. Echocardiography was used to determine coronary lesion parameters, enzymelinked immunosorbent assay (ELISA was used to determine serum levels of homocysteine (Hcy and coronary heart disease-related indexes, and the correlation between Hcy levels and coronary heart disease was further analyzed. Results: Serum Hcy level of observation group was higher than that of control group (P<0.05, absolute GLPSS value and E/A value under echocardiography were less than those of control group while E-DT and E/e value were higher than those of control group (P<0.05; serum adiponectin (APN level was lower than that of control group while P-selectin, asymmetric dimethylarginine (ADMA, oxidized high-density lipoprotein (OX-HDL, MMP-2, MMP-9, lipoprotein-associated phospholipase A2 (Lp-PLA2 and Resistin levels were higher than those of control group (P<0.05; Hcy was negatively correlated with absolute GLPSS value, E/A value and APN level, and was positively correlated with E-DT value, E/e value as well as P-selectin, ADMA, OX-HDL, MMP-2, MMP-9, Lp- PLA2 and Resistin levels (P<0.05. Conclusions: There is direct correlation between serum Hcy levels and the severity of coronary heart disease in patients with H-type hypertension and coronary heart disease, it can be a reliable way to early screen for coronary heart disease and evaluate the illness, and it is also a new target of coronary heart disease intervention.

  3. Coronary Angiography Findings and Its Determinants in Patients Presenting With Acute Coronary Syndrome: A Descriptive Analysis from Asian Population.

    Science.gov (United States)

    Chourasiya, M; Satheesh, S; Selvaraj, R; Jayaraman, B; Pillai, A A

    2017-10-01

    The aim was to study the angiographic profile in patients presented as acute coronary syndrome and its relation with risk factors and comparison between genders. This prospective observational study was performed on total 352 patients of acute coronary syndrome were analyzed for various risk factors, angiographic pattern in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, South India from January 2015 to July 2016. Mean age of presentation was 52.62±11.63 years. Male were 271(77.0%) and female were 81(23.0%). Majority of patients were STEMI (67.6%) followed by UA (24.4%) and NSTEMI (8%). Smoker was 117(33.3%) patients. Hypertensive were 124(35.2%) of patients and 149(42.3%) were diabetics. Family history of CAD was positive in 45(12.8%). On angiographic evaluation left main reference diameter was lower in females (4.02±0.72) than males (4.07±0.82). LAD was most commonly involved followed by RCA and LCX among all three group of acute coronary syndrome. Left main was least involved (8.3%). In STEMI SVD (40.3%) was most common presentation, after that DVD was seen in 22.3%, TVD in 10.5%, non-obstructive coronary was seen in 16% of patients and normal coronary was seen in 11% of patients. In UA 28%, 22.8%, 13.2%, 15.8%, 20.2% was seen in SVD, DVD, TVD, non-obstructive and normal coronary respectively. Long length coronary lesions (>20mm) were seen in majority in all type of acute coronary syndrome. Coronary lesion length was not associated with presentation acute coronary syndrome and genders. Male were most commonly presented as acute coronary syndrome. STEMI was most common presentation. Diabetic was most prevalent risk factor. SVD was most common angiographic pattern and LAD was most common involved arteries.

  4. Potential and limitations of wave intensity analysis in coronary arteries

    NARCIS (Netherlands)

    Siebes, M.; Kolyva, C.; Verhoeff, B.J.; Piek, J.J.; Spaan, J.A.

    2009-01-01

    Wave intensity analysis (WIA) is beginning to be applied to the coronary circulation both to better understand coronary physiology and as a diagnostic tool. Separation of wave intensity (WI) into forward and backward traveling components requires knowledge of pulse wave velocity at the point of

  5. f antihypertensive of coronary heart disease Hypertension in a rural

    African Journals Online (AJOL)

    1990-07-21

    Jul 21, 1990 ... a high body mass index, a high uric acid level, a high prevalence of coronary ... Little information exists on the prevalence of hypertension in white South ... selective ,B-blockers have adverse effects on lipid metabolism. Research ..... importance of attention to other coronary risk factors before and during ...

  6. Changing Trend in Coronary Heart Disease in Nigeria | Nwaneli ...

    African Journals Online (AJOL)

    Background: Coronary Heart Disease (CHD) is the greatest cause of death in Western countries but reported to be rare in sub-Saharan Africa. There are suggestions that the incidence of coronary heart disease is rising in Nigeria as a result of many factors. This review looks at the burden of CHD in Nigeria and its risk ...

  7. Visualization of myocardial perfusion derived from coronary anatomy

    NARCIS (Netherlands)

    Termeer, M.A.; Bescos, J.O.; Breeuwer, M.; Vilanova, A.; Gerritsen, F.A.; Gröller, M.E.; Nagel, Eike

    2008-01-01

    Visually assessing the effect of the coronary artery anatomy on the perfusion of the heart muscle in patients with coronary artery disease remains a challenging task. We explore the feasibility of visualizing this effect on perfusion using a numerical approach. We perform a computational simulation

  8. Is diet an essential risk factor for coronary heart disease?

    OpenAIRE

    Ball, K. P.

    1980-01-01

    Cigarette smoking, hypertension and diet each play a major role in the development of coronary heart attacks in most industrialized nations. In some countries where cigarette smoking and hypertension are prevalent there is a low risk of coronary heart disease (CHD). Hyperlipidaemia resulting from national food habits appears to be the essential factor in the high rates of CHD in developed countries.

  9. Coronary stenting as an adjunct to balloon angioplasty

    NARCIS (Netherlands)

    B.H. Strauss (Bradley)

    1991-01-01

    textabstractAndreas Gruentzig initiated the era of interventional cardiology in 19n with the introduction of percutaneous transluminal coronary angioplasty (PTCA) (1). The acceptance of coronary angioplasty is obvious by the widespread use of the procedure (>300,000 cases in the United States in

  10. Atherectomy for calcified coronary lesions: When and how?

    Science.gov (United States)

    Karatasakis, Aris; Brilakis, Emmanouil S

    2016-03-01

    Percutaneous coronary intervention of heavily calcified lesions can be challenging. Although the ROTAXUS trial did not demonstrate long-term clinical benefit with routine rotational atherectomy, atherectomy remains an indispensable tool to achieve acute procedural success. Until new data becomes available determining when and how to optimally use coronary atherectomy depends heavily on personal experience and clinical judgment. © 2016 Wiley Periodicals, Inc.

  11. Association of plasma protein C levels and coronary artery disease ...

    African Journals Online (AJOL)

    Several studies have shown the risk factor causes of coronary heart disease. In this study we tested the hypothesis that plasma protein C level might be used as a biomarker for coronary heart disease and myocardial infarction. The study included 60 men that were classified into 3 groups according to clinical examination; ...

  12. Coronary blood flow in the anesthetized American alligator (Alligator mississippiensis)

    NARCIS (Netherlands)

    Jensen, Bjarke; Elfwing, Magnus; Elsey, Ruth M.; Wang, Tobias; Crossley, Dane A.

    2016-01-01

    Coronary circulation of the heart evolved early within ectothermic vertebrates and became of vital importance to cardiac performance in some teleost fish, mammals and birds. In contrast, the role and function of the coronary circulation in ectothermic reptiles remains largely unknown. Here, we

  13. The prevalence and clinical profile of angiographic coronary ectasia

    International Nuclear Information System (INIS)

    Sultana, R.; Ishaq, M.; Samad, A.

    2011-01-01

    To determine the incidence of Coronary Artery Ectasia (CAE) at our teaching hospital to describe the patients and angiographic characteristics. Methods: A retrospective analysis was conducted on all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases, a tertiary care center, between the period of August 2006 and August 2008. A one year follow up was performed to look for primary and secondary endpoints. Data were collected from catheterization films, and medical records. Results: Five thousand coronary angiograms were performed during the period of of the study. A total of 140 (2.8%) angiograms showed coronary ectasia of both mixed and pure types. Pure ectasia with no coronary obstructive lesions was seen in 75 (1.5%). The left anterior descending artery (LAD) was the most commonly affected vessel (63%) followed by the right coronary artery (RCA) 25% and 10% patients had circumflex artery involvement. The primary composite endpoint showed 6 (4.2%) patients with non-ST elevation MI, 5 (3.6%) with ST elevation inferior wall myocardial infarction, 70 (50%) with unstable angina and 2 (1.4%) deaths due to pulmonary oedema. Secondary endpoints showed 50% of the patients still complaining of chest pain. Conclusion: Prevalence of Coronary ectasia in the population presenting to KIHD during the study period was 1.5%. Majority of patients were males, associated with dyslipidaemia, hypertension and smoking. CAE was associated with obstructive coronary artery disease in about 80% of cases. LAD was the most commonly affected vessel. (author)

  14. Spontaneous coronary artery dissection: complete angiographic resolution without stenting

    Directory of Open Access Journals (Sweden)

    Alexandre Abizaid

    2007-09-01

    Full Text Available A case of spontaneous coronary artery dissection in a 49-year-oldwoman is presented. She did not present the classical cardiovascular riskfactors. Etiology and treatment are discussed. She underwent primarypercutaneous coronary intervention of the left anterior descendingartery with no stenting and had complete angiographic resolution.

  15. Haptoglobin phenotypes as a risk factor for coronary artery disease ...

    African Journals Online (AJOL)

    Haptoglobin phenotypes as a risk factor for coronary artery disease in type 2 ... Recognition of diabetic individuals at greatest risk of developing coronary artery ... CAD, Group II: 48 type 2DM patients with developed CAD, Group III: 40 age and ...

  16. Impact of iterative reconstruction on CT coronary calcium quantification

    DEFF Research Database (Denmark)

    Kurata, Akira; Dharampal, Anoeshka; Dedic, Admir

    2013-01-01

    We evaluated the influence of sinogram-affirmed iterative reconstruction (SAFIRE) on the coronary artery calcium (CAC) score by computed tomography (CT).......We evaluated the influence of sinogram-affirmed iterative reconstruction (SAFIRE) on the coronary artery calcium (CAC) score by computed tomography (CT)....

  17. Edge detection versus densitometry for assessing coronary stenting quantitatively

    NARCIS (Netherlands)

    B.H. Strauss (Bradley); Y. Juilliere; B.J.W.M. Rensing (Benno); J.H.C. Reiber (Johan); P.W.J.C. Serruys (Patrick)

    1991-01-01

    textabstractThe optimal method used to analyze quantitatively the immediate angiographic results of coronary stenting in the coronary arteries has not been studied. Accordingly, minimal luminal cross-sectional area was determined by 2 methods, edge detection and densitometry, in 19 patients who

  18. Digital subtraction angiography (DSA) of the heart and coronary arteries

    International Nuclear Information System (INIS)

    Struyven, J.J.; Delcour, C.; Brion, J.P.; Vandenbosch, G.; Claessens, J.

    1986-01-01

    Digital subtraction angiography has potential advantages over conventional radiography. The removal of background structures makes possible to visualize chambers of the heart, great vessels and coronary arteries with a lower iodine signal than with conventional cineangiography. Digital data used for imaging can been manipulated for assessment and quantitation of the ventricular fonction and the coronary circulation

  19. Direct coronary and sagittal computerized tomography of the pelvis

    International Nuclear Information System (INIS)

    Maier, W.; Bargon, G.

    1981-01-01

    Whereas quite a number of reports have been published on direct coronary and sagittal computed tomography of the cranium, no extensive experience has been collected on multidimensional computerized tomography of the pelvis. In this article, the authors report on their preliminary experiences in direct approximately sagittal and coronary computerized tomography of the pelvis in a group of 76 patients. (orig.) [de

  20. Acute coronary syndromes amongst type 2 diabetics with ischaemic ...

    African Journals Online (AJOL)

    Majority had three coronary artery disease (CAD) risk factors: obesity 86%, elevated LDL 73% and hypertension 60%. Therapy in use was OHA 43%, insulin 42%, insulin and OHA 1%; prophylactic aspirin 14.7% and statins 8.4%. Thirty four (35.8%) were classified as acute coronary syndrome (ACS); 29 ( 30.5%) acute ...

  1. Coronary artery disease - strategies for primary prevention in Pakistan

    International Nuclear Information System (INIS)

    Khan, M.H.

    2000-01-01

    Coronary artery disease is the leading cause of death among middle aged and elderly population. The increase in prevalence of coronary artery disease in Pakistan, has also involved the younger population and about 30% of the patients of coronary artery disease are below the age of 40 years. It seems that with this high prevalence of coronary artery disease, we will be entering in the new millennium with coronary artery disease as number one killer in young adults in Pakistan. This is the time, though belated, we must embark on strategies for primary prevention of this disease so that we are able to reduce the incidence of the disease and the economic burden it entails on the national exchequer. Before suggesting the strategies for the prevention of coronary artery disease in Pakistan, let us briefly review the significance of modifiable risk factors for coronary artery disease. Several studies have been found a significant relationship between physical inactivity and coronary artery disease. (A.B./orig.)

  2. Coronary artery calcium in breast cancer survivors after radiation therapy

    NARCIS (Netherlands)

    Takx, Richard A P; Vliegenthart, Rozemarijn; Schoepf, U Joseph; Pilz, Lothar R; Schoenberg, Stefan O; Morris, Pamela B; Henzler, Thomas; Apfaltrer, Paul

    The purpose of the current study is to investigate whether breast cancer survivors after radiation therapy have a higher burden of coronary artery calcium as a potential surrogate of radiation-induced accelerated coronary artery disease. 333 patients were included. 54 patients underwent chest CT ae

  3. Length of Coronary Sinus in a Black Kenyan Population: Correlation ...

    African Journals Online (AJOL)

    The aim of the current study was to determine the length of coronary sinus among black Kenyans. Coronary sinuses of seventy-four hearts (43 males and 31 females) of adult age range (20-70years) black Kenyans obtained during autopsy were studied at the Department of Human Anatomy, University of Nairobi, Kenya.

  4. Physiological basis of clinically used coronary hemodynamic indices

    NARCIS (Netherlands)

    Spaan, Jos A. E.; Piek, Jan J.; Hoffman, Julien I. E.; Siebes, Maria

    2006-01-01

    In deriving clinically used hemodynamic indices such as fractional flow reserve and coronary flow velocity reserve, simplified models of the coronary circulation are used. In particular, myocardial resistance is assumed to be independent of factors such as heart contraction and driving pressure.

  5. The human coronary collateral circulation: development and clinical importance.

    Science.gov (United States)

    Seiler, Christian; Stoller, Michael; Pitt, Bertram; Meier, Pascal

    2013-09-01

    Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

  6. Multislice computed tomographic coronary angiography: experience in a UK centre

    International Nuclear Information System (INIS)

    Morgan-Hughes, G.J.; Marshall, A.J.; Roobottom, C.A.

    2003-01-01

    AIM: To evaluate the technique of coronary angiography with retrospectively electrocardiogram (ECG)-gated four-slice helical computed tomography (CT). MATERIALS AND METHODS: Within 1 month of undergoing routine day-case diagnostic coronary angiography, 30 consecutive patients also underwent retrospectively ECG-gated multislice CT coronary angiography. This enabled direct comparison of seven segments of proximal and mid-coronary artery for each patient by two blinded assessors. Each segment of coronary artery from the multislice CT image was evaluated initially for 'assessability' and those segments deemed assessable were subsequently investigated for the presence or absence of a significantly (n=70%) stenotic lesion. RESULTS: Overall 68% of proximal and mid-coronary artery segments were assessable. The sensitivity and specificity of four-slice CT coronary angiography in assessable segments for detecting the presence or absence (n=70%) of stenoses were 72 and 86%, respectively. These results correspond to a positive predictive value of 53% and a 93% negative predictive value. If the 32% of non-assessable segments are added into the calculation then the sensitivity and specificity fall to 49 and 66%, respectively. CONCLUSION: Although multislice CT coronary angiography is a promising technique, the overall assessability and diagnostic accuracy of four-slice CT acquisition is not sufficient to justify routine clinical use. Further, evaluation should investigate the benefit of the reduction in temporal and spatial resolution offered by 16 and 32 slice acquisition

  7. Job strain as a risk factor for coronary heart disease

    DEFF Research Database (Denmark)

    Kivimäki, Mika; Nyberg, Solja T; Batty, G David

    2012-01-01

    Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished...

  8. Change of anxiety in patients undergoing coronary angiography

    International Nuclear Information System (INIS)

    Huang Zuo; Wu Zonggui; Wang Yongmei

    2004-01-01

    Objective: To investigate the change of anxiety in patients undergoing coronary angiography. Methods: The Spielberger State-Trait Anxiety Inventory was carried out in hundred and forty five patients, 104 men, 41 women, mean age (63 ± 9) years, before and after the coronary angiography procedure respectively. Results: The state anxiety score after the procedure was significantly decreased from 35.8 ± 10.2 to 31.7 ± 9.9 (P<0.01). The trait anxiety score after the procedure was slighytly lowered from 35.7 ± 8.8 to 34.4 ± 9.4 (P=0.019). Sub- group analysis showed that the state anxiety score in 55 patients with normal coronary artery was markedly decreased from 37.5 ± 10.5 to 28.8 ± 8.2 (P<0.01) while the state anxiety score in 90 patients with abnormal coronary artery was unchanged. The score in those patients with abnormal coronary artery was much higher than that of patients with normal coronary artery (33.5 ± 10.4 vs 28.8 ± 8.2, P<0.01). The trait anxiety scores in both group were not changed. Conclusion: Good news about normal coronary artery after angiography may reduce the anxiety in patients suspected of coronary heart disease. (authors)

  9. Risk stratification of patients suspected of coronary artery disease

    DEFF Research Database (Denmark)

    Jensen, Jesper M; Voss, Mette; Hansen, Vibeke Bøgelund

    2012-01-01

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

  10. Socio-economic status, risk factors and coronary heart disease ...

    African Journals Online (AJOL)

    The relationship of socio-economic status (SES) indicators and coronary risk factors (RFs) with coronary heart disease (CHD) prevalence was examined in 5620 subjects aged 20 ... The SES indicators had Iitlle or no independent effect on CHD prevalence in multivariate logistic analyses after, inclusion of the standard RFs.

  11. Giant aneurysm in a left coronary artery fistula

    DEFF Research Database (Denmark)

    Frestad, Daria; Helqvist, Steffen; Helvind, Morten

    2013-01-01

    Congenital coronary artery fistula complicated with giant coronary artery aneurysm is a very rare condition. In this case report, we present a 65-year-old woman, referred to us with a continuous heart murmur, occasional atypical chest pain and few episodes of fainting. A giant aneurysm...

