稳定性冠心病患者循环内皮祖细胞与冠状动脉病变严重程度的分析

目的观察稳定性冠心病患者循环内皮祖细胞(EPCs)数量与冠状动脉病变严重程度的关系。方法对80例冠状动脉造影患者(排除急性冠状动脉综合征、心肌梗死)作病变严重程度及危险因素分析;以CD133/KDR作为EPCs标记物,用流式细胞仪检测患者的CD133/KDR双标记细胞数量。结果外周血EPCs数量与年龄、血清肌酐清除率(Ccr)、左室心肌重量指数(LVMI)呈负相关(P值分别=0.004,0.015,0.014);冠心病伴高血压患者较不伴高血压者EPCs数量显著减少(P=0.004)。冠状动脉造影阳性者EPCs数量较阴性者显著降低(P<0.01);EPCs数量与Gensini评分呈负相关(n=49,r=-0.305,P=0.039)。结论在稳定性冠心病患者循环EPCs数量与心血管危险因素及冠状动脉病变相关。     

冠心病患者胰岛素水平与内皮祖细胞及冠状动脉病变的相关性

目的 探讨冠心病患者不同胰岛素水平与循环内皮祖细胞(EPC)数量、功能及冠状动脉病变程度的关系并探讨相关临床意义.方法 69例经选择性冠状动脉造影证实的冠心病患者,按胰岛素水平高低分为胰岛素抵抗(IR)组和胰岛素敏感(IS)组,另设25例健康对照者.采集研究对象外周血以激酶插入区域受体(KDR)和CD133双阳性为循环EPC标记行流式细胞分析,同时采血进行EPC的分离培养,7 d后鉴定并检测增殖及迁移能力,将各组的一般临床资料,循环EPC数量、迁移、增殖能力指标、稳态模型胰岛素抵抗指数(HOMA-IR)及冠状动脉病变Gensini评分进行统计学分析.结果 IR组循环EPC数量明显少于IS组[(0.34±0.08)‰比(0.47±0.09)‰,P<0.01],HOMA-IR自然对数与循环EPC数量呈负相关(r=-0.291,P=0.01),循环EPC数量与Gensini评分呈负相关(r=-0.3984,P=0.006).IR组的增殖能力和迁移能力均低于IS组减弱(P<0.05).结论 冠心病患者血清胰岛素水平与循环EPC数量呈负相关.循环EPC数量及功能与冠状动脉病变程度呈负相关;IR或高胰岛素血症可能部分通过损害循环EPC的数量及功能,从而影响冠状动脉病变程度.     

Relationship between aortic valve sclerosis and the extent of coronary artery disease in patients undergoing diagnostic coronary angiography

BACKGROUND: Aortic valve sclerosis (AVS) is considered to be a manifestation of coronary atherosclerosis. Recent studies demonstrated an association between AVS and significant coronary artery disease (CAD). AIM: We sought to determine the association between AVS and the extent of coronary atherosclerosis by means of the Gensini score system, which was calculated to yield a measure of the extent and severity of coronary atherosclerosis in patients referred for coronary angiography. METHODS: A total of 160 consecutive patients referred for coronary angiography were subjected to echocardiography for screening of AVS and coronary risk assessment. Absence (group 1, n = 110) and presence of AVS (Group 2, n = 50) was established. The cardiac risk factors considered in this study were age, gender, family history of CAD, diabetes mellitus, hypertension, hypercholesterolemia and history of smoking. The body mass index was also measured. Atherosclerotic plaque burden was determined using the Gensini score. Significant CAD was defined as >50% reduction in the internal diameter of at least one coronary artery. Multivessel coronary disease was based on the presence of 2- or 3-vessel disease. RESULTS: The AVS patients had a higher rate of 3-vessel disease (AVS group vs. non AVS: 40 vs. 13.6%; p < 0.001). No significant correlations were found between AVS and 1- and 2-vessel disease. Individuals with AVS were found to have a higher Gensini score (40.7 +/- 38.05 vs. 18 +/- 16.4; p < 0.001). Multivariate analysis identified age (p < 0.001), male sex (p = 0.01), triglycerides (p = 0.02), LDL cholesterol (p = 0.001) and Gensini score (p = 0.003) as independent predictors of AVS. CONCLUSION: AVS is strongly interrelated with the coronary angiographic Gensini score. Echocardiographic detection of AVS in patients undergoing coronary angiography can provide a new surrogate marker of the extent of coronary atherosclerosis.     

