Association between paraoxonase 1 activity and severity of coronary artery disease in patients with acute coronary syndromes

OBJECTIVE: We sought to investigate serum paraoxonase/arylesterase activities in patients with acute coronary syndromes (ACS) and their correlations with the severity and extent of coronary artery disease (CAD). METHODS AND RESULTS: Three groups of patients were investigated: 89 patients with ACS, 54 patients with normal coronary angiograms (no-CAD group), and 27 healthy comparison subjects. ACS patients were divided into three groups according to their clinical presentation: unstable angina pectoris (UAP, Braunwald III-B, n = 31), non-ST elevation myocardial infarction (NSTEMI) (n = 27), and ST-elevation myocardial infarction (STEMI) (n = 31). Serum paraoxonase/arylesterase activities were measured spectrophotometrically. Angiographic CAD extent was expressed both by the number of vessels diseased and by the Gensini scoring system. Results showed that serum paraoxonase/ arylesterase activities and the paraoxonase/high density lipoprotein-cholesterol (HDL-C) ratio were significantly lower in the STEMI, NSTEMI, UAP groups than in no-CAD and control groups. Serum paraoxonase/arylesterase activities and paraoxonase/HDL-C ratio were reduced in patients with 2-vessel disease (VD) and 3-VD compared to the I-VD and no-CAD group (P < 0.001). In patients with ACS, the Gensini score correlated inversely with serum paraoxonase (r = -0.419, P < 0.001), arylesterase (r = -0.492, P < 0.0001), and the paraoxonase/HDL-C ratio (r = -0.377, P < 0.001). Serum arylesterase (r = 0.161, P = 0.03) and paraoxonase (r = 0.135, P = 0.002) activities were positively correlated with HDL-C levels. Serum arylesterase activity (P < 0.0001), gender (P = 0.0037), diabetes mellitus (P = 0.005) and LDL-C levels (P = 0.03) were independent predictors of CAD presence. CONCLUSIONS: Serum paraoxonase/arylesterase activities are reduced in ACS patients and inversely correlated with the severity of CAD.     

Poor coronary collateral circulation is associated with higher concentrations of soluble adhesion molecules in patients with single-vessel disease

OBJECTIVE: As the endothelium and inflammatory cells play a crucial role in the development of collaterals after a sudden or slowly progressing stenosis of coronary arteries, the levels of soluble endothelial adhesion molecules (CAMs) including vascular cell adhesion molecule (VCAM-1) intercellular adhesion molecule-1 (ICAM-1) and E-selectin were compared between patients with poor coronary collaterals and patients with well-developed collaterals. METHODS: In the study, 97 non-diabetic subjects with single-vessel disease were included. Collateral supply to the stenotic coronary artery was determined by angiographic grading system of 0-3 (Rentrop et al. J Am Coll Cardiol 1985; 5:587-592). Serum levels of adhesion molecules were measured by enzyme-linked immunosorbent assay. RESULTS: Patients were divided into two groups according to the collateral degree (group A: 50 patients with grade 0 and 1; group B: 47 patients with grade 2 and 3 collaterals). The groups were well matched with respect to baseline clinical and angiographic characteristics. Levels of soluble VCAM-1 (mean+/-SEM; 875+/-26.6 versus 742.7+/-35.1 ng/ml; P=0.004), ICAM-1 (322.4+/-12.4 versus 269.4+/-13.3 ng/ml; P=0.005), and E-selectin (43.6+/-2.6 versus 33+/-2.4 ng/ml; P=0.004) were found to be significantly higher in group A in comparison with group B. In addition, when patients were divided into four groups according to the collateral degree, patients with grade 0 collaterals had the highest values and those with grade 3 collaterals had the lowest values for all these molecules. CONCLUSIONS: We concluded that poor collateral circulation is associated with increased levels of soluble CAMs in patients with obstructive coronary artery disease. However, further studies are needed to elucidate the exact role of these inflammatory markers in the setting of poor collateral circulation.     