  12. Evaluation of myocardial bridging by coronary computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Rabelo, Daniel Rocha; Siqueira, Maria Helena Albernaz, E-mail: marciovlbarros@uol.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil); Garretto, Luiza Samarane; Paula, Marcela Mascarenhas De; Carvalho, Marina Oliveira; Alves, Marina Rangel Moreira Barros [Faculdade de Saude e Ecologia Humana (FASEH), Vespasiano, MG (Brazil)

    2013-01-15

    The myocardial bridge (MB) is defined as a segment of an epicardial coronary artery that has an intramural course in the myocardium. Although MB is clinically silent in most cases, has been associated with myocardial ischemia, arrhythmias and sudden death. Coronary conventional angiography is the gold standard for detection of MB, but is invasive and cannot be sufficiently sensitive compared to autopsy studies. Recently, multislice computed tomography of coronary arteries (MCTCA) has allowed the detection of coronary artery course, including PM. Objectives: to evaluate MB prevalence in patients with suspected coronary artery disease undergoing MCTCA and to evaluate the predictive value of this method at medium term. Methods: during the period 2008 to 2011, 498 consecutive patients were examined by TMC for the diagnosis of coronary artery disease, being conducted to evaluate the presence of BM and followed for a mean follow-up of 23 months for the occurrence of cardiovascular hard events (death, hospitalization or revascularization). Results: patients mean age was 55.3 ± 14.2, being male 71.1%. Among the patients, 7.6% (38 patients) showed MB. Main findings included angina pectoris in 40% and a positive stress test in 34%. 34.2% had atherosclerotic disease, and one patient had significant coronary stenosis. During follow-up, no patients showed adverse events. Conclusion: MCTCA is a noninvasive technique with high accuracy in anatomical evaluation of the coronary arteries and may be particularly useful to assess the incidence, location and morphology of myocardial bridging in vivo. (author)

  13. Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

    Directory of Open Access Journals (Sweden)

    Burgess SN

    2015-06-01

    Full Text Available Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French11Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the

  14. DECT evaluation of noncalcified coronary artery plaque

    Energy Technology Data Exchange (ETDEWEB)

    Ravanfar Haghighi, Rezvan [Medical Imaging Research Center and Colorectal Research Center, Shiraz University of Medical Science, Shiraz 719 363 5899 (Iran, Islamic Republic of); Chatterjee, S. [BGVS Chemical Engineering Building (Old), Indian Institute of Science, Bangalore 560012 (India); Tabin, Milo; Singh, Rishi P.; Sharma, Munish; Krishna, Karthik [Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi 110029 (India); Sharma, Sanjiv; Jagia, Priya [Department of Cardiac-Radiology, All India Institute of Medical Sciences, New Delhi 110029 (India); Ray, Ruma; Arava, Sudhir [Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029 (India); Yadav, Rakesh [Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029 (India); Vani, V. C. [Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore 560012 (India); Lakshmi, R.; Kumar, Pratik, E-mail: drpratikkumar@gmail.com [Department of Cardiac-Biochemistry, All India Institute of Medical Sciences, New Delhi 110029 (India); Mandal, Susama R. [Department of Medical Physics Unit IRCH, All India Institute of Medical Sciences, New Delhi 110029 (India)

    2015-10-15

    Purpose: Composition of the coronary artery plaque is known to have critical role in heart attack. While calcified plaque can easily be diagnosed by conventional CT, it fails to distinguish between fibrous and lipid rich plaques. In the present paper, the authors discuss the experimental techniques and obtain a numerical algorithm by which the electron density (ρ{sub e}) and the effective atomic number (Z{sub eff}) can be obtained from the dual energy computed tomography (DECT) data. The idea is to use this inversion method to characterize and distinguish between the lipid and fibrous coronary artery plaques. Methods: For the purpose of calibration of the CT machine, the authors prepare aqueous samples whose calculated values of (ρ{sub e}, Z{sub eff}) lie in the range of (2.65 × 10{sup 23} ≤ ρ{sub e} ≤ 3.64 × 10{sup 23}/cm{sup 3}) and (6.80 ≤ Z{sub eff} ≤ 8.90). The authors fill the phantom with these known samples and experimentally determine HU(V{sub 1}) and HU(V{sub 2}), with V{sub 1},V{sub 2} = 100 and 140 kVp, for the same pixels and thus determine the coefficients of inversion that allow us to determine (ρ{sub e}, Z{sub eff}) from the DECT data. The HU(100) and HU(140) for the coronary artery plaque are obtained by filling the channel of the coronary artery with a viscous solution of methyl cellulose in water, containing 2% contrast. These (ρ{sub e}, Z{sub eff}) values of the coronary artery plaque are used for their characterization on the basis of theoretical models of atomic compositions of the plaque materials. These results are compared with histopathological report. Results: The authors find that the calibration gives ρ{sub e} with an accuracy of ±3.5% while Z{sub eff} is found within ±1% of the actual value, the confidence being 95%. The HU(100) and HU(140) are found to be considerably different for the same plaque at the same position and there is a linear trend between these two HU values. It is noted that pure lipid type plaques

  15. [As cardioprotective and angiogenic biomarker, can ghrelin predict coronary collateral development and severity of coronary atherosclerosis?

    Science.gov (United States)

    Akboğa, Mehmet Kadri; Taçoy, Gülten; Yılmaz Demirtaş, Canan; Türkoğlu, Sedat; Boyacı, Bülent; Çengel, Atiye

    2017-06-01

    Ghrelin exerts protective effects on cardiovascular system by inhibiting progression of atherosclerosis, supression of vascular inflammation, and stimulating angiogenesis. Thus, the aim of this study was to investigate the effect of serum ghrelin on coronary collateral development and SYNTAX score in patients with severe coronary artery disease. Total of 91 patients who had ≥90% stenosis in at least one major coronary artery were prospectively included in this cross-sectional, observational study. Collateral degree was graded according to Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were allocated to Good Collateral Group and patients with grade 0 or 1 collateral degree were included in Poor Collateral Group. Ghrelin and vascular endothelial growth factor A (VEGF-A) levels were measured using radioimmunoassay and ELISA kits. Serum ghrelin and VEGF-A levels were significantly higher in Good Collateral Group. Furthermore, ghrelin level showed significant inverse correlation with SYNTAX score (r=0.348; p=0.001). In multivariable regression analysis, ghrelin (Odds ratio, 1.013; 95% confidence interval, 1.011-1.017; p=0.013), VEGF-A, fasting plasma glucose and presence of chronic total occlusion were independent predictors of good collateral development. In receiver operating characteristic curve analysis, ghrelin value cut-off point of ≥781 pg/mL predicted good collateral development with sensitivity of 73.1% and specificity of 67.7%. Findings suggested that ghrelin has antioxidant and antiinflammatory properties that protect endothelial functions and also stimulate angiogenesis, which results in development of good coronary collateral and inhibition of progression of coronary atherosclerosis.

  16. Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Assante, Roberta; Zampella, Emilia; Nappi, Carmela; Mainolfi, Ciro Gabriele; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Acampa, Wanda [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Arumugam, Parthiban; Tonge, Christine M. [Central Manchester University Teaching Hospitals, Nuclear Medicine Center, Manchester (United Kingdom); Gaudieri, Valeria; Panico, Mariarosaria; Magliulo, Mario [Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Petretta, Mario [University Federico II, Department of Translational Medical Sciences, Naples (Italy)

    2017-12-15

    To evaluate the prognostic value of coronary atherosclerotic burden, assessed by coronary artery calcium (CAC) score, and coronary vascular function, assessed by coronary flow reserve (CFR) in patients with suspected coronary artery disease (CAD). We studied 436 patients undergoing hybrid {sup 82}Rb positron emission tomography/computed tomography imaging. CAC score was measured according to the Agatston method, and patients were categorized into three groups (0, <400, and ≥400). CFR was calculated as the ratio of hyperemic to baseline myocardial blood flow, and it was considered reduced when <2. Follow-up was 94% complete during a mean period of 47±15 months. During follow-up, 17 events occurred (4% cumulative event rate). Event-free survival decreased with worsening of CAC score category (p < 0.001) and in patients with reduced CFR (p < 0.005). At multivariable analysis, CAC score ≥400 (p < 0.01) and CFR (p < 0.005) were independent predictors of events. Including CFR in the prognostic model, continuous net reclassification improvement was 0.51 (0.14 in patients with events and 0.37 in those without). At classification and regression tree analysis, the initial split was on CAC score. For patients with a CAC score < 400, no further split was performed, while patients with a CAC score ≥400 were further stratified by CFR values. Decision curve analyses indicate that the model including CFR resulted in a higher net benefit across a wide range of decision threshold probabilities. In patients with suspected CAD, CFR provides significant incremental risk stratification over established cardiac risk factors and CAC score for prediction of adverse cardiac events. (orig.)

  17. Analysis of digital subtraction coronary angiography for estimation of flow reserve in critical coronary stenosis

    International Nuclear Information System (INIS)

    Kohtoku, Shinya

    1988-01-01

    To examine the accuracy of digital subtraction angiographic assessment of coronary flow reserve in critical coronary stenosis, time-density curve was obtained from digital subtraction coronary angiograms for myocardial region of interest. Time to peak contrast(TPC) and time constant of the washout exponential curve(T) were measured in 14 patients with stable effort angina pectoris and critical one vessel lesion before and after percutaneous transluminal coronary angioplasty(PTCA). All patients had normal left ventricular ejection fraction (59 ± 7 %) and Tl 201 myocardial image at rest. The values of TPC and T were significantly shortened from 5.4 ± 1.3 to 4.5 ± 1.0 sec (p < 0.02) and from 10.9 ± 3.8 to 5.3 ± 1.3 sec(p < 0.001) after PTCA, respectively. However, in 9 of all patients TPC after PTCA showed approximately the same valued as those before PTCA. In 5 experimental dogs with critical circumflex stenosis, coronary flow(CF;Doppler flow meter) and systolic thickning of the posterior wall(by sonomicrometry) at rest were not different from control, however, contrast media-induced reactive hyperemia was markedly attenuated, accompanied with a significant of T (7.7 ± 4.5 vs 15.8 ± 10.9 sec, p < 0.01) and completely unchanged TPC (both 6.8 sec). With simultaneous tracing of CF and time-density curve, TPC and washout phase corresponded with contrast-induced transient CF reduction and hyperemic phase, respectively. We conclude that T might be more sensitive for estimation of CF is maintained almost normal, such as patients with stable effort angina pectoris having normal left ventricular wall motion at rest. (author)

  18. Contrast agent choice for intravenous coronary angiography

    International Nuclear Information System (INIS)

    Zeman, H.D.; Siddons, D.P.

    1990-01-01

    The screening of the general population for coronary artery disease would be practical if a method existed for visualizing the extent of occlusion after an intravenous injection of contrast agent. Measurements performed with monochromatic synchrotron radiation X-rays and an iodine-containing contrast agent at the Stanford Synchrotron Radiation Laboratory have shown that such an intravenous angiography procedure would be possible with an adequately intense monochromatic X-ray source. Because of the size and cost of synchrotron radiation facilities it would be desirable to make the most efficient use of the intensity available, while reducing as much as possible the radiation dose experienced by the patient. By choosing contrast agents containing elements with a higher atomic number than iodine, it is possible to both improve the image quality and reduce the patient radiation dose, while using the same synchrotron radiation source. By using Si monochromator crystals with a small mosaic spread, it is possible to increase the X-ray flux available for imaging by over an order of magnitude, without any changes in the storage ring or wiggler magnet. The most critical imaging task for intravenous coronary angiography utilizing synchrotron radiation X-rays is visualizing a coronary artery through the left ventricle or aorta which also contain contrast agent. Calculations have been made of the signal to noise ratio expected for this imaging task for various contrast agents with atomic numbers between that of iodine and bismuth. The X-ray energy spectrum of the X-17 superconduction wiggler beam line at the National Synchrotron Light Source at Brookhaven National Laboratory has been used for these calculations. Both perfect Si crystals and Si crystals with a small mosaic spread are considered as monochromators. Contrast agents containing Gd or Yb seem to have about the optimal calculated signal to noise ratio. (orig./HSI)

  19. Marijuana use in acute coronary syndromes.

    Science.gov (United States)

    Draz, Eman I; Oreby, Mervat M; Elsheikh, Eman A; Khedr, Lamia A; Atlam, Salwa A

    2017-09-01

    Cannabis is one of the most widely used illicit substances worldwide, and it has the highest prevalence among drugs used in Egypt. The aims were to evaluate whether the use of cannabis is a risk factor of acute coronary heart disease in low-risk, young males and to compare the cardiac pathological changes between cannabis exposed and non-exposed ischemic patients. This was a cross-sectional study that was performed on 138 male patients, aged ≤ 40 years, with acute myocardial infarction who were admitted to the Cardiac Care Unit at the University Hospital. Urine samples were submitted for toxicological analysis using a homogenous enzyme immunoassay technique to determine the substance of use. The patients were divided into three groups: group 1 (n = 23), cannabis-positive only patients; group 2 (n = 28), patients positive for any other substance of use; and group 3 (n = 34), patients negative for any substance of use. Smoking was prominent, whereas group 1 had no other risk factors. In groups 1 and 2, ST-segment elevation myocardial infarction (STEMI) was dominant, whereas no ST-segment elevation myocardial infarction (NSTEMI) was prominent in group 3. Ischemic resting wall motion abnormalities were presented in 47.8% of group 1 and in only 11.8% of group 3. None of group 1 had normal coronaries, whereas 14.3% of group 3 had normal coronaries. Significant changes in echocardiography and angiography were observed between group 1 and other groups. Cannabis smoking could be a potential risk factor for the development of cardiac ischemia.

  20. Metabolic syndrome in acute coronary syndrome

    International Nuclear Information System (INIS)

    Bhalli, M.A.; Aamir, M.; Mustafa, G.

    2011-01-01

    Objective: To determine the frequency of metabolic syndrome in male patients presenting with acute coronary syndrome Study design: A Descriptive study Place and duration of study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008 Patients and Methods: Male patients with acute coronary syndrome (ACS) were included. Patients having angioplasty (PCI), coronary artery bypass surgery in the past and other co-morbid diseases were excluded. All patients were assessed for the presence of five components of metabolic syndrome including hypertension, HDL-Cholesterol and triglycerides, glucose intolerance and abdominal obesity. Systolic, diastolic blood pressures, waist circumference (WC) and body mass index (BMI) were measured. ECG, cardiac enzymes, fasting glucose and lipid profile were also done. Results: A total of 135 male patients of ACS were studied with a mean age of 54.26 +- 11 years. Metabolic syndrome (MS) was present in 55 (40.7%) patients. MS with all five components was documented in 4 (7.27%) while MS with four and three components was seen in 23 (41.81%) and 28 (50.90%) patients respectively. Only 24 (43.63%) patients with MS had diabetes mellitus, remaining 31(56.36%) were non diabetic. Frequencies of diabetes, hypertension and family history of CAD were significantly higher (p<0.05) in patients with metabolic syndrome as compared to patients with normal metabolic status. Conclusion: Metabolic syndrome is fairly common and important risk factor in patients of IHD. Other risk factors like smoking, dyslipidemia, hypertension and diabetes were also frequently found. Public awareness to control the risk factors can reduce the prevalence of CAD in our country. (author)

  1. Metabolic syndrome in acute coronary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Bhalli, M A; Aamir, M; Mustafa, G [Combined Military Hospital, Abbottabad (Pakistan)

    2011-06-15

    Objective: To determine the frequency of metabolic syndrome in male patients presenting with acute coronary syndrome Study design: A Descriptive study Place and duration of study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008 Patients and Methods: Male patients with acute coronary syndrome (ACS) were included. Patients having angioplasty (PCI), coronary artery bypass surgery in the past and other co-morbid diseases were excluded. All patients were assessed for the presence of five components of metabolic syndrome including hypertension, HDL-Cholesterol and triglycerides, glucose intolerance and abdominal obesity. Systolic, diastolic blood pressures, waist circumference (WC) and body mass index (BMI) were measured. ECG, cardiac enzymes, fasting glucose and lipid profile were also done. Results: A total of 135 male patients of ACS were studied with a mean age of 54.26 +- 11 years. Metabolic syndrome (MS) was present in 55 (40.7%) patients. MS with all five components was documented in 4 (7.27%) while MS with four and three components was seen in 23 (41.81%) and 28 (50.90%) patients respectively. Only 24 (43.63%) patients with MS had diabetes mellitus, remaining 31(56.36%) were non diabetic. Frequencies of diabetes, hypertension and family history of CAD were significantly higher (p<0.05) in patients with metabolic syndrome as compared to patients with normal metabolic status. Conclusion: Metabolic syndrome is fairly common and important risk factor in patients of IHD. Other risk factors like smoking, dyslipidemia, hypertension and diabetes were also frequently found. Public awareness to control the risk factors can reduce the prevalence of CAD in our country. (author)

  2. Remote clinical prognosis in patients with coronary X syndrome

    Directory of Open Access Journals (Sweden)

    Sebov D.M.

    2015-09-01

    Full Text Available The article analyzes data of 3234 coronary angiographies with established coronary X syndrome (CXS in 217 cases, herewith expressed tortuosity of coronary arteries (ETCA was found out in 148 (more than 2/3 of cases. A 5-years’ analysis of cardio-vascular events (CVE in patients with CXS in comparison with the group of IHD patients and initial atherosclerosis of coronary arteries was made. Absence of reliable difference of developing severe cardio-vascular events (SCVE bet¬ween patients with initial atherosclerosis and CXS was proved. Risk of CVE development was significantey higher in patients with ETCA, OR=4,93; 95% (0,62; 3929. Patients with CXS had higher risk of severe arrhythmias development as compared with IHD patients with initial atherosclerosis: OR=2,36 (1,01; 5,56. There was no reliable difference between lethality of any causes and number of coronary interventions in all groups.

  3. Computed tomography with multidetectors in the diagnosis of coronary stenosis

    International Nuclear Information System (INIS)

    Lombo, Bernardo; Carvajal, Codos A; Tafur, Monica; Gomez, Rafael

    2007-01-01

    Coronary angiography that uses multislice spiral computed tomography is a noninvasive technique for the detection of coronary stenosis that has had significant improvements in recent years. The introduction of 16 and 64 row scanners, the development of synchronized scanning electrocardiogram and better reconstruction techniques permit higher spatial and temporal resolution that allows better identification of coronary plaques and significant obstructive coronary lesions. In the next years Multislice spiral computed tomography will continue maturing and it will become a useful non invasive diagnostic imaging tool for the diagnosis of coronary disease and will be integrated to the cardiologic management protocols. Our next review will be focused on the basic and technical aspects of the scanner, diagnostic performance and clinical applications of this new technology

  4. Angiographic prevalence and pattern of coronary artery disease in women.

    Science.gov (United States)

    Ezhumalai, Babu; Jayaraman, Balachander

    2014-01-01

    There are not many studies describing the prevalence and pattern of "coronary artery disease" (CAD) in women undergoing "coronary angiography" (CAG). Hence, uncertainty thrives with regard to the angiographic prevalence and pattern of CAD in women. Our objective was to study the prevalence and pattern of CAD among women undergoing CAG. Data of 500 women who underwent CAG for suspected CAD over 3 years were retrospectively analyzed. They were classified into young group (age right coronary artery. Bifurcation lesion involving distal left main coronary artery is the most prevalent pattern of LMD. There has been a change with regard to clinical presentation and onset of risk factors for CAD at young age, but the load of atherosclerotic burden and pattern of involvement of coronary arteries have not changed in women. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  5. Unusually Looped and Muzzled Branches of Right Coronary Artery

    Directory of Open Access Journals (Sweden)

    Anitha Guru

    2017-01-01

    Full Text Available Coronary artery disease (CAD is the major cause of death in developed countries as it accounts on an average for 1 of every 5 deaths. Morphological variations of coronary arterial system is one of the causative factor for CAD. Anatomical knowledge of all possible variant patterns of coronary arterial system is imperative in the diagnostic and therapeutic approach of CAD. We report here a rare branching pattern of right coronary artery (RCA. The origin of RCA was normal but the course and branching pattern of it were atypical. RCA was not occupying its usual position in atrioventricular (coronary sulcus and its course was incomplete. It gave a ventricular branch to right ventricle, which presented an unusual looping pattern. It terminated as right marginal artery following its muzzled appearance within the musculature of the ventricle.