The number of endothelial progenitor cell colonies in the blood is increased in patients with angiographically significant coronary artery disease.

OBJECTIVES: The objective of this study was to determine whether the number of endothelial progenitor cells (EPCs) and circulating angiogenic cells (CACs) in peripheral blood was associated with the presence and severity of coronary artery disease (CAD) in patients undergoing coronary angiography. BACKGROUND: Previous studies have suggested an inverse relationship between levels of circulating EPCs/CACs and the presence of CAD or cardiovascular risk factors, whereas other studies have observed increased numbers of EPCs in the setting of acute ischemia. However, the criteria used to identify specific angiogenic cell subpopulations and methods of evaluating CAD varied in these studies. In the present study, we used rigorous criteria to identify EPCs and CACs in the blood of patients undergoing coronary angiography. METHODS: The number of EPCs and CACs were measured in the blood of 48 patients undergoing coronary angiography. Patients with acute coronary syndromes were excluded. RESULTS: Compared with patients without angiographically significant CAD, the number of EPCs was increased (1.11 +/- 2.50 vs. 4.01 +/- 3.70 colonies/well, p = 0.004) and the number of CACs trended higher (175 +/- 137 vs. 250 +/- 160 cells per mm(2), p = 0.09) among patients with significant CAD. The highest levels of EPCs were isolated from patients subsequently selected for revascularization (5.03 +/- 4.10 colonies/well). CONCLUSIONS: In patients referred for coronary angiography, higher numbers of EPCs, and a trend toward higher numbers of CACs, were associated with the presence of significant CAD, and EPC number correlated with maximum angiographic stenosis severity. Endothelial progenitor cell levels were highest in patients with CAD selected for revascularization.     

Atherosclerotic changes of extracoronary arteries are associated with the extent of coronary atherosclerosis

The aim of the present study was to examine the association between carotid and femoral artery intima media thickness (IMT) and the extent and severity of coronary artery disease (CAD) as well as the effects of traditional vascular risk factors on the atherosclerotic changes in the carotid and femoral arteries. Two hundred twenty-four patients who underwent coronary angiography for suspected CAD were evaluated by B-mode ultrasound imaging of the common carotid, internal carotid, carotid bifurcation, and femoral artery for measurement of IMT; traditional vascular risk factors were also evaluated in these patients. CAD extent was evaluated by the number of diseased vessels and by Gensini score. Age, male gender, and diabetes were common risk factors for higher CAD extent and higher carotid and femoral IMT. Insulin levels were correlated with femoral IMT and CAD extent, whereas blood lipids were correlated predominantly with carotid IMT. IMT from carotid and femoral arteries increased significantly with an increase in CAD extent. Using multiple stepwise regression analysis, the following parameters were found to be independent predictors of CAD extent: male gender (p<0.0001), common femoral artery IMT (p = 0.0028), common carotid artery IMT (p = 0.015), age (p = 0.02), diabetes mellitus (p = 0.035), and carotid artery bulb IMT (p = 0.04). Common femoral IMT was the only independent parameter for predicting Gensini score (p<0.0001). In conclusion, there are territorial differences in the various arterial beds regarding their response to risk factors. Femoral artery and carotid bulb are independent predictors of CAD extent and the inclusion of these measurements would add information to that provided by the common carotid artery.     

同型半胱氨酸与冠脉病变程度及斑块的关系

目的探讨血浆同型半胱氨酸（Hey）水平与冠状动脉病变程度及斑块稳定性的关系。方法对200例可疑冠心病患者行冠状动脉造影,根据冠状动脉造影结果分为冠状动脉造影正常的对照组（54例）和冠心病组（146例）;冠心病组根据临床类型分为急性冠状动脉综合征组（ACS组,115例）和稳定型心绞痛组（SAP组,31例）。以Gensini积分评价动脉粥样硬化病变程度,以临床类型评价斑块稳定性。检查所有患者血浆Hcy、高敏C-反应蛋白（hs—CRP）等指标,分析Hey、hs—CRP与Gensini积分、斑块稳定性的关系。结果ACS组和SAP组Hcy水平均显著高于对照组[（28．8±6．5）mol／L比（10．2±4．1）mol／L,（16．3±5．7）mol／L比（10．2±4．1）mol／L,P均〈0．05],而且随着冠状动脉病变Gensini积分的增加而逐渐升高;ACS组Hey水平较SAP组高（P〈0．05）。结论冠心病患者血浆同型半胱氨酸水平与冠状动脉粥样硬化病变程度明显相关,且与斑块稳定性呈正相关。     