Serum level of lipoprotein (a) is inversely associated with the development of coronary collateral circulation

BACKGROUND: This study sought to determine the relationship between serum lipoprotein (a) levels and angiographically visible coronary collateral circulation and to evaluate whether lipoprotein (a) exerts any effect on vascular endothelial cell growth factor. METHODS: The study population included 60 patients (39 men, mean age 59+/-13 years) with angiographically documented total occlusion in one of the major coronary arteries. Development of collaterals was classified by Rentrop's method. Patients were defined as having poorly developed collaterals for grades 0 and 1 (group 1), or well-developed collaterals for grades 2 and 3 (group 2). Serum lipoprotein (a) and vascular endothelial cell growth factor levels were determined by enzyme-linked immunosorbent assay. RESULTS: In group 1, lipoprotein (a) levels were significantly higher and vascular endothelial cell growth factor levels were significantly lower than in group 2 (34+/-19 vs. 20+/-12 mg/dl, P<0.001, and 2.5+/-0.7 vs. 3.4+/-0.8 ng/dl, P<0.001, respectively). Poorly developed collaterals were significantly more frequent in patients with lipoprotein (a) levels >or=30 mg/dl than in patients with levels <30 mg/dl (72 vs. 37%, P=0.008). A strong negative correlation was observed between lipoprotein (a) and vascular endothelial cell growth, factor (r=-0.708, P<0.0001). Multivariate analysis revealed that a high level of lipoprotein (a) negatively affected the development of collaterals, whereas the duration of angina had a positive effect. CONCLUSION: This study demonstrated for the first time that the high level of lipoprotein (a) negatively affects the formation of coronary collateral vessels in human beings. Reduced production or bioactivity of vascular endothelial cell growth factor caused by high levels of lipoprotein (a) may be the possible responsible mechanisms of hyperlipoprotein (a)-related poor collateral formation.     

Serum paraoxonase-1 activity in Helicobacter pylori infected subjects

Previous studies have suggested that Helicobacter pylori (H. pylori) infection may play an important role in the process of atherosclerosis. The objective of this study was to investigate serum paraoxonase and arylesterase activities, and lipid hydroperoxide (LOOH) and total thiol (SH) levels along with lipid parameters in H. pylori infected subjects. Fifty-six H. pylori positive subjects and 43 H. pylori negative subjects were enrolled. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. LOOH levels were measured by FOX-2 assay. Serum SH levels, paraoxonase and arylesterase activities were significantly lower in H. pylori positive group than H. pylori negative group (all p<0.05), while LOOH levels were significantly higher (p<0.05). In H. pylori positive subjects, serum LOOH levels were correlated with SH levels (r=-0.247, p<0.05), serum paraoxonase (r=-0.432, p<0.05) and arylesterase activities (r=-0.404, p<0.001), and triglyceride (r=0.305, p<0.05), total cholesterol (r=0.568, p<0.05), high-density lipoprotein-cholesterol (HDL-C) (r=-0.300, p<0.05) and low-density lipoprotein-cholesterol (LDL-C) (r=0.577, p<0.05) levels. Serum paraoxonase and arylesterase activities were also correlated with HDL-C levels (r=0.221, p<0.05 and r=0.291, p<0.05, respectively), while no correlation was observed with triglyceride, total cholesterol and LDL-C levels (both p>0.05). In conclusion, paraoxonase and arylesterase activities decrease significantly in H. pylori infected subjects. Lower serum paraoxonase-1 (PON1) activity seems to be related to decrease in HDL-C and, in part, to increased oxidative stress and inflammatory condition induced by H. pylori infection. Measurement of serum PON1 activity may help in the early identification of H. pylori infected subjects with increased risk of atherosclerotic disease.     

Absence of myocardial ischemia during sudden controlled occlusion of coronary arteries in patients with well-developed collateral vessels

