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Coronary Angiography (coronary + angiography)

Distribution by Scientific Domains
Medical Sciences98%
2 Other Domains2%
Distribution within Medical Sciences
Cardiovascular Disease61%
General & Internal Medicine7%
Transplantation5%
Diabetes4%
Anesthesia & Pain Management2%
14 Other Subdomains21%

Kinds of Coronary Angiography

  • ct coronary angiography
  • diagnostic coronary angiography
    		•
  • invasive coronary angiography
  • quantitative coronary angiography
    		•
  • selective coronary angiography

    • Selected Abstracts

    The Relation Between Mitral Annular Calcification and Mortality in Patients Undergoing Diagnostic Coronary Angiography

    ECHOCARDIOGRAPHY, Issue 9 2006
    Howard J. Willens M.D.
    To determine whether the observed association between mitral annular calcification (MAC) and mortality is independent of the severity of coronary artery disease (CAD), we analyzed data from 134 male veterans (age 63 ± 10 years) followed for 5 years who had undergone diagnostic coronary angiography and transthoracic echocardiography within 6 months of each other. Echocardiograms were retrospectively reviewed for the presence of MAC. The relation of MAC to all-cause mortality was analyzed using logistic regression, and odds ratios (OR) were calculated. MAC was present in 49 (37%) subjects. Over the 5-year follow-up period, 38 (28%) patients expired. Five-year survival was 80% for subjects without MAC and 56% for subjects with MAC (P = 0.003). MAC (OR = 3.16, 95% confidence interval [CI]= 1.43,6.96, P = 0.003), ejection fraction (OR = 0.76, 95% CI = 0.59,0.97, P = 0.02), and left main CAD (OR = 2.70, 95% CI = 1.11,6.57, P = 0.02) were significantly associated with mortality in univariate analysis. After adjusting for left ventricular ejection fraction, number of obstructed coronary arteries and the presence of left main coronary artery stenosis, MAC significantly predicted death (OR = 2.48, 95% CI = 1.09,5.68, P = 0.03). Similarly, after adjusting for predictors of MAC, including ejection fraction, age, diabetes, peripheral vascular disease, and heart failure, MAC remained a significant predictor of death (OR = 2.38, 95% CI = 1.02,5.58, P = 0.04). MAC also predicted death independent of smoking status, hypertension, serum creatinine, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and C-reactive protein levels (OR = 3.98, 95% CI = 1.68,9.40, P = 0.001). MAC detected by two-dimensional echocardiography independently predicts mortality and may provide an easy-to-perform and inexpensive way to improve risk stratification. [source]

    Physician Referral Patterns and Race Differences in Receipt of Coronary Angiography

    HEALTH SERVICES RESEARCH, Issue 4 2002
    Thomas A. LaVeist
    Objective. This study addresses the following research questions: (1) Is race a predictor of obtaining a referral for coronary angiography (CA) among patients who are appropriate candidates for the procedure? (2) Is there a race disparity in obtaining CA among patients who obtain a referral for the procedure? Study Setting. Three community hospitals in Baltimore, Maryland. Study Design. We abstracted hospital records of 7,927 patients from three hospitals to identify 2,653 patients who were candidates for CA. Patients were contacted by telephone to determine if they received a referral for CA. Logistic regression was used to assess whether racial differences in obtaining a referral were affected by adjustment for several potential confounders. A second set of analyses examined race differences in use of the procedure among a subsample of patients that obtained a referral. Principal Findings. After controlling for having been hospitalized at a hospital with in-house catheterization facilities, ACC/AHA (American College of Cardiology/American Heart Association) classification, sex, age, and health insurance status, race remained a significant determinant of referral (OR=3.0, p<.05). Additionally, we found no significant race differences in receipt of the procedure among patients who obtained a referral. Conclusions. Our results demonstrate that race differences in utilization of CA tend to occur during the process of determining the course of treatment. Once a referral is obtained, African American patients are not less likely than white patients to follow through with the procedure. Thus, future research should seek to better understand the process by which the decision is made to refer or not refer patients. [source]

    Diagnostic Coronary Angiography in Patients with Peripheral Arterial Disease: A Sub-study of the Coronary Artery Revascularization Prophylaxis Trial