老年人脂蛋白相关磷脂酶A2与冠心病冠状动脉病变程度及危险因素的关系

目的 观察老年人脂蛋白相关磷脂酶A2(Lp-PLA2)水平与冠心病冠状动脉造影病变程度及冠心病危险因素的关系. 方法 测定90例临床怀疑冠心病行冠状动脉造影老年患者Lp-PLA2、超敏C反应蛋白(hs-CRP),血脂等指标,根据冠状动脉造影结果以病变支数及Gensini积分评价冠状动脉病变程度,分析Lp-PLA2与冠心病的关系. 结果冠心病组Lp-PLA2水平较对照组明显升高[(352.7±129.0)μg/L与(204.0±59.7)μg/L,P<0.01].Lp-PLA2水平随着冠状动脉病变支数和Gensini积分的增加而升高.Lp-PLA2与年龄(r=0.25,P<0.05)、三酰甘油(r=0.33,P<0.01)、低密度脂蛋白胆固醇(r=0.27,P<0.05)、载脂蛋白B(r=0.36,P<0.01)呈正相关.在冠心病组,Lp-PLA2与年龄呈正相关(r=0.29,P<0.05).Stepwise回归分析结果显示Lp-PLA2与冠心病相关. 结论 冠心病患者Lp-PLA2水平升高,其水平的高低可能反映冠状动脉病变的严重程度.为冠心病的危险因素之一.     

High levels of serum uric acid predict severity of coronary artery disease in patients with acute coronary syndrome

We aimed to elucidate the relation between serum uric acid (SUA) level and severity of coronary artery disease (CAD) in nondiabetic, nonhypertensive patients (n = 246) with acute coronary syndrome (ACS). Severity of CAD was assessed by the Gensini score. One, 2, and 3 or more diseased vessels were identified in 87 (35.4%), 55 (22.4%), and 104 (42.2%) patients, respectively. Patients with hyperuricemia had higher Gensini score, high number of diseased vessels, critical lesions, and total occlusion. Serum uric acid level was significantly associated with number of diseased vessels. Serum uric acid was an independent risk factor for multivessel disease by univariate analysis. High levels of SUA associated with the severity of CAD in nondiabetic, nonhypertensive patients with ACS.     

Clinical and angiographic correlates and prognostic significance of the coronary extent score

The clinical and angiographic correlates and the prognostic significance of the "coronary extent score" in a consecutive series of 313 patients who were catheterized twice were studied. The extent score was defined as the number of 5 to 75% stenosed segments in a 15-segment coding system. The extent score was higher in subgroups of patients with new onset angina at the time of the first angiogram (4.3 +/- 2.4 vs 3.3 +/- 1.9, p less than 0.01), unstable angina at the time of the second angiogram (4.0 +/- 2.0 vs 3.3 +/- 1.9, p less than 0.05) or multifocal progression from the first to the second angiogram (4.0 +/- 2.1 vs 3.3 +/- 1.9, p less than 0.01), suggesting that it is an index of active coronary artery disease. The extent score did not correlate with the number of diseased vessels (r = 0.03), the ejection fraction (r = 0.03), the Friesinger score (r = 0.04) and the Gensini score (r = -0.07) (difference not significant for each). Cox's model was fit to the survival data recorded on a prospective basis after the second angiogram. Independent predictors of survival were ejection fraction (p less than 0.001), extent score (p = 0.001), number of diseased vessels (p = 0.01) and percent of left main luminal stenosis (p less than 0.05). The extent score was also an independent predictor of myocardial infarction and unstable angina. Thus, the extent score, an index of active progressive disease, is an independent predictor of mortality and cardiac events in patients with coronary artery disease.     

