Multiple coronary artery-left ventricular fistulae: clinical, angiographic, and pathologic findings

Multiple fistulae between all 3 major coronary arteries and the left ventricle were found at cardiac catheterization in a 69-year-old woman presenting with typical angina. Subsequent necropsy showed abnormal intramyocardial vessels communicating with the left ventricular lumen. This is the first report to document clinical, angiographic, and pathologic findings in this anomaly.     

Comparison of angiographic and postmortem findings in patients with coronary artery disease.

The accuracy of coronary cineangiography in predicting the degree of stenosis in coronary arteries was evaluated by comparing autopsy and premortem cineangiographic findings in 25 patients. Coronary cineangiograms and autopsy specimens were reviewed independently by two cardiologists and two pathologists. Identical diagrams dividing the cononary arteries into 12 segments were used by both groups to record the location and degree of stenosis observed. Cineangiographic findings were in agreement with pathologic findings (less than 25 percent difference in cross-sectional luminal area) in 178 (79 percent) of the 226 segments examined, but overestimated the degree of stenosis in 13 (6 percent) and underestimated it in 34 (15 percent). Thus, cineangiography appears to be a reliable tool in evaluating coronary artery disease. When diagnostic errors are made, they are usually underestimations of the degree of disease; common causes of error are circumferential stenosis, eccentric lesions, obstruction of view by artifical valves and poor opacification due to severe proximal stenosis.     

Hematologic parameters and angiographic progression of coronary atherosclerosis

Hematologic parameters have prognostic importance in cardiovascular disease. However, the relation between atherosclerosis progression and hematologic parameters is not well defined. A total of 394 patients requiring repeat coronary angiography were included in the study. According to angiography, patients were divided into 2 groups, progressive (n = 196) and nonprogressive (n = 198) diseases. Hematologic parameters including mean platelet volume (MPV) and neutrophil/lymphocyte (N/L) ratio were measured. Glucose, creatinine, and cholesterol were significantly higher in the progressive group. Mean platelet volume count was similar in both groups. The N/L ratio was significantly higher in the progressive group (5.0 ± 5.1 vs 3.2 ± 3; P = .001). In multivariate analysis, the N/L ratio was significantly related with progression (relative risk [RR]: 2.267, 95% CI: 1.068-4.815, P = .03). Progression rate was significantly high in patients with high N/L ratio (39% vs 56%). Our results suggest that the N/L ratio is a predictor of progression of atherosclerosis.     

Progression and regression of coronary artery disease—Linkage of clinical,pathologic, and angiographic findings

Progression and regression of coronary artery disease are analyzed with respect to clinical, pathologic, and angiographic findings. Clinically, progression of coronary artery disease is a highly unpredictable process. The pattern of progression is not linear in time but sometimes is rapid and other times is slow. The atherosclerotic lesion is not pathologically homogeneous. Regression therapies, therefore, might be effective depending on the composition of the lesion and the phase of atherosclerotic evolution. True clinical regression should be concordant with the clinical improvement of symptoms as well as prognosis. Further studies are required to establish the effectiveness of therapy for the prevention of progressive coronary artery disease.     

Preventing angiographic progression of coronary atherosclerosis with pravastatin

We conducted a prospective study to investigate the relationship between the decrease of serum lipid levels during pravastatin therapy and changes of coronary angiography parameters in Japanese patients with coronary atherosclerosis. The patients were predominantly male, aged between 18 and 75 years (mean: 58 years), had at least 25% stenosis of one or more major coronary arteries, and had a serum total cholesterol ( TC) level > or = 200 mg/dl (5.18 mM/l). Treatment with pravastatin (10 mg/day) was continued for 3 years. Coronary angiography was performed before and 3 years after the start of pravastatin therapy to assess the relationship between the mean segment diameter (MSD), the minimal lumen diameter (MLD), and the annual changes of percent stenosis and TC levels. of 265 patients who were initially registered, 129 were followed for an average of 35 months. Consequently, second angiograms were only obtained in 68 patients for various reasons, so this group was used for analysis. During pravastatin therapy, the TC level significantly decreased from 239 mg/dl (6.19 mM/l) to 210 mg/dl (5.44 mM/l) (a 12% reduction; p<0.001). In addition, HDL-cholesterol increased by 5% (p=0.007), but the triglyceride level did not show a significant change. Both MSD and MLD were significantly improved on follow-up angiography, increasing from 2.67 mm to 2.76 mm and from 2.09 mm to 2.13 mm, respectively. However, no change of percent stenosis was observed. The mean TC level during treatment did not show any significant correlation with the changes of angiography parameters. However, a significant correlation was observed between the percent reduction of TC and the annual change of MSD (r=-0.272, p=0.027). A similar relationship was also found between the change of MLD and the percent reduction of TC (r=-0.260, p=0.035). In conclusion, the percent decrease of serum cholesterol may be a better indicator of clinical efficacy than the absolute cholesterol level during pravastatin therapy.     