  6. Patent ductus arteriosus associated with congenital anomaly of coronary artery.

    Science.gov (United States)

    Maleki, Majid; Azizian, Nassrin; Esmaeilzadeh, Maryam; Moradi, Bahieh

    2013-11-01

    We reported a case of patent ductus arteriosus (PDA) with congenital anomaly of coronary arteries as abnormal origin of right coronary artery (RCA) and left coronary artery (LCA) from a single ostium of the right coronary sinus. A 21-year-old man referred to our institution for evaluation of cardiac murmur. He has suffered from palpitation and atypical chest pain for three months. On physical examination, a continuous murmur was heard in the second left parasternal space. Transthoracic echocardiography showed normal left and right ventricular size and systolic function (LVEF = 55%). Main pulmonary artery (PA) and left pulmonary artery (LPA) branch were considerably dilated. Considering normal coronary flow, lack of clinical evidence of myocardial ischemia and echocardiography findings, patient underwent surgical closure of PDA via left thoracotomy and after five days discharged uneventfully.

  7. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes.

    Science.gov (United States)

    Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G

    2016-02-01

    Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

  8. Technical Considerations of Giant Right Coronary Artery Aneurysm Exclusion

    Directory of Open Access Journals (Sweden)

    James Barr

    2016-01-01

    Full Text Available Giant coronary artery aneurysms are rare clinical entities. We report the case of a 49-year-old man who presented with dyspnoea and exertional chest pain. Investigations confirmed an aneurysmal right coronary artery measuring 4 cm with a fistulous communication to the right atrium. Following right atriotomy, the fistula was oversewn and the aneurysmal right coronary artery ligated at its origin and at several points along its course. A saphenous vein graft was anastomosed to the posterior descending artery. Persistent ventricular fibrillation occurred upon chest closure, attributed to ischaemia following ligation of the aneurysmal coronary artery. Emergent resternotomy and internal defibrillation were successfully performed. The sternum was stented open to reduce right ventricular strain and closed the following day. The patient made an unremarkable recovery. We here address the technical challenges associated with surgical repair of right coronary aneurysms and the physiology and management of potential complications.

  9. Psychological factors and coronary heart disease

    Directory of Open Access Journals (Sweden)

    Hadži-Pešić Marina

    2007-01-01

    Full Text Available Coronary heart disease (CAD results from an interaction of different somatic, environmental and behavioral risk factors. Commonly, development of CAD is associated with arterial hypertension, dyslipidemia, diabetes mellitus, smoking, sedentary life style and the like. Psychological factors in their own sake or in combination with other risk factors are also important for genesis of CAD. In this study, 170 people that were diagnosed with CAD and 170 healthy controls of corresponding sex and age were compared for anxiety, aggressiveness and Eysenck's two personality dimension. The data indicate that patients with CAD have very low level of anxiety and aggressiveness and very high level of neuroticism relative to the controls. .

  10. Gender differences following percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Holmvang, L.; Mickley, H.

    2008-01-01

    PCI is effective for reducing symptoms in patients with stable angina pectoris but does not improve prognosis. In earlier trials PCI has been associated with more procedure related complications in women than men, but this difference between genders has been less pronounced in more recent studies....... In acute coronary syndromes there is no evidence of gender differences regarding the benefit of primary PCI for ST-segment elevation myocardial infarction. However, several trials of unstable angina and non-ST-segment elevation myocardial infarction indicate that women do not have the similar benefit...

  11. The prognostic value of coronary endothelial and microvascular dysfunction in subjects with normal or non-obstructive coronary artery disease

    DEFF Research Database (Denmark)

    Brainin, Philip; Frestad, Daria; Prescott, Eva

    2018-01-01

    AIMS: Coronary vascular dysfunction is linked with poor cardiovascular prognosis in patients without obstructive coronary artery disease (CAD) but a critical appraisal of the literature is lacking. METHODS AND RESULTS: We performed a systematic review and meta-analysis to quantify...

  12. Quantitative relationship between coronary calcium content and coronary flow reserve as assessed by integrated PET/CT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Curillova, Zelmira [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); VA Boston Healthcare System, Division of Cardiology, Department of Medicine, West Roxbury, MA (United States); Yaman, Bettina F.; Sitek, Arkadius; El Fakhri, Georges [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Dorbala, Sharmila [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Kwong, Raymond Y. [Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women' s Hospital, Boston, MA (United States); Brigham and Women' s Hospital, Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Anagnostopoulos, Constantinos [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Royal Brompton Hospital, Department of Nuclear Medicine, London (United Kingdom); Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women' s Hospital, Boston, MA (United States); Brigham and Women' s Hospital, Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Boston, MA (United States)

    2009-10-15

    To evaluate the relationship between coronary artery calcium (CAC) and coronary vasodilator function. We evaluated 136 patients without known coronary artery disease (CAD) undergoing vasodilator stress {sup 82}Rb PET/CT and CAC scoring who showed normal myocardial perfusion. The CAC score, resting and hyperemic myocardial blood flow (MBF), coronary flow reserve (CFR) and coronary vascular resistance were analyzed. Global and regional CAC scores showed significant but weak inverse correlations with hyperemic MBF (r=-0.31 and r=-0.26, p{<=}0.0002 respectively) and CFR (r=-0.28 and r=-0.2, p{<=}0.001 respectively). With increasing CAC score, there was a modest stepwise decline in CFR on a per-patient basis (1.8{+-}0.5 vs 1.7{+-}0.5 vs 1.5{+-}0.4, p=0.048, with total CAC=0, 1-400 and >400, respectively) and on a per-vessel basis. In multivariable modeling only body mass index and CAC score were predictive of CFR. In patients with an intermediate likelihood of, but without overt, CAD, there is a statistically significant but weak inverse correlation between CAC content and coronary vasodilator function. The strength of this association weakens after adjusting CAC scores for age, gender and coronary risk factors. This suggests that CAC and coronary vasodilator function provide biologically different information regarding atherosclerosis. (orig.)

  13. Impact of triple antithrombotic therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention in real-world practice

    NARCIS (Netherlands)

    Yan, Yan; Wang, Xiao; Fan, Jing-Yao; Nie, Shao-Ping; Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Henriques, Jose P. Simao; D'Ascenzo, Fabrizio; Saucedo, Jorge; González-Juanatey, José R.; Wilton, Stephen B.; Kikkert, Wouter J.; Nuñez-Gil, Iván; Ariza-Sole, Albert; Song, Xian-Tao; Alexopoulos, Dimitrios; Liebetrau, Christoph; Kawaji, Tetsuma; Moretti, Claudio; Huczek, Zenon; Fujii, Toshiharu; Correia, Luis Cl; Kawashiri, Masa-Aki; Kedev, Sasko

    2017-01-01

    The optimal antithrombotic regimen for patients on oral anticoagulation (OAC) after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI) remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world

  14. Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

    DEFF Research Database (Denmark)

    Giustino, Gennaro; Mastoris, Ioannis; Baber, Usman

    2016-01-01

    OBJECTIVES: The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES). BACKGROUND: The clinical correlates and the prognostic significance of CAC...

  15. Zotarolimus-eluting vs. sirolimus-eluting coronary stents in patients with and without acute coronary syndromes

    DEFF Research Database (Denmark)

    Thim, Troels; Maeng, Michael; Kaltoft, Anne Kjer

    2012-01-01

    To compare clinical outcomes among patients with acute coronary syndrome treated with zotarolimus-eluting and sirolimus-eluting stents in the SORT OUT III trial.......To compare clinical outcomes among patients with acute coronary syndrome treated with zotarolimus-eluting and sirolimus-eluting stents in the SORT OUT III trial....

  16. Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Cholenahally Nanjappa Manjunath

    2014-01-01

    Conclusion: The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%, while its prevalence is highest in DAVD (23.4%.

  17. 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

  18. Quantitative relationship between coronary calcium content and coronary flow reserve as assessed by integrated PET/CT imaging

    International Nuclear Information System (INIS)

    Curillova, Zelmira; Yaman, Bettina F.; Sitek, Arkadius; El Fakhri, Georges; Dorbala, Sharmila; Kwong, Raymond Y.; Anagnostopoulos, Constantinos; Di Carli, Marcelo F.

    2009-01-01

    To evaluate the relationship between coronary artery calcium (CAC) and coronary vasodilator function. We evaluated 136 patients without known coronary artery disease (CAD) undergoing vasodilator stress 82 Rb PET/CT and CAC scoring who showed normal myocardial perfusion. The CAC score, resting and hyperemic myocardial blood flow (MBF), coronary flow reserve (CFR) and coronary vascular resistance were analyzed. Global and regional CAC scores showed significant but weak inverse correlations with hyperemic MBF (r=-0.31 and r=-0.26, p≤0.0002 respectively) and CFR (r=-0.28 and r=-0.2, p≤0.001 respectively). With increasing CAC score, there was a modest stepwise decline in CFR on a per-patient basis (1.8±0.5 vs 1.7±0.5 vs 1.5±0.4, p=0.048, with total CAC=0, 1-400 and >400, respectively) and on a per-vessel basis. In multivariable modeling only body mass index and CAC score were predictive of CFR. In patients with an intermediate likelihood of, but without overt, CAD, there is a statistically significant but weak inverse correlation between CAC content and coronary vasodilator function. The strength of this association weakens after adjusting CAC scores for age, gender and coronary risk factors. This suggests that CAC and coronary vasodilator function provide biologically different information regarding atherosclerosis. (orig.)

  19. [THE INFLUENCE OF MONO- AND MULTIVASCULAR LESIONS OF CORONARY ARTERIES ON THE COURSE OF CORONARY HEART DISEASE IN PATIENTS WITH DIABETES MELLITUS TYPE 2].

    Science.gov (United States)

    Sypalo, A; Kravchun, P; Kadykova, O

    2017-03-01

    The article assesses the influence of mono- and multivascular lesions of coronary arteries on the course of coronary heart disease at patients with diabetes mellitus type 2. For this purpose, a comprehensive survey of 75 patients with coronary heart disease and diabetes mellitus type 2 was arranged. Depending on the number of vascular lesions of the coronary arteries, according to the data of coronary arteries computer tomography, all patients were divided into two subgroups. The first subgroup included 27 patients with coronary heart disease and diabetes mellitus type 2 with monovascular lesions of coronary arteries. To the second subgroup were included 48 patients with coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries. During the analysis of carbohydrate metabolism in cases of coronary heart disease and diabetes mellitus type 2 the HOMA index increase by 25.40% and insulin level increase by 17.05% were revealed at patients with multivascular lesions of coronary arteries in comparison with patients with monovascular lesions of coronary arteries, respectively. The combination of coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries was associated with an increase of sortilin level (233,47±47,85 ng/l). A significant increase in triglycerides, lipoprotein cholesterol of very low density influences greatly on the progression of coronary atherosclerosis with lesions of greater number of coronary arteries at patients surveyed. At patients with coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries the left ventricle myocardial re-modeling occurred through the increase of left ventricle's size and cavity.

  20. Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?

    International Nuclear Information System (INIS)

    Noergaard, B.L.; Jensen, J.M.; Leipsic, J.

    2015-01-01

    Fractional flow reserve (FFR) measured during invasive coronary angiography is the gold standard for lesion-specific decisions on coronary revascularization in patients with stable coronary artery disease (CAD). Current guidelines recommend non-invasive functional or anatomic testing as a gatekeeper to the catheterization laboratory. However, the ''holy grail'' in non-invasive testing of CAD is to establish a single test that quantifies both coronary lesion severity and the associated ischemia. Most evidence to date of such a test is based on the addition of computational analysis of FFR to the anatomic information obtained from standard-acquired coronary CTA data sets at rest (FFR CT ). This review summarizes the clinical evidence for the use of FFR CT in stable CAD in context to the diagnostic performance of other non-invasive testing modalities. (orig.)

  1. Coronary heart disease risk assessment and characterization of coronary artery disease using coronary CT angiography: comparison of asymptomatic and symptomatic groups

    International Nuclear Information System (INIS)

    Hwang, Y.; Kim, Y.; Chung, I.-M.; Ryu, J.; Park, H.

    2010-01-01

    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.

  2. ranching pattern of the left anterior descending coronary artery in a ...

    African Journals Online (AJOL)

    Branching pattern of the left anterior descending coronary artery is important in explaining variations in occurrence of coronary atherosclerosis, informing management strategies for coronary heart disease and interventional cardiology. Data on African populations are, however, scarce. Since coronary heart disease is ...

  3. Explaining the Decline in Coronary Heart Disease Mortality in the Czech Republic between 1985 and 2007

    Czech Academy of Sciences Publication Activity Database

    Bruthans, J.; Cifková, R.; Lánská, V.; O'Flaherty, M.; Critchley, J.A.; Holub, J.; Janský, P.; Zvárová, Jana; Capewell, S.

    2014-01-01

    Roč. 21, č. 7 (2014), s. 829-839 ISSN 2047-4873 Institutional support: RVO:67985807 Keywords : coronary heart disease * Czech MONICA and Czech post-MONICA * coronary heart disease management * coronary heart disease mortality * coronary heart disease risk factors Subject RIV: FA - Cardiovascular Disease s incl. Cardiotharic Surgery Impact factor: 3.319, year: 2014

  4. Automatic coronary calcium scoring using noncontrast and contrast CT images

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Guanyu, E-mail: yang.list@seu.edu.cn; Chen, Yang; Shu, Huazhong [Laboratory of Image Science and Technology, School of Computer Science and Engineering, Southeast University, No. 2, Si Pai Lou, Nanjing 210096 (China); Centre de Recherche en Information Biomédicale Sino-Français (LIA CRIBs), Nanjing 210096 (China); Key Laboratory of Computer Network and Information Integration, Southeast University, Ministry of Education, Nanjing 210096 (China); Ning, Xiufang; Sun, Qiaoyu [Laboratory of Image Science and Technology, School of Computer Science and Engineering, Southeast University, No. 2, Si Pai Lou, Nanjing 210096 (China); Key Laboratory of Computer Network and Information Integration, Southeast University, Ministry of Education, Nanjing 210096 (China); Coatrieux, Jean-Louis [INSERM-U1099, Rennes F-35000 (France); Labotatoire Traitement du Signal et de l’Image (LTSI), Université de Rennes 1, Campus de Beaulieu, Bat. 22, Rennes 35042 Cedex (France); Centre de Recherche en Information Biomédicale Sino-Français (LIA CRIBs), Nanjing 210096 (China)

    2016-05-15

    Purpose: Calcium scoring is widely used to assess the risk of coronary heart disease (CHD). Accurate coronary artery calcification detection in noncontrast CT image is a prerequisite step for coronary calcium scoring. Currently, calcified lesions in the coronary arteries are manually identified by radiologists in clinical practice. Thus, in this paper, a fully automatic calcium scoring method was developed to alleviate the work load of the radiologists or cardiologists. Methods: The challenge of automatic coronary calcification detection is to discriminate the calcification in the coronary arteries from the calcification in the other tissues. Since the anatomy of coronary arteries is difficult to be observed in the noncontrast CT images, the contrast CT image of the same patient is used to extract the regions of the aorta, heart, and coronary arteries. Then, a patient-specific region-of-interest (ROI) is generated in the noncontrast CT image according to the segmentation results in the contrast CT image. This patient-specific ROI focuses on the regions in the neighborhood of coronary arteries for calcification detection, which can eliminate the calcifications in the surrounding tissues. A support vector machine classifier is applied finally to refine the results by removing possible image noise. Furthermore, the calcified lesions in the noncontrast images belonging to the different main coronary arteries are identified automatically using the labeling results of the extracted coronary arteries. Results: Forty datasets from four different CT machine vendors were used to evaluate their algorithm, which were provided by the MICCAI 2014 Coronary Calcium Scoring (orCaScore) Challenge. The sensitivity and positive predictive value for the volume of detected calcifications are 0.989 and 0.948. Only one patient out of 40 patients had been assigned to the wrong risk category defined according to Agatston scores (0, 1–100, 101–300, >300) by comparing with the ground

  5. Impaired coronary microvascular function in diabetics

    International Nuclear Information System (INIS)

    Tsujimoto, Go

    2000-01-01

    Global and regional myocardial uptake was determined with technetium-99m tetrofosmin and a 4 hour exercise (370 MBq iv) and rest (740 MBq iv) protocol, in 24 patients with non-insulin dependent diabetes mellitus and in 22 control subjects. The purpose of this study was to evaluate impaired coronary microvascular function in diabetics by measurement of % uptake increase in myocardial counts. The parameter of % uptake increase (ΔMTU) was calculated as the ratio of exercise counts to rest myocardial counts with correction of myocardial uptake for dose administered and physical decay between the exercise study and the rest study. Global ΔMTU was significantly lower in the diabetics than in control subjects (14.4±5.4% vs. 21.7±8.5%, p<0.01). Regional ΔMTU in each of 4 left ventricular regions (anterior, septal, inferior, posterolateral) was significantly lower in the diabetic group than in the control group (p<0.01) respectively, but there were no significant differences between ΔMTU in the 4 left ventricular regions in the same group. ΔMTU was useful as a non-invasive means of evaluating impaired coronary microvascular function in diabetics. (author)

  6. Intravenous coronary angiography using the orbital radiation

    Energy Technology Data Exchange (ETDEWEB)

    Ohtsuka, Sadanori; Yamaguchi, Iwao; Wu, Jin; Takeda, Toru; Itai, Yuji; Maruhashi, Akira [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine; Hyodo, Kazuyuki; Ando, Masami [High Energy Accelerator Research Org., Tsukuba, Ibaraki (Japan). Inst. of Materials Structure Science

    2002-09-01

    This review described the progress and current status of intravenous coronary angiography (IVCAG) using the orbital radiation generated by the synchrotron. Authors diagnosed 4 patients of coronary artery disease in 1996 and 33 until 2000. Monochromatic 2-D X-ray beam (2.0 X 10{sup 10} photons/mm{sup 2}/sec, 130 X 75 mm) of 37 keV was obtained by non-symmetrical reflection of synchrotron radiation generated by 5.0 GeV accelerated electron. The use of 2-D beam enabled to give the dynamic IVCAG image in contrast with the static image by the 1-D slit beam. Intermittent irradiation (5 msec/100 msec) reduced the exposure dose to <750 mSv. Images were recorded in the Sony digital video-recorder placed behind the Sony Charge-coupled device (CCD) camera and Toshiba photo-multiplier, and gave the precision of 1 mm of the artery. The IVCAG by synchrotron radiation reduced patients' burden and was expected to be more widely used in future. (K.H.)

  7. Continuous glucose monitoring in acute coronary syndrome.

    Science.gov (United States)

    Rodríguez-Quintanilla, Karina Alejandra; Lavalle-González, Fernando Javier; Mancillas-Adame, Leonardo Guadalupe; Zapata-Garrido, Alfonso Javier; Villarreal-Pérez, Jesús Zacarías; Tamez-Pérez, Héctor Eloy

    2013-01-01

    Diabetes mellitus is an independent risk factor for cardiovascular disease. To compare the efficacy of devices for continuous glucose monitoring and capillary glucose monitoring in hospitalized patients with acute coronary syndrome using the following parameters: time to achieve normoglycemia, period of time in normoglycemia, and episodes of hypoglycemia. We performed a pilot, non-randomized, unblinded clinical trial that included 16 patients with acute coronary artery syndrome, a capillary or venous blood glucose ≥ 140 mg/dl, and treatment with a continuous infusion of fast acting human insulin. These patients were randomized into 2 groups: a conventional group, in which capillary measurement and recording as well as insulin adjustment were made every 4h, and an intervention group, in which measurement and recording as well as insulin adjustment were made every hour with a subcutaneous continuous monitoring system. Student's t-test was applied for mean differences and the X(2) test for qualitative variables. We observed a statistically significant difference in the mean time for achieving normoglycemia, favoring the conventional group with a P = 0.02. Continuous monitoring systems are as useful as capillary monitoring for achieving normoglycemia. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  8. HFE gene mutations in coronary atherothrombotic disease

    Directory of Open Access Journals (Sweden)

    Calado R.T.

