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1.
Lauro Cortigiani Rosa Sicari Riccardo Bigi Patrizia Landi Francesco Bovenzi Eugenio Picano 《The American journal of medicine》2009,122(3):301-309
Objective
To compare the prognostic value of stress echocardiography results in men and women with known and suspected coronary artery disease.Methods
We analyzed the data of 8737 patients (5529 men and 3208 women) who underwent stress echocardiography (exercise in 523 patients, dipyridamole in 6227 patients, dobutamine in 1987) for evaluating known (n = 3857) or suspected (n = 4880) coronary artery disease. Patients were followed up for the occurrence of overall mortality or nonfatal myocardial infarction.Results
During a median follow-up of 25 months, 1218 cardiac events (693 deaths and 525 infarctions) occurred. Moreover, 2263 patients (1731 men [31%] and 532 women [17%]; P < .0001) underwent coronary revascularization and were censored. Stress echocardiography results added prognostic information to that of clinical findings and resting wall motion score index in men and women with both known and suspected coronary artery disease. In patients with known coronary artery disease, women had a higher (P = .01) event rate than men in the presence of ischemia. The annual event rate was worse for nondiabetic women (P = .007) but not diabetic women; age had a neutral prognostic effect in the 2 sexes. In patients with suspected coronary artery disease, men without ischemia had a higher (P < .0001) event rate than women. The annual event rate was worse in men aged less than 65 years (P < .0001) or more than 65 years (P = .04), and those with (P = .03) or without (P < .0001) diabetes.Conclusion
Prognosis is at least comparable in men and women with ischemia and in those with coronary artery disease and no ischemia at stress echocardiography. In these clinical settings, availability for major procedures should be similar for both genders. 相似文献2.
da Silva CA Ribeiro JP Canto JC da Silva RE Silva Junior GB Botura E Malschitzky MA 《Diabetes research and clinical practice》2012,95(2):237-245
Background
The aim of this study is to compare the effect of physical exercise program on the endothelial function of patients with metabolic syndrome and type 2 diabetes mellitus.Methods
Patients were randomized for high intensity aerobic training (HI: 80% maximum heart rate, n = 10), low intensity aerobic training (LI: 55% of maximum heart rate, n = 10) and control (n = 11). Before and after 6 weeks of training, subjects performed the maximal exercise test and a study of the endothelial function, through a high resolution ultrasound of the brachial artery, which was assessed after reactive hyperemia (endothelium dependent vasodilation) and nitrate administration (endothelium independent vasodilation).Results
A total of 31 patients with metabolic syndrome and type 2 diabetes mellitus were studied, with mean age of 58 ± 6 years, The percentage diameter difference of the vessel after hyperemia was significantly higher for the high intensity group (HI before 2.52 ± 2.85% and after 31.81 ± 12.21%; LI before 3.23 ± 3.52% and after 20.61 ± 7.76%; controls before 3.56 ± 2.33% and after 2.43 ± 2.14%; p < 0.05).Conclusions
High intensity aerobic training improved the functional capability and endothelium dependent vasodilator response, but it does not improve the endothelium independent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus. 相似文献3.
I. Ghrissi W. Amara P. Michaud J.-B. Estève S. Cattan 《Annales de cardiologie et d'angeiologie》2009,58(5):293-298
Aim
Acute main left coronary artery occlusion is rarely observed during primary angioplasty in myocardial infarction. This retrospective study reports the results of six patients treated by angioplasty in a hospital without cardiac surgery department.Patients and methods
From 2002 to 2009, 746 patients were treated by primary angioplasty for acute coronary syndromes with ST elevation. Among those patients, six (0,7%) had acute non protected main left coronary occlusion. We report clinical, angiographical data and follow-up.Results
The population was composed of six patients (five males) with an average age of 64 ± 7 years. Five patients were admitted with cardiogenic shock and four were mechanically ventilated. Distal occlusion of main left coronary artery and dominant right coronary artery were noted in all cases. Sub-occluded lesion of right coronary artery was noted in one case. Successful procedure with bare metal stent was achieved in five cases. Mortality rate was 66% (n = 4): three patients died in hospital and another 1 or 2 months later of congestive heart failure. Coronary artery bypass grafting was performed at 4 and 12 months later for two patients. They are alive after 12 and 72 months of follow-up.Conclusion
We demonstrate the feasibility of percutaneous coronary intervention of acute main left coronary occlusion. Inspite successful procedure, intrahospital mortality rate is still high and prognosis is related to cardiogenic shock. 相似文献4.
