Relation between obesity and severity of coronary artery disease in patients undergoing coronary angiography

We examined the relations among body mass index (BMI), extent of coronary artery disease, and frequency of high-risk coronary anatomy (HRCA) in 928 consecutive patients who underwent coronary angiography during a 6-month period. HRCA was defined as >or=50% stenosis of the left main coronary artery and/or significant 3-vessel coronary artery disease (>or=70% narrowing). BMI was classified into 5 subgroups: low (<21 kg/m(2)), normal (21 to 24 kg/m(2)), overweight (25 to 29 kg/m(2)), obese (30 to 34 kg/m(2)), and severely obese (>or=35 kg/m(2)). Obese patients (BMI >or=30 kg/m(2)) were younger (61.4 +/- 10.7 vs 65.3 +/- 11.4 years, p <0.0001) and had higher prevalences of hyperlipidemia, systemic hypertension, and diabetes mellitus. HRCA was present less often in obese patients (56 of 245, 23%, vs 250 of 683, 37%, p = 0.0002). Multivariate regression analysis showed that advancing age (p <0.0001), male gender (p = 0.007), diabetes mellitus (p = 0.0004), and hyperlipidemia (p = 0.0008) were independent predictors of high-risk anatomy, whereas obesity remained a significant negative independent predictor (p = 0.02). Late (30 to 36 months) mortality was not different between obese (6.9%) and nonobese (8.2%) patients but was significantly higher in patients with HRCA (12.4%) than in those without HRCA (5.6%, p = 0.0003). In conclusion, obese patients who were referred for coronary angiography were younger and had a lower prevalence of HRCA. Obese patients were probably referred for angiography at an earlier stage of their disease, thus explaining the "obesity paradox" in several reports of better short-term outcome in obese patients who undergo cardiac procedures.     

Relation of coronary collateral circulation with epicardial fat volume in patients with stable coronary artery disease

Objective

To investigated the relationship between epicardial fat volume (EFV) and coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD).

Methods

The study population consisted of 152 consecutive patients with CAD who underwent coronary angiography and were found to have at least 95% significiant lesion in at least one major coronary artery. EFV was assessed utilizing 64-multislice computed tomography. The patients were classifield into impaired CCC group (Group 1, Rentrop grades 0−1, n = 58), or adequate CCC (Group 2, Rentrop grades 2−3, n = 94).

Results

The EFV values were significantly higher in paitients with adequate CCC than in those with impaired CCC. In multivariate logistic regression analysis, EFV (OR = 1.059; 95% CI: 1.035−1.085; P = 0.001); and presence of angina were independent predictors of adequate CCC. In receiver-operating characteristic curve analysis, the EFV value > 106.5 mL yielded an area under the curve value of 0.84, with the test sensitivity of 49.3%, and with 98.3% specifity.

Conclusions

High EFV, and the presence of angina independently predict adequate CCC in patients with stable coronary artery disease. This association offers new diagnostic opportinities to assess collateral flow by conventional ultrasound techniques.     

The relation between pericoronary fat thickness and density quantified by coronary computed tomography angiography with coronary artery disease severity

ObjectiveTo study the correlation between epicardial fat thickness (EFT), pericoronary fat thickness (PCFT), and pericoronary fat density (PCFD) with the existence and severity of coronary artery disease (CAD).MethodsThis cross-sectional study included 210 patients referred for multislice CT angiography. Group I normal CTCA, Group II patients had non-obstructive atherosclerosis, and Group III patients had obstructive atherosclerosis. All patients underwent a clinical examination, history taking, and multislice CT angiography.ResultsThe mean EFT was significantly greater in group III (10.43 ± 2.31 mm) compared to groups II (6.30 ± 1.61 mm) and I (5.06 ± 1.14 mm). The mean PCFT was significantly greater in group III (17.96 ± 2.89 mm) compared to group II (11.47 ± 2.51 mm) and group I (9.67 ± 1.99 mm). PCFD was significantly higher adjacent to the lesion (?80.47 ± 29.14) compared to the normal segment (?109.03 ± 35.24), higher in the obstructive group (?59.44 ± 20.10) compared to the non-obstructive group (?101.51 ± 20.23), but lower in calcified lesions (?89.58 ± 28.94) compared to non-calcified (?75.01 ± 29.20), and mixed lesions (?74.83 ± 26.90). EFT and PCFT cut-off values for predicting obstructive CAD were 8.3 and 12.4 mm, respectively, with 87.1% and 92.9% sensitivity and 92.9% and 86.4% specificity, respectively.ConclusionThere is a significant association between epicardial fat thickness, pericoronary fat thickness and density with the severity of coronary artery disease.     