OBJECTIVE: To determine whether the presence of well-developed collateral vessels (visualized by baseline angiography) prevents myocardial ischemia associated with electrocardiographic ST-segment deviation or anginal pain during subsequent coronary balloon occlusion. METHODS: Study patients with stable effort angina but without complete coronary obstruction were divided into two groups on the basis of whether myocardial ischemia was observed during the first minute of coronary balloon occlusion in order to compare the degrees of collateral development at baseline. Patients in group A (n = 47) had electrocardiographic ischemic ST-segment deviations or angina, or both, during balloon inflation, whereas patients in group B (n = 13) had neither. RESULTS: The incidences both of poor anterograde perfusion with TIMI grade 1 or 2 (77 versus 38%, P < 0.05) and of well-developed collateral vessels (Rentrop grade 3) in the perfusion territory of the target vessel for coronary angioplasty (77 versus 15%, P < 0.01) were higher for patients in group B than they were for those in group A. The incidence of no myocardial ischemia during balloon inflation among the patients with well-developed collateral vessels was higher than that among those without (59 versus 7%, P < 0.01). The prediction of the absence of myocardial ischemia during balloon inflation according to whether well-developed collateral vessels were present had the sensitivity 77% (10 of 13) and the specificity 93% (40 of 43) for the study patients. CONCLUSION: Absence of myocardial ischemia (revealed by electrocardiographic changes or angina during transient coronary balloon occlusion) was associated with presence of well-developed collateral vessels (Rentrop grade 3; visualized by baseline angiography), suggesting that the patients with well-developed collateral vessels have a low risk of developing acute myocardial infarction or hemodynamic instability upon abrupt closure of the culprit coronary artery.     

2型糖尿病患者血清糖化白蛋白水平与冠脉侧支循环的关系研究

目的：探讨2型糖尿病患者血清糖化白蛋白水平与冠脉侧支循环的关系,并与非糖尿病患者作比较。方法：入选连续434例稳定型心绞痛伴1支或以上冠脉完全阻塞的患者,其中糖尿病组317例,非糖尿病组117例。检测空腹血清糖化白蛋白（GA）和糖化血红蛋白（HbA1c）水平,并用Rentrop计分法评估阻塞远端来自对侧冠脉提供的侧支循环情况（Rentrop 0或1分为侧支循环不佳,2或3分为侧支循环良好）。结果：在总的437例患者中,侧支循环不佳患者的GA[（20.9±6.3）%对（18.6±5.5）%,P〈0.001]和HbA1c[（6.9±1.0）%对（6.7±1.1）%,P〈0.05]显著高于侧支循环良好患者。糖尿病组中,侧支循环不佳患者（118例）较侧支循环良好者（199例）血清GA水平明显增高,为（21.2±6.5）%对（18.7±5.6）%,P〈0.001;但HbA1c水平相似,为（7.0±1.1）%对（6.8±1.3）%,P=0.27。GA与Rentrop计分呈显著负相关（r=-0.28,P〈0.001）,但HbA1c与其无关（r=-0.10,P=0.09）。在预测冠脉侧支循环不佳方面,GA的曲线下面积较HbA1c明显增大（0.64对0.58）。在非糖尿病组,GA和HbA1c水平与冠脉侧支循环状态无关。多因素分析发现,年龄〉65岁、女性、非高血压、高脂血症和肾功能减退是预测糖尿病和非糖尿病患者冠脉侧支循环不佳的独立危险因素。经校正混杂因素后,GA〉18.3%仍然较HbA1c〉7%更为敏感地预测糖尿病患者冠脉侧支循环不佳。结论：血清GA水平增高是2型糖尿病患者冠脉侧支循环形成不佳的重要原因之一。     

Paraoxonase and arylesterase activities in patients with cardiac syndrome X, and their relationship with oxidative stress markers

OBJECTIVES: Paraoxonase-1 is a high-density lipoprotein-associated enzyme with three activities, which are paraoxonase, arylesterase and dyazoxonase. Paraoxonase-1 was shown to decrease in patients with cardiovascular diseases. We aimed to examine serum paraoxonase and arylesterase activities, and their relation with oxidative stress markers such as lipid hydroperoxide and total antioxidant status in patients with cardiac syndrome X. METHODS: Forty-one consecutive patients with cardiac syndrome X (CSX group), 33 consecutive patients without cardiac syndrome X (non-cardiac syndrome X group) and 20 healthy volunteers as control group were taken into the study. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. Lipid hydroperoxide levels were measured by ferrous oxidation with xylenol orange assay. Total antioxidant status was determined using an automated measurement method. RESULTS: Basal paraoxonase, salt-stimulated paraoxonase and arylesterase activities were significantly lower in patients with cardiac syndrome X than those of the non-cardiac syndrome X and control groups (P<0.001, for both). Moreover, lipid hydroperoxide was found at high level, and total antioxidant status was found at low level in patients with cardiac syndrome X than control and non-cardiac syndrome X groups (P<0.001, for all). In patients with cardiac syndrome X, in multiple linear regression analysis, both paraoxonase and arylesterase activities were independently correlated with lipid hydroperoxide levels (P=0.001, P=0.003, respectively), and also arylesterase activity was independently correlated with magnitude of ST depression (P=0.002). CONCLUSION: Reduced paraoxonase and arylesterase activities and total antioxidant status levels and enhanced lipid hydroperoxide levels in patients with cardiac syndrome X might indicate increased oxidative stress that can play a role in pathogenesis of cardiac syndrome X.     