Urinary 8-isoprostane levels can indicate the presence, severity and extent of angiographic coronary artery disease

BACKGROUND: Atherosclerotic coronary artery disease is the leading cause of death worldwide. Oxidative stress is one of the key elements in the pathogenesis of atherosclerosis. Isoprostanes are established markers of oxidative stress. The aim of this study was to investigate the association of urinary 8-isoprostane levels with the presence and severity of coronary artery disease (CAD) assessed by a validated scoring system. METHOD: Urinary 8-isoprostane levels were measured in 100 consecutive patients scheduled for coronary angiography. Extent and severity of CAD were assessed by modified Gensini scores. RESULTS: In patients with CAD, 8-isoprostane levels were higher (P < 0.001) than in patients without CAD (68.75 +/- 5.5 vs. 38.27 +/- 3.7 pg/ml). The levels of 8-isoprostane correlated with the number of risk factors (P < 0.001) and significantly increased in relation with the number of diseased vessels (P < 0.001). A significant (P < 0.001) correlation was found between 8-isoprostane levels and Gensini scores (r = 0.496), and a stepwise elevation in 8-isoprostane levels was observed across the increasing tertiles of the Gensini scores (P < 0.001). The multivariate logistic regression analysis revealed that 8-isoprostane was an independent predictor (odds ratio: 7.19 and P = 0.007) associated with angiographic CAD. CONCLUSION: These results confirm the role of oxidative stress in the atherosclerotic process. Urinary 8-isoprostane levels reflect the extent and severity of CAD and they may provide additional information for risk assessment in patients with suspected CAD.     

空腹血糖与冠状动脉病变程度的相关性

目的探讨空腹血糖（FPG）水平与冠状动脉（下称冠脉）病变程度的相关性。方法回顾分析913例高度怀疑冠心病（CHD）而行冠脉造影的患者的临床资料,冠脉造影病变程度由是否诊断CHD、冠脉病变支数和冠脉病变Gensini总积分三方面表示。对FPG水平与冠脉病变程度进行单因素和多因素分析。结果FPG与冠脉病变程度密切相关：（1）Logistic回归结果显示FPG与冠脉有无病变显著相关（OR值1.462,95%CI为1.178~1.813,P〈0.01）;（2）多元逐步回归结果显示在校正了年龄、性别等因素之后,FPG与冠脉病变支数（r=0.164,P〈0.01）、冠脉病变总积分（r=0.088,P〈0.05）仍然独立相关。随着FPG的升高,冠脉病变支数增加。结论冠心病高危人群的FPG水平与冠脉病变程度密切相关,即使在糖尿病前期,随着FPG升高,冠脉病变程度也更加严重。     

Joint effects of N-terminal pro-B-type-natriuretic peptide and C-reactive protein vs angiographic severity in predicting major adverse cardiovascular events and clinical restenosis after coronary angioplasty in patients with stable coronary artery disease

BACKGROUND: This study was designed to evaluate the joint effects of plasma C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) vs coronary angiographic severity on cardiovascular risk stratification. METHODS AND RESULTS: A total of 345 patients with stable coronary artery disease (CAD) were recruited after successful percutaneous coronary intervention (PCI). Endpoints were major adverse cardiovascular events (MACE) and cumulative clinical restenosis rate after 18-36-month follow-up. Plasma NT-proBNP and CRP levels were among the strongest predictors of MACE. Adjusted hazard ratios of MACE according to combined biomarkers were 2.4 (p=0.05) for elevated CRP only, 5.22 (p<0.001) for elevated NT-proBNP only, and 7.04 (p<0.001) for elevation of both. The differential capacity using both plasma CRP and NT-proBNP in a receiver-operating-characteristics curve analysis (area under curve, AUC: 0.82) was significantly higher than using either biomarker alone or conventional risk factors (AUC: 0.67). Significant predictors of clinical restenosis were plasma NT-proBNP and the Gensini score. The combination of NT-proBNP and the Gensini score was the strongest predictor (AUC: 0.77) for clinical restenosis. CONCLUSIONS: Plasma NT-proBNP, CRP, and the Gensini score are complementary in risk stratification. Combined use of these biomarkers has provided substantial extra information to conventional risk factors in stable CAD patients.     

Effects of plasma adiponectin levels on the number and function of endothelial progenitor cells in patients with coronary artery disease.