Impact of epicardial fat volume on coronary artery disease in symptomatic patients with a zero calcium score

Background

This study sought to evaluate the prevalence of coronary artery disease (CAD) and the impact of epicardial fat volume (EFV) on CAD in symptomatic patients with a zero calcium score (CS) using multislice computed tomography (MSCT).

Methods

In this study, 1308 consecutive symptomatic patients who underwent 64-slice MSCT with a zero CS were evaluated. EFV was quantified with CS data sets. Presence of an obstructive plaque (diameter stenosis > 50%) and a CT-derived vulnerable plaque, which was defined as a plaque with remodeling index > 1.10 and mean CT density value < 30 HU, was assessed with a CT coronary angiography.

Results

Obstructive plaques were detected in 86 patients (7%) and CT-derived vulnerable plaques in 63 (5%). EFV was larger in patients with obstructive plaques than no plaque (124.3 ± 43.2 cm³ vs. 95.1 ± 40.3 cm³; p < 0.01). Patients with CT-derived vulnerable plaques had a greater amount of EFV than no plaque (133.0 ± 40.2 cm³ vs. 95.1 ± 40.3 cm³; p < 0.01). Multivariate analysis revealed EFV as a predictor of the presence of an obstructive and a CT-derived vulnerable plaque (per 10 cm³; Odds ratio (OR) 1.10; 95% confidence interval (CI), 1.04-1.16; p < 0.01 and OR 1.19; 95% CI, 1.12-1.27; p < 0.01). The combination of EFV and Framingham risk score (FRS) resulted in an area under the receiver-operating characteristic curve for prediction of obstructive and CT-derived vulnerable plaque of 0.75 and 0.75, which was significantly higher than 0.68 and 0.64 for FRS alone (p = 0.02 and p < 0.01).

Conclusions

A zero CS doesn't exclude CAD and EFV can be a useful marker of CAD in symptomatic zero CS patients.     

Relation of routine, periodic fasting to risk of diabetes mellitus, and coronary artery disease in patients undergoing coronary angiography

Previously we discovered that routine periodic fasting was associated with a lower prevalence of coronary artery disease (CAD). Other studies have shown that fasting increases longevity in animals. A hypothesis-generating analysis suggested that fasting may also associate with diabetes. This study prospectively tested whether routine periodic fasting is associated with diabetes mellitus (DM). Patients (n = 200) undergoing coronary angiography were surveyed for routine fasting behavior before their procedure. DM diagnosis was based on physician reports of current and historical clinical and medication data. Secondary end points included CAD (physician reported for ≥ 1 lesion of ≥ 70% stenosis), glucose, and body mass index (BMI). Meta-analyses were performed by evaluation of these patients and 448 patients from a previous study. DM was present in 10.3% of patients who fasted routinely and 22.0% of those who do not fast (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.17 to 0.99, p = 0.042). CAD was found in 63.2% of fasting and 75.0% of nonfasting patients (OR 0.42, CI 0.21 to 0.84, p = 0.014), and in nondiabetics this CAD association was similar (OR 0.38, CI 0.16 to 0.89, p = 0.025). Meta-analysis showed modest differences for fasters versus nonfasters in glucose concentrations (108 ± 36 vs 115 ± 46 mg/dl, p = 0.047) and BMI (27.9 ± 5.3 vs 29.0 ± 5.8 kg/m(2), p = 0.044). In conclusion, prospective hypothesis testing showed that routine periodic fasting was associated with a lower prevalence of DM in patients undergoing coronary angiography. A reported fasting association with a lower CAD risk was also validated and fasting associations with lower glucose and BMI were found.     