    2000-01-01

    Full Text Available Although iron can catalyze the production of free radicals involved in LDL lipid peroxidation, the contribution of iron overload to atherosclerosis remains controversial. The description of two mutations in the HFE gene (Cys282Tyr and His63Asp related to hereditary hemochromatosis provides an opportunity to address the question of the association between iron overload and atherosclerosis. We investigated the prevalence of HFE mutations in 160 survivors of myocardial infarction with angiographically demonstrated severe coronary atherosclerotic disease, and in 160 age-, gender- and race-matched healthy control subjects. PCR amplification of genomic DNA followed by RsaI and BclI restriction enzyme digestion was used to determine the genotypes. The frequency of the mutant Cys282Tyr allele was identical among patients and controls (0.022; carrier frequency, 4.4%, whereas the mutant His63Asp allele had a frequency of 0.143 (carrier frequency, 27.5% in controls and of 0.134 (carrier frequency, 24.5% in patients. Compound heterozygotes were found in 2 of 160 (1.2% controls and in 1 of 160 (0.6% patients. The finding of a similar prevalence of Cys282Tyr and His63Asp mutations in the HFE gene among controls and patients with coronary atherothrombotic disease, indirectly questions the possibility of an association between hereditary hemochromatosis and atherosclerosis.

  9. Chronic total coronary occlusion: treatment results.

    Science.gov (United States)

    Kirk Christensen, Martin; Freeman, Phillip Fischer; Rasmussen, Jeppe Groendal; Villadsen, Anton Boel; Raungaard, Bent; Eggert Jensen, Svend; Thuesen, Leif

    2017-08-01

    To describe the clinical and procedural coronary chronic total occlusion (CTO) treatment results in a Nordic PCI centre during the implementation of a CTO treatment program. In a retrospective registry study, we assessed; (1) indication for the procedure, (2) Canadian Cardiovascular Society angina pectoris score (CCS)/New York Heart Association (NYHA) heart failure score, (3) lesion complexity and (4) adverse events during hospital stay and three months following the index procedure. The study cohort included 503 patients (594 lesions). From 2010 to 2013 96% of procedures were performed with antegrade wire-escalation technique and 4% performed using retrograde techniques, from 2013-2016 the corresponding numbers were 83% and 17.0%. The procedural success rate was 69%, increasing from 64% before to 72% (p = .06) after routinely using the retrograde approach. No individual patient characteristic, lesion variable or score was strongly associated with procedural success or failure. There were 4% serious procedure related complications. In patients with PCI of a CTO lesion only, 87% were in CCS or NYHA functional class ≥2 before the index procedure vs. 22% at follow-up. Routine use of retrograde techniques tended to increase the procedural success rate. Clinical results after three months were acceptable, but the complication rate was higher than for non-CTO PCI. Individual patient and lesion characteristics had a low predictability for procedural success. Therefore, clinical symptoms, objective signs of myocardial ischemia and procedural risk should be focus points in coronary chronic total occlusion treatment strategies.

  10. Instrument for assessing coronary symptoms in women

    Directory of Open Access Journals (Sweden)

    Cándida Rosa Castañeda Valencia

    2015-09-01

    Full Text Available Objective: To design and validate an instrument for assessing the symptoms in women with coronary disease framed in the Theory of the Unpleasant Symptoms. Methodology: Methodological, psychometric study oriented by The symptoms, first concept of the Theory of Unpleasant Symptoms by Lenz et al. Theoretical critique of the construct chosen was performed proving usefulness in research and practice discipline. From the empirical, 260 evidences were weighted through methodological and empirical critique, applying the Integrative Review System articulated to the Empirical Conceptual Model by Fawcett Garity. Only 30 research pieces were obtained, used for the construction of the items. To the Lenz symptoms were added the reported psychosocial symptoms in women with coronary disease, generating a first design composed of 87 items. Results:The design was done by experts Content Validation with the Escobar and Cuervo Model 2008 (statistical analysis spss, 20 with Kendall Correlation Coefficient k = 0.682 (p ; 0.05 with good agreement between judges. Lawshe Model normalized by Tristán 2008 reported a Content Validity Ratio = 0.57 and Content Validity Index = 0.797, showing that items are units of essential analysis. Finally, Validation Facial made by means of the pilot test, conducted on 21 women who met the inclusion criteria, allowed the discrimination semiotics of items, obtaining an instrument consisting of 67 items.  Conclusions:This is a remnant of research that requires further validation to increase its psychometric capacity.

  11. Recent perspective on coronary artery bifurcation interventions.

    Science.gov (United States)

    Dash, Debabrata

    2014-01-01

    Coronary bifurcation lesions are frequent in routine practice, accounting for 15-20% of all lesions undergoing percutaneous coronary intervention (PCI). PCI of this subset of lesions is technically challenging and historically has been associated with lower procedural success rates and worse clinical outcomes compared with non-bifurcation lesions. The introduction of drug-eluting stents has dramatically improved the outcomes. The provisional technique of implanting one stent in the main branch remains the default approach in most bifurcation lesions. Selection of the most effective technique for an individual bifurcation is important. The use of two-stent techniques as an intention to treat is an acceptable approach in some bifurcation lesions. However, a large amount of metal is generally left unapposed in the lumen with complex two-stent techniques, which is particularly concerning for the risk of stent thrombosis. New technology and dedicated bifurcation stents may overcome some of the limitations of two-stent techniques and revolutionise the management of bifurcation PCI in the future.

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

    Directory of Open Access Journals (Sweden)

    Luís Alberto Oliveira Dallan

    2013-06-01

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

  13. Successful percutaneous coronary intervention significantly improves coronary sinus blood flow as assessed by transthoracic echocardiography.

    Science.gov (United States)

    Lyubarova, Radmila; Boden, William E; Fein, Steven A; Schulman-Marcus, Joshua; Torosoff, Mikhail

    2018-06-01

    Transthoracic echocardiography (TTE) has been used to assess coronary sinus blood flow (CSBF), which reflects total coronary arterial blood flow. Successful angioplasty is expected to improve coronary arterial blood flow. Changes in CSBF after percutaneous coronary intervention (PCI), as assessed by TTE, have not been systematically evaluated. TTE can be utilized to reflect increased CSBF after a successful, clinically indicated PCI. The study cohort included 31 patients (18 females, 62 ± 11 years old) referred for diagnostic cardiac catheterization for suspected coronary artery disease and possible PCI, when clinically indicated. All performed PCIs were successful, with good angiographic outcome. CSBF per cardiac cycle (mL/beat) was measured using transthoracic two-dimensional and Doppler flow imaging as the product of coronary sinus (CS) area and CS flow time-velocity integral. CSBF per minute (mL/min) was calculated as the product of heart rate and CSBF per cardiac cycle. In each patient, CSBF was assessed prospectively, before and after cardiac catheterization with and without clinically indicated PCI. Within- and between-group differences in CSBF before and after PCI were assessed using repeated measures analysis of variance. Technically adequate CSBF measurements were obtained in 24 patients (77%). In patients who did not undergo PCI, there was no significant change in CSBF (278.1 ± 344.1 versus 342.7 ± 248.5, p = 0.36). By contrast, among patients who underwent PCI, CSBF increased significantly (254.3 ± 194.7 versus 618.3 ± 358.5 mL/min, p < 0.01, p-interaction = 0.03). Other hemodynamic and echocardiographic parameters did not change significantly before and after cardiac catheterization in either treatment group. Transthoracic echocardiographic assessment can be employed to document CSBF changes after angioplasty. Future studies are needed to explore the clinical utility of this noninvasive metric.

  14. Evaluation of coronary artery bypass grafts with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Okamura, Yoshitaka; Yamada, Yasuyuki; Mochizuki, Yoshihiko; Iida, Hiroshi; Mori, Hideaki; Sugita, You-ichi; Shimada, Kou-ichirou

    1997-01-01

    Currently, the efficacy of magnetic resonance imaging (MRI) for evaluating coronary artery disease has been reported. In this study, we have evaluated the usefulness and the problems of MRI for evaluating the patency of coronary artery bypass grafts. Thirty-five patients who received coronary artery bypass grafting (CABG) were evaluated by using MRI for determining the graft patency compared with conventional coronary angiography. There were 30 men and 5 women. The mean age was 61.2 years (range 45 to 75). The 35 patients had a total of 92 grafts (28 internal thoracic artery, 7 gastroepiploic artery and 57 saphenous vein grafts). Magnetic resonance coronary angiogram (MRCA) was performed with SIGNA HORIZON 1.5 T (GE Inc.) by using 2D-FASTCARD sequence. All patients underwent imaging in the transverse and coronal planes, most had imaging in the sagittal plane, and a few had in the oblique plane. By using MRCA, 82 of 90 grafts were diagnosed correctly as patent, and 1 of 2 grafts were diagnosed correctly as occluded. Thirty-four of 40 LAD grafts (85%), 20 of 22 RCA grafts (91%) and 29 of 30 Cx grafts (97%) were correctly evaluated. The efficacy of MRCA for evaluating the patency of coronary artery bypass grafts was recognized. But the sternal wire (stainless steel) and hemoclip interfere with the interpretation and reduce the sensitivity. Higher sensitivity may be obtained by changing the material of the sternal wires and hemoclips at coronary surgery. (author)

  15. Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region

    International Nuclear Information System (INIS)

    Dragano, Nico; Hoffmann, Barbara; Stang, Andreas; Moebus, Susanne; Verde, Pablo E.; Weyers, Simone; Moehlenkamp, Stefan; Schmermund, Axel; Mann, Klaus; Joeckel, Karl-Heinz; Erbel, Raimund; Siegrist, Johannes

    2009-01-01

    Inhabitants of deprived neighbourhoods are at higher risk of coronary heart disease. In this study we investigate the hypothesis that social inequalities at neighbourhood level become already manifest in subclinical coronary atherosclerosis, as defined by electron-beam computed tomography derived measures. Coronary artery calcification was assessed as a marker of atherosclerosis in a population based sample of 4301 men and women (45-75 years) without a history of coronary heart disease. Participants lived in three adjacent cities in Germany and were examined between 2000 and 2003 as part of the Heinz Nixdorf Recall Study. Individual level data was combined with neighbourhood level information about unemployment, welfare and living space per inhabitant. This dataset was analysed with descriptive and multilevel regression methods. An association between neighbourhood deprivation and subclinical coronary calcification was observed. After adjustment for age and individual socioeconomic status male inhabitants of high unemployment neighbourhoods had an odds ratio of 1.45 (1.11, 1.96) of exhibiting a high calcification score (>75th percentile) compared to men living in low unemployment areas. The respective odds for women was 1.29 (0.97, 1.70). Additional explorative analyses suggest that clustering of unhealthy lifestyles in deprived neighbourhoods contributes to the observed association. In conclusion, findings suggest that certain neighbourhood characteristics promote the emergence of coronary atherosclerosis. This might point to a pathway from neighbourhood deprivation to manifest coronary heart disease

  16. Coexistence of Single Coronary Artery Anomaly and Aortic Arch Anomaly

    Directory of Open Access Journals (Sweden)

    Yilmaz Omur Otlu

    2014-03-01

    Full Text Available A 74-year-old male patient was admitted to our hospital for evaluation of recent onset atypical chest pain. His medical history included hypertension, dislipidemia and smoking. Physical examination was unremarkable. The resting electrocardiogram was demonstrated biphasic T waves on lateral derivations. Transthoracic echocardiography showed normal left and right ventricular dimensions and functions. Coronary angiography was planned for the patient. First, right transradial approach tried; but guidewire could not be advanced to ascendig aorta. Coronary angiography was performed through the right femoral artery. Multiple attempts to cannulate the left coronary ostium were unsuccessful. The right coronary artery cannulated from its normal ostium in the right sinus of Valsalva. After a very short common main stem, the artery divided into a right coronary artery, and separate left anterior descending artery and circumflex artery (Figure A. The coronary arteries were normal without any significant stenosis and any extrinsic compression. An aortic root injection confirmed the absence of left coronary ostium. Also, a retroesophageal right subclavian artery originating from the left aortic arch (arteria lusoria was detected as the last branch of aortic arch on contrast enhanced computerized tomography (Figure B-C. The patient discharged with medical teraphy.

  17. Coronary angioscopy: a monorail angioscope with movable guide wire.

    Science.gov (United States)

    Nanto, S; Ohara, T; Mishima, M; Hirayama, A; Komamura, K; Matsumura, Y; Kodama, K

    1991-03-01

    A new angioscope was devised for easier visualization of the coronary artery. In its tip, the angioscope (Olympus) with an outer diameter of 0.8 mm had a metal lumen, through which a 0.014-in steerable guide wire passed. Using a 8F guiding catheter and a guide wire, it was introduced into the distal coronary artery. With injection of warmed saline through the guiding catheter, the coronary segments were visualized. In the attempted 70 vessels (32 left anterior descending [LAD], 10 right coronary [RCA], 28 left circumflex [LCX]) from 48 patients, 60 vessels (86%) were successfully examined. Twenty-two patients who underwent attempted examination of both LAD and LCX; both coronary arteries were visualized in 19 patients (86%). In the proximal site of the lesion, 40 patients have the diagonal branch or the obtuse marginal branch. In 34 patients (85%) the angioscope was inserted beyond these branches. In 12 very tortuous vessels, eight vessels (67%) were examined. In conclusion, the new monorail coronary angioscope with movable guide wire is useful to examine the stenotic lesions of the coronary artery.

  18. Multiple Coronary Chamber Microfistulas or Persistent Thebesian Vessels?

    Directory of Open Access Journals (Sweden)

    Cernica Daniel

    2017-09-01

    Full Text Available Coronary fistulas are rare, not gender-specific congenital conditions, consisting of communications between the coronary arteries and either another coronary vessel or a cardiac chamber. In contrast to large fistulas, small fistulas, named “minimae cordis veneae” or the Thebesius venous system, are draining into heart chambers and form a vascular network in the cardiac lumen. In this article, we present the case of a 72-year-old female with a significant history of cardiovascular disease, admitted to our clinic because of rest dyspnea, fatigue, and minimal chest pain. The 12-lead electrocardiogram showed a trifascicular block (a second-degree atrioventricular block Mobitz II, associated with a right bundle branch block and left anterior fascicle block and negative T waves in DII, DIII, aVF, V4–V6 leads. An invasive coronary angiography was performed, which revealed no significant atherosclerotic lesions. However, a persistent capillary blush was present at the apex site of the left ventricular chamber, draining from the distal segments of both the anterior descending coronary artery and the posterior interventricular coronary artery. The intramural vascular network generating a left ventricle angiogram image of this kind was suggestive for persistent Thebesian vessels connecting the two coronaries with the left ventricular chamber.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun; Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee

    2009-01-01

    In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

  1. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea); Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun [University of Ulsan College of Medicine, Department of Pediatric Cardiac Surgery, Asan Medical Center, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [University of Ulsan College of Medicine, Department of Pediatric Cardiology, Asan Medical Center, Seoul (Korea)

    2009-03-15

    In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

  2. Assessment of myocardial collateral circulation by intracoronary injection of radioactive microspheres and selective coronary angiography

    International Nuclear Information System (INIS)

    Uhde, W.

    1986-01-01

    In 46 patients selective coronary angiography was performed followed by selective coronary perfusion scintigraphy and a comparative assessment was made of the contralateral coronary collateral circulation. Intracoronary injection of radioactively marked imcrospheres resulted in the detection of microcirculatory processes and made it possible to evaluate the relative efficiency of coronary collaterals. This in turn meant a low-risk supplement and extension of the findings of coronary angiography. This holds particularly true for the area of the left ventricular myocardium. (author)

  3. Flow regulation in coronary vascular tree: a model study.

    Directory of Open Access Journals (Sweden)

    Xinzhou Xie

    Full Text Available Coronary blood flow can always be matched to the metabolic demand of the myocardium due to the regulation of vasoactive segments. Myocardial compressive forces play an important role in determining coronary blood flow but its impact on flow regulation is still unknown. The purpose of this study was to develop a coronary specified flow regulation model, which can integrate myocardial compressive forces and other identified regulation factors, to further investigate the coronary blood flow regulation behavior.A theoretical coronary flow regulation model including the myogenic, shear-dependent and metabolic responses was developed. Myocardial compressive forces were included in the modified wall tension model. Shear-dependent response was estimated by using the experimental data from coronary circulation. Capillary density and basal oxygen consumption were specified to corresponding to those in coronary circulation. Zero flow pressure was also modeled by using a simplified capillary model.Pressure-flow relations predicted by the proposed model are consistent with previous experimental data. The predicted diameter changes in small arteries are in good agreement with experiment observations in adenosine infusion and inhibition of NO synthesis conditions. Results demonstrate that the myocardial compressive forces acting on the vessel wall would extend the auto-regulatory range by decreasing the myogenic tone at the given perfusion pressure.Myocardial compressive forces had great impact on coronary auto-regulation effect. The proposed model was proved to be consistent with experiment observations and can be employed to investigate the coronary blood flow regulation effect in physiological and pathophysiological conditions.

  4. Nuclear Techniques for Coronary Heart Disease Therapy after Percutaneous Transluminal Coronary Angioplasty

    International Nuclear Information System (INIS)

    Nurlaila-Z

    2005-01-01

    Nuclear techniques studies of the heart represent one of the fastest growing areas of research. Several years ago, nuclear medicine cardiac studies were limited for the evaluation and diagnosis of myocardial infarction. Development in radiopharmaceutical-chemistry and instrumentation have made possible advances in nuclear medicine for restenosis cardiovascular therapy after percutaneous transluminal coronary angioplasty.The radionuclide as radiation source can be delivered to the target basically by two techniques, those are catheter-based systems and radioactive stents. For this purpose,it can be use the γ and β emitter radionuclides, in which the β emitter radionuclides is an ideal radionuclide for endovascular therapy. Restenosis after percutaneous transluminal coronary angioplasty can be prevented by using the radioactive stent. This review discusses several techniques which could be used for restenosis cardiovascular therapy. Furthermore, several types of radiopharmaceutical and kinds of radionuclides as well as doses of the compounds for this purpose are also reviewed. (author)

  5. Aggressive nonsurgical management of acute coronary artery occlusions developing immediately after percutaneous transluminal coronary angioplasty (PTCA)

    International Nuclear Information System (INIS)

    Levin, D.C.; Meyerovitz, M.; Boxt, L.; Taus, R.; Ganz, P.; Friedman, P.; Selwyn, A.

    1986-01-01

    In 368 consecutive percutaneous transluminal coronary angiography (PTCA) procedures, acute occlusion of the dilated artery developed within the first hour after the procedure in 24 cases (6.5%). Four patients underwent emergency bypass surgery. In 17 of the remaining 20 patients, repeat balloon dilation was immediately attempted, and was successful in 11 instances (65%). Five of the six cases in which repeat balloon dilation was not successful responded well to surgical or medical therapy. The author conclude that acute occlusions of dilated coronary arteries shortly after PTCA do not automatically necessitate emergency bypass. Approximately two thirds of such cases can be managed by repeat dilation, converting a potential complication into a successful outcome

  6. Comparison of primary coronary percutaneous coronary intervention between Diabetic Men and Women with acute myocardial infarction.