Comparison of platelet activation in unstable and stable angina pectoris and correlation with coronary angiographic findings

We sought to investigate the relation between platelet activation and the angiographic evidence of ruptured plaque in patients presenting with unstable and stable angina pectoris. We prospectively enrolled 25 consecutive patients (5 women and 20 men, mean age 62 +/- 3 years), 17 with unstable angina and 8 with stable angina. Systemic venous blood samples were collected within 4 to 6 hours of admission for flow cytometry analysis. Activation-dependent epitope CD63 and glycoprotein IIb/IIIa on the platelet membrane were assayed. Fibrinogen levels were also measured. All patients with unstable angina underwent cardiac catheterization and had angiographic evidence of ruptured plaque. Of the patients with stable angina, 5 underwent coronary angiography with smooth noncomplex lesions and 3 had negative technetium-99m sestamibi stress tests. Patients with unstable angina were characterized by 39% higher levels of fibrinogen than patients with stable angina (423 +/- 304 vs 304 +/- 51 mg/dl, p = 0.004). The percentage of platelets positive for the activation-dependent epitope CD63 was 5 times higher in patients with unstable than stable angina (14.6 +/- 5.6% vs 2.75 +/- 1.6%, p = 0.0026). They also had a 15% higher expression of their glycoprotein IIb/IIIa (517 +/- 79 vs 449 +/- 50 mean fluorescence intensity, p = 0.038). Thus, this study establishes a direct relation between the morphology of ruptured plaque and platelet activation in patients with unstable angina. This may allow for further risk stratification. Patients with unstable complex lesions had a fivefold higher expression of the platelet activation epitope CD63 than patients with stable angina. Furthermore, they had 15% more glycoprotein IIb/IIIa aggregation sites expressed on their platelet membrane, thus indicating an intense thrombogenic potential.     

Correlation of coronary angioscopic to angiographic findings in coronary artery disease

An Olympus ultrathin fiberscope, 1.8 mm outer diameter, was inserted intraluminally into 11 stenoses of the left anterior descending and circumflex coronary arteries in 8 patients at coronary bypass surgery. Intraluminal views were obtained by coupling the angioscope to a color video camera and videotape recorder, and compared with preoperative coronary angiographic findings in right and left anterior oblique views. Atherosclerotic plaque was observed as yellow-white mass attached onto the luminal lining, which may be large enough to virtually obliterate the vascular lumen. Angioscopy provided a topographic view and cross-sectional picture of stenosis not observed by angiography. Single-plane angioscopic cross-sectional stenotic lumens correlated well (r = 0.90, p less than 0.001) with calculated angiographic luminal narrowings. However, with subtotal obstruction, lesion length must be assessed angiographically. Coronary angioscopy can be a useful adjunct to angiography by providing the added dimension of the true cross-sectional view of obstruction.     

Coronary atherosclerosis in Type II diabetes: angiographic findings and clinical outcome

Aims/hypothesis. Prevalence and incidence of coronary heart disease (CHD) are increased in patients with Type II (non-insulin-dependent) diabetes mellitus; whether this is entirely due to more extensive coronary atherosclerosis is, however, controversial. Methods. We analysed the clinical, angiographic and follow-up data of 2253 consecutive patients undergoing coronary angiography over the decade 1983–1992. Results. Abnormal coronary arteries (≥ 50 % stenosis) were found more frequently in diabetic than in non-diabetic subjects (85 vs 67 %, p < 0.0001), the excess being explained by a higher prevalence of three-vessel disease (36 vs 17 %, p < 0.0001). The sum of all angiographically detectable lumen stenoses (atherosclerosis score, ATS) was higher in diabetic than in non-diabetic subjects (352 ± 232 vs 211 ± 201 units, p < 0.0001). After adjusting for measured cardiovascular risk factors, diabetes was still associated with an excess ATS (114 units in men and 187 units in women, p < 0.0001 for both, p < 0.03 for the interaction ATS x sex). Within the diabetic group, the only variable that was independently (of sex and age) associated with ATS was serum cholesterol, whereas plasma glucose concentration, disease duration and type of treatment were not correlated with the severity of coronary atherosclerosis. In contrast, clinical grade proteinuria was not associated with a more diffuse coronary atherosclerosis either in diabetic (366 ± 243 vs 354 ± 233 units) or non-diabetic subjects (231 ± 201 vs 207 ± 197 units). Over a mean follow-up period of 88 months, 19 % of diabetic patients compared with 10 % of non-diabetic patients died of a cardiac cause (age and sex-adjusted odds ratio OR = 1.34 [1.14–1.57]). In a Cox model adjusting for age, sex and all major risk factors, diabetes was still associated with a significant excess risk of dying of a cardiac cause (OR = 1.37 [1.14–1.60]); this excess was similar to, and independent of, that carried by the presence of prior myocardial infarction in the whole population (OR = 1.42 [1.25–1.62]). Proteinuria was associated with a higher risk of cardiac death, particularly in diabetic patients, independently of coronary atherosclerosis (adjusted OR = 1.46 [1.03–1.99]). Conclusion/interpretation. In patients undergoing angiography, diabetes, especially in women, is associated with more severe and diffuse coronary atherosclerosis which is not explained by either the traditional risk factors or the presence of proteinuria. On follow-up, these patients experience an excess of cardiac deaths, to which coronary atherosclerosis and proteinuria make independent, quantitative contributions. [Diabetologia (2000) 43: 632–641] Received: 13 December 1999 and in revised form: 7 March 2000     

Cardiac angiosarcoma arising in a coronary artery: Angiographic and pathologic findings

We discuss a unique case of an angiosarcoma which arose in an atherosclerotic coronary artery. It was widely metastatic. We describe the angiographic findings and their differential diagnosis, and briefly discuss this relatively common cardiac malignancy.     