微量尿蛋白与冠状动脉病变相关性研究

目的：分析微量尿蛋白与冠状动脉病变程度和范围的相关性。方法：入选连续179例冠状动脉造影患者,根据尿白蛋白肌酐比值(UACR)分为微量尿蛋白组(30～300μg/mg,n=43)和对照组(UACR＜30μg/mg,n=136)。比较两组冠状动脉造影结果差异,同时分析微量尿蛋白与冠状动脉病变之间的相关性。结果：与对照组相比,微量蛋白尿组高血压、糖尿病患者多见,且其造影阳性率(46．51%比30．15%,P＜0．05)、多支冠状动脉病变发病率(30．23%比8．82%,P<0．01)显著增高。结论：微量蛋白尿患者更易发生严重的冠状动脉病变。     

冠状动脉造影与肾动脉狭窄的关系研究

目的:探讨冠状动脉(冠脉)造影与肾动脉狭窄(RAS)发生率的关系。方法:采用前瞻性设计,在冠脉造影的患者中同时进行选择性双侧肾动脉造影,对临床资料和 RAS之间的关系进行单变量和多变量 Logistic回归分析。结果: 402 例冠脉造影患者中有 377 例(93. 8%)同时行选择性双侧肾动脉造影, RAS 者 71 例(18.8%),其中轻度狭窄(<50%)者39例(10.3%),明显狭窄(>50%)者32例(8.5%),其中双侧明显狭窄者17例(4.5%)。明显RAS单变量分析,年龄、颈动脉斑块形成、糖尿病、高血压、肾功能不全、严重冠脉病变是 RAS的预测因素。多变量回归分析,年龄、高血压、严重冠脉病变是 RAS的独立预测因素。结论:冠脉造影尤其冠心病患者RAS发生率高,在冠心病患者行冠脉造影的同时应常规进行肾动脉造影,以便及早发现RAS。     

Echocardiographic epicardial fat thickness and coronary artery disease.

BACKGROUND: The association between epicardial fat and coronary artery disease has not been evaluated. The objective of the present study was to evaluate the relationship of echocardiographic epicardial fat to the presence and severity of coronary artery disease in a clinical setting. METHODS AND RESULTS: Two hundred and three consecutive patients who underwent echocardiography and diagnostic coronary angiography were studied. The epicardial fat thickness on the free wall of the right ventricle was measured at end-diastole from the parasternal long-axis views of 3 cardiac cycles. Coronary angiograms were analyzed for the extent and severity of coronary artery disease using Gensini's score. The patients were divided into 2 groups according to the fourth quartile of epicardial fat thickness (Group I <7.6 mm; Group II > or =7.6 mm). There were no significant differences in the baseline characteristics except for waist circumference (p=0.023). Significant correlations were demonstrated between epicardial fat thickness and age (r=0.332, p<0.001), C-reactive protein (r=0.182, p=0.009), body mass index (r=0.142, p=0.044) and waist circumference (r=0.229, p=0.001). The patients with a higher epicardial fat thickness were associated with a high Gensini's score (p=0.014). Multivariate analysis showed that age (odds ratio (OR) 5.29, p=0.003), epicardial fat thickness (OR 10.53, p=0.004), diabetes (OR 8.06, p=0.006) and smoking (OR 14.65, p=0.015) were independent factors affecting significant coronary artery stenosis. CONCLUSIONS: Epicardial fat thickness was significantly correlated with the severity of coronary artery disease in patients with known coronary artery disease.     

心外膜脂肪脂联素水平与冠状动脉病变程度的关系

目的探讨冠心病患者心外膜脂肪脂联素水平与冠状动脉病变程度的关系。方法选择冠心病及心脏瓣膜病手术患者168例,分为冠心病组86例和瓣膜病组82例,同时冠心病组按冠状动脉病变程度积分分为<30分23例、30~90分35例、>90分28例,分别采集患者的心外膜脂肪及血清标本,采用酶联免疫法及RT-PCR分别测定血清脂联素及脂肪脂联素mRNA的表达。结果冠心病组血清脂联素低于瓣膜病组[(9.1±3.1)mg/L vs(13.5±3.9)mg/L,P<0.05],冠心病组积分<30分、30~90分、>90分患者血清脂联素分别为(12.3±4.8)mg/L、(9.1±4.5)mg/L和(7.2±5.1)mg/L,差异有统计学意义(P<0.05)。与瓣膜病组比较,冠心病组心外膜脂肪脂联素mRNA表达降低(P<0.05)。结论老年冠心病患者随冠状动脉病变程度加重,血清及心外膜脂肪脂联素水平下降。     

