Coronary artery disease(CAD) occurring in less than 45 years of age is termed as young CAD.Recent studies show a prevalence of 1.2% of CAD cases in this age group.Ethnic wise south Asians especially Indians are more v...Coronary artery disease(CAD) occurring in less than 45 years of age is termed as young CAD.Recent studies show a prevalence of 1.2% of CAD cases in this age group.Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%.Conventional risk factors such as smoking,diabetes,hypertension,obesity and family history seems to be as important as in older CAD subjects.But the prevalence of these risk factors seems to vary in younger subjects.By far the most commonly associated risk factor is smoking in young CAD.Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein(CETP) gene,hepatic lipase gene,lipoprotein lipase gene,apo A1 gene,apo E gene and apo B.Biomarkers such as lipoprotein(a),fibrinogen,D-dimer,serum Wnt,gamma glutamyl transferase,vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies.In general CAD in young has better prognosis than older subjects.In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes.Angiographic studies shows predominance of single vessel disease in young CAD patients.Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.展开更多
Bilirubin has traditionally been considered a cytotoxic waste product.However,recent studies have shown bilirubin to have anti-oxidant,anti-inflammatory,vasodilatory,anti-apoptotic and anti-proliferative functions.The...Bilirubin has traditionally been considered a cytotoxic waste product.However,recent studies have shown bilirubin to have anti-oxidant,anti-inflammatory,vasodilatory,anti-apoptotic and anti-proliferative functions.These properties potentially confer bilirubin a new role of protection especially in coronary artery disease(CAD),which is a low grade inflammatory process exacerbated by oxidative stress.In fact,recent literature reports an inverse relationship between serum concentration of bilirubin and the presence of CAD.In this article,we review the current literature exploring the association between levels of bilirubin and risk of CAD.We conclude that current evidence is inconclusive regarding the protective effect of bilirubin on CAD.A causal relationship between low serum bilirubin level and increased risk of CAD is not currently established.展开更多
Myocardial infarction is a major cause of death and disability worldwide and myocardial infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion following an ischemi...Myocardial infarction is a major cause of death and disability worldwide and myocardial infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion following an ischemic event is the most effective strategy to reduce final infarct size and improve clinical outcome,but reperfusion may induce further myocardial damage itself. Development of adjunctive therapies to limit myocardial reperfusion injury beyond opening of the coronary artery gains increasing attention. A vast number of experimental studies have shown cardioprotective effects of ischemic and pharmacological conditioning,but despite decades of research,the translation into clinical effects has been challenging. Recently published clinical studies,however,prompt optimism as novel techniques allow for improved clinical applicability. Cyclosporine A,the GLP-1 analogue exenatide and rapid cooling by endovascular infusion of cold saline all reduce infarct size and may confer clinical benefit for patients admitted with acute myocardial infarcts. Equally promising,three follow-up studies of the effect of remote ischemic conditioning(RIC) show clinical prognostic benefit in patients undergoing coronary surgery and percutaneous coronary intervention. The discovery that RIC canbe performed noninvasively using a blood pressure cuff on the upper arm to induce brief episodes of limb ischemia and reperfusion has facilitated the translation of RIC into the clinical arena. This review focus on novel advances in adjunctive therapies in relation to acute and elective coronary procedures.展开更多
Coronary heart disease(CHD) continues to be the greatest mortality risk factor in the developed world. Estrogens are recognized to have great therapeutic potential to treat CHD and other cardiovascular diseases; howev...Coronary heart disease(CHD) continues to be the greatest mortality risk factor in the developed world. Estrogens are recognized to have great therapeutic potential to treat CHD and other cardiovascular diseases; however,a significant array of potentially debilitating side effects continues to limit their use. Moreover,recent clinical trials have indicated that long-term postmenopausal estrogen therapy may actually be detrimental to cardiovascular health. An exciting new development is the finding that the more recently discovered G-protein-coupled estrogen receptor(GPER) is expressed in coronary arteries-both in coronary endothelium and in smooth muscle within the vascular wall. Accumulating evidence indicates that GPER activation dilates coronary arteries and can also inhibit the prolif-eration and migration of coronary smooth muscle cells. Thus,selective GPER activation has the potential to increase coronary blood flow and possibly limit the debilitating consequences of coronary atherosclerotic disease. This review will highlight what is currently known regarding the impact of GPER activation on coronary arteries and the potential signaling mechanisms stimulated by GPER agonists in these vessels. A thorough understanding of GPER function in coronary arteries may promote the development of new therapies that would help alleviate CHD,while limiting the potentially dangerous side effects of estrogen therapy.展开更多