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2008
    SANTIAGO GARCIA M.D.
    Background: Although patients in need of elective vascular surgery are often considered candidates for diagnostic coronary angiography, the safety of this invasive study has not been systematically studied in a large cohort of patients scheduled for an elective vascular operation. The goal of this sub-study of the Coronary Artery Revascularization Prophylaxis (CARP) trial was to assess the safety of coronary angiography in patients with peripheral vascular disease. Methods: The CARP trial tested the long-term benefit of coronary artery revascularization prior to elective vascular operations. Among those patients who underwent diagnostic coronary angiography during screening for the trial, the associated complications were determined at 24 hours following the diagnostic procedure. Results: Over 5,000 patients were screened during a 4-year recruitment period at 18 major VA medical centers and the present cohort consists of 1,298 patients who underwent preoperative coronary angiography. Surgical indications for vascular surgery included an expanding aortic aneurysm (AAA) (n = 446; 34.4%) or arterial occlusive disease with either claudication (n = 457; 35.2%) or rest pain (n = 395; 30.4%). A total of 39 patients had a confirmed complication with a major complication identified in 17 patients (1.3%). Complication rates were higher in patients with arterial occlusive symptoms compared with expanding aneurysms (1.8% vs. 0.5%; P = 0.07) and were not dissimilar with femoral (2.8%) versus nonfemoral (4.7%) access sites (P = 0.42). Conclusions: Coronary angiography is safe in patients with peripheral arterial disease undergoing preoperative coronary angiography. The complication rate is higher in patients with symptoms of arterial occlusive disease. [source]

    CT Coronary Angiography Predicts the Outcome of Percutaneous Coronary Intervention of Chronic Total Occlusion

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2007
    F.R.A.C.P., KEAN H. SOON M.B.B.S.
    Background: The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA. Methods: Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed. Results: In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification ,50% as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95% confidence interval [CI]: 0.02,0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95% CI: 0.07,0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification ,50% on CT-CA was the only significant predictor of failed PCI. Conclusions: Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI. [source]

    Safety, Efficacy, and Cost Advantages of Combined Coronary Angiography and Angioplasty

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2003
    CLAUDE LE FEUVRE M.D., F.E.S.C.
    Aim: The safety and efficacy of ad hoc PTCA has been previously reported and this approach is performed in many angioplasty centers as a routine procedure. The aim of this study is to examine whether this approach reduces the length, and cost of hospital stay. Methods and results: To determine the hospital costs we studied 2,440 PTCAs over 11 years in our institution (1990,2000). Urgent PTCA for acute coronary syndromes refractory to medical treatment were excluded. In 1809 patients (74%) angioplasty was performed immediately after coronary angiography, while separate procedures were performed in 631 patients. Indication for PTCA was unstable angina in 1342 patients (55%). In the ad hoc PTCA group, 92% of the culprit lesions were successfully treated; complications included myocardial infarction (2%), urgent bypass surgery (0.6%) and death (0.9%). The rate of combined procedure progressively increased from 54% in 1990 to 88% in 2000, with a significant decrease in the rate of complications. After adjusting for clinical and angiographic differences between combined and separate procedures, angiographic success and complication rates were not statistically different in the two groups. Mean length of hospital stay decreased all along the years, and was 45% less in the ad hoc PTCA group (11.4 ± 6.9vs18.2 ± 7.7in 1990,5.4 ± 4.3vs10.8 ± 5.7in 2000,P < 0.0001). The cost was 40% lower in the ad hoc PTCA group. For patients with stable angina, the savings were 49%, and for those with unstable angina, they were 29%. Conclusion: In the era of coronary stenting, ad hoc PTCA can be performed in most of the patients as safely and successfully as a separate procedure. It reduces the length, and the cost of hospital stay in patients with stable or unstable angina. (J Interven Cardiol 2003;16:195,199) [source]

    Importance of Anterograde Visualization of the Coronary Venous Network by Selective Left Coronary Angiography Prior To Resynchronization