BACKGROUND: It is not known whether plasma adiponectin levels are associated with the number and function of endothelial progenitor cells (EPCs) in patients with coronary artery disease (CAD). METHODS AND RESULTS: Plasma levels of adiponectin were measured in 70 patients undergoing coronary angiography. The numbers of colony-forming units (CFUs) of EPCs and senescent EPCs, determined by acidic beta-galactosidase staining, were counted. The angiogenic growth factors in the culture medium were also measured. There was a significant positive correlation between adiponectin level and CFUs (r=0.257, p<0.05) but not with the occurrence of senescent EPCs. Next, patients were divided into a high adiponectin group (high ADP: > or =6.17 microg/ml, n=36) and low adiponectin group (low ADP: <6.17 microg/ml, n=34). The number of diseased coronary arteries was less in the high ADP group than that in the low ADP patients (1.7+/-0.8 vs 2.1+/-0.7, p<0.05). No significant differences between the 2 groups were demonstrated in angiogenic growth factors secreted from EPCs. CONCLUSIONS: The results suggest that plasma adiponectin levels are associated with the number of EPCs in patients with CAD.     

急性冠脉综合征患者并发焦虑障碍与冠状动脉狭窄严重程度的相关性

目的:探讨急性冠脉综合征(ACS)患者并发焦虑障碍患者焦虑评分与冠状动脉狭窄严重程度的关系。方法:180例ACS患者采用Zung焦虑自评量表(SAS)测试评分,分为焦虑组和非焦虑组,并行冠状动脉造影检查及心脏彩超检查测左室射血分数(LVEF),对冠状动脉病变狭窄程度进行Gensini评分,分析SAS评分与ACS患者冠状动脉病变评分(Gensini评分)的关系。结果:根据SAS评分将ACS患者分为无焦虑组82例,焦虑组98例(轻度焦虑54例,中度30例,重度14例)。焦虑组冠状动脉病变评分(Gensini评分)为(36±22)分,显著高于无焦虑组Gensini评分(25±13)分(P<0.01)。SAS评分与冠状动脉病变Gensini积分呈正相关(r=0.36,P<0.01)。结论:ACS患者焦虑障碍程度与冠脉病变狭窄程度相关。     

可溶性糖蛋白130与稳定型冠心病患者冠状动脉粥样硬化严重程度之间关系

目的: 评估稳定型冠状动脉疾病（stable coronary artery disease, CAD）患者血清白细胞介素-6（IL-6）、可溶性IL-6受体（sIL-6R）和可溶性糖蛋白130（sgp130）浓度及与冠状动脉粥样硬化严重程度间的关系。方法：纳入2017年1月到2019年1月间于惠州市第六人民医院心内科具有动脉造影适应症疑似冠心病患者89例,根据冠状动脉造影结果将患者分成两组：存在冠状动脉粥样斑块CAD组,即粥样斑块组,共64例;不存在冠状动脉粥样斑块CAD组,即非粥样斑块组,共25例。采用ELISA法检测两组患者血清IL-6、sIL-6R和sgp130浓度,Spearman相关分析sgp130浓度与受累冠脉数目及Gensini评分的相关性,多因素logistic回归分析冠状动脉粥样硬化斑块病变的预测因子。结果： 粥样斑块组与非粥样斑块组在年龄、BMI、高血压、糖尿病、血脂参数上无统计学差异（P>0.05）, 粥样斑块组患者男性吸烟者居多（P<0.05）。粥样斑块组血清sgp130浓度显著低于非粥样斑块组（314.97±84.39 VS 399.08±79.99 ng/ml, P<0.001）,粥样斑块组血清IL-6浓度显著高于非粥样斑块组（P<0.05）, 粥样斑块组血清sIL-6R浓度和C-反应蛋白浓度(CRP)与非粥样斑块组比较差异无统计学意义。多因素logistic回归分析示血清sgp130浓度是冠状动脉粥样硬化斑块病变存在的预测因子（P=0.018）。血清sgp130浓度与受累冠状动脉数目间呈负相关（r=-0.310,P=0.007）,Gensini评分指数与血清sgp130浓度呈负相关（r=-0.410, P=0.001）,稳定型CAD患者sgp130浓度是Gensini评分指数独立危险因素。结论：稳定型CAD患者血清sgp130浓度与冠状动脉损伤严重程度呈负相关,血清sgp130水平是冠状动脉粥样硬化严重程度血清标志物。     