Non-alcoholic fatty liver disease(NAFLD) is a chronic liver disease associated with insulin resistance and metabolic syndrome. The spectrum of disease ranges from simple steatosis to steatohepatitis and progression to...Non-alcoholic fatty liver disease(NAFLD) is a chronic liver disease associated with insulin resistance and metabolic syndrome. The spectrum of disease ranges from simple steatosis to steatohepatitis and progression to cirrhosis. Compelling evidence over the past several years has substantiated a significant link between NAFLD and cardiovascular disease ranging from coronary artery disease to subclinical carotid atherosclerosis. Close follow up, treatment of risk factors for NAFLD, and cardiovascular risk stratification are necessary to predict morbidity and mortality in this subset of patients.展开更多
AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patient...AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram(defined as ST segment elevation or pre-sumably new left bundle branch block) whounderwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm(ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm(n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared. RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age(68.1 years vs 61 years, P = 0.001) in the nonshockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality(60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score(CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score(mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm(29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group(21.9% vs 9.1%, P = 0.03). CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs nonshockable group.展开更多
In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However,in patients with previous coronary artery bypass graft operation(CABG) u...In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However,in patients with previous coronary artery bypass graft operation(CABG) using internal mammary artery grafts,great vessel disease should also be considered. Herein we present two patients with history of CABG whose symptoms were suspicious for coronary ischemia. During cardiac catheterization reverse blood flow was observed from the left artery disease to the left internal mammary artery(LIMA) graft in both cases. After angioplasty and stent implantation of the left subclavian artery antegrade flow was restored in the LIMA grafts and both patients had complete resolution of symptoms.展开更多
AIM: To evaluate the feasibility of coronary artery calcium score(CACS) on low-dose non-gated chest CT(ngCCT).METHODS: Sixty consecutive individuals(30 males; 73 ± 7 years) scheduled for risk stratification by me...AIM: To evaluate the feasibility of coronary artery calcium score(CACS) on low-dose non-gated chest CT(ngCCT).METHODS: Sixty consecutive individuals(30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed to-mography(gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner(Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores(Volume, Mass, Agatston) as previ-ously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered sig-nificant.RESULTS: Mean CACS values were significantly higher for gCCT as compared to ngCCT(Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high(Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2(33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1(33%) showed an Agatston score of 0 in the ngCCT. Overall, 23(38%) patients were reclassified in a different car-diovascular risk category, mostly(18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT(DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01).CONCLUSION: CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.展开更多
Disease registries,containing systematic records of cases,have for nearly 100 years been valuable in exploring and understanding various aspects of cardiology. This is particularly true for myocardial infarction,where...Disease registries,containing systematic records of cases,have for nearly 100 years been valuable in exploring and understanding various aspects of cardiology. This is particularly true for myocardial infarction,where such registries have provided both epidemiological and clinical information that was not readily available from randomised controlled trials in highlyselected populations. Registries,whether mandated or voluntary,prospective or retrospective in their analysis,have at their core a common study population and common data definitions. In this review we highlight how registries have diversified to offer information on epidemiology,risk modelling,quality assurance/improvement and original research-through data mining,transnational comparisons and the facilitation of enrolment in,and follow-up during registry-based randomised clinical trials.展开更多
AIM To assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease(CAD) in men undergoing angiography.METHODS We conducted a prospective multicenter,multi-ethnic,cross sect...AIM To assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease(CAD) in men undergoing angiography.METHODS We conducted a prospective multicenter,multi-ethnic,cross sectional observational study at five hospitals in Saudi Arabia and the United Arab Emirates,in which we used logistic regression analysis with and without adjustment for baseline differences. RESULTS Data were collected for 1068 enrolled patients undergoing coronary angiography for clinical indications during the period of April 1^(st),2013 to March 30^(th),2014. Ethnicities of spouses were available only for male patients. Of those enrolled,687 were married men and constituted the cohort for the present analysis. Intra-ethnic marriages were reported in 70% and inter-ethnic marriages in 30%. After adjusting for baseline differences,interethnic marriage was associated with lower odds of having significant CAD [adjusted odds ratio 0.52(95%CI:0.33,0.81)] or multi-vessel disease(MVD) [adjusted odds ratio 0.57(95%CI:0.37,0.86)]. The adjusted association with left main disease showed a similar trend,but was not statistically significant [adjusted odds ratio 0.74(95%CI:0.41,1.32)]. The association between interethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives(P interaction > 0.05 for both).CONCLUSION Among married men undergoing coronary angiography,inter-ethnic,as compared to intra-ethnic,marriage is associated with lower odds of significant CAD and MVD.展开更多