The relationship of serum erythropoietin level with coronary collateral grade

Background

Erythropoietin has been shown to induce neovascularization and protect against ischemic vascular injury. We investigated whether a higher serum erythropoietin (EPO) level is related to better coronary collateral vessel grade.

Methods

Ninety-nine patients with stable angina pectoris who have at least 1 coronary stenosis of equal to or greater than 70% at coronary angiography were prospectively enrolled. Serum EPO and vascular endothelial growth factor (VEGF) levels were studied. Coronary collateral degree was graded according to the Rentrop method. Patients with grade 2-3 collateral degree were included in the good collateral group and formed Group I. The patients with grade 0-1 collateral degree were included in the poor collateral group and formed Group II.

Results

The serum EPO level was significantly higher in the good collateral group (17.3 ± 9.3 mU/mL vs 11.7 ± 5.0 mU/mL; P < 0.001). There was also a positive correlation between serum EPO level and Rentrop score (r = 0.39; P < 0.001). In multivariate analysis, serum EPO level (odds ratio [OR] 1.336; 95% confidence interval [CI], 1.120-1.593; P = 0.001), oxygen saturation (OR 0.638; 95% CI, 0.422-0.963; P = 0.033) and presence of chronic total occlusion (CTO) (OR 26.7; 95% CI, 3.874-184.6; P = 0.001) were independently related to well-developed coronary collaterals.

Conclusions

Higher serum EPO level is related to better coronary collateral development. Erythropoietin may have a positive effect on the development of collaterals and may provide a new agent for the treatment strategies to enhance coronary collateral vessel development.     

侧支循环对ST段抬高心肌梗死急诊PCI患者N端脑钠肽前体及心功能的影响

目的 评价ST段抬高急性心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)后,急诊冠状动脉造影显示冠脉侧支循环对于N端脑钠肽前体(NT-proBNP)水平的影响及对心功能的影响。方法 纳入2014年12月至2015年12月在徐州医学院附属医院心内科行急诊PCI的STEMI患者60例,入院后均急诊行冠状动脉造影,行急诊介入治疗,成功开通罪犯血管。根据冠状动脉造影结果按Rentrop方法评价侧支循环情况,分为有侧支循环组(16例)和无侧支循环组(44例)。分别于术后24h、7d后抽取静脉血行NT-proBNP检查,术后7d和术后30d应用超声心动图评价心功能情况。结果 STEMI患者急诊PCI后有侧支循环组24h内的NT-proBNP水平明显高于无侧支循环组NT-proBNP水平[988.0(428.2-1658.0) pg/mL比3023.0(1947.5-4935.5) pg/mL]、入院7d的有侧支循环组NT-proBNP水平明显高于无侧支循环组NT-proBNP水平[832.0(561.7-1062.0) pg/mL比2219.0(1149.0-3445.8) pg/mL],差异有统计学意义(P<0.05);两组间患者入院Killip分级≥2级的比例为6.2% 比34.1% (P=0. 013),差异有统计学意义,心脏超声结果比较PCI术后7d的心脏超声结果显示,有侧支循环组的左心室射血分数明显高于无侧支循环组［(53.4±7.1)％比(47.1±8.4)％,P＜0.05］。术后30d门诊随访心脏超声结果显示,有侧支循环组的左室射血分数依然高于无侧支循环组［(56.3±6.9)％比(49.5±8.9)％,P＜0.05］。结论 早期开放的侧支循环可降低ST段抬高急性心肌梗死患者急诊PCI术后NT-ProBNP水平并且对心功能有保护作用。     