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2007
    NICOLAS DELARCHE M.D.
    Background: Understanding of coronary anatomy is essential to the advancement of cardiac resynchronization therapy (CRT) techniques. We determined whether the difficulties associated with catheterization of the coronary sinus (CS) and its lateral branches could be overcome by a preliminary angiographical study of the coronary venous system carried out during a pre-operative coronary angiography with examination of venous return. Methods and Results: All patients were scheduled for an exploratory angiography procedure and indicated for CRT. Group A patients were implanted with a CRT device after a right arterial angiographical procedure while group B patients had a selective left angiogram including examination of venous return. Data analyzed in group B were: position of CS ostium, number and distribution of lateral branches, and ability to preselect a marginal vein suitable for catheterization. Subsequent device implantation was guided by these parameters. A total of 96 and 89 patients were included in groups A and B, respectively. Implantation success rates were not different (98% and 100%, respectively), but CS catheterization time was reduced in group B (6 minutes vs 4 minutes; P < 10,6) as well as total time required to position the left ventricular lead (25 minutes vs 15 minutes; P < 10,6), fluoroscopy exposure (7 minutes vs 5 minutes; P < 10,6), and volume of contrast medium required (45 mL vs 15 mL; P < 10,6). Conclusion: A coronary angiographical study, including examination of the coronary venous return prior to implantation of a CRT device, can simplify the device implant and allows patient-specific preselection of appropriate tools for the procedure. [source]

    Noninvasive Coronary Angiography: A Revolutionary Technique Seeking Its Role in Patient Care

    PREVENTIVE CARDIOLOGY, Issue 3 2008
    Ezra A. Amsterdam MD
    No abstract is available for this article. [source]

    Spiral Multislice Computed Tomography Coronary Angiography: A Current Status Report

    CLINICAL CARDIOLOGY, Issue 9 2007
    P. J. De Feyter M.D., PH.D.
    Abstract Multislice computed tomography coronary angiography (MSCT-CA) has emerged as a powerful noninvasive diagnostic modality to visualize the coronary arteries and to detect significant coronary stenoses. The latest generation 64-slice computed tomography (CT) scanners is a robust technique which allows high-resolution, isotropic, nearly motion-free coronary imaging. Coronary stenoses are detected with high sensitivity and a normal scan accurately rules out the presence of a coronary stenosis. With the introduction of further novel concepts in CT-technology one may expect that MSCT-CA will become a clinically used diagnostic tool. Copyright © 2007 Wiley Periodicals, Inc. [source]

    Computed Tomography Coronary Angiography for Rapid Disposition of Low-risk Emergency Department Patients with Chest Pain Syndromes

    ACADEMIC EMERGENCY MEDICINE, Issue 2 2007
    Judd E. Hollander MD
    Background Patients with recent normal cardiac catheterization are at low risk for complications of ischemic chest pain. Computed tomography (CT) coronary angiography has high correlation with cardiac catheterization for detection of coronary stenosis. Therefore, the investigators' emergency department (ED) incorporated CT coronary angiography into the evaluation of low-risk patients with chest pain. Objectives To report on the 30-day cardiovascular event rates of the first 54 patients evaluated by this strategy. Methods Low-risk chest pain patients (Thrombolysis In Myocardial Infarction [TIMI] score of 2 or less) without acute ischemia on an electrocardiogram had CT coronary angiography performed in the ED. If the CT coronary angiography was negative, the patient was discharged home. The main outcomes were death and myocardial infarction within 30 days of ED discharge, as determined by telephone follow up and record review. Data are presented as percentage frequency of occurrence with 95% confidence intervals (CIs). Results Of the 54 patients evaluated, after CT coronary angiography, 46 patients (85%) were immediately released from the ED, and none had cardiovascular complications within 30 days. Eight patients were admitted after CT coronary angiography: one had >70% stenosis, five patients had 50%,69% stenosis, and two had 0,49% stenosis. Three patients had further noninvasive testing; one had reversible ischemia, and catheterization confirmed the results of CT coronary angiography. All patients were followed for 30 days, and none (0; 95% CI = 0 to 6.6%) had an adverse event during index hospitalization or at 30-day follow up. Conclusions When used in the clinical setting for the evaluation of ED patients with low-risk chest pain, CT coronary angiography may safely allow rapid discharge of patients with negative studies. Further study to conclusively determine the safety and cost effectiveness of this approach is warranted. [source]

    Acute Myocardial Infarction With Sumatriptan: A Case Report and Review of the Literature