AIM To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with nondominant right coronary artery anatomy.METHODS This was a retrospective observational analysis of conse...AIM To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with nondominant right coronary artery anatomy.METHODS This was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain.Only patients who underwent single photon emission computed tomography(SPECT)myocardial perfusion imaging(MPI)were included.Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed.Patients with prior history of coronary artery disease(CAD)including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded.True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography,in the same territory as identified on SPECT MPI.Coronary artery dominance was determined on coronary angiography.Patients were divided into group 1 and group 2.Group1 included patients with non-dominant right coronary artery(RCA)(left dominant and codominant).Group2 included patients with dominant RCA anatomy.Demographics,baseline characteristics and positive predictive value(PPV)were analyzed for the two groups.RESULTS The mean age of the study cohort was 57.6 years.Sixtyone point seven percent of the patients were males.The prevalence of self-reported diabetes mellitus,hypertension and dyslipidemia was 36%,71.9%and 53.9%respectively.A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men.For inferior wall ischemia on SPECT MPI,patients in study group 2 had a significantly higher PPV,32/42(76.1%),compared to patients in group 1,in which only 3 out of the 29 patients(10.3%)had true positive results(P value<0.001 Z test).The difference remained statistically significant even when only patients with left dominant coronary system(without co-dominant)were compared to patients with right dominant system(32/40,76.1%in right dominant group,3/19,15.8%in left dominant group,P value<0.001 Z test).There was no significant difference in mean hospital stay,re-hospitalization,and in-hospital mortality between the two groups.CONCLUSION The positive predictive value of SPECT MPI for inferior wall ischemia is affected by coronary artery dominance.More studies are needed to explain this phenomenon.展开更多
文摘Coronary artery disease(CAD) occurring in less than 45 years of age is termed as young CAD.Recent studies show a prevalence of 1.2% of CAD cases in this age group.Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%.Conventional risk factors such as smoking,diabetes,hypertension,obesity and family history seems to be as important as in older CAD subjects.But the prevalence of these risk factors seems to vary in younger subjects.By far the most commonly associated risk factor is smoking in young CAD.Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein(CETP) gene,hepatic lipase gene,lipoprotein lipase gene,apo A1 gene,apo E gene and apo B.Biomarkers such as lipoprotein(a),fibrinogen,D-dimer,serum Wnt,gamma glutamyl transferase,vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies.In general CAD in young has better prognosis than older subjects.In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes.Angiographic studies shows predominance of single vessel disease in young CAD patients.Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.
文摘Bilirubin has traditionally been considered a cytotoxic waste product.However,recent studies have shown bilirubin to have anti-oxidant,anti-inflammatory,vasodilatory,anti-apoptotic and anti-proliferative functions.These properties potentially confer bilirubin a new role of protection especially in coronary artery disease(CAD),which is a low grade inflammatory process exacerbated by oxidative stress.In fact,recent literature reports an inverse relationship between serum concentration of bilirubin and the presence of CAD.In this article,we review the current literature exploring the association between levels of bilirubin and risk of CAD.We conclude that current evidence is inconclusive regarding the protective effect of bilirubin on CAD.A causal relationship between low serum bilirubin level and increased risk of CAD is not currently established.
文摘Myocardial infarction is a major cause of death and disability worldwide and myocardial infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion following an ischemic event is the most effective strategy to reduce final infarct size and improve clinical outcome,but reperfusion may induce further myocardial damage itself. Development of adjunctive therapies to limit myocardial reperfusion injury beyond opening of the coronary artery gains increasing attention. A vast number of experimental studies have shown cardioprotective effects of ischemic and pharmacological conditioning,but despite decades of research,the translation into clinical effects has been challenging. Recently published clinical studies,however,prompt optimism as novel techniques allow for improved clinical applicability. Cyclosporine A,the GLP-1 analogue exenatide and rapid cooling by endovascular infusion of cold saline all reduce infarct size and may confer clinical benefit for patients admitted with acute myocardial infarcts. Equally promising,three follow-up studies of the effect of remote ischemic conditioning(RIC) show clinical prognostic benefit in patients undergoing coronary surgery and percutaneous coronary intervention. The discovery that RIC canbe performed noninvasively using a blood pressure cuff on the upper arm to induce brief episodes of limb ischemia and reperfusion has facilitated the translation of RIC into the clinical arena. This review focus on novel advances in adjunctive therapies in relation to acute and elective coronary procedures.