Kana ShimadaYu Mikami Toshinori MurayamaMasayuki Yokode Masatoshi FujitaToru Kita Chiharu Kishimoto 《International journal of cardiology》2011,151(3):284-289
Background
We assessed the hypothesis whether behavioral stress may affect the development of atherosclerosis and whether regular exercise training may influence the composition of atherosclerotic plaques in apolipoprotein (apo) E-deficient mice.Methods
Atherosclerosis was induced in apo E-deficient mice fed a high fat diet. Exercise training (45 min swimming, 3 times/week) was conducted, and behavioral stress was provoked by glass marble-burying procedure. Mice were treated with marble-burying, marble-burying behavior plus swimming training, and swimming alone over 8 weeks.Results
Exercise training decreased the atherosclerotic lesions, but marble-burying behavior increased the lesions. The plaques containing macrophage accumulation with intercellular adhesion molecule-1 (ICAM-1) expression associated with reduced collagen contents were induced in the mice treated with marble-burying. However, ICAM-1 expression was suppressed and collagen contents were reversed in the mice that received marble-burying behavior plus exercise training. In addition, exercise alone and concomitant exercise training reduced the superoxide production in aortic walls, shown by dihydroethidium staining, compared with that in mice with marble-burying behavior alone. There were no significant differences in the serum lipids profiles among the groups.Conclusions
Behavioral stress increased the atherosclerotic lesions and induced the adhesion molecule expression with superoxide production on the lesions in apo E-deficient mice. Exercise training may stabilize plaque lesions induced by marble-burying behavior in this animal model. 相似文献5.
Biagini E Schinkel AF Elhendy A Bax JJ Rizzello V van Domburg RT Krenning BJ Schouten O Branzi A Rocchi G Simoons ML Poldermans D 《The American journal of medicine》2005,118(12):1381-1386
Purpose
Noninvasive pacemaker stress echocardiography is a newly introduced method for the diagnosis of coronary artery disease in patients with a permanent pacemaker. The prognostic value of pacemaker stress echocardiography has not been studied.Subjects and methods
We studied 136 patients (mean age 64 ± 12 years) with a permanent pacemaker who underwent pacemaker stress echocardiography for evaluation of coronary artery disease. All patients underwent pacemaker stress echocardiography by external programming (pacing heart rate up to ischemia or target heart rate).Results
Thirty-one patients (23%) had normal study results. Ischemia was detected in 75 patients (55%). During a mean follow-up of 3.5 ± 2.4 years, 35 deaths (26%) (20 the result of cardiac causes) and 2 nonfatal myocardial infarctions (1%) occurred. The annual cardiac death rate was 1.3% in patients without ischemia and 4.6% in patients with ischemia (P = .01). The annual all-cause mortality rate was 3.1% in patients without ischemia and 7% in patients with ischemia (P = .004). The presence of ischemia during pacemaker stress echocardiography was the strongest independent predictor of cardiac death (hazard ratio 4.1, confidence interval 1.2-14.5) and all-cause mortality (hazard ratio 2.7, confidence interval 1.2-6.0) in a multivariable model.Conclusion
Myocardial ischemia during pacemaker stress echocardiography is an independent predictor of cardiac death and all-cause mortality in patients with a permanent pacemaker. 相似文献6.