The relationship of chronic angiotensin converting enzyme inhibitor use and coronary collateral vessel development

BACKGROUND: Angiotensin II induces various growth factors such as vascular endothelial growth factor, platelet-derived growth factor, and fibroblast growth factor, and recent studies suggest that the expression of these growth factors promotes collateral growth. We hypothesized that the blockage of angiotensin II production by ACE inhibitors might interfere with collateral development in patients with coronary occlusion. METHODS: The study group consisted of 187 patients (114 males, mean ages, 62 +/- 11 years) who had chronic (> 1 month) coronary occlusion (TIMI flow grade < or = 1) in one of 3 epicardial coronary arteries. Collaterals were graded using the Rentrop classification, and the patients were divided into 2 groups according to having good (grade 2 and 3) or poor (grade 0 and 1) collaterals (n = 127 and 60, respectively). Clinical and angiographic characteristics were compared in the 2 groups. RESULTS: ACE inhibitor use (52% versus 35%, P = 0.04) and the prevalence of diabetes mellitus (DM) (43% versus 27%, P = 0.02) was higher in patients with poor collaterals. Patients with poor collaterals had a higher frequency of circumflex artery (Cx) occlusion, worse wall motion, and lower ejection fraction. In multivariate analysis, ACE inhibitor use (OR: 2.4; 95% CI = 1.23-4.68, P = 0.01) and the occlusion of Cx (OR: 3.3, 95% CI; 1.33-8.12, P = 0.01) were found to be independent predictors for poor collateral development, whereas there was a trend for DM as a predictor for poor collaterals (OR: 1.9, 95% CI = 0.97-3.8, P = 0.06). CONCLUSION: The findings suggest that ACE inhibitor therapy may contribute to poor collateral development in patients with coronary occlusion.     

Role of collateral circulation in the acute phase of ST-segment-elevation myocardial infarction treated with primary coronary intervention.

AIMS: The role of collateral flow in the first hours of infarction remains unclear. Our aim was to determine whether the presence of coronary collateral flow, as evidenced by angiography, has a beneficial effect on infarct size and left ventricular function in acute myocardial infarction (MI) treated by means of early percutaneous coronary intervention (PCI). METHODS: Between 1994 and 2001, 1059 patients with acute MI treated with primary PCI, TIMI (Thrombolysis in Myocardial Infarction) 0 or 1 flow at first contrast injection and technically adequate angiograms for collateral flow detection were analysed. RESULTS: Comparison of collateral flow grades 0, 1, and 2/3 showed that increased collateral flow was associated with a lower incidence of Killip class >/= 2 at presentation (12% vs. 10% vs. 3%, p for trend 0.02), less need for intra-aortic balloon pumping after PCI (17% vs. 13% vs. 5%, p for trend 0.005), better myocardial blush grade (MBG) in infarcts related with the left anterior descending coronary artery (LAD) (MBG3: 14% vs. 18% vs. 34%, p for trend 0.01), and smaller enzymatic infarct size (cumulative lactate dehydrogenase release 36 h after symptom onset [LDHQ(36)]) (1932+/-1531 U/l vs. 1870+/-1458 U/l vs. 1217+/-762 U/l, p for trend 0.041). These beneficial effects were particularly evident in LAD-related infarcts. CONCLUSION: The presence of angiographically detectable collaterals has a protective effect on enzymatic infarct size and pre- and postintervention haemodynamic conditions in patients with acute MI treated by primary PCI, in particular when Rentrop grade 2/3 is present and the LAD is involved in the infarct.     

冠心病患者血清IGF—I浓度检测的临床意义

目的探讨血清IGF-I浓度检测对估价冠心病患者左室功能及冠脉侧支循环状况的临床意义。方法应用放射免疫分析法检测4l例冠心病患者和15例正常人的血清IGF-I浓度;冠心病患者均行选择性冠状动脉造影,按Ren-trop法对侧支循环分级;左室造影测左室射血分数(LVEF)。结果冠心病患者组血清IGF-I浓度与正常对照组比较无显著性差异[(107.92±44.74)n/mL vs(113.05±33.65)n/mL,P＞0.05]。冠心病组中,IGF-I水平≥120 ng/mL的A亚组LVEF及Rentrop侧支循环分级均显著高于IGF-I水平＜ 120 ng/mL的B亚组(LVEF 0.62±0.13 vs 0.5l±0.12,P＜0.01;Rentrop 1.56±0.96 vs 0.12±0.33,P＜0.001)。IGF-I水平与LVEF(r=0.45,P＜0.001)及Rentrop侧支循环分级(r=0.74,P＜0.001)均呈显著正相关。结论较高的IGF-I水平可能提示冠心病患者有较好的左室功能和冠脉侧支循环;血清IGF-I浓度检测可作为估价冠心病患者左室功能及冠脉侧支循环状况的指标。     