基金Acknowledgments This study was funded by the National Natural Science Foundation of China （81570323, 30972709, 81061120527, 81241082） and the 12th Five-Year National Program of the Ministry of Scientific Technology （2012BAI10B01）. We thank Liu M and Zhou L from Beijing Hospital for providing experimental data, the nurses from Beijing Anzhen Hospital for collecting specimens, and the study volunteers.
文摘编码 adiponectin 受体 1 的基因( ADIPOR1 )和小象ubiquitin一样修饰词( SUMO4 ) 4 被连接了到 anti-atherogenic 效果，但是很少对是否被知道在二基因的多型性，独立行动或交往，没有 diabetes.MethodsWe genotyped ，影响冠的动脉疾病( CAD )的风险没有糖尿病的 200 个 CAD 病人和没有 CAD 的 200 控制，它被选择基于前一个没有 diabetes.ResultsRisk 等位基因，协会也是的潜力在 ADIPOR1 (rs7539542-G， rs7514221-C 和 rs3737884-G ) 在三 SNP 在这些 SNP 和 CAD 的临床的特征之间探索了，没有糖尿病，在在 SUMO4 的 SNP rs237025 的 G 等位基因显著地增加了 CAD 的风险，与从 1.79 ～ 4.44 的 ORs。任何这四风险等位基因的搬运人出现了类似不利 ? 临床的特征。与有 CC 或 GC 遗传型的个人相比，有在 rs3737884 的 GG 遗传型的那些在影响了左前面的下降冠的动脉的 CAD 的显著地更高的风险(或：6.77， P = 0.009 ) ，恰好冠的动脉(或：4.81， P = 0.028 ) 或容器的一个相对大的数字(P = 0.04 ) 。没有糖尿病，在 SUMO4 在 SNP 象风险等位基因一样在 ADIPOR1 在三 SNP 中的至少一个带风险等位基因的个人比不带任何风险等位基因的个人在 CAD 的显著地更高的风险(或：5.82， 95% CI：1.2327.7， P = 0.013 ) 没有糖尿病，在 ADIPOR1 和 SUMO4 的 .ConclusionsSNPs 与 CAD 的提高的风险被联系，并且在二基因的 SNP 可以交往联合影响疾病风险。
基金This work was partly supported by National Natural Scientific Foundation （81070171, 81241121）, Specialized Research Fund for the Doctoral Program of Higher Education of China （20111106110013）, Capital Special Foundation of Clinical Application Research （Z 121107001012015）, Capital Health Development Fund （2011400302）, and Beijing Natural Science Foundation （7131014） awarded to Dr. Jian-Jun LI.
基金Supported by The American Heart Association,Texas Affiliate,No.7370061the Center for Chronic Disorders of Aging,PCOM
文摘Coronary heart disease(CHD) continues to be the greatest mortality risk factor in the developed world. Estrogens are recognized to have great therapeutic potential to treat CHD and other cardiovascular diseases; however,a significant array of potentially debilitating side effects continues to limit their use. Moreover,recent clinical trials have indicated that long-term postmenopausal estrogen therapy may actually be detrimental to cardiovascular health. An exciting new development is the finding that the more recently discovered G-protein-coupled estrogen receptor(GPER) is expressed in coronary arteries-both in coronary endothelium and in smooth muscle within the vascular wall. Accumulating evidence indicates that GPER activation dilates coronary arteries and can also inhibit the prolif-eration and migration of coronary smooth muscle cells. Thus,selective GPER activation has the potential to increase coronary blood flow and possibly limit the debilitating consequences of coronary atherosclerotic disease. This review will highlight what is currently known regarding the impact of GPER activation on coronary arteries and the potential signaling mechanisms stimulated by GPER agonists in these vessels. A thorough understanding of GPER function in coronary arteries may promote the development of new therapies that would help alleviate CHD,while limiting the potentially dangerous side effects of estrogen therapy.
文摘Non-alcoholic fatty liver disease(NAFLD) is a chronic liver disease associated with insulin resistance and metabolic syndrome. The spectrum of disease ranges from simple steatosis to steatohepatitis and progression to cirrhosis. Compelling evidence over the past several years has substantiated a significant link between NAFLD and cardiovascular disease ranging from coronary artery disease to subclinical carotid atherosclerosis. Close follow up, treatment of risk factors for NAFLD, and cardiovascular risk stratification are necessary to predict morbidity and mortality in this subset of patients.
文摘AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram(defined as ST segment elevation or pre-sumably new left bundle branch block) whounderwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm(ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm(n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared. RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age(68.1 years vs 61 years, P = 0.001) in the nonshockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality(60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score(CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score(mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm(29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group(21.9% vs 9.1%, P = 0.03). CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs nonshockable group.