Maaike G.J. GademanYiping Sun Liming Han Vanessa J. ValkMartin J. Schalij Henk J. van Exel Carolien M.H.B. LucasArie C. Maan Harriette F. VerweyHedde van de Vooren Gian D. PinnaRoberto Maestri Maria Teresa La RovereErnst E. van der Wall Cees A. Swenne 《International journal of cardiology》2011,152(2):237-241
Background
One of the beneficial effects of exercise training in chronic heart failure (CHF) is an improvement in baroreflex sensitivity (BRS), a prognostic index in CHF. In our hypothesis-generating study we propose that at least part of this effect is mediated by neural afferent information, and more specifically, by exercise-induced somatosensory nerve traffic.Objective
To compare the effects of periodic electrical somatosensory stimulation on BRS in patients with CHF with the effects of exercise training and with usual care.Methods
We compared in stable CHF patients the effect of transcutaneous electrical nerve stimulation (TENS, N = 23, LVEF 30 ± 9%) with the effects of bicycle exercise training (EXTR, N = 20, LVEF 32 ± 7%). To mimic exercise-associated somatosensory ergoreceptor stimulation, we applied periodic (2/s, marching pace) burst TENS to both feet. TENS and EXTR sessions were held during two successive days.Results
BRS, measured prior to the first intervention session and one day after the second intervention session, increased by 28% from 3.07 ± 2.06 to 4.24 ± 2.61 ms/mm Hg in the TENS group, but did not change in the EXTR group (baseline: 3.37 ± 2.53 ms/mm Hg; effect: 3.26 ± 2.54 ms/mm Hg) (P(TENS vs EXTR) = 0.02). Heart rate and systolic blood pressure did not change in either group.Conclusions
We demonstrated that periodic somatosensory input alone is sufficient and efficient in increasing BRS in CHF patients. This concept constitutes a basis for studies towards more effective exercise training regimens in the diseased/impaired, in whom training aimed at BRS improvement should possibly focus more on the somatosensory aspect. 相似文献7.
Firas J. Al BadarinAaron M. From Robert B. McCullyFrancisco Lopez-Jimenez 《International journal of cardiology》2011,152(2):207-211
Background
Metabolic syndrome (MetSx) encompasses several risk factors for macrovascular coronary artery disease. An association between MetSx and coronary syndrome X has also been reported, suggesting that patients with MetSx are more likely to have endothelial dysfunction in the setting of angiographically normal coronary arteries. It remains unknown whether MetSx patients with abnormal stress echocardiography (SE) are more likely to have obstructive coronary disease (CAD) compared to patients without MetSx.Methods
We identified symptomatic patients without known CAD and abnormal SE who underwent coronary angiography within 4 weeks after the SE. Patients were grouped according to their MetSx and impaired fasting glucose (IFG) status. We compared the proportion of patients with obstructive CAD in each subgroup using the x2 test. Multivariate regression analysis was used to adjust for the pre-test probability of underlying coronary artery disease.Results
Among 583 consecutive symptomatic patients who had an abnormal SE and were referred for angiography, 158 (36%) met the NCEP definition of MetSx. MetSx patients had a trend towards having more obstructive CAD than those without MetSx (OR 1.44, p = 0.07). After adjusting for pre-test probability of coronary disease, smoking and LDL-C, MetSx/IFG combination was an independent predictor of obstructive CAD (OR 2.06 [1.24-3.44], p < 0.001) but MetSx with normal fasting blood glucose was not (OR 0.91 [0.47-1.70], p 0.09).Conclusion
Symptomatic patients with MetSx and IFG are more likely to have angiographically significant CAD after abnormal SE than patients without MetSx or those with normal fasting blood glucose. 相似文献8.
Morise AP Olson MB Merz CN Mankad S Rogers WJ Pepine CJ Reis SE Sharaf BL Sopko G Smith K Pohost GM Shaw L 《American heart journal》2004,147(6):1085-1092
Background
Recently revised American College of Cardiology/American Heart Association guidelines have suggested that exercise test scores be used in decisions concerning patients with suspected coronary artery disease (CAD). Pretest and exercise test scores derived for use in women without known CAD have not been tested in women with a low prevalence of CAD.Methods
Within the Women's Ischemia Syndrome Evaluation (WISE) study, we evaluated 563 women undergoing coronary angiography for suspected myocardial ischemia. The prevalence of angiographic CAD was 26%. Overall, 189 women underwent treadmill exercise testing. Prognostic end points included death, myocardial infarction, stroke, and revascularization.Results
Each score stratified women into 3 probability groups (P <.001) according to the prevalence of coronary disease: Pretest: low 20/164 (12%), intermediate 53/245 (22%), high 75/154 (49%); Exercise test: low 11/83 (13%), intermediate 22/74 (30%), high 17/32 (53%). However, the Duke score did not stratify as well: low 7/46 (15%), intermediate 36/126 (29%), high 6/17 (35%); P = .44. When pretest and exercise scores were considered together, the best stratification with the exercise test score was in the intermediate pretest group (P < .03). The Duke score did not stratify this group at all (P = .98). Pretest and exercise test scores also stratified women according to prognostic end points: pretest—low 7/164 (4.3%), intermediate 28/245 (11.4%), high 27/154 (17.5%), P < .01; exercise test—low 4/83 (4.8%) and intermediate-high 17/106 (16%), P = .014.Conclusion
Both pretest and exercise test scores performed better than the Duke score in stratifying women with a low prevalence of angiographic CAD. The exercise test score appears useful in women with an intermediate pretest score, consistent with American College of Cardiology/American Heart Association guidelines. 相似文献9.
