Non-diabetic hyperglycaemia correlates with angiographic coronary artery disease prevalence and severity

AimThe role of glycaemia as a coronary artery disease (CAD) risk factor is controversial, and the optimal glucose level is still a matter of debate. For this reason, we assessed the prevalence and severity of angiographic CAD across hyperglycaemia categories and in relation to haemoglobin A_1c (HbA_1c) levels.MethodsWe studied 273 consecutive patients without prior revascularization undergoing coronary angiography for suspected ischaemic pain. CAD severity was assessed using three angiographic scores: the Gensini's score; extent score; and arbitrary index. Patients were grouped, according to 2003 American Diabetes Association criteria, into those with normal fasting glucose (NFG), impaired fasting glucose (IFG) and diabetes mellitus (DM).ResultsCAD prevalence was 2.5-fold higher in both the IFG and DM groups compared with the NFG group. Deterioration of glycaemic profile was a multivariate predictor of angiographic CAD severity (extent score: P = 0.027; arbitrary index: P = 0.007). HbA_1c levels were significantly higher among CAD patients (P = 0.016) and in those with two or more diseased vessels (P = 0.023) compared with the non-CAD group. HbA_1c levels remained predictive of CAD prevalence even after adjusting for conventional risk factors, including DM (adjusted OR: 1.853; 95% CI: 1.269–2.704).ConclusionNon-diabetic hyperglycaemia, assessed either categorically by fasting glucose categories or continuously by HbA_1c levels, correlates with the poorest angiographic outcomes.     

Impaired fasting glucose and the prevalence and severity of angiographic coronary artery disease in high-risk Chinese patients

We assessed the relation between different fasting plasma glucose (FPG) levels of 5.6 to 6.9 mmol/L and the prevalence and severity of angiographic coronary artery disease (CAD) in high-risk Chinese patients. Among 512 subjects who were to undergo coronary angiography for the confirmation of suspected myocardial ischemia, 409 subjects were enrolled and categorized into 3 groups based on FPG levels: (1) 相似文献   

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。     

心脏变时功能不全对冠心病严重度的预测价值

目的探讨变时功能不全与冠心病严重度的关系。方法经选择性冠状动脉造影确诊的91例冠心病患者分为单支病变组(30例)、双支病变组(31例)和三支病变组(30例),所有患者完成亚极量运动负荷试验并计算变时功能指标运动最高心率与预测最大心率值之比(rHR)和心率储备率(HRR)。结果rHR和HRR在双支病变和三支病变组显著低于单支病变组(P<0.01),而双支病变和三支病变组间比较差异无显著性(P>0.05);冠心病患者中HRR<0.72预测多支病变的OR为4.67(95%CI1.8～12.1),预测冠脉狭窄≥75%的OR为3.06(95%CI1.1～8.3)。结论冠心病多支病变患者变时功能降低更严重,变时功能不全可能对冠心病多支病变和冠脉狭窄程度有预测价值。     

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。     

The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease

OBJECTIVES: We sought to examine the age and gender distribution of coronary artery calcium (CAC) by diabetes status in a large cohort of asymptomatic individuals. BACKGROUND: Among individuals with diabetes, coronary artery disease (CAD) is a major cause of morbidity and mortality. Electron-beam tomography (EBT) quantifies CAC, a marker for atherosclerosis. METHODS: Screening for CAC by EBT was performed in 30,904 asymptomatic individuals stratified by their self-reported diabetes status, gender, and age. The distribution of CAC across the strata and the association between diabetes and CAC were examined. RESULTS: Compared with nondiabetic individuals (n = 29,829), those with diabetes (n = 1,075) had higher median CAC scores across all but two age groups (women 40 to 44 years old and men and women > or =70 years old). Overall, the likelihood of having a CAC score in the highest age/gender quartile was 70% greater for diabetic individuals than for their nondiabetic counterparts. CONCLUSIONS: Younger diabetic individuals appear to have calcified plaque burden comparable to that of older individuals without diabetes. These findings call for future research to determine if EBT-CAC screening has an incremental value over the current CAD risk assessment of individuals with diabetes.     

Association of ankle-brachial index with severity of angiographic coronary artery disease in patients with peripheral arterial disease and coronary artery disease

The ankle-brachial index (ABI) was correlated with the severity of coronary artery disease (CAD) in 273 patients, mean age 71 years, with peripheral arterial disease and angiographically obstructive CAD (> 50% occlusion). Of 155 patients with an ABI < 0.40, 130 (84%) had 3- or 4-vessel CAD, 17 (11%) had 2-vessel CAD and 8 (5%) had 1-vessel CAD. Of 80 patients with an ABI of 0.40-0.69, 37 (46%) had 3- or 4-vessel CAD, 33 (41%) had 2-vessel CAD and 10 (13%) had 1-vessel CAD. Of 38 patients with an ABI of 0.70-0.89, 10 (26%) had 3- or 4-vessel CAD, 16 (42%) had 2-vessel CAD and 12 (32%) had 1-vessel CAD. The lower the ABI, the higher the prevalence of 3- or 4-vessel CAD and the lower the prevalence of 1-vessel CAD.     