Reduced collateral circulation to the infarct-related artery in elderly patients with acute myocardial infarction

OBJECTIVES: The purpose of this study was to investigate the hypothesis that circulation via collateral vessels to an infarct-related artery (IRA) is impaired with aging in patients with acute myocardial infarction (AMI). BACKGROUND: Animal experiments have shown that advanced age blunts the development of new vessels in response to angiogenic cytokines. METHODS: Of 3,573 consecutive patients with AMI, 1,934 patients who fulfilled the following criteria were enrolled in this study: 1) coronary angiograms were obtained within 72 h after the onset of AMI; and 2) IRA showed complete occlusion (Thrombolysis In Myocardial Infarction [TIMI] flow grade 0 or 1). Collaterals to the IRA were angiographically evaluated using the Rentrop score. Rentrop scores 1 to 3 were defined as demonstrating significant collaterals. RESULTS: The prevalence of collaterals decreased with age, from 47.9%, 45.8%, 43.4%, to 34.0% in patients <50 years, 50 to 59 years, 60 to 69 years, > or =70 years, respectively (p < 0.001). Advanced age was an independent factor predicting the absence of collateral circulation to the IRA. In contrast, time to catheterization, history of angina pectoris, and preinfarction angina were independent predictors for the presence of collaterals. Multivariate analysis showed that the absence of collaterals was an independent predictor of in-hospital mortality in elderly patients > or =70 years (odds ratio, 15.6; 95% confidence interval, 3.5 to 69.6), although this finding was not significant in patients <70 years. CONCLUSIONS: Advanced age is associated with decreased angiographic presence of collaterals to the IRA in patients with AMI. This abnormality may contribute to the poor prognosis of elderly patients with AMI.     

High levels of serum uric acid impair development of coronary collaterals in patients with acute coronary syndrome

We evaluated the association of serum uric acid (SUA) level and development of coronary collateral vessels (CCVs) in patients with acute coronary syndrome (ACS). Patients (n = 224) with ACS were included in the study. Coronary collateral vessels were graded according to the Rentrop scoring system. Rentrop grade 0 was accepted as absence of CCV (group 1; n = 117) and Rentrop grade ≥1 was accepted as presence of CCV (group 2; n = 107). Rentrop 0-1 (poor CCV) were determined in 167 patients and Rentrop 2-3 (good CCV) were determined in 57 patients. Both presence of CCV (P < .001) and development of good CCV (P = .003) were significantly associated with low levels of SUA. We suggest that high levels of SUA affect the CCV development negatively in nondiabetic and nonhypertensive patients with ACS.     

Association of lipids, lipoproteins, apolipoproteins and paraoxonase enzyme activity with premature coronary artery disease

BACKGROUND AND DESIGN: The association of serum apolipoprotein (apo) A-I and apo B concentrations and paraoxonase (PON) enzyme activity with angiographically determined coronary artery disease (CAD) was investigated in Iranian non-diabetic patients with premature CAD and control participants in a sex- and age-matched case-control study. METHODS: The study population consisted of 59 non-diabetic patients with premature CAD and 55 CAD control participants. Premature CAD was defined as the presence of angiographically proven coronary stenosis (> or =50% involvement) in men and women younger than 55 and 65 years, respectively. Apolipoprotein concentrations were measured by immunoturbidometric assay and paraoxonase/arylesterase activities by spectrophotometric assay of p-nitrophenol/phenol production following addition of paraoxon/phenylacetate to serum. RESULTS: In CAD patients, increased concentrations of total cholesterol (215 +/- 43 compared with 193 +/- 43, P < 0.001), low-density lipoprotein cholesterol (137 +/- 46 compared with 116 +/- 39, P < 0.05) and apo B (102 +/- 24 compared with 84 +/- 17, P < 0.001) and a decreased ratio of apo A-I/apo B (1.7 +/- 0.4 compared with 2.0 +/- 0.6, P < 0.001) were observed compared to the control group. Other study variables were not significantly different between the two groups. On multiple logistic regression analysis, the only marker for discrimination between the CAD+ group and the CAD- control group was apo B level. CONCLUSIONS: In Iranian non-diabetic patients with premature CAD, the concentration of apo B is a better marker than traditional lipids in discriminating between CAD+ and CAD- patients. The lack of significant difference in PON activity between CAD patients and control participants supports the concept of interethnic variability in PON activity and gene polymorphism observed in other studies.     