冠状动脉造影患者中肾动脉狭窄的发生率

目的　在进行冠状动脉 (冠脉 )造影的人群中观察肾动脉狭窄 (RAS)的发生率 ,并识别RAS的危险因素。方法　冠脉造影和心室造影结束后 ,进行非选择性肾动脉造影。临床因素和RAS的关系采用单变量和多变量Logistic回归分析。结果　 8个月内共入选 370例患者 ,平均年龄 6 0 6岁(2 9～ 81岁 ) ,其中 10 6例患者 (2 8 6 %)存在RAS ,6 3例患者 (17 0 %)存在显著的RAS(腔径狭窄≥5 0 %) ,43例患者 (11 6 %)存在轻度的RAS(直径狭窄 <5 0 %)。 41例患者 (11 1%)存在显著单侧RAS ,2 2例患者 (5 9%)存在显著双侧RAS。经单变量和多变量Logistic回归分析 ,独立预测因子为年龄(OR =1 0 6 ,95 %CI:1 0 3～ 1 10 ,P <0 0 0 0 1)、冠脉病变的严重程度 (OR =1 6 5 ,95 %CI:1 34～ 2 0 3,P <0 0 0 0 1)和外周血管疾病 (OR =2 6 4,95 %CI:1 2 7～ 5 4 7,P =0 0 0 95 )。结论　接受冠脉造影检查的患者中 ,RAS发病率高 ,多见于存在全身弥漫性动脉粥样硬化的老年患者。     

Association of thyroid autoimmunity with the presence and severity of coronary atherosclerosis in patients undergoing coronary angiography

Studies on the association of thyroid autoimmunity with cardiometabolic risk and coronary artery disease (CAD) have produced conflicting results. This study aimed to investigate the relationship of thyroid autoimmune bodies (thyroid peroxidase antibody [TPOAb] and thyroglobulin antibody [TgAb]) with CAD in euthyroid subjects undergoing coronary angiography.A total of 307 subjects who underwent coronary angiography were included. The severity of coronary atherosclerosis was evaluated by using Gensini score. Serum TSH, total T3, total T4, TPOAb, TgAb, lipid levels et al were measured and compared between the groups with and without CAD. Logistic multivariate regression analysis were performed to assess the associations. Levels of thyroid hormones were comparable between the two groups.The positive percentage of anti-Tg antibodies was higher in non-CAD group (15.22% vs 7.91%, χ² = 3.95, p = .047) while no significant difference was observed for anti-TPO antibodies (19.57% vs 17.21%, χ² = 0.243, p = .622). The natural log-transformed Gensini score (ln (Gensini score)) was lower in the TgAb+ group (2.94 ± 1.11 vs 2.41 ± 1.18, P = .015). There was no significant difference for ln (Gensini score) between TPOAb− and TPOAb+ group (2.90 ± 1.14 vs 2.85 ± 1.09, P = .782). Logistical regression analysis revealed that positive TgAb was inversely associated with the presence of CAD (OR: 0.387, 95% CI: 0.157–0.952, p = .039) independent of other risk factors.The results showed that TgAb positivity might be an independent protective factor for CAD.     

Factor VII levels in patients undergoing coronary angiography: factor VII and coronary artery disease

BACKGROUND: Factor VII (F VII) has been widely investigated as a risk factor for coronary atherosclerosis, however there is still debate about its role in the progression of coronary artery disease (CAD). In this study F VII levels were measured in patients with angiographically proven CAD and its relation with disease severity, coronary events and with other risk factors of coronary atherosclerosis were examined. METHODS: Consecutive patients referred to coronary angiography were divided in three groups: 1. CAD group--those with a significant lesion in one or more coronary arteries (n = 155), 2. High-risk group--patients with normal coronary arteries and with two or more risk factors (n = 54), 3. Controls--patients with normal coronary arteries and with no or one risk factor (n = 90). CAD group was also studied according to the number of vessels involved and to the history of coronary events. RESULTS: Mean F VII levels were not different between the three groups of patients. In CAD group, F VII increased parallel to the number of vessels involved (one vessel disease: 85 +/- 20%, two vessel disease: 92 +/- 23%, three vessel disease: 105 +/- 23%). Patients with a history of coronary events had significantly higher F VII levels than those without such a history (96 +/- 25% versus 89 +/- 22% respectively, P = 0.02). However, logistic regression analysis revealed no significant relation between F VII and either the presence of CAD or coronary events. CONCLUSIONS: F VII levels increase in patients with previous coronary events, but it is not an independent risk factor for the progression or for the severity of CAD.     