空腹血糖及糖尿病与冠状动脉病变程度的相关性

目的 探讨空腹血糖及糖尿病与冠状动脉病变程度的相关性.方法 回顾分析419例拟诊为冠心病并行冠状动脉造影的患者的临床资料,采用Gensini积分系统对冠状动脉病变程度进行评估.采用Logistic回归分析空腹血糖及糖尿病与冠脉病变总积分的相关性.结果 Logistic回归分析发现糖尿病与冠脉病变积分显著相关,但根据Gensini积分四分位分组,空腹血糖并没有是随着冠脉病变程度的加重而升高.结论 冠脉病变可能与糖尿病疾病显著相关,但与空腹血糖水平关系不大.因此,对糖尿病的治疗在于全面控制各危险因素,而不是单纯的控制血糖.     

Determinants of coronary artery compliance in subjects with and without angiographic coronary artery disease

OBJECTIVES: The goal of this study was to determine factors contributing to the biomechanical properties of coronary arteries in people with and without angiographic coronary artery disease (CAD). BACKGROUND: The stiffness of the aorta is known to increase with increasing age and in the presence of CAD. However, little is known about the mechanics of coronary arteries, which may have important clinical consequences. METHODS: Intravascular ultrasound was used to determine the mechanical properties of coronary arteries and plaque behavior in subjects with CAD (n = 38), those with chest pain but angiographically normal coronary arteries (N) (n = 9) and those early (<2 weeks) after cardiac transplant (T) (n = 14). RESULTS: Coronary arteries dilated during systole in all groups, but cross-sectional compliance and distensibility were lowest in the proximal left anterior descending artery (LAD) in the subjects with CAD compared with the N and T groups (compliance: 1.2 +/- 0.2 vs. 1.7 +/- 0.5 and 2.7 +/- 0.6 x 10(-2) mm(2) mm Hg(-1) [mean +/- SEM] respectively, p < 0.02 CAD vs. T; distensibility: 0.8 +/- 0.2 vs. 1.7 +/- 0.5 and 1.7 +/- 0.3 x 10(-3) mm Hg(-1), p < 0.05 CAD vs. T). There was extensive plaque in the CAD group, and plaque was also present in the N group, but minimal atheroma was present in the T group. Plaque cross-sectional area diminished significantly during systole in both the LAD and circumflex arteries. Absolute changes were: 0.50 +/- 0.30, 0.33 +/- 0.11 and 0.68 +/- 0.13 mm(2) in the proximal LAD, distal LAD and proximal circumflex arteries, respectively. In subjects with atheroma, there was a significant correlation between cross-sectional compliance and plaque compression at all sites, and plaque compression was a significant determinant of cross-sectional compliance at both proximal sites in multiple regression analyses with age, mean arterial pressure and extent of plaque as the other independent variables. CONCLUSIONS: A major determinant of the systolic increase in coronary luminal area in patients with atheroma is a reduction in plaque cross-sectional area during systole.     

冠状动脉病变程度与胰岛素敏感性的关系

目的：探讨冠心病患冠状动脉病变和蔼与胰岛素敏感性的关系。方法对５０例冠心病患（冠心病组）和２０例健康人（对照组）行口服葡萄糖耐量试验、胰岛素和Ｃ肽释放试验,冠心病患均行冠状动脉造影检查,分别以冠状动脉病变记分、病变冠状动脉记分和病变冠状动脉支数为因变量,９个胰岛素敏感性指标为自变量,进行单元直线相关分析和多元逐步回归分析。结果冠心病组胰岛素敏感性显低于对照组。冠心病组ＩＳＩ（胰岛敏感性指数     

非糖尿病的冠心病患者尿微量白蛋白与冠脉病变程度的关系

目的 探讨非糖尿病的冠心病患者尿微量白蛋白(MAU)与冠脉病变程度的关系.方法 对172例可疑冠心病的非糖尿患者进行冠状动脉造影检查并检测其尿白蛋白排泄率(UAER).根据冠状动脉造影结果将患者分为对照组51例和冠心病组121例.根据病变血管的数量分为无血管病变组51例、单支病变组51例、双支病变组32例、三支及以上病变组38例,对比各组间UAER和MAU阳性率之间的差异.结果 冠心病组男性患者的比例、UAER、MAU的阳性率、高敏C反应蛋白和纤维蛋白原均高于对照组(P＜0.01).随着冠脉病变数量和程度的增加,UAER(分别为12.9 mg/L、34.4 mg/L、45.1 mg/L和60.7 mg/L)和MAU的阳性率(分别为9.8%、41.2%、56.3%和68.4%)均进行性升高(P＜0.05,P＜0.01).相关分析显示冠脉病变的Gensini评分与UAER呈正相关(r=0.959,P＜0.05).结论 非糖尿病的冠心病患者UAER水平升高,UAER与冠脉病变严重程度呈正相关.     