    HEADACHE, Issue 5 2009
    Flavio Devetag Chalaupka MD
    We report a case of myocardial infarction associated with the use of sumatriptan and review the literature regarding similar cases. A 54-year-old woman with a history of migraine without aura, mild arterial hypertension, depression, and no history of coronary artery disease was admitted to our hospital for acute myocardial infarction, 30 minutes after using 6 mg of subcutaneous sumatriptan. Coronary angiography performed several days later revealed a normal coronary arterial system. Although at discharge the patient was advised to permanently avoid triptans, she continued the use of oral sumatriptan at low dosage (25-50 mg) without any problems. [source]

    Diagnostic Coronary Angiography in Patients with Peripheral Arterial Disease: A Sub-study of the Coronary Artery Revascularization Prophylaxis Trial

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2008
    SANTIAGO GARCIA M.D.
    Background: Although patients in need of elective vascular surgery are often considered candidates for diagnostic coronary angiography, the safety of this invasive study has not been systematically studied in a large cohort of patients scheduled for an elective vascular operation. The goal of this sub-study of the Coronary Artery Revascularization Prophylaxis (CARP) trial was to assess the safety of coronary angiography in patients with peripheral vascular disease. Methods: The CARP trial tested the long-term benefit of coronary artery revascularization prior to elective vascular operations. Among those patients who underwent diagnostic coronary angiography during screening for the trial, the associated complications were determined at 24 hours following the diagnostic procedure. Results: Over 5,000 patients were screened during a 4-year recruitment period at 18 major VA medical centers and the present cohort consists of 1,298 patients who underwent preoperative coronary angiography. Surgical indications for vascular surgery included an expanding aortic aneurysm (AAA) (n = 446; 34.4%) or arterial occlusive disease with either claudication (n = 457; 35.2%) or rest pain (n = 395; 30.4%). A total of 39 patients had a confirmed complication with a major complication identified in 17 patients (1.3%). Complication rates were higher in patients with arterial occlusive symptoms compared with expanding aneurysms (1.8% vs. 0.5%; P = 0.07) and were not dissimilar with femoral (2.8%) versus nonfemoral (4.7%) access sites (P = 0.42). Conclusions: Coronary angiography is safe in patients with peripheral arterial disease undergoing preoperative coronary angiography. The complication rate is higher in patients with symptoms of arterial occlusive disease. [source]

    "Backdoor" Alternative Approach to Stenting of a Post-Anastomotic Coronary Artery Lesion via a Chronically Obstructed Right Coronary Artery after Failure to Stent through a Tortuous Free Internal Mammary Graft

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2007
    RICHARD Y.J. CHAN M.B.Ch.B.
    We describe the case of a patient who previously had coronary artery bypass grafting including a free right internal mammary artery graft anastomosed to a chronic totally occluded right coronary artery (RCA) proximally and distally and who presented with a high-risk acute coronary syndrome. Coronary angiography revealed the graft to be patent with a distal post-anastomotic culprit lesion within the posterolateral branch of the native RCA. Because of technical challenges, PCI could not be performed through the graft and the lesion was stented via the chronically occluded RCA instead, in a "backdoor" approach with a good final result. [source]

    Magnetic resonance imaging of acute myocardial infarction in dextrocardia with situs solitus (dextroversion)

    JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 5 2005
    JC Salanitri
    Summary The case report of an 88-year-old woman with dextroversion and acute anterior wall myocardial infarction is presented. The patient, who had been diagnosed with dextrocardia 3 years prior to this admission, presented with right-sided chest pain. Coronary angiography demonstrated an 80% proximal left anterior descending artery stenosis which was successfully stented. A cardiac MRI was performed to exclude a left atrial thrombus after an inconclusive echocardiogram. The MRI demonstrated findings consistent with dextroversion, with delayed contrast-enhanced viability sequences confirming a near transmural anterior wall myocardial infarct. To our knowledge, this is the first report illustrating the cardiac MRI findings in such a case. [source]