Impact of continued hospitalization in patients pre-treated with clopidogrel prior to coronary angiography and undergoing coronary artery bypass grafting

Pre-treatment of patients with clopidogrel prior to coronary angiography (CAG) and possible percutaneous coronary intervention (PCI) is a standard practice. Candidates for coronary artery bypass surgery (CABG) are discharged or remain in the hospital until CABG after clopidogrel is discontinued. We investigated whether any differences exist in the rates of surgical complications and outcomes between these two groups of patients. We conclude that continued hospitalization of clopidogrel pre-treated patients does not confer any safety benefit with regard to post-operative complications and 30-day mortality. Discharging these patients after CAG may reduce hospitalization costs.     

Prevalence of coronary artery ectasia in older adults and the relationship with epicardial fat volume by cardiac computed tomography angiography

Objective Coronary artery ectasia (CAE) refers to abnormal dilation of coronary artery segments to 1.5 times of adjacent normal ones. Epicardial fat is associated with cardiovascular risk factors. The relationship between CAE and epicardial fat has not yet been investigated. This study aimed to assess the relationship between CAE and epicardial fat volume (EFV) in older people by dual-source computed tomography coronary angiography (CTCA). Methods We prospectively enrolled 1400 older adults who were scheduled for dual-source CTCA. Under reconstruction protocols, patients with abnormal segments 1.5 times larger than the adjacent segments were accepted as CAE. EFV was measured by semi-automated software. Traditional risk factors in CAE patients, as well as the extent of EFV, were analyzed and compared to non-CAE group. Results A total of 885 male and 515 female older patients were enrolled. CAE was identified by univariable analysis in 131 patients and significantly correlated to hypertension, smoking, hyperlipidemia, prior percutaneous coronary intervention and ascending aorta aneurysm. EFV was shown to be significantly higher in CAE patients than patients without ectasia. In multivariable analyses, EFV (P = 0.018), hypertension (P < 0.001) and hyperlipidemia (P < 0.001) were significantly correlated to CAE. There was a significant negative correlation between EFV and Markis classification. Conclusions CAE can be reliably recognized by dual-source CTCA. Epicardial fat might play a role in etiopathogenesis and progression of CAE, providing a new target for treating ectasia.     

Predictors of coronary artery disease in patients with left bundle branch block undergoing coronary angiography

Patients with left bundle branch block (LBBB) and concomitant coronary artery disease (CAD) have a worse prognosis than those with LBBB without CAD. In addition, subjects with CAD and concomitant LBBB have a higher cardiovascular mortality than those with a similar extent of CAD but without LBBB. Because the presence of LBBB makes the noninvasive identification of CAD problematic, patients with LBBB often are referred for coronary angiography to assess the presence and severity of CAD. To determine the clinical and demographic variables that might help identify those with CAD, we analyzed data from 336 consecutive patients with LBBB referred for coronary angiography. Of the 336, 54% had CAD. In conclusion, those with CAD were likely to be older, Caucasian, and men; they were more likely to have angina pectoris, myocardial infarction, and diabetes mellitus; and they were more likely to have a left ventricular ejection fraction <0.50. In contrast, patients with heart failure were less likely to have CAD.     

Prevalence of obstructive coronary artery disease in patients with and without prior stroke undergoing coronary angiography for suspected coronary artery disease

This study was conducted to investigate the prevalence and severity of obstructive coronary artery disease (CAD) in 64 men and 38 women (mean age 71+/-9 years) with previous stroke and in 102 age- and gender-matched patients with similar coronary risk factors without previous stroke who underwent coronary angiography for chest pain. Obstructive CAD was present in 100 of 102 patients (98%) with previous stroke and in 84 of 102 (82%) patients without previous stroke (p<0.001). Obstructive 3-vessel CAD was present in 56 of 102 patients (55%) with previous stroke and in 35 of 102 patients (34%) without previous stroke (p<0.005). The prevalence of 2-vessel CAD and of 1-vessel CAD was not significantly different between patients with and without previous stroke. In conclusion, patients with previous stroke have a significantly higher prevalence of obstructive CAD and of obstructive 3-vessel CAD than age- and gender-matched patients with similar coronary risk factors without previous stroke who undergo coronary angiography for chest pain.