Increased fasting plasma insulin concentrations are associated with the severity of angiographic coronary artery disease

Fasting plasma insulin concentrations were obtained in 82 patients (51 men and 31 women), mean age 60 +/- 11 years, with a body mass index >25 kg/m(2) who had coronary angiography because of suspected symptomatic coronary artery disease (CAD). Obstructive CAD was diagnosed if there was >50% obstruction of > or =1 vessel. Of 82 patients, 37 (45%) had left main or 3-vessel CAD, 22 (27%) had 2-vessel CAD, 9 (11%) had 1-vessel CAD, and 14 (17%) had no obstructive CAD. Among the 4 groups, there was no significant difference in gender, age, dyslipidemia, and smoking. Hypertension (p = 0.0003), diabetes mellitus (p = 0.035), and increased fasting plasma insulin concentration (p < 0.0001) were significantly associated with the severity of CAD. Stepwise ordinal logistic regression analysis identified increased fasting plasma insulin concentrations in these obese subjects as a significant independent risk factor for the severity of angiographic CAD (p < 0.0001).     

The prevalence of endothelial dysfunction in patients with and without coronary artery disease

Background:

Endothelial dysfunction (ED) is frequently present in patients presenting with acute or stable coronary artery disease (CAD), but it is also found in patients presenting with chest pain without angiographic coronary lesions.

Hypothesis:

We hypothesized that even in patients without CAD, the presence of cardiovascular (CV) risk factors will correlate with the presence of ED.

Methods:

Our study included a total of 341 consecutive patients referred for coronary angiography. We used pulse wave analysis with a finger plethysmograph (peripheral arterial tonometry) to determine endothelial function. Hyperemia ratio was calculated as the ratio of the postischemic hyperemia response relative to baseline measurement.

Results:

The hyperemia ratio was significantly higher in patients without CAD (2.02 ± 0.52) compared with patients with chronic CAD (1.81 ± 0.44, P = 0.001) or acute CAD (1.74 ± 0.49, P < 0.001). Prevalence of ED was 33%, 46%, and 58%, respectively. In multivariate analysis, the presence of CAD, diabetes, and cigarette smoking, and the total number of CV risk factors, were strong predictors of ED. In 67% of the patients without CAD but with ≥3 CV risk factors, ED was present.

Conclusions:

Prevalence of ED in patients with chest pain depends on the presence of CAD and CV risk factors. Patients without CAD but with ≥3 risk factors frequently presented with ED. Such patients may be at increased risk for future CV events and may profit from intensified therapy to control CV risk factors. The authors have no funding, financial relationships, or conflicts of interest to disclose. This study was supported by the Swiss Heart Foundation, Bern, Switzerland, and the Kamillo Eisner Foundation, Hergiswil, Switzerland. Stefan Toggweiler was supported by a grant from the Swiss National Foundation. None of the granting institutions had any influence on the study design, data collection, analysis, or interpretation.     

Bundle branch block in patients with chronic coronary artery disease: angiographic correlates and prognostic significance

The onset of bundle branch block during acute myocardial infarction is indicative of ischemia in the distribution of the left anterior descending coronary artery. However, whether patients with chronic coronary artery disease and bundle branch block have a predominance of left anterior descending artery lesions is not known. Similarly, the prognostic implications of bundle branch block have been studied primarily in the setting of acute myocardial infarction, and the independent prognostic implications of bundle branch block in patients with chronic coronary artery disease are not known. The electrocardiograms (ECGs) of 15,609 patients with chronic coronary artery disease who underwent coronary and left ventricular angiography as part of the Coronary Artery Surgery Study (CASS) were reviewed, and 522 patients with bundle branch block were identified. Patients with bundle branch block had both more extensive coronary artery disease and worse left ventricular function than did patients without bundle branch block. However, no particular location of coronary artery stenosis or left ventricular wall motion abnormality predominated in patients with bundle branch block. During a follow-up period of 4.9 +/- 1.3 years, 2,386 patients died. Actuarial probability of mortality at 2 years in patients with left bundle branch block was more than five times that in patients without bundle branch block (p less than 0.0001), and in patients with right bundle branch block the mortality rate was approximately twice that in patients without bundle branch block (p less than 0.0001). Stepwise Cox regression analysis showed that left bundle branch block, but not right bundle branch block, was a strong predictor of mortality, independent of degree of heart failure, extent of coronary disease and other variables (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Myocardial perfusion abnormalities in treated hypertensive patients without known coronary artery disease