Influence of clinical and angiographic factors on development of collateral channels

BACKGROUND: The degree of coronary collateralization is believed to be related to several clinical and angiographic factors. The duration and frequency of angina may be important factors in determining development of collateral channels. OBJECTIVE: To assess these factors for a consecutive series of patients suspected to have coronary artery disease. METHODS: Patients without at least one stenosis of < 50% and patients who had previously undergone bypass surgery were excluded from our study. Severity of stenosis was quantified by digital analysis, antegrade flow in terms of TIMI grade, and collaterals using the Rentrop classification. RESULTS: We reviewed 106 patients [mean age 61 years (range 35-84), 77.6% men]. Of these, 22 (21%) had presented with an acute coronary syndrome on this admission, whilst 46 patients (43%) had previously had an acute coronary syndrome. Collaterals were more likely in patients with stenoses of > 90% (Spearman correlation 0.65, P < 0.001) in patients with lower than normal TIMI flow grade (Spearman correlation 0.86, P < 0.01) and were related to regions of hypokinesis (Spearman correlation 0.35, P < 0.01). Significant collaterals were present in 14 patients (13%) despite their having TIMI grade II/III flow. Two of these patients had grade 2/3 collaterals with TIMI grade II/III antegrade flow. Degree of collateralization was not related to chronicity and frequency of symptoms, age, risk factors for atherosclerosis and nature of presentation (i.e. acute or stable symptoms). CONCLUSION: The likelihood of coronary collateralization cannot be prospectively predicted from clinical history alone, but appears to be largely a function of severity of stenosis and level of antegrade flow. A few patients develop high-grade collateral channels despite the presence of good antegrade flow.     

Plasma level of homocysteine is inversely-associated with the development of collateral circulation in patients with single-vessel coronary artery disease.

Homocysteine induces endothelial injury and inhibits endothelial cell proliferation, which is a key role in angiogenesis. The purpose of this study was to investigate whether the plasma level of homocysteine is associated with the development of collaterals in patients with single-vessel coronary artery disease (CAD). Among a series of 105 male patients with angiographic estimation, 49 with single-vessel CAD were intensively investigated. Development of collaterals was classified by Rentrop's method. Univariate and multivariate analyses revealed that hyperhomocysteinemia negatively affected the development of collaterals (p=0.0015 and 0.0011, odds ratio 0.69, 95% confidence interval 0.52-0.90), whereas the duration of angina and percent stenosis evaluated by quantitative coronary angiography had a positive affect. Moreover, the level of homocysteine in the group with poorly developed collaterals (n=7, Rentrop class 0 and 1) was significantly higher than that in the group with well-developed collaterals (n=12, Rentrop class 2 and 3) of the patients with single-vessel disease showing total occlusion (p=0.034). This study clearly demonstrates that the plasma level of homocysteine is independently and inversely associated with the development of collateral circulation in CAD patients. Homocysteine might be a new undesirable aspect of ischemic heart disease through its inhibition of collateral development.     

Blood flow velocity in donor coronary artery depends on the degree and pattern of collateral vessel development: a study using thrombolysis in myocardial infarction frame count method.