Gullestad L Myers J Edvardsen T Kjekshus J Geiran O Simonsen S 《American heart journal》2004,147(1):49-54
Background
Maximal exercise capacity is limited in patients after heart transplantation. The extent to which transplant coronary artery disease contributes to exercise intolerance in these patients has not been well defined.Methods
This prospective study examined exercise capacity among 174 heart transplant recipients who underwent 358 exercise tests 0.3 to 13 years after surgery. Data were collected as part of routine posttransplantation treatment that each year consist of clinical and hemodynamic measurements (including ejection fraction, cardiac index, pulmonary capillary wedge pressure, and the presence of coronary artery disease) and cardiopulmonary exercise test (including measures of peak Vo2). The mean follow-up was 3.5 ± 0.2 years after transplantation. Serial exercise test data were available in 102 patientsResults
Peak Vo2 was 19.4 ± 0.4 mL/kg per minute, representing 70% ± 1.3% of the age-predicted value. Exercise capacity increased significantly after transplantation and then remained stable throughout long-term follow-up. Only age, maximal systolic blood pressure, pulmonary vascular resistance, and body mass index were independent determinants of exercise capacity (R2 = 0.51), whereas specific transplant factors such as denervation, hemodynamic variables, donor characteristics, immunosuppressive drugs, biochemical parameters, and transplant coronary artery disease (TxCAD) did not contribute to the explanation of reduced exercise capacity. Although TxCAD was not related to exercise capacity in the multivariate analysis, exercise capacity declined by 17.1% (P < .05) among those in whom CAD developed during follow-up.Conclusions
Exercise capacity is reduced among heart transplant recipients, and age is the strongest determinant of aerobic performance. Specific transplant-related factors, including TxCAD, do not contribute significantly to the explanation of exercise capacity. However, the occurrence of TxCAD may contribute to reduced exercise capacity during follow-up, since peak Vo2 appears to decline only among those who have TxCAD. 相似文献10.
Purpose
Depression following major cardiac events is associated with higher mortality, but little is known about whether this can be reduced through treatment including cardiac rehabilitation and exercise training. We evaluated the impact of cardiac rehabilitation on depression and its associated mortality in coronary patients.Patients and Methods
We evaluated 522 consecutive coronary patients (381 men, 141 women; aged 64 ± 10 years) enrolled in cardiac rehabilitation from January 2000 to July 2005 and a control group of 179 patients not completing rehabilitation. Depressive symptoms were assessed by questionnaire at baseline and following rehabilitation, and mortality was evaluated after a mean follow-up of 1296 ± 551 days.Results
Prevalence of depressive symptoms decreased 63% following rehabilitation, from 17% to 6% (P <.0001). Depressed patients following rehabilitation had an over 4-fold higher mortality than nondepressed patients (22% vs 5%, P = .0004). Depressed patients who completed rehabilitation had a 73% lower mortality (8% vs 30%; P = .0005) compared with control depressed subjects who did not complete rehabilitation. Reductions in depressive symptoms and its associated mortality were related to improvements in fitness; however, similar reductions were noted in those with either modest or marked increases in exercise capacity.Conclusion
In patients following major coronary events, cardiac rehabilitation is associated with both reductions in depressive symptoms and the excess mortality associated with it. Moreover, only mild improvements in levels of fitness appear to be needed to produce these benefits on depressive symptoms and its associated mortality. 相似文献11.