OBJECTIVE: Myocardial perfusion abnormalities may occur in hypertensive patients in absence of significant coronary artery disease. However, it is not well established whether hypertensive patients without known coronary artery disease have a higher prevalence or extent of myocardial perfusion abnormalities compared with normotensive patients with similar clinical features. DESIGN: This study compares the prevalence and extent of rest and stress-induced myocardial perfusion abnormalities in patients with and without hypertension. METHODS: Dobutamine (up to 40 microg/kg per min) stress technetium-99m myocardial perfusion SPECT imaging was performed for evaluation of myocardial ischaemia in 350 patients (mean age = 60+/-13 years, 146 men) without known coronary artery disease. One hundred and forty-eight patients were hypertensive. Rest SPECT images were acquired 24 h after the test Abnormal perfusion was defined as the presence of reversible or fixed perfusion defects. RESULTS: No significant difference was detected between patients with and without hypertension regarding gender, prevalence of symptoms, risk factors, pretest probability of coronary artery disease (52+/-28 versus 53+/-29%), peak rate pressure product (21040+/-4755 versus 20774+/-4865) or number of patients achieving the target heart rate during stress (85 versus 86%). Hypertensive patients were significantly older (62+/-11 versus 58+/-13 years, P = 0.005) and were receiving beta-blockers more frequently (34 versus 18%, P = 0.0001). The prevalence of myocardial perfusion abnormalities was similar in patients with and without hypertension (28 versus 31% in patients with low, 38 versus 33% in patients with intermediate and 60 versus 58% in patients with high pretest probability of coronary artery disease, respectively). No significant difference was detected between the two groups regarding stress perfusion defect score (1.45+/-2.5 versus 1.50+/-2.6) or rest score (0.72+/-1.8 versus 0.68+/-1.6). CONCLUSION: Treated hypertensive patients without known coronary artery disease have a similar prevalence and severity of myocardial perfusion abnormalities at rest and at dobutamine stress compared with normotensive patients with similar clinical characteristics.     

2型糖尿病冠心病患者的临床及冠状动脉造影特点

目的探讨2型糖尿病冠心病患者的临床特征和冠状动脉造影特点。方法357例经冠状动脉造影确诊冠心病的患者，根据1999年WHO标准分为2型糖尿病冠心病组189例，单纯冠心病组168例，对所有研究对象均进行口服75g葡萄糖耐量试验，检测血糖、胰岛素、HbA1C、血脂、24h尿白蛋白／肌酐比值（24h-Alb／Cr），采用稳态模型计算胰岛素抵抗指数（HOMA—IR）和胰岛素分泌指数（HOMA—IS）。对比分析两组患者的临床和冠状动脉造影资料。结果与单纯冠心病组比较，2型糖尿病冠心病组HOMA—IR和24h-Alb／Cr明显增高（均P〈0．05），HOMA—IS明显降低（P〈0．01）。2型糖尿病冠心病组发生3支病变较多（P〈0．05），冠状动脉重度狭窄、完全闭塞、弥漫病变比例较高（P〈0．05或P〈0．01），冠状动脉病变程度总评分较高（P〈0．01）。结论2型糖尿病冠心病组冠状动脉病变累及范围广且程度重。     

老年冠心病合并糖尿病的冠状动脉病变特点

目的 探讨老年冠心病(CAD)合并2型糖尿病(DM)患者冠状动脉病变特点. 方法 对198 例老年CAD合并DM 患者(DM 组) 和387例老年CAD非合并DM患者(NDM 组) 的临床资料及冠脉造影结果 进行统计分析,分别记录各组的冠脉病变特点. 结果 2组间年龄、体质量指数(BMI)、吸烟史、高血压史、低密度脂蛋白胆固醇(LDL-C)、血肌酐(Cr)及CAD家族史差异均无统计学意义(P＞0.05);DM组糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、三酰甘油(TG)及C反应蛋白(CRP)明显高于NDM组(P＜0.05);2组间的左主干(LM)病变、单支病变、双支病变情况差异无统计学意义(P＞0.05);但是DM组三支病变的发生率与NDM 组比较差异显著(P＜0.05),平均置入支架数比较差异极显著(P＜0.01);FINS、CRP及HbA1c是多支冠状动脉病变的独立危险因子. 结论 2 型DM合并CAD患者病变累及冠状动脉数目较多,血管病变弥漫.