    Science.gov (United States)

    Liu, Heng-Liang; Liu, Yang; Hao, Zhen-Xuan; Geng, Guo-Ying; Zhang, Zhi-Fang; Jing, Song-Bin; Ba, Ning; Guo, Wei

    2015-01-01

    This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention (PCI) in female diabetic patients complicated with acute myocardial infarction (AMI). A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A (52 females) and group B (117 males). The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compared between two groups. The average age, history of hyperlipidemia, double branch lesions, triple branch lesions, and left main lesions were significantly higher in group A than in group B (P paid to the therapy of diabetic women with acute myocardial infarction as well as the control of risk factors.

  7. A Review of Coronary Artery Disease Research in Malaysia.

    Science.gov (United States)

    Ang, C S; Chan, K M J

    2016-06-01

    Coronary artery disease is the major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on coronary artery disease in Malaysia published between 2000-2015. 508 papers were identified of which 146 papers were selected and reviewed on the basis of their relevance. The epidemiology, etiology, risk factors, prevention, assessment, treatment, and outcomes of coronary artery disease in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

  8. Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients

    DEFF Research Database (Denmark)

    Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik

    2015-01-01

    Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors...... and purification steps, and demonstration of sensitivity levels of 25-125 colony forming units (CFU), we did not detect bacterial DNA from any of the coronary angioplasty balloons. A subsequent questionnaire indicated that the prevalence of periodontitis in the study cohort was at least 39.5%. Although coronary...

  9. Spontaneous bacterial coronary sinus septic thrombophlebitis treated successfully medically.

    Science.gov (United States)

    Fournet, Maxime; Behaghel, Albin; Pavy, Carine; Flecher, Erwan; Thebault, Christophe

    2014-03-01

    A 38-year-old farmer was hospitalized for fever, chills, cough, and chest pain lasting for 7 days. Due to persistent symptoms, patient was referred to hospital. Blood cultures identified oxacillin-sensitive Staphylococcus aureus (OSSA). Transthoracic echocardiography (TTE) showed large pericardial effusion, a mobile heterogeneous mass originating from the coronary sinus ostium, no sign of valvular endocarditis. Pericardiocentesis was done carrying out purulent fluid, microbiological culture isolating an OSSA. Parenteral penicillin M was administered for 6 weeks. At the end of this antibiotherapy regimen, TTE showed no coronary sinus mass with complete vacuity of the coronary sinus vein and no pericardial effusion.

  10. Exertional headache and coronary ischemia despite normal electrocardiographic stress testing.

    Science.gov (United States)

    Cutrer, F Michael; Huerter, Karina

    2006-01-01

    Exertional headaches may under certain conditions reflect coronary ischemia. We report the case of a patient seen in a neurology referral practice whose exertional headaches, even in the face of two normal electrocardiographic stress tests and in the absence of underlying chest pain were the sole symptoms of coronary ischemia as detected by Tc-99m Sestamibi testing SPECT stress testing. Stent placement resulted in complete resolution of headaches. Exertional headache in the absence of chest pain may reflect underlying symptomatic coronary artery disease (CAD) even when conventional electrocardiographic stress testing does not indicate ischemia.

  11. The Effect of Elective Percutaneous Coronary Intervention of the Right Coronary Artery on Right Ventricular Function

    Directory of Open Access Journals (Sweden)

    Farahnaz Nikdoust

    2014-12-01

    Full Text Available Background: Right Ventricular (RV dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. Patients and Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson’s correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF. P value < 0.05 was considered as statistically significant. Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males. In the pre-procedural echocardiography, 15 patients (50% had normal RV function, 14 patients (46.7% had grade-1 RV dysfunction, and only 1 patient (3.3% had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV function. Conclusions:: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia

  12. Multiple coronary stenting negatively affects myocardial recovery after coronary bypass grafting.

    Science.gov (United States)

    Yajima, Shin; Yoshioka, Daisuke; Fukushima, Satsuki; Toda, Koichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Hata, Hiroki; Saito, Shunsuke; Domae, Keitaro; Sawa, Yoshiki

    2018-05-14

    We aimed to elucidate the relationship between the magnitude of myocardial recovery after coronary artery bypass grafting (CABG) and the prognosis and to explore the predictors of myocardial non-recovery. Eighty-one patients with a preoperative left ventricular ejection fraction (LVEF) ≤ 40% who underwent isolated CABG between 2002 and 2015 and had undergone echocardiographic follow-up (median follow-up, 3.1 years; interquartile range 1.2-6.0 years) were analyzed. The Recovery group comprised patients with LVEF improvement ≥ 10%, whereas the Non-recovery group comprised those with an LVEF improvement events (MACEs), and readmission due to heart failure were evaluated. In addition, the risk factors for LVEF non-recovery were evaluated in a multivariate analysis. A total of 39 patients (48%) were in the Recovery group, whereas 42 patients (52%) were in the Non-recovery group. Although the survival and freedom from MACE rates were comparable, the rate of freedom from heart failure requiring hospitalization at 1, 5, and 8 years of follow-up was significantly lower in the Non-recovery group than in the Recovery group (p = 0.012). A history of percutaneous coronary intervention (PCI) was an exclusive independent risk factor for post-CABG myocardial non-recovery (odds ratio, 16.0; 95% confidence interval, 3.44-125). Furthermore, the number of coronary stents was negatively correlated with LVEF recovery (r = - 0.460, p = 0.024). Great consideration should be taken when performing CABG in patients with left ventricular dysfunction and a history of PCI, particularly in those with multiple coronary stents.

  13. Comparisons of images simultaneously documented by digital subtraction coronary arteriography and cine coronary arteriography

    International Nuclear Information System (INIS)

    Kimura, Koji; Takamiya, Makoto; Yamamoto, Kazuo; Ohta, Mitsushige; Naito, Hiroaki

    1988-01-01

    Using an angiography apparatus capable of simultaneously processing digital subtraction angiograms and cine angiograms, the diagnostic capabilities of both methods for the coronary arteries (DSCAG and Cine-CAG) were compared. Twenty stenotic lesions of the coronary arteries of 11 patients were evaluated using both modalities. The severity of stenosis using DSCAG with a 512x512x8 bit matrix was semiautomatically measured on the cathode ray tube (CRT) based on enlarged images on the screen of a Vanguard cine projector which were of the same size as those of or 10 times larger than images of Cine-CAG. The negative and positive hard copies of DSCAG images were also compared with those of Cine-CAG. The correlation coefficients of the severity of stenosis by DSCAG and Cine-CAG were as follows: (1) the same size DSCAG images on CRT to Cine-CAG, 0.95, (2) 10 times enlarged DSCAG images on CRT to Cine-CAG, 0.96, and (3) the same size DSCAG images on negative and positive hard copies to Cine-CAG, 0.97. The semiautomatically measured values of 10 times enlarged DSCAG images on CRT and the manually measured values of the same size negative and positive DSCAG images in hard copy closely correlated with the values measured using Cine-CAG. When the liver was superimposed in the long-axis projection, the diagnostic capabilities of DSCAG and Cine-CAG were compared. The materials included 10 left coronary arteriograms and 11 right coronary arteriograms. Diagnostically, DSCAG was more useful than Cine-CAG in the long-axis projection. (author)

  14. In vitro evaluation of 56 coronary artery stents by 256-slice multi-detector coronary CT

    International Nuclear Information System (INIS)

    Steen, Henning; Andre, Florian; Korosoglou, Grigorios; Mueller, Dirk; Hosch, Waldemar; Kauczor, Hans-Ulrich; Giannitsis, Evangelos; Katus, Hugo A.

    2011-01-01

    Objective: We sought to investigate stent lumen visibility of 56 coronary stents with the newest 256-multi-slice-CT (256-MDCT) technology for different reconstruction algorithms in an in vitro model. Background: Early identification of in-stent restenosis (ISR) is important to avoid recurrent ischemia and prevent acute myocardial infarction (AMI). Since angiography has the disadvantage of high costs and its invasiveness, MDCT could be a convenient and safe non-invasive alternative for detection of ISR. Material and methods: Percentages of in-stent lumen diameter and in-stent signal attenuation (measured as contrast-to-noise ratio (CNR)) of 56 coronary stents (group A ≤2.5 mm; group B = 2.75-3.0 mm; group C = 3.5-4.0 mm) were evaluated in a coronary vessel in vitro phantom (iodine-filled plastic tubes) employing four different reconstruction algorithms (XCD, CC, CD, XCB) on a novel 256-MDCT (Philips-iCT, collimation = 128 mm x 0.625 mm; rotation time = 270 ms; tube current = 800 mA s with 120 kV). Analysis was conducted with the semi-automatical full-width-at-half-maximum (FWHM) method. P-values 60% for group C stents was significantly larger and CNR was significantly lower (both p 3.0 mm when analysed with cardio-dedicated sharp kernels, although clinical studies corroborating this claim should be performed. However, stents ≤3.0 mm reconstructed by soft kernels revealed insufficient in-stent lumen visualisation and should not be used in clinical practice. Further improvements in spatial and temporal image resolution as well as reductions of radiation exposure and image noise have to be accomplished for the ambitious goal of characterising both CT coronary artery anatomy and in-stent lumen.

  15. Differences in coronary plaque composition with aging measured by coronary computed tomography angiography.

    Science.gov (United States)

    Tota-Maharaj, Rajesh; Blaha, Michael J; Rivera, Juan J; Henry, Travis S; Choi, Eue-Keun; Chang, Sung-A; Yoon, Yeonyee E; Chun, Eun Ju; Choi, Sang-Il; Blumenthal, Roger S; Chang, Hyuk-Jae; Nasir, Khurram

    2012-07-12

    Little is known about the independent impact of aging on coronary plaque morphology and composition in the era of cardiac computed tomography angiography (CCTA). We studied 1015 consecutive asymptomatic South Korean subjects (49 ± 10 years, 64% men) who underwent 64-slice CCTA during routine health evaluation. Coronary plaque characteristics were analyzed on a per-segment basis according to the modified AHA classification. Plaques with >50% calcified tissue were classified as calcified (CAP), plaques with NCAP). Multiple regression analysis was employed to describe the cross-sectional association between age tertile and plaque type burden (≥ 2 affected segments) after adjustment for other cardiovascular risk factors. The prevalence of coronary plaque increased with age, (1st tertile: 7.5%, 3rd tertile: 38.5% [pNCAP to overall plaque burden decreased with age from nearly 50% in the first tertile to approximately 20% in the third, while there was a reciprocal increase in both MCAP and CAP subtypes. In multivariable analysis, patients in the oldest tertile had a 2.5-fold increase in burden of NCAP, yet a nearly 40-fold increase in MCAP and 16-fold increase in CAP compared to the youngest tertile. In conclusion, CCTA is an effective method for measuring age-related differences in the burden of individual coronary plaque subtypes. Future research is needed to determine whether the increase in mixed and calcified plaques seen with aging produce an independent contribution to the age-related increase in cardiovascular risk. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  16. Factors associated with coronary artery disease progression assessed by serial coronary computed tomography angiography

    International Nuclear Information System (INIS)

    Camargo, Gabriel Cordeiro; Gottlieb, Ilan; Rothstein, Tamara; Derenne, Maria Eduarda; Sabioni, Leticia; Lima, Ronaldo de Souza Leão; Lima, João A. C.

    2017-01-01

    Background: Coronary computed tomography angiography (CCTA) allows for noninvasive coronary artery disease (CAD) phenotyping. Factors related to CAD progression are epidemiologically valuable. Objective: To identify factors associated with CAD progression in patients undergoing sequential CCTA testing. Methods: We retrospectively analyzed 384 consecutive patients who had at least two CCTA studies between December 2005 and March 2013. Due to limitations in the quantification of CAD progression, we excluded patients who had undergone surgical revascularization previously or percutaneous coronary intervention (PCI) between studies. CAD progression was defined as any increase in the adapted segment stenosis score (calculated using the number of diseased segments and stenosis severity) in all coronary segments without stent (in-stent restenosis was excluded from the analysis). Stepwise logistic regression was used to assess variables associated with CAD progression. Results: From a final population of 234 patients, a total of 117 (50%) had CAD progression. In a model accounting for major CAD risk factors and other baseline characteristics, only age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01–1.07), interstudy interval (OR 1.03, 95%CI 1.01–1.04), and past PCI (OR 3.66, 95%CI 1.77–7.55) showed an independent relationship with CAD progression. Conclusions: A history of PCI with stent placement was independently associated with a 3.7-fold increase in the odds of CAD progression, excluding in-stent restenosis. Age and interstudy interval were also independent predictors of progression. (author)

  17. Prediction of postpercutaneous coronary intervention myocardial infarction: insights from intravascular imaging, coronary flow, and biomarker evaluation.

    Science.gov (United States)

    Hoole, Stephen P; Hernández-Sánchez, Jules; Brown, Adam J; Giblett, Joel P; Bennett, Martin R; West, Nick E J

    2018-05-01

    Percutaneous coronary intervention-induced myocardial infarction (PMI) has prognostic significance. Identifying patients at high risk for PMI is desirable as it may alter strategy and facilitate early preventative therapy. We therefore sought to establish whether preprocedural demographic, interventional (plaque characteristics and coronary microcirculatory function), and inflammatory, endothelial damage, and platelet-derived biomarker data could predict the risk of PMI. We performed target vessel pressure wire to assess fractional flow reserve, index of microcirculatory resistance (IMR) and coronary flow reserve, plaque characterization by virtual histology intravascular ultrasound, and assayed peripheral biomarkers before uncomplicated PCI in 88 patients. We then analyzed post-PCI cardiac troponin level to adjudicate PMI based on the third universal definition of myocardial infarction. Overall incidence of PMI was 27%. Women [10/15 (66%) vs. 14/73 (19%), PPMI. Preprocedural coronary flow reserve was lower in individuals with a subsequent PMI (1.8±1.2 vs. 2.1±1.3. P=0.03), and patients with higher pre-PCI IMR were more likely to sustain PMI [IMR>22: 10/23 (44%) vs. ≤22: 14/65 (22%), P=0.04], although neither was predictive after multivariate analysis. Plaque characterization by virtual histology intravascular ultrasound did not discriminate those at risk of PMI. However, peripheral venous interleukin (IL)-18 and IL-8 levels were independently negatively and positively associated with PMI, respectively. Women and those with low BMI, particularly when associated with high IL-8 and low IL-18 levels, appear to be at increased risk of PMI.

  18. Factors associated with coronary artery disease progression assessed by serial coronary computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Camargo, Gabriel Cordeiro; Gottlieb, Ilan, E-mail: ilangottlieb@gmail.com [Casa de Saúde São José, Rio de Janeiro, RJ (Brazil); Rothstein, Tamara; Derenne, Maria Eduarda; Sabioni, Leticia; Lima, Ronaldo de Souza Leão [Centro de Diagnóstico por Imagem CDPI, Rio de Janeiro, RJ (Brazil); Lima, João A. C. [Johns Hopkins University, Baltimore (United States)

    2017-05-15

    Background: Coronary computed tomography angiography (CCTA) allows for noninvasive coronary artery disease (CAD) phenotyping. Factors related to CAD progression are epidemiologically valuable. Objective: To identify factors associated with CAD progression in patients undergoing sequential CCTA testing. Methods: We retrospectively analyzed 384 consecutive patients who had at least two CCTA studies between December 2005 and March 2013. Due to limitations in the quantification of CAD progression, we excluded patients who had undergone surgical revascularization previously or percutaneous coronary intervention (PCI) between studies. CAD progression was defined as any increase in the adapted segment stenosis score (calculated using the number of diseased segments and stenosis severity) in all coronary segments without stent (in-stent restenosis was excluded from the analysis). Stepwise logistic regression was used to assess variables associated with CAD progression. Results: From a final population of 234 patients, a total of 117 (50%) had CAD progression. In a model accounting for major CAD risk factors and other baseline characteristics, only age (odds ratio [OR] 1.04, 95% confidence interval [95%CI] 1.01–1.07), interstudy interval (OR 1.03, 95%CI 1.01–1.04), and past PCI (OR 3.66, 95%CI 1.77–7.55) showed an independent relationship with CAD progression. Conclusions: A history of PCI with stent placement was independently associated with a 3.7-fold increase in the odds of CAD progression, excluding in-stent restenosis. Age and interstudy interval were also independent predictors of progression. (author)

  19. Evaluation of coronary artery disease by helical CT using retrospective ECG-gating

    International Nuclear Information System (INIS)

    Kawawa, Yoko

    2001-01-01

    The purpose of this study is to evaluate the usefulness of helical CT using retrospective ECG-gating for visualization of the coronary artery and detection of coronary artery disease. We performed a coronary artery phantom study and established this new application, with 1-mm collimation, 1-mm table increment, and 0.1-mm reconstruction (0.8 sec/rotation). Helical CT of 31 patients with 39 coronary artery diseases (34 coronary artery stenoses, 1 vasospastic angina, 1 coronary artery dissection, 1 coronary artery ectasia and 2 coronary artery aneurysms) was performed in a single breath hold and ECG-gating without and with intravenous injection of nonionic iodine contrast material. We selected the images which were not affected by cardiac motion from the reconstruction images, in order to visualize the coronary artery for detection of coronary artery disease. The coronary artery was well visualized in 32 out of 39 vessels (82%). A good visualization of the coronary artery was correlated with the heart rate. Further, in this well visualized group, coronary artery diseases were detected in 24 out of 31 cases (77%). One case of vasospastic angina was not included. It was difficult to detect coronary artery disease in cases of heavily calcified vessels or in the left circumflex artery. Helical CT using this retrospective ECG-gating is a useful noninvasive examination for evaluation of coronary artery disease. (author)

  20. Behavioral interventions for coronary heart disease patients

    Directory of Open Access Journals (Sweden)

    Orth-Gomér Kristina

    2012-02-01

    Full Text Available Abstract Introduction There is a strong clinical need to provide effective stress reduction programs for patients with an acute coronary syndrome. Such programs for men have been implemented and their cardiovascular health benefit documented. For women such programs are scarce. In this report, The feasibility of a cognitive method that was recently demonstrated to prolong lives of women is tested. A setting with gender segregated groups was applied. Method The principles of a behavioural health educational program originally designed to attenuate the stress of patients with coronary prone behaviours were used as a basis for the intervention method. For the groups of female patients this method was tailored according to female stressors and for the groups of men according to male stressors. The same core stress reduction program was used for women and men, but the contents of discussions and responses to the pre planned program varied. These were continuously monitored throughout the fifteen sessions. Implementation group: Thirty consecutive patients, eleven women and nineteen men, hospitalized for an acute coronary syndrome were included in this intervention. All expressed their need to learn how to cope with stress in daily life and were highly motivated. Five groups, three groups of men and two groups of women were formed. Psychological assessments were made immediately before and after completion of the program. Results No gender differences in the pre planned programs were found, but discussion styles varied between the women and men, Women were more open and more personal. Family issues were more frequent than job issues, although all women were employed outside their homes. Men talked about concrete and practical things, mostly about their jobs, and not directly about their feelings. Daily stresses of life decreased significantly for both men and women, but more so for women. Depressive thoughts were low at baseline, and there was no

  1. Behavioral interventions for coronary heart disease patients.

    Science.gov (United States)

    Orth-Gomér, Kristina

    2012-02-02

    There is a strong clinical need to provide effective stress reduction programs for patients with an acute coronary syndrome. Such programs for men have been implemented and their cardiovascular health benefit documented. For women such programs are scarce.In this report, The feasibility of a cognitive method that was recently demonstrated to prolong lives of women is tested. A setting with gender segregated groups was applied. The principles of a behavioural health educational program originally designed to attenuate the stress of patients with coronary prone behaviours were used as a basis for the intervention method. For the groups of female patients this method was tailored according to female stressors and for the groups of men according to male stressors. The same core stress reduction program was used for women and men, but the contents of discussions and responses to the pre planned program varied. These were continuously monitored throughout the fifteen sessions. Implementation group: Thirty consecutive patients, eleven women and nineteen men, hospitalized for an acute coronary syndrome were included in this intervention. All expressed their need to learn how to cope with stress in daily life and were highly motivated. Five groups, three groups of men and two groups of women were formed. Psychological assessments were made immediately before and after completion of the program. No gender differences in the pre planned programs were found, but discussion styles varied between the women and men, Women were more open and more personal. Family issues were more frequent than job issues, although all women were employed outside their homes. Men talked about concrete and practical things, mostly about their jobs, and not directly about their feelings. Daily stresses of life decreased significantly for both men and women, but more so for women. Depressive thoughts were low at baseline, and there was no change over time. In contrast, anxiety scores were high at

  2. Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Dewey, Marc; Hamm, Bernd

    2007-01-01

    We compared the cost effectiveness of recent approaches [coronary angiography and calcium scoring using computed tomography (CT) and stress magnetic resonance imaging (MRI)] to the diagnosis of coronary artery disease (CAD) with those of the traditional diagnostic modalities [conventional angiography (CATH), exercise ECG, and stress echocardiography] using a decision tree model. For patients with a 10% to 50% pretest likelihood of coronary artery disease, non-invasive coronary angiography using CT was the most cost effective approach, with costs per correctly identified CAD patient of EUR4,435 (10% likelihood) to EUR1,469 (50% likelihood). Only for a pretest likelihood of 30% to 40% was calcium scoring using CT more cost effective than any of the traditional diagnostic modalities, while MRI was not cost effective for any pretest likelihood. At a pretest likelihood of 60%, CT coronary angiography and CATH were equally effective, while CATH was most cost effective for a pretest likelihood of at least 70%. In conclusion, up to a pretest likelihood for coronary artery disease of 50%, CT coronary angiography is the most cost-effective procedure, being superior to the other new modalities and the most commonly used traditional diagnostic modalities. With a very high likelihood for disease (above 60%), CATH is the most effective procedure from the perspective of society. (orig.)