Zidi M Nallet O Esteve JB Michaud P Cattan S 《Annales de cardiologie et d'angeiologie》2010,59(5):306-310
Purpose of the study
Extensive coronary dissection is a rare complication of intraluminal angioplasty. We report a retrospective study of 19 patients who consulted in a general hospital without cardiac surgery.Patients and methods
After consulting our coronarography and angioplasty database, we included the extensive coronary dissections (type D, E and F) in our study. The medical files of the selected patients were analysed.Results
Between January 2003 and March 2010, 19 coronary angioplasty (total: 2542) were complicated with extensive dissections (incidence 0,75%). For 62,3% of the patients, the dissection was related to the guiding catheter. Eleven patients had type A and B1 lesions. The dissections affected the right coronary artery for 16 patients, the left anterior descending coronary artery for two patients and the left main coronary artery for one patient. After angioplasty, a final TIMI flow 3 was obtained for only 11 patients. In nine cases, we observed a limited extension to the aorta that did not need a chirurgical intervention and had no influence on the prognosis. The complications were common, such as death (n = 1), coronary bypass (n = 2), myocardial infarction (n = 8), cardiogenic shock (n = 2) and circulatory assistance (n = 2).Conclusion
Extensive coronary dissection is a rare complication of angioplasty. The right coronary is the most frequent vessel concerned and an extension to aorta is usual. The treatment is usually based on sealing the entry with a coronary stent. The complications are common and serious and we did not find any predicting factors to extensive coronary dissections that are unpredictable. 相似文献12.
Mihai GheorghiadeJames D. Flaherty Gregg C. FonarowRavi V. Desai Richard LeeDavid McGiffin Thomas E. LoveInmaculada Aban Eric J. EichhornRobert O. Bonow Ali Ahmed 《International journal of cardiology》2011,151(1):69-75
Background
Associations between coronary artery disease (CAD) and outcomes in systolic heart failure (HF) and that between coronary artery bypass graft (CABG) surgery and outcomes in patients with HF and CAD have not been examined using propensity-matched designs.Methods
Of the 2707 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial (BEST), 1593 had a history of CAD, of whom 782 had prior CABG. Using propensity scores for CAD we assembled a cohort of 458 pairs of CAD and no-CAD patients. Propensity scores for prior CABG in those with CAD were used to assemble 500 pairs of patients with and without CABG. Matched patients were balanced on 68 baseline characteristics.Results
All-cause mortality occurred in 33% and 24% of matched patients with and without CAD respectively, during 26 months of median follow-up (hazard ratio {HR} when CAD was compared with no-CAD, 1.41; 95% confidence interval {CI}, 1.11-1.81; P = 0.006). HR's (95% CIs) for CAD-associated cardiovascular mortality, HF mortality, and sudden cardiac death (SCD) were 1.53 (1.17-2.00; P = 0.002), 1.44 (0.92-2.25; P = 0.114) and 1.76 (1.21-2.57; P = 0.003) respectively. CAD had no association with hospitalization. Among matched patients with HF and CAD, all-cause mortality occurred in 32% and 39% of those with and without prior CABG respectively (HR for CABG, 0.77; 95% CI, 0.62-0.95; P = 0.015).Conclusions
In patients with advanced chronic systolic HF, CAD is associated with increased mortality, and in those with CAD, prior CABG seems to be associated with reduced all-cause mortality but not SCD. 相似文献13.