文摘In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However,in patients with previous coronary artery bypass graft operation(CABG) using internal mammary artery grafts,great vessel disease should also be considered. Herein we present two patients with history of CABG whose symptoms were suspicious for coronary ischemia. During cardiac catheterization reverse blood flow was observed from the left artery disease to the left internal mammary artery(LIMA) graft in both cases. After angioplasty and stent implantation of the left subclavian artery antegrade flow was restored in the LIMA grafts and both patients had complete resolution of symptoms.
文摘AIM: To evaluate the feasibility of coronary artery calcium score(CACS) on low-dose non-gated chest CT(ngCCT).METHODS: Sixty consecutive individuals(30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed to-mography(gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner(Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores(Volume, Mass, Agatston) as previ-ously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered sig-nificant.RESULTS: Mean CACS values were significantly higher for gCCT as compared to ngCCT(Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high(Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2(33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1(33%) showed an Agatston score of 0 in the ngCCT. Overall, 23(38%) patients were reclassified in a different car-diovascular risk category, mostly(18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT(DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01).CONCLUSION: CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.
文摘Disease registries,containing systematic records of cases,have for nearly 100 years been valuable in exploring and understanding various aspects of cardiology. This is particularly true for myocardial infarction,where such registries have provided both epidemiological and clinical information that was not readily available from randomised controlled trials in highlyselected populations. Registries,whether mandated or voluntary,prospective or retrospective in their analysis,have at their core a common study population and common data definitions. In this review we highlight how registries have diversified to offer information on epidemiology,risk modelling,quality assurance/improvement and original research-through data mining,transnational comparisons and the facilitation of enrolment in,and follow-up during registry-based randomised clinical trials.
文摘AIM To assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease(CAD) in men undergoing angiography.METHODS We conducted a prospective multicenter,multi-ethnic,cross sectional observational study at five hospitals in Saudi Arabia and the United Arab Emirates,in which we used logistic regression analysis with and without adjustment for baseline differences. RESULTS Data were collected for 1068 enrolled patients undergoing coronary angiography for clinical indications during the period of April 1^(st),2013 to March 30^(th),2014. Ethnicities of spouses were available only for male patients. Of those enrolled,687 were married men and constituted the cohort for the present analysis. Intra-ethnic marriages were reported in 70% and inter-ethnic marriages in 30%. After adjusting for baseline differences,interethnic marriage was associated with lower odds of having significant CAD [adjusted odds ratio 0.52(95%CI:0.33,0.81)] or multi-vessel disease(MVD) [adjusted odds ratio 0.57(95%CI:0.37,0.86)]. The adjusted association with left main disease showed a similar trend,but was not statistically significant [adjusted odds ratio 0.74(95%CI:0.41,1.32)]. The association between interethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives(P interaction > 0.05 for both).CONCLUSION Among married men undergoing coronary angiography,inter-ethnic,as compared to intra-ethnic,marriage is associated with lower odds of significant CAD and MVD.
文摘AIM To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with nondominant right coronary artery anatomy.METHODS This was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain.Only patients who underwent single photon emission computed tomography(SPECT)myocardial perfusion imaging(MPI)were included.Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed.Patients with prior history of coronary artery disease(CAD)including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded.True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography,in the same territory as identified on SPECT MPI.Coronary artery dominance was determined on coronary angiography.Patients were divided into group 1 and group 2.Group1 included patients with non-dominant right coronary artery(RCA)(left dominant and codominant).Group2 included patients with dominant RCA anatomy.Demographics,baseline characteristics and positive predictive value(PPV)were analyzed for the two groups.RESULTS The mean age of the study cohort was 57.6 years.Sixtyone point seven percent of the patients were males.The prevalence of self-reported diabetes mellitus,hypertension and dyslipidemia was 36%,71.9%and 53.9%respectively.A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men.For inferior wall ischemia on SPECT MPI,patients in study group 2 had a significantly higher PPV,32/42(76.1%),compared to patients in group 1,in which only 3 out of the 29 patients(10.3%)had true positive results(P value<0.001 Z test).The difference remained statistically significant even when only patients with left dominant coronary system(without co-dominant)were compared to patients with right dominant system(32/40,76.1%in right dominant group,3/19,15.8%in left dominant group,P value<0.001 Z test).There was no significant difference in mean hospital stay,re-hospitalization,and in-hospital mortality between the two groups.CONCLUSION The positive predictive value of SPECT MPI for inferior wall ischemia is affected by coronary artery dominance.More studies are needed to explain this phenomenon.