Correlates of atherosclerosis in coronary arteries of patients undergoing angiographic evaluation

The correlations between lipid and lipoprotein measurements and other risk factors of coronary artery disease were evaluated in 101 men undergoing coronary angiography. Clinically significant disease was present in 75 patients, whereas 24 had no observable lesions and 2 had minimal lesions. Comparisons of individual lipid and lipoprotein levels were nearly all significantly different between patients with and patients without clinically significant disease; however, no single variable could predict the presence of disease among patients. Logistic regression analysis identified five factors: apolipoprotein A-I, apolipoprotein B, diabetes, age, and family history of heart disease, which account for most of the differences between the two patient groups. These results could have important implications for the evaluation and management of patients suspected of having coronary atherosclerosis.     

Clinical and angiographic findings in a patient with vasospasm in an anomalous coronary artery

We report the case of a 58-year-old man with coronary vasospasm that occurred within an anomalous coronary artery. The rapidly progressive clinical course and the dramatic treadmill test result preceeded the diagnostic cardiac catheterization. Combination therapy with isosorbide, beta blocker, and nifedipine resulted in complete resolution of symptoms.     

Post-mortem angiographic and histologic findings of coronary artery fibromuscular dysplasia

The present report highlights on exceptional angiographic and histologic features of coronary artery fibromuscular dysplasia in a young man complaining of chest discomfort during strenuous exercise. The striking features of fibromuscular dysplasia were the relative proximal localization of the lesion in left anterior descending coronary artery, the extensive length of the lesion, and the exclusive involvement of the intima producing a diffuse regular narrowing lesion. An eccentric intimal proliferation of the small left anterior descending coronary artery branches along their epicardial and intramural course was additionally demonstrated. No involvement of other coronary arteries or arteries of any other organs was observed.     

Correlation of angiographic and surgical findings in distal coronary branches.

In 60 consecutive patients undergoing vein graft surgery the angiographic appearances of the coronary vessels were compared with those of the vessels at operation. On the basis of lumen diameter at the potential sites for grafting it was possible to predict with reasonable accuracy from examination of the angiogram which vessels were large enough to be grafted. Angiographic predictive accuracy was 82% and was similar both for vessels which filled normally and for those which filled by collaterals. The predictive value of the angiographic assessment was similar for branches thought to be too small (predictive value 74%) and for those considered sufficiently large (predictive value 85%) to receive a vein graft. Disease of the vessel walls was found at surgery (66% of coronary branches examined) more frequently than was predicted from the angiographic appearances (33%). Previous necropsy studies have found a high prevalence of coronary atheroma in the population, yet normal angiographic appearances in the coronary arteries are not uncommon in patients undergoing investigation for suspected coronary disease. The present study showed that atheroma may be present in coronary vessels without encroaching into the vessel lumen, so that it is not evident on the angiogram. Coronary atheroma is thus present more often and is more widely distributed in the coronary tree than is indicated by coronary angiography.     

血清瘦素水平与冠状动脉病变程度的关系

目的:探讨血清瘦素水平与冠状动脉病变程度的关系。方法:用放射免疫法检测冠状动脉造影确诊的冠心病患者101例(男59例,女42例)及与其年龄,性别及体质指数相匹配的健康体检者96例(男50例,女46例)的血清瘦素水平。用改良的Gensini评分系统对冠状动脉病变程度进行评分。结果:冠心病组无论男女,血清瘦素水平均显著高于对照组[(8.43±4.29)∶(4.34±2.15)μg/L、(15.87±8.07)∶(8.36±3.81)μg/L](P<0.01)。随着冠状动脉病变程度的加重,冠心病患者血清瘦素水平逐渐升高。Gensini积分为11的患者与积分为5的患者之间血清瘦素水平差异有统计学意义[(12.90±0.92)∶(8.44±0.57)μg/L,P<0.05]。结论:冠心病患者的血清瘦素水平明显高于健康者,并随着冠脉病变程度的增加而升高。     

Spontaneous coronary artery dissection and associated CT coronary angiographic findings: a case report and review

We report a case of an acute coronary syndrome in a 21-year-old male with invasive coronary angiography and computed tomography (CT) coronary angiography showing a spontaneous dissection of the left anterior descending artery. To our knowledge the CT coronary angiographic appearance of spontaneous coronary artery dissection has been reported only once before. We describe the role CT coronary angiography may have in the evaluation of coronary dissection as well as potential treatment options.