Shlipak MG Ix JH Bibbins-Domingo K Lin F Whooley MA 《The American journal of medicine》2008,121(1):50-57
Purpose
The study purpose was to evaluate the ability of 6 biomarkers to improve the prediction of cardiovascular events among persons with established coronary artery disease.Background
Cardiovascular risk algorithms are designed to predict the initial onset of coronary artery disease but are less effective in persons with preexisting coronary artery disease.Methods
We examined the association of N-terminal prohormone brain natriuretic peptide (Nt-proBNP), cystatin C, albuminuria, C-reactive protein (CRP), interleukin-6, and fibrinogen with cardiovascular events in 979 Heart and Soul Study participants with coronary artery disease after adjusting for demographic, lifestyle, and behavior variables; cardiovascular risk factors; cardiovascular disease severity; medication use; and left ventricular ejection fraction. The outcome was a composite of stroke, myocardial infarction, and coronary heart disease death during an average of 3.5 years of follow-up.Results
During follow-up, 142 participants (15%) developed cardiovascular events. The highest quartiles (vs lower 3 quartiles) of 5 biomarkers were individually associated with cardiovascular risk after multivariate analysis: Nt-proBNP hazard ratio (HR) = 2.13 (95% confidence interval [CI], 1.43-3.18); cystatin C HR = 1.72 (95% CI, 1.10-2.70); albuminuria HR = 1.71 (95% CI, 1.15-2.54); CRP HR = 2.00 (95% CI, 1.40-2.85); and interleukin-6 HR = 1.76 (95% CI, 1.22-2.53). When all biomarkers were included in the multivariable analysis, only Nt-proBNP, albuminuria, and CRP remained significant predictors of events: HR = 1.88 (95% CI, 1.23-2.85), HR = 1.63 (95% CI, 1.09-2.43), and HR = 1.82 (95% CI, 1.24-2.67), respectively. The area under the receiver operator curve for clinical predictors alone was 0.73 (95% CI, 0.68-0.78); adding Nt-proBNP, albuminuria, and CRP significantly increased the area under the receiver operator curve to 0.77 (95% CI, 0.73-0.82, P <.005).Conclusion
Among persons with prevalent coronary artery disease, biomarkers reflecting hemodynamic stress, kidney damage, and inflammation added significant risk discrimination for cardiovascular events. 相似文献14.
A.-L. Deman P. Schiano M.-C. Chenilleau F. Barbou A.-C. Martin A. Charbonnel J. Monsegu 《Annales de cardiologie et d'angeiologie》2010,59(5):278-284
Aim
To determine the feasibility of percutaneous coronary intervention (PCI) in very old patients.Background
The elderly are a growing population with a high prevalence of ischemic heart disease and then subsequent possibility to benefit from coronary interventions.Method
We have conducted a retrospective study using our PCI database since January 2000. Population characteristics, clinical presentation, type of lesions, technical procedure, immediate results and in hospital outcome are compare between patients older than 85 and the other.Results
Between January 2008 and March 2009, 3130 patients benefit from coronary angioplasty. Among them, 85 patients were older than 85. There were more female in this group (24.7 vs. 14.3%, P = 0.007), but no difference in cardiovascular risk profile. The older was more symptomatic (acute coronary syndrome: 59.52 vs. 44%, P = 0.004; silent ischemia: 3.6 vs. 25.7%, P = 0.000003). The ejection fraction was worse (EF < 55%: 29.4 vs. 14.5%, P = 0.0001). The lesion was more complex (B2 and C: 67.2 vs. 57.1% P = 0.027) and concern more often the left descending artery (85.9 vs. 57.1%, P = 0.000001). The technical success was similar in the two groups (93.28 vs. 94.32%, P = 0.34) with similar rate of per procedure complications (2.35 vs. 1.5%, P = 0.37). Nevertheless, the in-hospital rate mortality was higher in the older patients (7 vs 1.38%, P = 0.0014).Conclusion
PCI is safe and safety in very old patients despite significant but acceptable increasing in-hospital mortality due to more severe disease and co morbidities. Further evaluations are necessary in order to edict specific recommendations. 相似文献15.
Shry EA Eckart RE Furgerson JL Stajduhar KC Krasuski RA 《American heart journal》2003,146(6):1090-1094
Background
Exercise treadmill testing has limited sensitivity for the detection of coronary artery disease, frequently requiring the addition of imaging modalities to enhance the predictive value of the test. Recently, there has been interest in using nonstandard electrocardiographic (ECG) leads during exercise testing.Methods
We consecutively enrolled all patients undergoing exercise myocardial imaging with four additional leads recorded (V4R, V7, V8, and V9). The test characteristics of the 12-lead, the 15-lead (12-lead, V7, V8, V9), and the 16-lead (12-lead, V4R, V7, V8, V9) ECGs were compared with stress imaging in all patients. In the subset of patients who underwent angiography within 60 days of stress testing, these lead arrays were compared with the catheterization findings.Results
There were 727 subjects who met entry criteria. The mean age was 58.5 ± 12.3 years, and 366 (50.3%) were women. Pretest probability for disease was high in 241 (33.1%), intermediate in 347 (47.7%), and low in 139 (19.1%). A total of 166 subjects had an abnormal 12-lead ECG during exercise. The addition of 3 posterior leads to the standard 12-lead ECG resulted in 7 additional subjects having an abnormal electrocardiographic response to exercise. The addition of V4R resulted in only 1 additional patient having an abnormal ECG during exercise. The sensitivity of the ECG for detecting ischemia as determined by stress imaging was 36.6%, 39.2%, and 40.0% (P = NS) for the 12-lead, 15-lead, and 16-lead ECGs, respectively. In those with catheterization data (n = 123), the sensitivity for determining obstructive coronary artery disease was 43.5%, 45.2%, and 45.2% (P = NS) for the 12-lead, 15-lead, and 16-lead ECGs, respectively. The sensitivity of imaging modalities was 77.4% when compared with catheterization.Conclusions
In patients undergoing stress imaging studies, the addition of right-sided and posterior leads did not significantly increase the sensitivity of the ECG for the detection of myocardial ischemia. Additional leads should not be used to replace imaging modalities for the detection of coronary artery disease. 相似文献16.