Body iron stores and coronary atherosclerosis assessed by coronary angiography

BACKGROUND AND AIM: Epidemiological studies have suggested an association between higher body iron stores and coronary artery disease (CAD), but recent trials have reported conflicting data on the role of ferritin in CAD. To assess these findings, we examined the association between serum ferritin and the angiographic extent of coronary atherosclerosis in consecutive patients referred for coronary angiography. METHODS AND RESULTS: We studied 100 consecutive white subjects (41 women and 59 men; mean age 63.7 +/- 11.0 years) who underwent coronary angiography. The data collected at baseline included conventional risk factors for coronary artery disease (CAD), lipid and fasting total homocysteine levels, serum ferritin levels and transferrin saturation, and clinical characteristics. Serum ferritin levels and transferrin saturation (serum iron concentration divided by total iron-binding capacity) were used as measures of the amount of circulating iron available to tissues. Two experienced cardiologists blinded to the clinical and laboratory data reviewed the angiographic cinefilms, and defined the angiographic severity of CAD on the basis of the sum of three vessel scorring systems. The risk of CAD assessed by coronary angiography was not related to ferritin concentrations or transferrin saturation levels. The estimated relative risk of CAD for the fifth vs the first quintile of serum ferritin was 0.83 (95% CI: 0.63-1.24). Forty of the 100 patients had no or minimal CAD (group A; score 0-3), 33 moderate CAD (group B; score 4-8) and 27 severe CAD (group C; score > 8): the serum ferritin levels in the three groups were respectively 165 +/- 126, 167 +/- 121 and 164 +/- 110 ng/ml, and did not represent an independent risk factor for CAD (p = 0.98). Transferrin saturation in the three groups was 22.9 +/- 10%, 21 +/- 9% and 19.9 +/- 10%, with no significant relationship to the severity of CAD (p = 0.23). The presence of angiographic CAD was associated with patient age (p = 0.048), male gender (p < 0.01), high lowdensity lipoprotein cholesterol levels (p = 0.02), low high-density lipoprotein cholesterol levels (p = 0.02), high plasma fibrinogen levels (p < 0.01) and high fasting total homocysteine levels (p = 0.04). CONCLUSION: In patients referred for coronary angiography, higher ferritin concentrations and transferrin saturation levels were not associated with an increased extent of coronary atherosclerosis.     

The role of paraoxonase (PON) enzyme in the extent and severity of the coronary artery disease in type-2 diabetic patients

Increased coronary artery disease (CAD) risk is well established in diabetes mellitus (DM). Paraoxonase (PON) enzyme is known to have protective effects on lipid peroxidation. This study aimed to investigate the changes in PON activity levels with duration of DM as well as the role of PON activity in progression of CAD. Eighty-four consecutive diabetic patients (mean age 58 years, 46 men) who underwent coronary angiography for diagnostic purposes were examined. Before the angiography, fasting venous blood samples were taken for PON enzyme activity, thiobarbituric acid reactive substances (TBARS), and routine biochemical parameters. Severity and extent of coronary atherosclerosis were scored numerically using the Gensini scoring system. The population was divided into three groups according to Gensini score: Group 1, mild CAD; Group 2, moderate CAD; Group 3, severe CAD. Group 1 had higher PON levels and shorter DM duration than those of Group 3. Gensini score was significantly correlated with, PON activity (r = −0.361) and apo-AI (r = −0.375). TBARS (r = −0.290) and the duration of DM (r = −0.336) also showed a significant correlation with PON activity levels. Also, multivariate linear regression and Pearson correlation analyses showed that PON activity (P = 0.04), apo-AI levels (P = 0.01), and the duration of DM (P = 0.003) were significantly associated with Gensini score. Paraoxonase activity decreases parallel to DM duration. The lack of protective effect of PON enzyme on lipid peroxidation may be a factor in acceleration of CAD in DM. This study was presented as a poster in at the International Symposium on Atherosclerosis Rome, Italy, June 18–22, 2006.     

The association of liver transaminase activity with presence and severity of premature coronary artery disease

There is growing clinical interest in liver transaminases as novel biomarkers of cardiovascular risk. We investigated the possible association of serum liver transaminase activity with the presence and angiographic severity of premature coronary artery disease (CAD). A cross-sectional study was conducted on 187 younger patients (females < 55 years and males < 45 years) who underwent coronary angiography and had serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and high-sensitivity C-reactive protein (hsCRP) measured. Evaluation of coronary stenosis was by Gensini score. Both ALT and AST were significantly correlated with the presence of CAD in univariate and multivariate analyses. Both ALT and AST were also significantly correlated with Gensini score even after adjustment for potential confounders. Serum ALT and AST levels are independently positively associated with the risk and severity of premature CAD, suggesting that these enzymes could serve as surrogate markers for cardiovascular risk in this specific group of patients.     