  3. Three-dimensional coronary MR angiography with continuous administration of Gd-DTPA. Delineation and detection of coronary artery stenosis

    International Nuclear Information System (INIS)

    Yokoyama, Kenichi

    1999-01-01

    Three-dimensional coronary MR angiography (3D coronary MRA) with Gd-DTPA administration was performed in 19 patients to evaluate the vascular delineation and diagnostic capability for stenotic lesions. A 3D fast low-angle shot (FLASH) with a navigator echo respiratory gating technique was used with a superconducting 1.5 tesla MR system (Vision, Siemens Medical Systems, Erlangen, Germany). Administration of the conventional T 1 contrast agent with extra-cellular distribution produced a significant increase in the SNR and CNR of the proximal coronary arterial images. Visual score of both the source images and the multiplanar reconstruction (MPR) images assessed by three radiologists was superior to those on control images (without contrast enhancement). The MRA findings of stenotic lesions of the coronary artery were compared with the results of the conventional coronary angiographic study. Overall sensitivity and specificity for the detection of stenosis were almost the same as those of control images. In conclusion, 3D coronary MRA with Gd-DTPA administration improved coronary artery delineation. However, further technical improvements are required to enhance the value of the technique in detecting stenoses. (author)

  4. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ghoshhajra, Brian B.; Staziaki, Pedro V.; Vadvala, Harshna; Kim, Phillip; Meyersohn, Nandini M.; Janjua, Sumbal A.; Hoffmann, Udo [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Takx, Richard A.P. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Neilan, Tomas G.; Francis, Sanjeev [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston, MA (United States); Bittner, Daniel [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuernberg (FAU), Department of Medicine 2 - Cardiology, Erlangen (Germany); Mayrhofer, Thomas [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Stralsund University of Applied Sciences, School of Business Studies, Stralsund (Germany); Greenwald, Jeffrey L. [Massachusetts General Hospital and Harvard Medical School, Department of Medicine, Boston, MA (United States); Truong, Quyhn A. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Weill Cornell College of Medicine, Department of Radiology, New York, NY (United States); Abbara, Suhny [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); UT Southwestern Medical Center, Department Cardiothoracic Imaging, Dallas, TX (United States); Brown, David F.M.; Nagurney, John T. [Massachusetts General Hospital and Harvard Medical School, Department of Emergency Medicine, Boston, MA (United States); Januzzi, James L. [Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston, MA (United States); Collaboration: MGH Emergency Cardiac CTA Program Contributors

    2017-07-15

    To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %. Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS. (orig.)

  5. 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.

  6. Advanced 2-dimensional quantitative coronary angiographic analysis for prediction of fractional flow reserve in intermediate coronary stenoses.

    Science.gov (United States)

    Opolski, Maksymilian P; Pregowski, Jerzy; Kruk, Mariusz; Kepka, Cezary; Staruch, Adam D; Witkowski, Adam

    2014-07-01

    The widespread clinical application of coronary computed tomography angiography (CCTA) has resulted in increased referral patterns of patients with intermediate coronary stenoses to invasive coronary angiography. We evaluated the application of advanced quantitative coronary angiography (A-QCA) for predicting fractional flow reserve (FFR) in intermediate coronary lesions detected on CCTA. Fifty-six patients with 66 single intermediate coronary lesions (≥ 50% to 80% stenosis) on CCTA prospectively underwent coronary angiography and FFR. A-QCA including calculation of the Poiseuille-based index defined as the ratio of lesion length to the fourth power of the minimal lumen diameter (MLD) was performed. Significant stenosis was defined as FFR ≤ 0.80. The mean FFR was 0.86 ± 0.09, and 18 lesions (27%) were functionally significant. FFR correlated with lesion length (R=-0.303, P=0.013), MLD (R=0.527, P44%, and >69%, respectively (maximum negative predictive value of 94% for MLA, maximum positive predictive value of 58% for diameter stenosis). The Poiseuille-based index was the most accurate (C statistic 0.86, sensitivity 100%, specificity 71%, positive predictive value 56%, and negative predictive value 100%) predictor of FFR ≤ 0.80, but showed the lowest interobserver agreement (intraclass correlation coefficient 0.37). A-QCA might be used to rule out significant ischemia in intermediate stenoses detected by CCTA. The diagnostic application of the Poiseuille-based angiographic index is precluded by its high interobserver variability.

  7. Bioabsorbable coronary stents--are these the next big thing in coronary angioplasty?

    Science.gov (United States)

    Balla, Sudarshan; Aggarwal, Kul; Nistala, Ravi

    2010-06-01

    The role of percutaneous coronary intervention (PCI) in the treatment of coronary artery disease has grown at an astronomical pace. Drug eluting stents (DES) offer advantages over bare metal stents (BMS) such as reduction in early in-stent restenosis rates. However, they have disadvantages like from increased late stent thrombosis when compared with BMS. Furthermore, recent data suggest endothelial dysfunction in the DES stented segments of the arteries. Currently, bioabsorbable stents are under development to avert the complications of DES such as stent thrombosis via degradation of the stent over time. The hypothetical advantage of leaving behind a natural vessel and restoring vasoreactivity may be the almost normal physiology which can be achieved after an intervention with a stent. The ABSORB and the PROGRESS AMS are two of the recent clinical trials that have looked at the outcomes of using bioabsorbable stents. So far, data from these and other studies has yielded mixed results in terms of angiographic and clinical outcomes. Newer stents such as REVA and WHISPER are presently being tested in preclinical and clinical trials. The landscape for bioabsorbable stents is constantly evolving through continued improvisation on existing technology and emergence of new technology. Large scale randomized trials are still needed with adequate long term follow-up for safety and benefits to have mainstream application in coronary artery disease, bioabsorbable stents are a promising innovation in the field of PCI. We review some of the patents and the data that is emerging on bioabsorbable stents in addition to currently ongoing clinical trials.

  8. Technical feasibility and validation of a coronary artery calcium scoring system using CT coronary angiography images

    Energy Technology Data Exchange (ETDEWEB)

    Pavitt, Christopher W. [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Harron, Katie [Institute of Child Health, UCL, Centre for Paediatric Epidemiology and Biostatistics, London (United Kingdom); Lindsay, Alistair C.; Ray, Robin [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Zielke, Sayeh; Rubens, Michael B. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Gordon, Daniel [Royal Marsden Hospital, Department of Physics, London (United Kingdom); Padley, Simon P. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Imperial College, Faculty of Medicine, London (United Kingdom); Nicol, Edward D. [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Imperial College, Faculty of Medicine, London (United Kingdom)

    2016-05-15

    We validate a novel CT coronary angiography (CCTA) coronary calcium scoring system. Calcium was quantified on CCTA images using a new patient-specific attenuation threshold: mean + 2SD of intra-coronary contrast density (HU). Using 335 patient data sets a conversion factor (CF) for predicting CACS from CCTA scores (CCTAS) was derived and validated in a separate cohort (n = 168). Bland-Altman analysis and weighted kappa for MESA centiles and Agatston risk groupings were calculated. Multivariable linear regression yielded a CF: CACS = (1.185 x CCTAS) + (0.002 x CCTAS x attenuation threshold). When applied to CCTA data sets there was excellent correlation (r = 0.95; p < 0.0001) and agreement (mean difference -10.4 [95 % limits of agreement -258.9 to 238.1]) with traditional calcium scores. Agreement was better for calcium scores below 500; however, MESA percentile agreement was better for high risk patients. Risk stratification was excellent (Agatston groups k = 0.88 and MESA centiles k = 0.91). Eliminating the dedicated CACS scan decreased patient radiation exposure by approximately one-third. CCTA calcium scores can accurately predict CACS using a simple, individualized, semiautomated approach reducing acquisition time and radiation exposure when evaluating patients for CAD. This method is not affected by the ROI location, imaging protocol, or tube voltage strengthening its clinical applicability. (orig.)

  9. Reconsidering the Gatekeeper Paradigm for Percutaneous Coronary Intervention in Stable Coronary Disease Management.

    Science.gov (United States)

    Schulman-Marcus, Joshua; Weintraub, William S; Boden, William E

    2017-10-15

    Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes. Nevertheless, the decision-making paradigm for patients with stable CAD often continues to propagate the upfront use of "ad hoc PCI" and disadvantages alternative therapeutic approaches. In our editorial, we discuss how multiple systemic and interpersonal factors continue to favor early revascularization with PCI in stable patients. We discuss whether the interventional cardiologist can be an unbiased "gatekeeper" for the use of PCI or whether other physicians should also be involved with the patient in decision-making. Finally, we offer suggestions that can redefine the gatekeeper role to facilitate an evidence-based approach that embraces shared decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Percutaneous coronary intervention versus coronary artery bypass grafting: where are we after NOBLE and EXCEL?

    Science.gov (United States)

    Fortier, Jacqueline H; Shaw, Richard E; Glineur, David; Grau, Juan B

    2017-11-01

    The publication of the NOBLE and EXCEL trials, with seemingly conflicting results, brought into question whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is better for low-risk patients with left main coronary artery stenosis (LMCAS). This review appraises the methods and results of NOBLE and EXCEL, contextualizes them within the literature, and determines how they may affect clinical practice. We appraised the trials and describe differences in methodology and results. NOBLE recruited primarily isolated LMCAS, and found that CABG was superior to PCI. EXCEL's population included patients LMCAS in the context of multivessel CAD, and found PCI and CABG were comparable. Both trials enrolled young patients with few comorbidities, and there was more protocol-mandated consistency in the procedural techniques and medical therapy of patients receiving PCI. The generalizability of these trials is limited by the use of young, healthy patients at highly skilled centres that rarely reflect typical clinical practice. If these studies are to maintain relevance, trialists must address the lack of protocolization of surgical interventions and inconsistent medical therapies. Unfortunately, the limitations of NOBLE and EXCEL mean that we are no closer to answering the question of what is the optimal treatment for patients with LMCAS.

  11. The clinical usefulness evaluation of normal saline injection in coronary artery computed tomography angiography (Coronary CTA)

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Kang Kyo; Lee, Mi Hwa; Cho, Pyong Kon [Dept. of Radiological Science, Catholic University of Daegu, Daegu (Korea, Republic of)

    2014-12-15

    The purpose of this study is that in coronary artery angiography computed tomography (coronary CTA), to gain high quality of image and to use low dose radiation by administrating normal saline and converting the mode of scanning heart rate (HR) characteristics before infusing contrast media. All patients data (total specimens: 200, male: 108, female: 92) were measured by using appropriate mode of scanning the heart rate (HR) after injection of saline. in addition we measured radiation dose (CTDIvol, effective dose) in all examinations. CT number and noise, and blurring of coronary artery (proximal RCA, middle RCA, proximal LCA) were measured and compared. The result of this study after injection of saline, mean heart rate was decreased about 4.8±0.3 bpm (beats per minute). 33 patients (13%) got converting scan mode due to reducing heart rate (HR). In prospective gating mode, radiation dose were measured less 6.0±1.0 mSv (54.1%) than retrospective gating mode. Also showed a significant difference in heart rate decrease in image evaluation.

  12. Percutaneous coronary intervention and the management of acute coronary syndromes in patients with von Willebrand disease.

    Science.gov (United States)

    Rathore, Sulaiman; Deleon, Dexter; Akram, Hafsa; Sane, David; Ball, Timothy

    2013-04-01

    Von Willebrand disease (vWD) results from quantitative or qualitative deficiency of von Willebrand factor (vWF). The occurrence of myocardial infarction is very rare in patients with vWD. A few case reports of acute coronary syndrome (ACS) in vWD patients are present in the literature, but no definite management recommendations are available for such patients. We report a case of successful percutaneous coronary intervention (PCI) with bare-metal stent (BMS) implantation in a 46-year-old woman with type 1 vWD and history of coronary artery disease (CAD). She received periprocedural dual-antiplatelet therapy for 2 weeks and then continued aspirin without any bleeding complications. The optimal management of patients with vWD and ACS is complex and presents a therapeutic challenge. We propose that dual-antiplatelet therapy can be used safely in most vWD patients presenting with ACS as most of them are type 1 vWD. PCI with BMS can be done safely. Long-term management of these patients requires a systemic approach including hematological consultation, ascertaining vWF levels, as well as patient education and close outpatient follow-up.

  13. Incremental value of the CT coronary calcium score for the prediction of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Genders, Tessa S.S. [Erasmus University Medical Center, Department of Epidemiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Radiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Pugliese, Francesca; Mollet, Nico R.; Meijboom, W. Bob; Weustink, Annick C.; Mieghem, Carlos A.G. van; Feyter, Pim J. de [Erasmus University Medical Center, Department of Radiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Cardiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Hunink, M.G.M. [Erasmus University Medical Center, Department of Epidemiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Radiology, P.O. Box 2040, CA, Rotterdam (Netherlands); Harvard University, Department of Health Policy and Management, Harvard School of Public Health, Boston (United States)

    2010-10-15

    To validate published prediction models for the presence of obstructive coronary artery disease (CAD) in patients with new onset stable typical or atypical angina pectoris and to assess the incremental value of the CT coronary calcium score (CTCS). We searched the literature for clinical prediction rules for the diagnosis of obstructive CAD, defined as {>=}50% stenosis in at least one vessel on conventional coronary angiography. Significant variables were re-analysed in our dataset of 254 patients with logistic regression. CTCS was subsequently included in the models. The area under the receiver operating characteristic curve (AUC) was calculated to assess diagnostic performance. Re-analysing the variables used by Diamond and Forrester yielded an AUC of 0.798, which increased to 0.890 by adding CTCS. For Pryor, Morise 1994, Morise 1997 and Shaw the AUC increased from 0.838 to 0.901, 0.831 to 0.899, 0.840 to 0.898 and 0.833 to 0.899. CTCS significantly improved model performance in each model. Validation demonstrated good diagnostic performance across all models. CTCS improves the prediction of the presence of obstructive CAD, independent of clinical predictors, and should be considered in its diagnostic work-up. (orig.)

  14. The clinical usefulness evaluation of normal saline injection in coronary artery computed tomography angiography (Coronary CTA)

    International Nuclear Information System (INIS)

    Jung, Kang Kyo; Lee, Mi Hwa; Cho, Pyong Kon

    2014-01-01

    The purpose of this study is that in coronary artery angiography computed tomography (coronary CTA), to gain high quality of image and to use low dose radiation by administrating normal saline and converting the mode of scanning heart rate (HR) characteristics before infusing contrast media. All patients data (total specimens: 200, male: 108, female: 92) were measured by using appropriate mode of scanning the heart rate (HR) after injection of saline. in addition we measured radiation dose (CTDIvol, effective dose) in all examinations. CT number and noise, and blurring of coronary artery (proximal RCA, middle RCA, proximal LCA) were measured and compared. The result of this study after injection of saline, mean heart rate was decreased about 4.8±0.3 bpm (beats per minute). 33 patients (13%) got converting scan mode due to reducing heart rate (HR). In prospective gating mode, radiation dose were measured less 6.0±1.0 mSv (54.1%) than retrospective gating mode. Also showed a significant difference in heart rate decrease in image evaluation

  15. Incremental value of the CT coronary calcium score for the prediction of coronary artery disease

    International Nuclear Information System (INIS)

    Genders, Tessa S.S.; Pugliese, Francesca; Mollet, Nico R.; Meijboom, W. Bob; Weustink, Annick C.; Mieghem, Carlos A.G. van; Feyter, Pim J. de; Hunink, M.G.M.

    2010-01-01

    To validate published prediction models for the presence of obstructive coronary artery disease (CAD) in patients with new onset stable typical or atypical angina pectoris and to assess the incremental value of the CT coronary calcium score (CTCS). We searched the literature for clinical prediction rules for the diagnosis of obstructive CAD, defined as ≥50% stenosis in at least one vessel on conventional coronary angiography. Significant variables were re-analysed in our dataset of 254 patients with logistic regression. CTCS was subsequently included in the models. The area under the receiver operating characteristic curve (AUC) was calculated to assess diagnostic performance. Re-analysing the variables used by Diamond and Forrester yielded an AUC of 0.798, which increased to 0.890 by adding CTCS. For Pryor, Morise 1994, Morise 1997 and Shaw the AUC increased from 0.838 to 0.901, 0.831 to 0.899, 0.840 to 0.898 and 0.833 to 0.899. CTCS significantly improved model performance in each model. Validation demonstrated good diagnostic performance across all models. CTCS improves the prediction of the presence of obstructive CAD, independent of clinical predictors, and should be considered in its diagnostic work-up. (orig.)