Jiménez-Quevedo P Suzuki N Corros C Ferrer MC Angiolillo DJ Alfonso F Hernández-Antolín R Gonzalo N Bañuelos C Escaned J Fernández C Costa M Macaya C Bass T Sabaté M 《Revista espa?ola de cardiología》2011,64(7):557-563
Introduction and objectives
One of the aims of secondary prevention is to achieve plaque stabilization. This study sought to investigate the clinical consequences and predictive factors of the change in the type of plaque (CTP) as assessed by serial intracoronary ultrasound in type II diabetic patients with known coronary artery disease.Methods
237 segments (45 patients) from the DIABETES I, II, and III trials were included. Intracoronary ultrasound from motorized pullbacks (0.5 mm/s) after index procedure and at 9-month angiographic follow-up was performed in the same coronary segment. Nontreated mild lesions (angiographic stenosis <25%) with ≥0.5 mm plaque thickening and ≥5 mm of length assessed by intracoronary ultrasound were included. As different types of plaques may be encountered throughout a given coronary lesion, each study lesion was divided into 3 segments for serial quantitative and qualitative analyses. Statistical adjustment by multiple lesion segments per patient (generalized estimating equations method) was performed. A CTP was defined as any qualitative change in plaque type at follow-up. At 1-year follow-up, major adverse cardiac events - death, myocardial infarction and target vessel revascularization) - were recorded.Results
A CTP was observed in 48 lesions (20.2%) and occurred more frequently (52.1%) in mixed plaques. Independent predictors of CTP were glycated hemoglobin levels (odds ratio [OR] 1.2; 95% confidence interval [CI] 1.01-1.5; P = .04); glycoprotein IIb-IIIa inhibitors (OR 0.3; 95% CI 0.1-0.7; P = .004) and statin administration (OR 0.3; 95% CI 0.1-0.8; P = .02). At 1-year follow-up CTP was associated with an increase in major adverse cardiac events rate (CTP 20.8% vs non-CTP 13.8%, P = .008; hazard ratio = 1.9, 95% CI 1.3-1.9, P = .01).Conclusions
Qualitative changes in mild stenosis documented by intracoronary ultrasound in type II diabetics are associated with suboptimal secondary prevention and may have clinical consequences.Full English text available from: www.revespcardiol.org 相似文献17.
Khanal S Obeidat O Hudson MP Al-Mallah M Bloome M Lu M Greenbaum AB Kugelmass AD Weaver WD 《The American journal of medicine》2007,120(8):734-734.e17
Purpose
Many providers have implemented specialized lipid clinics to more effectively identify, monitor, and treat hyperlipidemia in patients with coronary artery disease. The effectiveness of such a strategy is not known. We sought to investigate whether a specialized clinic achieves better lipid results and clinical outcomes than standard care.Subjects and Methods
A total of 1233 patients who had coronary disease documented by coronary angiography were randomized to lipid clinic or standard care groups by their providers and followed for 2 years. The primary end point was a composite of death, myocardial infarction, repeat revascularization, and stroke.Results
Lipid clinic (n = 617) and standard care (n = 616) groups had no significant baseline differences. After 2 years, the lipid clinic group had similar total cholesterol (166 ± 42 mg/dL vs 166 ± 41 mg/dL, P = .83), low-density lipoprotein cholesterol levels (84 ± 32 vs 85 ± 32, P = .28), and percentage of patients with low-density lipoprotein cholesterol less than 100 mg/dL (77.5% vs 77.6%, P = .97). There were no significant differences in the primary end point (12.3% vs 11.4%, P = .60) and mortality (7.6% vs 7.3%, P = .80) between the lipid clinic and standard care groups.Conclusions
In patients identified by diagnostic coronary angiography and managed within a single health care system, implementation of a specialized lipid clinic did not achieve greater attainment of hyperlipidemia treatment goals or improved cardiac outcomes. 相似文献18.