Relation between the extent of coronary artery disease and tachyarrhythmias during dobutamine stress echocardiography

Despite accumulating data regarding the safety of dobutamine stress testing, the possible induction of tachyarrhythmias during the test remains a major concern for physicians, particularly in patients with extensive coronary artery disease (CAD) or left ventricular dysfunction. The aim of this study is to evaluate the clinical, echocardiographic, and angiographic predictors of arrhythmias during dobutamine stress testing. Dobutamine (up to 40 microg/kg/min)-atropine (up to 1 mg) stress echocardiography was performed in 286 patients (age 58 +/- 11 years, 200 men) with suspected myocardial ischemia who underwent coronary angiography within 3 months of the test. Wall motion score index was derived using a 16 segment/4 grade score model where 1 = normal and 4 = dyskinesia. No myocardial infarction or death occurred during the test. Ventricular and supraventricular tachycardia occurred in 16 (6%) and 21 (7%) patients, respectively. Systolic blood pressure decrease > or = 40 mm Hg occurred in 7 patients (2%). Significant CAD was detected in 220 patients (77%). There was no significant difference between patients with and without tachyarrhythmias with regard to the prevalence of CAD (78% vs 77%) or the mean number of diseased coronary arteries (1.51 +/- 0.7 vs 1.45 +/- 0.8). Independent predictors of tachyarrhythmias by multivariate analysis of clinical, angiographic, and echocardiographic characteristics were a higher resting wall motion score index (p <0.01) and mole gender (p <0.05). Independent predictors of systolic blood pressure decrease > or = 40 mm Hg were a higher baseline systolic blood pressure (p <0.0001), a history of myocardial infarction (p <0.0001), and a higher resting wall motion score index (p <0.01). It is concluded that tachyarrhythmias during dobutamine stress testing are predicted by the extent of left ventricular dysfunction but not by the presence or the extent of CAD.     

冠心病患者心脏变时功能不全的临床意义

目的探讨冠心病患者心脏变时功能不全与冠心病严重度的关系,以及运动试验中心脏变时功能不全的临床应用价值。方法选择130例完成冠状动脉造影(CAG)的病例,对冠状动脉病变进行 Duke 评分和 Gensini 评分,并分为对照组(39例)、冠状动脉单支病变组(30例)、双支病变组(31例)和三支病变组(30例);CAG 前1个月内完成症状限制性踏车运动试验并测定心脏变时功能指标最高心率与预测最大心率值之比(rHR)和心率储备率(HRR)。结果冠心病双支病变组[rHR(0.79±0.08),HRR(0.63±0.11)]和三支病变组[rHR(0.78±0.07),HRR(0.59±0.12)]的心脏变时功能指标明显低于对照组[rHR(0.89±0.06),HRR(0.80±0.10)]和单支病变组[rHR(0.86±0.08),HRR(0.74±0.15)](均 P<0.01);rHR 在双支病变组和三支病变组之间及对照组和单支病变组之间差异无统计学意义(P>0.05);HRR 在双支病变组和三支病变组之间差异无统计学意义(P>0.05),而对照组和单支病变组比较差异有统计学意义(P<0.05)。rHR 和 HRR 与 Duke 评分(r 分别为-0.554、-0.578,均 P<0.01)和 Gennisi 评分(r 分别为-0.453、-0.467,均 P<0.01)呈明显的负相关。运动试验无 ST 段下移但 rHR<85%或 HRR<72%的患者中冠心病发生率达75%。以 rHR<85%或 HRR<72%作为 ST 标准阴性患者的附加阳性判定标准对冠心病的诊断价值[敏感性86.8%(P<0.01)、84.6%(P<0.01),特异性46.2%、46.2%,准确性74.6%(P<0.05)、73.1%,阳性预测值79.0%、78.6%,阴性预测值60.0%、56.3%]略高于传统的 ST 标准(敏感性63.7%,特异性64.1%,准确性63.8%,阳性预测值80.6%,阴性预测值43.1%)。结论心脏变时功能与冠心病的严重度呈负相关,心脏变时功能不全可以预测冠心病的严重度。运动试验中无 ST 段下移的变时功能不全患者有较高的冠心病发生率,rHR<85%或 HRR<72%可以作为运动试验阳性的附加判定标准。