To understand the influence of collateral vessels on the coronary flow, TIMI frame count (TFC) method was applied as a measure of mean coronary blood flow velocity in artery giving collateral blood supply to the other artery in angiograms of 76 patients with single occluded coronary artery: RCA giving collaterals to occluded LAD or LAD giving collaterals to occluded RCA. As a control group, TFC was applied in angiograms of 30 patients with mild or no coronary artery disease. TFC was lower (faster blood flow) in LAD giving collaterals to occluded RCA (43 patients) than in LAD in control group (21.8 +/- 10.5 vs. 33.9 +/- 20.8 frames; P < 0.01). Higher degree of collateral vessels (Rentrop classification) and mixed- and distal-type collaterals (through the interventricular septum and heart apex) was associated with lower TFC. There was no difference in TFC in the RCA giving collaterals to an occluded LAD (33 patients) compared to the TFC in RCA in control group (16.6 +/- 9.0 vs. 18.5 +/- 6.0; P = NS), even in angiograms with higher degree of collateral vessel development. TFC was lower (faster blood flow) only in subgroups with mixed (proximal and distal types together in the same patient) and distal (through the interventricular septum and the apex of the heart) collateral types. A delayed contrast appearance in occluded LAD compared to occluded RCA has been found (35.1 +/- 16.1 vs. 20.2 +/- 7.3 frames; P < 0.001) with earlier contrast appearance in occluded LAD when proximal collateral vessels (through the conal and acute marginal branches of RCA) were presented. The coronary flow in donor arteries depends not only on the degree but also on the pattern of collateral vessels. The simple TFC method may facilitate the study of collateral filling pattern and offer insight into the influence of collaterals on the ventricular function.     

侧支循环对急性ST段抬高心肌梗死未及时血运重建患者心功能的影响

目的:评价择期经皮冠状动脉介入治疗(PCI)时,冠状动脉造影显示的侧支循环对于急性ST段抬高心肌梗死未能及时血运重建患者心功能的影响。方法:纳入2012年4月至2014年2月间,在北京安贞医院急诊科就诊未能行急诊介入治疗的ST段抬高型心肌梗死(STEMI)患者76例,入院后均择期行冠状动脉造影和介入治疗,成功开通罪犯血管。根据择期冠状动脉造影结果按Rentrop方法评价侧支循环情况,分为有侧支循环组(n=33)和无侧支循环组(n=43)。分别于术后24小时内和术后30天应用超声心动图评价心功能情况。结果:PCI术后24小时内,有侧支循环组和无侧支循环组左心室射血分数差异无统计学意义(P0.05);两组间出现室壁瘤的比例,差异无统计学意义(P0.05)。术后30天门诊随访,有7例患者失访。术后30天超声结果显示两组的左心室射血分数和室壁瘤的发生比例差异没有统计学意义(P0.05)。结论:择期冠状动脉造影时显示的冠状动脉侧支循环可能与急性ST段抬高心肌梗死未及时血运重建患者择期PCI术后的心功能无关。     

Predictor of poor coronary collaterals in chronic kidney disease population with significant coronary artery disease

ABSTRACT: BACKGROUND: Coronary collateral circulation plays an important role to protect myocardium from ischemia, preserve myocardial contractility and reduce cardiovascular events. Chronic kidney disease (CKD) is associated with poor coronary collateral development and cardiovascular outcome. However, limited research investigates the predictors for collateral development in the CKD population. METHODS: We evaluated 970 consecutive patients undergoing coronary angiography and 202 patients with CKD, defined as a glomerular filtration rate less than 60 ml/min/1.73 m2, were finally analyzed. The collateral scoring system developed by Rentrop was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group. RESULTS: The patients with poor collateral (n = 122) had a higher incidence of hypertension (82 % vs 63.8 %, p = 0.005), fewer diseased vessels numbers (2.1 [PLUS-MINUS SIGN] 0.9 vs 2.6 [PLUS-MINUS SIGN] 0.6, p < 0.001) and a trend to be diabetic (56.6 % vs. 43.8 %, p = 0.085) or female sex (37.7 % vs. 25.0 %, p = 0.067). Multivariate analysis showed hypertension (odd ratio (OR) 2.672, p = 0.006), diabetes (OR 1.956, p = 0.039) and diseased vessels numbers (OR 0.402, p < 0.001) were significant predictors of poor coronary collaterals development. Furthermore, hypertension and diabetes have a negative synergistic effect on collateral development (p = 0.004 for interaction). CONCLUSIONS: In the CKD population hypertension and diabetes might negatively influence the coronary collaterals development.