R. Rossi D. IaccarinoA. Nuzzo E. ChiurliaLidia Bacco Antonio VenturelliMaria Grazia Modena 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2011,21(2):86-93
Background and Aim
To estimate if a meaningful relationship exists between body mass index (BMI) and the entity of coronary atherosclerosis, coronary events and mortality in a cohort of consecutive patients with suspected coronary artery disease (CAD).Methods and results
In this prospective study, we enrolled 1299 consecutive patients (905 [69.7%] males) who had undergone coronary angiography. Our sample consisted of 477 patients (36.8%) of normal weight; 567 (43.6%) overweight and 255 (19.6%) obese, according to the WHO classification. Conventional cardiovascular risk factors, BMI, endothelial function and subclinical inflammation were studied. Different angiographic CAD scores were used to quantify coronary atherosclerotic burden. In overweight and obese patients, respect to normal weight population, there is a higher prevalence of hypertension, hypercholesterolemia and diabetes mellitus, but BMI was not significantly associated with greater extent of coronary atherosclerosis. At follow-up (mean: 40; range: 24-82 months) obese and overweight patients showed a higher incidence of coronary events compared to the normal weight population (74.9% [obese] versus 62.7% [overweight] versus 53.2% [normal weight]; adjusted relative risk [obese versus overweight]: 1.08 [95% confidence interval: 1.02-1.23]; P < 0.05; and adjusted RR [obese versus normal weight]: 1.17 [95% CI: 1.10-1.42], P < 0.01). Mortality from cardiac events was not significant within the categories. The Cox regression model showed flow mediated dilation (P < 0.0001), high-sensitive C reactive protein (P = 0.022) and BMI (P = 0.045) as independent predictors of acute coronary events.Conclusion
BMI is not associated with the extent of coronary atherosclerosis and mortality. The higher incidence of coronary events in obese subjects is only partly explained by conventional associated risk factors. Impaired endothelial function and sub-clinical inflammation could be involved in this association but BMI itself is related to cardiovascular events suggesting that other unknown (or not considered) pathways are involved. 相似文献19.
Introduction
Coronary artery stenoses have been shown in various trials to be moderated by treatment with statins. A similar effect on coronary artery calcification has not been demonstrated. We therefore undertook meta-analyses of trials examining the effect of statin treatment on coronary artery stenoses and coronary artery calcification.Methods
Literature searches identified five controlled trials suitable for inclusion in the analysis of the effect of statins (high dose versus either low dose or placebo) on coronary artery calcification and six trials suitable for inclusion in the analysis of the effect of statins on coronary artery stenoses.Results
All trials reported substantial and significant reductions in LDL-C with statin treatment which results in net reductions of LDL-C in the CAC and coronary stenoses trials of 1.0 mmol/L and 0.9 mmol/L, respectively. Analysis of the CAC trials did not demonstrate any effect of statins on the progression of calcification. In contrast, in the coronary stenoses trials there was a consistent moderation of stenosis severity progression with statins (p < 0.0001).Conclusions
Meta-analyses of the available trials have demonstrated a significant moderation of coronary stenoses associated with the statin-induced reduction in LDL-C. In contrast, there was no effect on coronary calcification despite a similar reduction in LDL-C levels. This suggests that the pathogenesis of the two conditions may be different, if not in aetiology, then certainly in their development. It further suggests that statin use to moderate arterial calcification is not effective. 相似文献20.
Kazuhisa NishimuraHideki Okayama Katsuji InoueMakoto Saito Toyofumi YoshiiGo Hiasa Takumi SumimotoShinji Inaba Akiyoshi OgimotoTomoaki Ohtsuka Jun-ichi FunadaYuji Shigematsu Jitsuo Higaki 《International journal of cardiology》2011,151(2):170-174