  16. High-Risk Coronary Plaques Complicated with Acute Coronary Syndrome in Young Patients

    Directory of Open Access Journals (Sweden)

    Opincariu Diana

    2017-06-01

    Full Text Available Coronary computed tomography angiography (CCTA has evolved notably over the last decade, gaining an increased amount of temporo-spatial resolution in combination with decreased radiation exposure. The importance of CCTA is emerging especially in vulnerable and young patients who might not have developed a viable collateral vascular network to sustain the circulation to an infarction area during a major adverse coronary event. There are a few well-known markers by which a vulnerable plaque can be assessed and that can predict the subsequent events of sudden myocardial ischemia, such as an increased positive remodeling index (cut-off >1.4, low-attenuation plaque (cut-off 0.7, and napkin-ring sign (NRS. This manuscript presents a series of 3 clinical cases of young patients experiencing symptoms and signs of myocardial ischemia who underwent CCTA in order to assess the composition and functional characteristics of atherosclerotic plaques and their repercussion in developing an acute coronary syndrome.

  17. Coronary artery aneurysms in acute coronary syndrome: case series, review, and proposed management strategy.

    Science.gov (United States)

    Boyer, Nathan; Gupta, Rajesh; Schevchuck, Alex; Hindnavis, Vindhya; Maliske, Seth; Sheldon, Mark; Drachman, Douglas; Yeghiazarians, Yerem

    2014-06-01

    Coronary artery aneurysm (CAA) is an uncommon clinical finding, with an incidence varying from 1.5%-4.9% in adults, and is usually considered a variant of coronary artery disease (CAD). CAA identified in the context of acute coronary syndrome (ACS) represents a unique management challenge, particularly if the morphology of the CAA is suspected to have provoked the acute clinical syndrome. CAA is associated with thrombus formation due to abnormal laminar flow, as well as abnormal platelet and endothelial-derived pathophysiologic factors within the CAA. Once formed, mural thrombus may potentiate the deposition of additional thrombus within aneurysmal segments. Percutaneous revascularization of CAA has been associated with complications including distal embolization of thrombus, no-reflow phenomenon, stent malapposition, dissection, and rupture. Presently, there are no formal guidelines to direct the management of CAA in patients presenting with ACS; controversies exist whether conservative, surgical, or catheter-based management should be pursued. In this manuscript, we present an extensive review of the existing literature and associated clinical guidelines, and propose a management algorithm for patients with this complex clinical scenario. Armed with this perspective, therapeutic decisions may be tailored to synthesize patient factors and preferences, individualized clinical assessment, and existing American Heart Association/American College of Cardiology guidelines for management of ACS.

  18. Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease

    DEFF Research Database (Denmark)

    Flintholm Raft, Kristoffer; Frestad, Daria; Michelsen, Marie Mide

    2017-01-01

    PURPOSE: We investigated whether impaired flow-mediated dilation (FMD) and plasma biomarkers reflecting endothelial dysfunction are associated with coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease (CAD). METHODS: Patients (n = 194) were rand...

  19. Impact of abciximab in elderly patients with high-risk acute coronary syndrome undergoing percutaneous coronary intervention: an observational registry study

    DEFF Research Database (Denmark)

    Iversen, Allan Z; Galatius, Soeren; Haahr-Pedersen, Sune Ammentorp

    2011-01-01

    BACKGROUND: An increasing proportion of patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI) are classified as elderly (aged =70 years). The glycoprotein IIb/IIIa inhibitor abciximab is known to reduce adverse outcomes in patients aged

  20. Platelet Glycoprotein IIb/IIIa Receptor Inhibition in Non-ST-Elevation Acute Coronary Syndromes : Early Benefit During Medical Treatment Only, With Additional Protection During Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    K.M. Akkerhuis (Martijn); P. Théroux (Pierre); R.M. Califf (Robert); E.J. Topol (Eric); M.L. Simoons (Maarten); H. Boersma (Eric)

    1999-01-01

    textabstractBACKGROUND: Glycoprotein (GP) IIb/IIIa receptor blockers prevent life-threatening cardiac complications in patients with acute coronary syndromes without ST-segment elevation and protect against thrombotic complications associated with percutaneous coronary

  1. Coronary Artery Calcium Distribution and Interscan Measurement Variability in End-Stage Renal and Coronary Heart Disease Patients

    Energy Technology Data Exchange (ETDEWEB)

    Serafin, Z.; Laskowska, K.; Marzec, M.; Lasek, W. (Dept. of Radiology and Diagnostic Imaging, Nicolaus Copernicus Univ., Collegium Medicum, Bydgoszcz (Poland)); Sinjab, T.A.; Wlodarczyk, Z. (Dept. of Transplantology, Nicolaus Copernicus Univ., Collegium Medicum, Bydgoszcz (Poland))

    2009-04-15

    Background: Coronary heart disease patients and end-stage renal disease patients have been documented to have an increased amount of coronary artery calcifications (CAC). Purpose: To evaluate the distribution of CAC and its influence on interscan variability of measurement in end-stage renal disease and coronary heart disease patients, proven to have calcifications. Material and Methods: 69 patients having CAC, including 34 with coronary heart disease and 35 with end-stage renal disease, were scanned twice with multidetector-row computed tomography (MDCT). Amount of CAC was determined as the number of calcified lesions (CN), total calcium score (CS), calcium volume (CV), and calcium mass (CM). Distribution of CAC was evaluated on a per-patient basis as the median CS and CM of a single lesion. Density of the calcifications was calculated as the patient's CM divided by CV. Results: The overall median CS was 457.2, and the median CM was 75.6 mg. There were no significant differences in the number of calcified lesions, CS, or CM between the two groups. Both CS and CM of a single lesion, as well as the mean calcium density were lower in renal disease patients (P<0.05) than in coronary heart disease subjects. The relative interscan variability of coronary calcium measurement was higher in the renal disease group (P<0.05). There was a negative correlation between the calcium concentration and the relative interscan variability. Conclusion: The results indicate that the coronary calcium distribution influences the measurement interscan reproducibility, and the distribution may differ between end-stage renal disease patients and coronary heart disease patients, reflecting the dissimilar nature of coronary calcifications in those groups.

  2. Evaluation value of coronary CTA for coronary plaque features and its correlation with platelet function and serum biochemical indexes

    Directory of Open Access Journals (Sweden)

    Jin-Xia Yang

    2017-01-01

    Full Text Available Objective: To analyze the evaluation value of coronary CT angiography for coronary plaque features and its correlation with platelet function and serum biochemical indexes. Methods: A total of 450 patients with coronary heart disease were divided into calcified plaque group (CT value≥130HU (n=117, soft plaque group (CT value≤60HU (n=150 and mixed plaque group (CT value 60-130HU (n=183 by coronary CT angiography (CTA, and 100 healthy subjects who received physical examination in our hospital during the same period were selected as control group. Differences in platelet function and serum biochemical indexes were compared among four groups of patients, and the judgment value of atheromatous plaque CT value from CTA for the severity of coronary heart disease was analyzed. Results: Platelet function parameters MPV, TEG-MA, P-selectin, PDGF-BB and vWF levels in peripheral blood of soft plaque group were higher than those of the other three groups; inflammatory factors CRP, IL-6, IL-12, IL-18 and IL-23 content in serum were higher than those of the other three groups; chemokines MCP-1, CXCL16, Fractalkine and RANTES content in serum were higher than those of the other three groups; adipocytokines Leptin and RBP4 content in serum were higher than those of the other three groups while SFRP5 content was lower than those of the other three groups. Atheromatous plaque CT value in patients with coronary heart disease was directly correlated with platelet function and the content of serum biochemical indexes. Conclusions: Coronary CTA can accurately assess coronary atheromatous plaque features, and can also be a reliable noninvasive method to judge coronary heart disease severity, treatment prognosis and so on.

  3. Coronary Artery Calcium Distribution and Interscan Measurement Variability in End-Stage Renal and Coronary Heart Disease Patients

    International Nuclear Information System (INIS)

    Serafin, Z.; Laskowska, K.; Marzec, M.; Lasek, W.; Sinjab, T.A.; Wlodarczyk, Z.

    2009-01-01

    Background: Coronary heart disease patients and end-stage renal disease patients have been documented to have an increased amount of coronary artery calcifications (CAC). Purpose: To evaluate the distribution of CAC and its influence on interscan variability of measurement in end-stage renal disease and coronary heart disease patients, proven to have calcifications. Material and Methods: 69 patients having CAC, including 34 with coronary heart disease and 35 with end-stage renal disease, were scanned twice with multidetector-row computed tomography (MDCT). Amount of CAC was determined as the number of calcified lesions (CN), total calcium score (CS), calcium volume (CV), and calcium mass (CM). Distribution of CAC was evaluated on a per-patient basis as the median CS and CM of a single lesion. Density of the calcifications was calculated as the patient's CM divided by CV. Results: The overall median CS was 457.2, and the median CM was 75.6 mg. There were no significant differences in the number of calcified lesions, CS, or CM between the two groups. Both CS and CM of a single lesion, as well as the mean calcium density were lower in renal disease patients (P<0.05) than in coronary heart disease subjects. The relative interscan variability of coronary calcium measurement was higher in the renal disease group (P<0.05). There was a negative correlation between the calcium concentration and the relative interscan variability. Conclusion: The results indicate that the coronary calcium distribution influences the measurement interscan reproducibility, and the distribution may differ between end-stage renal disease patients and coronary heart disease patients, reflecting the dissimilar nature of coronary calcifications in those groups

  4. Prevalence of Atherosclerotic Coronary Stenosis in Asymptomatic North Indian Population: A Post-mortem Coronary Angiography Study.

    Science.gov (United States)

    Bansal, Yogender Singh; Mandal, Shatrugan Prasad; Kumar, Senthil; Setia, Puneet

    2015-09-01

    A preliminary study of coronaries using post-mortem angiography was undertaken to see the prevalence of atherosclerotic coronary stenosis in non-cardiac unnatural deaths. This study was conducted in a tertiary care centre located in Chandigarh. A total of 128 medico-legal cases were studied comprising 88 males and 40 females. Post-mortem examinations of these MLC cases were conducted in the Department of Forensic Medicine, PGIMER, Chandigarh. All hearts were visually screened by post-mortem coronary angiography first and then grossly examined using serial transverse incision technique in positive screening cases to find the degree of narrowing. Of the study group, 34% males and 20% females showed evidence of narrowing on angiography. Of the males showing coronary stenosis, 83% had single vessel disease and 13% had double vessel disease, while only one individual had triple vessel disease. In cases of female, all the cases of coronary stenosis were single vessel disease. Left anterior descending coronary artery (LAD) was the most common vessel involved, followed by right coronary artery (RCA) & Left circumflex artery (LCX) and in cases of double vessel disease, LAD in combination with LCX was responsible for 75% of the cases. Remarkably 23.6% of study population in the age group of less than 40 years showed appreciable narrowing in at least one of the coronaries. In general, the prevalence of CAD is on the rise, particularly in younger population owing to the changes in their lifestyle and food habits. This preliminary study revealed evidence of narrowing of at least one coronary in 34% male and 20% female population and 23.6% subjects were less than 40 years old. Further detailed studies are needed especially in younger age group and to support the need for preventive cardiology in the early years of life.

  5. Nationwide trends in use and timeliness of diagnostic coronary angiography in acute coronary syndromes from 2005 to 2011

    DEFF Research Database (Denmark)

    Hansen, Kim Wadt; Sørensen, Rikke; Madsen, Mette

    2015-01-01

    -values for trend 0.90-0.98) for 2008-2009 and 0.94 (0.90-0.98) for 2010-2011. Corresponding figures for long DT were 0.74 (0.72-0.76) for 2005-2007, 0.87 (0.83-0.90) for 2008-2009 and 0.......94 (0.90-0.98) for 2010-2011. Length of hospital stay, time to coronary angiography, and 60-day mortality decreased in all DT. CONCLUSIONS: This nationwide study found significant increases in diagnostic coronary angiography use over time in incident acute coronary syndrome patients with a relatively...

  6. Transient coronary aneurysm formation after Nevo™ stent implantation versus persistent coronary aneurysm after Cypher Select™ stent implantation

    DEFF Research Database (Denmark)

    Christiansen, Evald Høj; Lassen, Jens Flensted; Jensen, Lisette Okkels

    2011-01-01

    We implanted a Cypher Select™ coronary stent and two months later a Nevo™ sirolimus-eluting coronary stent in another vessel. At a prescheduled angiographic follow-up, coronary aneurysms were seen in the two stented segments, 6 and 8 months after stent implantation, respectively. Six months later......, the aneurysm had healed in the Nevo, but was still present in the Cypher stented segment. We hypothesize that aneurysm formation was induced by sirolimus and the polymer of the implanted stents, and that subsequent healing was possible in the Nevo stent after degradation of the polymer....

  7. Contribution of inhibitory receptor glycoprotein iib / iiia in coronary angioplasty and acute coronary syndrome, about 152 patients

    International Nuclear Information System (INIS)

    Sellami, Walid

    2007-01-01

    The aim of our study was to evaluate the immediate results and long-term intake of anti-GP IIb / IIIa inhibitors for patients with acute coronary syndrome treated with coronary angioplasty. The use of anti-GP IIb / IIIa is a valid therapeutic option in patients with acute coronary syndrome with signs of severity and for patients undergoing complex angioplasty. Adverse effects of anti-GP IIb / IIIa can be seen to encourage vigilance and careful monitoring during the administration of these molecules and perfect knowledge of their pharmacological properties for appropriate use.

  8. Vital Exhaustion and Coronary Heart Disease Risk

    DEFF Research Database (Denmark)

    Frestad, Daria; Prescott, Eva

    2017-01-01

    INFO (1980 to July 2015; articles in English and published articles only), and bibliographies. Information on aim, study design, sample size, inclusion and exclusion criteria, assessment methods of psychological risk factors, and results of crude and adjusted regression analyses were abstracted independently......OBJECTIVES: The construct of vital exhaustion has been identified as a potential independent psychological risk factor for incident and recurrent coronary heart disease (CHD). Despite several decades of research, no systematic review or meta-analysis has previously attempted to collate.......22-1.85) for prospective studies, and 2.61 (95% CI = 1.66-4.10) for case-control studies using hospital controls. Risk of recurrent events in patients with CHD was 2.03 (95% CI = 1.54-2.68). The pooled adjusted risk of chronic heart failure in healthy populations was 1.37 (95% CI = 1.21-1.56), but this was based...

  9. Nuclear Cardiology in Acute Coronary Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Paeng, Jin Chul; Lee, Dong Soo [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2009-06-15

    Nuclear myocardial perfusion imaging is very effective in the evaluation of patients with suspicious acute coronary syndrome (ACS), for adequate diagnosis and treatment. There have been many clinical evidences to support the efficacy and cost-effectiveness. In addition, many authoritative guidelines support the utility of myocardial perfusion imaging in ACS with an appropriate diagnostic protocol. However, with the development of other cardiac imaging modalities, the choice of modality for the diagnosis of suspicious ACS now depends on the availability of each modality in each institute. Newly developed imaging technologies, especially including molecular imaging, are expected to have great potential not only for diagnosis but also for primary, secondary, and tertiary prevention of ACS.

  10. Coronary artery disease in Bangladesh: A review

    Directory of Open Access Journals (Sweden)

    A.K.M. Monwarul Islam

    2013-07-01

    Full Text Available Coronary artery disease (CAD is an increasingly important medical and public health problem, and is the leading cause of mortality in Bangladesh. Like other South Asians, Bangladeshis are unduly prone to develop CAD, which is often premature in onset, follows a rapidly progressive course and angiographically more severe. The underlying pathophysiology is poorly understood. Genetic predisposition, high prevalence of metabolic syndrome and conventional risk factors play important role. Lifestyle related factors, including poor dietary habits, excess saturated and trans fat, high salt intake, and low-level physical activity may be important as well. Some novel risk factors, including hypovitaminosis D, arsenic contamination in water and food-stuff, particulate matter air pollution may play unique role. At the advent of the new millennium, we know little about our real situation. Largescale epidemiological, genetic and clinical researches are needed to explore the different aspects of CAD in Bangladesh.

  11. Nuclear Cardiology in Acute Coronary Syndrome

    International Nuclear Information System (INIS)

    Paeng, Jin Chul; Lee, Dong Soo

    2009-01-01

    Nuclear myocardial perfusion imaging is very effective in the evaluation of patients with suspicious acute coronary syndrome (ACS), for adequate diagnosis and treatment. There have been many clinical evidences to support the efficacy and cost-effectiveness. In addition, many authoritative guidelines support the utility of myocardial perfusion imaging in ACS with an appropriate diagnostic protocol. However, with the development of other cardiac imaging modalities, the choice of modality for the diagnosis of suspicious ACS now depends on the availability of each modality in each institute. Newly developed imaging technologies, especially including molecular imaging, are expected to have great potential not only for diagnosis but also for primary, secondary, and tertiary prevention of ACS

  12. 1-year rehospitalization after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hansen, Kirstine Nørregaard; Bendix, Kristoffer; Antonsen, Lisbeth

    2018-01-01

    AIMS: To evaluate the incidence and causes of rehospitalization within 1-year after percutaneous coronary intervention (PCI) in a country where the National Health Service provides universal tax-supported health care, guaranteeing residents free hospital access. METHODS AND RESULTS: Between January.......26-1.34) and Charlson Comorbidity Index ≥ 3 (OR 3.03;95% CI 2.71-3.27) Conclusions: In an unselected patient cohort treated with PCI, half of the patients were rehospitalized within 1-year, illuminating the impact of comorbidity in patients with ischemic heart disease....... 2010 and September 2014, 17,111 patients were treated with PCI in two University Hospitals in Western Denmark. Patients who were readmitted within 1-year after PCI were identified. Overall 1-year readmission rate was 50.4%. The cause was angina/myocardial infarction (MI) in 4,282 patients (49...

  13. [Inflammatory biomarkers in ischemic acute coronary syndrome].

    Science.gov (United States)

    Domínguez-Rodríguez, Alberto; Abreu-González, Pedro

    2015-10-01

    Diagnosing acute coronary syndrome (ACS) in the emergency department is often a complex process. Inflammatory markers might be useful for the rapid assessment of a patient's overall risk and might also help predict future episodes. The clinical use of these biomarkers could potentially lower the number of emergency visits and help in the prevention of future adverse events. The aim of this review was to evaluate the clinical utility of markers of cardiovascular inflammation in emergency patients with ACS. Based on a critical analysis of a selection of the literature, we concluded that none of the biomarkers of cardiovascular inflammation would at present be useful for stratifying risk in emergency situations, aiding prognosis, or guiding therapy for patients with ACS.

  14. Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with acute coronary syndromes undergoing left main percutaneous coronary intervention

    OpenAIRE

    Jaberg, L; Toggweiler, S; Puck, M; Frank, M; Rufibach, K; Lüscher, T F; Corti, R

    2011-01-01

    BACKGROUND: Patients undergoing acute left main (LM) coronary artery revascularization have a high mortality and natriuretic peptides such as N-terminal pro-B-type (NT-proBNP) have been shown to have prognostic value in patients with acute coronary syndromes. The present study looked at the prognostic value of NT-proBNP in these patients. METHODS AND RESULTS: We studied all consecutive patients undergoing acute LM coronary artery percutaneous coronary intervention between January 2005 and Dec...

  15. Coronary artery calcium scoring in myocardial infarction

    International Nuclear Information System (INIS)

    Beslic, S.; Dalagija, F.

    2005-01-01

    Background. The aim of this study was to evaluate coronary artery calcium scoring and the assessment of the risk factors in patients with myocardial infarction (MI). Methods. During the period of three years, 27 patients with MI were analyzed. The average age of patients was 66.1 years (46 to 81). Coronary arteries calcium was evaluated by multi row detector computed tomography (MTDC) S omatom Volume Zoom Siemens , and, retrospectively by ECG gating data acquisition. Semi automated calcium quantification to calculate Agatston calcium score (CS) was performed with 4 x 2.5 mm collimation, using 130 ml of contrast medium, injected with an automatic injector, with the flow rate of 4 ml/sec. The delay time was determined empirically. At the same time several risk factors were evaluated. Results. Out of 27 patients with MI, 3 (11.1%) patients had low CS (10- 100), 5 (18.5%) moderate CS (101- 499), and 19 (70.4%) patients high CS (>500). Of risk factors, smoking was confirmed in 17 (63.0%), high blood pressure (HTA) in 10 (57.0%), diabetes mellitus in 7 (25.9%), positive family history in 5 (18.5%), pathological lipids in 5 (18.5%), alcohol abuse in 4 (1.8%) patients. Six (22.2%) patients had symptoms of angina pectoris. Conclusions. The research showed high correlation of MI and high CS (>500). Smoking, HTA, diabetes mellitus, positive family history and hypercholesterolemia are significant risk factors. Symptoms are relatively poor in large number of patients. (author)

  16. Nuclear cardiology in acute coronary syndromes

    International Nuclear Information System (INIS)

    Bulow, H.; Schwaiger, M.

    2005-01-01

    Acute coronary syndromes are a frequent manifestation of a coronary artery disease, usually being associated with chest pain and presenting as a medical emergency. Since a considerable number of patients with chest pain, however, have a non cardiac etiology of trier pain, properly triaging these patients represents a diagnostic challenge for physicians in the emergency department. As the available diagnostic procedures have limited accuracy, many different diagnostic strategies have been evaluated. Among these, radionuclide myocardial perfusion imaging (MPI) at rest or in combination with stress procedures has been investigated in many trails. MPI has been proven to be useful, especially in a patient population with a low to intermediate probability of an ischemic event. Perfusion scintigraphy has a high sensitivity in the detection of myocardial infarction and reveals an excellent negative predictive value, allowing a safe discharge strategy of patients with a negative scan result. Moreover, it enables risk stratification and provides incremental and independent prognostic information regarding short to long term future cardiac adverse events. Several cost effectiveness studies have shown that perfusion imaging leads to lower overall direct costs, mainly by a reduction of unnecessary hospital admissions and diagnostic angiograms, without worsening of the clinical outcome of these patients. As a possible study endpoint, myocardial perfusion imaging in the acute setting enables the quantification of salvaged myocardium and therefore the evaluation of treatment efficacy. Besides perfusion agents, several infarcts avid radiopharmaceuticals have been developed, which in part show promising results. However, larger randomized trials evaluating these tracers in clinical settings are needed to warrant routine clinical application

  17. CORONARY ARTERY DISEASE IN INDIAN WOMEN

    Directory of Open Access Journals (Sweden)

    Mohammed Umar Farooque

    2017-05-01

    Full Text Available BACKGROUND Cardiovascular disease is the leading cause of death among women regardless of race or ethnicity accounting for deaths of 1 in 3 women. The aim of the study is to identify the important risk factors contributing to the coronary artery disease in Indian women. MATERIALS AND METHODS Study conducted on 120 women patients of age >40 yrs. visiting a female outpatient department of Jawahar Lal Nehru Medical College, Bhagalpur, who presented with complaints related to CAD cases diagnosed from the electrocardiogram findings, clinical features and biochemical marker as per World Health Organization guidelines. RESULTS 50-59 years age group is most effected group in study with 44.2%. Most of the women are of postmenopausal age group. The maximum number of cases was seen in upper lower socioeconomic status (37.5% followed by lower (19.2%. CAD incidence was minimum in upper class. Chest pain was the main complaint in patients, next in frequency was sweating and followed by breathlessness. The major risk factors in the study group were hypertension (74.1, diabetes (63.3, sedentary habits (49.1, stress (34.2, family history (29.2 and tobacco consumption (21.8. 25 patients had obesity and 54 peoples were overweight. In our study, 48 patients had 3 children, 19 had more than 3 children. 61.7% of the patients are with hypercholesterolaemia, which most of the patients found with 2 vessel block is most common blocks observed. CONCLUSION Despite this delay in onset, mortality from coronary heart disease is increasing more rapidly among women than men.

  18. Percutaneous coronary intervention for poor coronary microcirculation reperfusion of patients with stable angina pectoris.

    Science.gov (United States)

    Li, J S; Zhao, X J; Ma, B X; Wang, Z

    2016-01-01

    Percutaneous coronary intervention (PCI) has been extensively applied to repair the forward flow of diseased coronary artery and can achieve significant curative results. However, some patients with acute myocardial infarction (AMI) develop non-perfusion or poor perfusion of cardiac muscle tissue after PCI, which increases the incidence of cardiovascular events and the death rate. PCI can dredge narrowed or infarct-related artery (IRA) and thus induce full reperfusion of ischemic myocardium. It is found in practice that some cases of AMI still have no perfusion or poor perfusion in myocardial tissue even though coronary angiography suggests opened coronary artery after PCI, which increases the incidence of vascular events and mortality. Therefore, to explore the detailed mechanism of PCI in treating coronary microcirculation of patients with stable angina pectoris, we selected 140 patients with stable angina pectoris for PCI, observing the index of microcirculatory resistance (IMR) of descending branch and changes of myocardial injury markers and left ventricular systolic function, and made a subgroup analysis based on the correlation between clinical indexes, IMR and other variables of diabetic and non-diabetic patients, PCI-related and non-PCI-related myocardial infarction patients. The results suggest that IMR of anterior descending branch after PCI was higher compared to that before PCI, and the difference was significant (P less than 0.05); creatine kinase-MB (CK-MB), myohemoglobin and high sensitive troponin T were all increased after PCI, and the difference was also significant (P less than 0.05); brain natriuretic peptide (BNP) level became higher after PCI, with significant difference (P less than 0.05); left ventricular ejection fraction (LVEF) declined after PCI, and the difference before and after PCI was statistically significant (P less than 0.05). Moreover, subgroup analysis results of the three groups all demonstrated statistically significant

  19. Prevalence of Risk Factors for Coronary Artery Disease in Southern ...

    African Journals Online (AJOL)

    (48.5 %), fatty food consumption (47.5 %), obesity (38 %) and smoking (37 %), respectively. Other less ... Keywords: Risk factors, Prevalence, Coronary artery disease, Diabetes, Southern Punjab ... developing world, including Pakistan [1]. The.

  20. Heart and coronary artery damage related to Kawasaki syndrome

    Directory of Open Access Journals (Sweden)

    A. A. Leontyeva

    2014-01-01

    Full Text Available Kawasaki syndrome is an acute systemic vasculitis of unknown etiology, which mainly affects children within the first 5 years of fife. At the present time, Kawasaki syndrome is recognized to be a leading cause of acquired organic heart diseases in children, which may result in coronary heart disease, myocardial infarction, and sudden death in children and young people. Most complications are associated with the cardiovascular system, with coronary artery changes in particular. Transthoracic echocardiography, which, besides coronary artery assessment, makes it possible to evaluate right and left ventricular systolic and diastolic functions and to study the cardiac valves and changes in pericardial effusion, is a major technique in Kawasaki syndrome. The paper outlines an update on the epidemiology, etiology, pathogenetic mechanisms, and pathomorphology of Kawasaki syndrome and considers possible coronary and noncoronary changes, outcomes, and clinical manifestations.

  1. Changing Trend In Coronary Heart Disease In Nigeria

    African Journals Online (AJOL)

    Buchi

    lifestyle. Conclusion: Coronary Heart disease is still relatively uncommon in ... the world where most health resources are channeled into .... cholesterol in the elderly population in Benin, Nigeria, .... Reducing risks, promoting healthy life.

  2. Prevention of Radiocontrast-Induced Nephropathy after Coronary ...

    African Journals Online (AJOL)

    ) in patients undergoing coronary angiography pretreated with N-acetylcysteine NAC plus saline hydration or saline hydration alone and to determine the association between various risk factors and RCIN. Methods: Patients were ...

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  4. Design and modeling balloon-expandable coronary stent for manufacturability

    Science.gov (United States)

    Suryawan, D.; Suyitno

    2017-02-01

    Coronary artery disease (CAD) is a disease that caused by narrowing of the coronary artery. The narrowing coronary artery is usually caused by cholesterol-containing deposit (plaque) which can cause a heart attack. CAD is the most common cause mortality in Indonesia. The commonly CAD treatment use the stent to opens or alleviate the narrowing coronary artery. In this study, the stent design is optimized for the manufacturability. Modeling is used to determine the free stent expansion due to applied pressure in the inner surface of the stent. The stress distribution, outer diameter change, and dogboning phenomena are investigated in the simulation. The result of modeling and simulating was analyzed and used to optimize the stent design before it is manufactured using EDM (Electric Discharge Machine) in the next research.

  5. Psychological distress, cortisol stress response and subclinical coronary calcification

    NARCIS (Netherlands)

    Seldenrijk, A.; Hamer, M.; Lahiri, A.; Penninx, B.W.J.H.; Steptoe, A.

    2012-01-01

    Objectives: Poor mental health has been associated with coronary heart disease (CHD). One hypothesized underlying mechanism is hypothalamus pituitary adrenal axis dysfunction. We examined the associations between psychological distress, cortisol response to laboratory-induced mental stress and

  6. Balloon angioplasty in acute and chronic coronary artery disease

    International Nuclear Information System (INIS)

    Holmes, D.R. Jr.; Vlietstra, R.E.

    1989-01-01

    Percutaneous transluminal coronary angioplasty has grown exponentially since its introduction. Currently, selection criteria include single-vessel and multivessel disease, stable and unstable angina, and acute infarction. The outcome depends on specific patient and antiographic characteristics. In ideal lesions, success rates should be greater than 90%, with low morbidity and mortality. With more severe and diffuse multivessel disease, success rates are lower and complication rates are higher. In these cases, percutaneous transluminal coronary angioplasty still offers a reasonable option, provided complete revascularization can be achieved or the angina-producing lesion dilated. Numerous issues remain unresolved, including (1) the role of percutaneous transluminal coronary angioplasty vs coronary surgery (currently being tested), (2) restenosis, which occurs in approximately 30% of treated lesions, and (3) organizational adjustments such as training and certification to maintain high standards of care

  7. Baseline Glutathione Peroxidase Activity Affects Prognosis after Acute Coronary Syndromes

    OpenAIRE

    García-Pinilla, José Manuel; Gálvez, Julio; Cabrera-Bueno, Fernando; Jiménez-Navarro, Manuel; Gómez-Doblas, Juan José; Galisteo, Milagros; Camuesco, Desiré; de Teresa Galván, Carlos; Espinosa-Caliani, Salvador; Zarzuelo, Antonio; de Teresa-Galván, Eduardo

    2008-01-01

    Oxidative stress is associated with atherosclerosis and plaque lesions in experimental in vitro models. Few in vivo studies have examined the association between redox status and the prognosis of acute coronary syndromes.

  8. Angiographic prevalence and pattern of coronary artery disease in women

    Directory of Open Access Journals (Sweden)

    Babu Ezhumalai

    2014-07-01

    Conclusion: There has been a change with regard to clinical presentation and onset of risk factors for CAD at young age, but the load of atherosclerotic burden and pattern of involvement of coronary arteries have not changed in women.

  9. Anomalous left coronary artery from the pulmonary artery

    Science.gov (United States)

    ... anomalies of mitral valve. In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery ... of the coronary arteries. In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery ...

  10. Left coronary arterial blood flow: Noninvasive detection by Doppler US

    International Nuclear Information System (INIS)

    Gramiak, R.; Holen, J.; Moss, A.J.; Gutierrez, O.H.; Picone, A.L.; Roe, S.A.

    1986-01-01

    Continuous wave (CW) and pulsed Doppler ultrasound studies with spectral analysis were used to detect the left coronary arterial blood flow in patients who were undergoing routine echocardiography. The pulmonary artery is a stable ultrasonic landmark from which detection of the blood flow can be effected. The left coronary artery can be distinguished by its blood flow toward the cardiac apex and by specific, functional flow features. Flow patterns vary among the left main, circumflex, and anterior descending arteries; patterns also vary with respiration cycles. In the present study, coronary arterial blood flow was detected in 58 of 70 patients (83%). Findings were validated by selectively injecting an agitated saline contrast medium into the left coronary artery and, in another study, by comparing human Doppler phasic flow waveforms with electromagnetic flowmeter recordings obtained in dogs

  11. Noninvasive physiologic assessment of coronary stenoses using cardiac CT.

    Science.gov (United States)

    Xu, Lei; Sun, Zhonghua; Fan, Zhanming

    2015-01-01

    Coronary CT angiography (CCTA) has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD). CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive "one-stop-shop" diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT), and transluminal attenuation gradient (TAG), CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.

  12. Noninvasive Physiologic Assessment of Coronary Stenoses Using Cardiac CT

    Directory of Open Access Journals (Sweden)

    Lei Xu

    2015-01-01

    Full Text Available Coronary CT angiography (CCTA has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD. CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive “one-stop-shop” diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT, and transluminal attenuation gradient (TAG, CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.

  13. Impact of copeptin on diagnosis of acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Zeinab H. El Sayed

    2014-07-01

    Conclusion: In suspected acute coronary syndrome, determination of copeptin and cardiac troponin I provides a remarkable negative predictive value, which aids in early and safe ruling out of myocardial infarction.

  14. Haptoglobin phenotypes as a risk factor for coronary artery disease ...

    African Journals Online (AJOL)

    Gehan Hamdy

    2014-04-22

    Apr 22, 2014 ... Recognition of diabetic individuals at greatest risk of developing coronary ..... Early detection of the disease and timely interventions can reduce the morbidity ..... additional risk factor of retinopathy in type 2 diabetes mellitus.

  15. The association of opium with coronary artery disease.

    Science.gov (United States)

    Sadeghian, Saeed; Darvish, Soodabeh; Davoodi, Gholamreza; Salarifar, Mojtaba; Mahmoodian, Mehran; Fallah, Nader; Karimi, Abbas Ali

    2007-10-01

    The effects of opium consumption on coronary artery disease are still unknown. A cross-sectional study was conducted on 2405 patients admitted to the Angiographic Ward at Tehran Heart Center from 7 May 2005 to 13 August 2005. After adjusting for conventional cardiovascular risk factors, opium consumption was a significant risk factor for coronary artery disease (P=0.01 and odds ratio=1.8). Moreover, the amount of opium consumption was associated significantly with the severity of coronary atherosclerosis, as measured by clinical vessel score (r=0.2, P=0.002). To our knowledge, this is the first time that the adverse effects of opium consumption on coronary arteries was defined.

  16. Follow-up experience with coronary hybrid-revascularisation

    NARCIS (Netherlands)

    Wittwer, T; Haverich, A; Cremer, J; Boonstra, P; Franke, U; Wahlers, T

    2000-01-01

    Background: Minimally invasive direct coronary artery bypass (MIDCAB) grafting is an accepted therapeutical option especially in multimorbid, elderly and reoperative patients with single vessel disease. To expand the benefits of MIDCAB to patients with multivessel disease, an interdisciplinary

  17. Non-invasive method for recognition of coronary artery spasm

    International Nuclear Information System (INIS)

    Mathey, D.; Montz, R.; Hanrath, P.; Kuck, K. H.; Bleifeld, W.; Hamburg Univ.

    1980-01-01

    For evaluation of coronary artery spasm 201 thallium sequential scintigraphy of the myocardium after ergotamine provocation was performed in 10 patients with recurrent angina pectoris at rest and normal exercise ECG. In 9 out of the 10 patients ergotamine administration in the same dosage was repeated during the coronary angiography. A reversible defect in the 201 thallium scintigram representative of regional myocardial ischaemia developed in 9 patients after ergotamine. Only in 4 out of the 9 patients angina pectoris and ST elevation were present at the same time. In all cases coronary spasm after ergotamine was demonstrable in the coronary angiogram; in the 4 patients with ergotamine-induced Prinzmetal angina pectoris it consisted of complete vascular occlusion, in the asymptomatic patients of incomplete vascular narrowing of a higher degree. In all cases the spasm could be relieved by ergotamine antidotes within a few minutes. (orig.) [de

  18. Optical Coherence Tomography Imaging in Acute Coronary Syndromes

    Directory of Open Access Journals (Sweden)

    Takashi Kubo

    2011-01-01

    Full Text Available Optical coherence tomography (OCT is a high-resolution imaging technique that offers microscopic visualization of coronary plaques. The clear and detailed images of OCT generate an intense interest in adopting this technique for both clinical and research purposes. Recent studies have shown that OCT is useful for the assessment of coronary atherosclerotic plaques, in particular the assessment of plaque rupture, erosion, and intracoronary thrombus in patients with acute coronary syndrome. In addition, OCT may enable identifying thin-cap fibroatheroma, the proliferation of vasa vasorum, and the distribution of macrophages surrounding vulnerable plaques. With its ability to view atherosclerotic lesions in vivo with such high resolution, OCT provides cardiologists with the tool they need to better understand the thrombosis-prone vulnerable plaques and acute coronary syndromes. This paper reviews the possibility of OCT for identification of vulnerable plaques in vivo.

  19. Asymptomatic giant coronary aneurysm in an adolescent with Behcet's syndrome

    Directory of Open Access Journals (Sweden)

    Kahn Philip J

    2012-01-01

    Full Text Available Abstract Objective Behcet's is an idiopathic multi-organ syndrome, which may have onset during childhood. Vascular involvement is uncommon, with rarely reported coronary aneurysm formation. We present a case report of a teenager girl who developed recalcitrant life-threatening Behcet's vasculitis, involving both small and large venous and arterial systems including a giant coronary aneurysm. Case report De-identified data were collected retrospectively in case report format. Although our sixteen year old female with Behcet's vasculitis had resolution of many arterial aneurysms, she had persistent venous thrombosis of large vessels, as well as persistent, giant arterial aneurysms requiring intra-arterial coiling of a lumbar artery and coronary bypass grafting despite intensive immunosuppression including glucocorticoids, cyclophosphamide, infliximab, methotrexate, azathioprine and intravenous immunoglobulin. Conclusions Vascular manifestations may be seen in Behcet's syndrome, including asymptomatic coronary aneurysm, which may be refractory to immunosuppression and ultimately require surgical intervention. Increased awareness is essential for prompt diagnosis and management.

  20. Spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Tuncer, M.; Gumrukcuoglu, H.A.; Ekim, H.; Gunes, Y.; Simsek, H.

    2010-01-01

    Apical hypertrophic cardiomyopathy (HCM) is a relatively uncommon inherited disease. Spontaneous coronary artery dissection (SCAD) is also uncommonly observed, which often occurs in pregnant or post partum women but is rare in men. This report describes a 38 years old man with apical hypertrophic cardiomyopathy who developed SCAD leading to acute inferior myocardial infarction. After emergent appendectomy operation at another hospital, he was immediately transferred to the Cardiology Department of our hospital due to acute myocardial infarction. He emergently underwent coronary angiography which showed a long dissection involving the right coronary. He underwent an emergent CABG with cardiopulmonary bypass. Postoperative recovery was uneventful and he was discharged. According to our knowledge, no case of spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy unrelated to postpartum period or oral contraceptive use has been reported so far. (author)