    Takotsubo syndrome during induction of general anaesthesia

    ANAESTHESIA, Issue 5 2007
    M. Jabaudon
    Summary A 77-year-old female was admitted in our hospital for uterine prolapse surgery. She developed ventricular tachycardia during induction of general anaesthesia and after initial symptomatic measures, she was transferred to the coronary care unit. Heart failure persisted and electrocardiographic changes mimicking acute myocardial infarction appeared. Coronary angiography was normal and left ventriculography revealed akinesis of the apical region of the left ventricle and apical ballooning during systole, with relative sparing of the base of the heart. Complete recovery of left ventricular function occurred 8 days after the initial onset of symptoms. A diagnosis of Takotsubo syndrome was made on the basis of consistent clinical and laboratory findings, typical echocardiography and angiography findings, and reversible course. This case emphasises the importance of being aware of uncommon causes of cardiac dysfunction in stressful situations, especially during induction of general anaesthesia. [source]

    Left main coronary artery compression from pulmonary artery enlargement due to pulmonary hypertension: A contemporary review and argument for percutaneous revascularization,

    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2010
    Michael S. Lee MD
    Abstract Extrinsic compression of the left main coronary artery by an enlarged pulmonary artery is an increasingly recognized and potentially reversible cause of angina and left ventricular dysfunction in patients with pulmonary hypertension. The diagnosis of extrinsic left main coronary artery compression requires a high index of suspicion and should be considered in patients with severe pulmonary hypertension who experience angina. Coronary angiography with intravascular ultrasound is the gold standard for diagnosis of this condition, though cardiac computed tomography and magnetic resonance angiography allow for noninvasive means of screening. The optimal treatment is debatable, but percutaneous coronary intervention appears to be a feasible, safe, and effective treatment option for patients with extrinsic compression of the left main coronary artery from pulmonary artery enlargement. Given the high risk of postoperative right ventricular failure and mortality observed with surgical revascularization in these patients, we recommend that physicians recognize percutaneous coronary intervention as the preferred revascularization strategy for selected patients with extrinsic compression of the left main coronary artery due to pulmonary hypertension. © 2010 Wiley-Liss, Inc. [source]

    Atrial myxoma's and coronary angiography,

    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2010
    Isma Rafiq MBBS
    Abstract Coronary angiography is not an only important component of preoperative evaluation of the patient with underlying coronary artery disease but also diagnostic tool for delineating cardiac myxomas. This also serve as an important surgical anatomical marker. We present two cases which presented with repeated episode of chest pain, were found to have atrial blushing on coronary angiography subsequent confirmation of diagnosis of atrial myxoma on echocardiography. © 2010 Wiley-Liss, Inc. [source]

    Systolic Total Narrowing of Left Anterior Descending Coronary Artery and Flow Interruption Secondary to Myocardial Bridge: A Rare Case Report and Review of Literature

    CLINICAL CARDIOLOGY, Issue 10 2008
    Fehmi Kacmaz MD
    Abstract A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow-up period. Copyright © 2008 Wiley Periodicals, Inc. [source]

    Stent implantation in variant angina refractory to medical treatment

    CLINICAL CARDIOLOGY, Issue 12 2006
    Dr Vicens Martí M.D.
    Abstract Background Vasospastic angina usually responds well to medical treatment. Hypothesis The present study describes our experience in patients who received a coronary stent because of recurrent variant angina refractory to medical treatment and evaluates stent implantation as an alternative treatment. Materials and methods Between March 1998 and February 2005, recurrent variant angina was diagnosed in 22 patients admitted to our coronary care unit. Of these, five patients (22.7%), were refractory to pharmacologic treatment. Coronary angiography and coronary stents were indicated. Clinical follow-up was 29 ± 6 months. Results Stenting was performed during diagnostic coronary angiography in two patients. In the other three patients, the stent was implanted 24,48 h later. We observed coronary spasm recurrences proximal or distal to the stent in four patients,two during the stent implantation procedure and the other two in the coronary care unit within 48 h post angioplasty. Three patients where treated with additional stenting and the fourth patient improved with pharmacologic treatment. During follow-up three patients remained asymptomatic. The fourth patient had diffuse in-stent restenosis in the third month, and the fifth patient showed a de novo lesion in the treated segment 2 years later. Conclusions Stent implantation in patients with recurrent variant angina refractory to medical treatment may be an alternative treatment in carefully selected, clinically unstable patients. Spasm recurrences may occur in other segments of the treated artery, probably due to the diffuse nature of the disease. Immediate and continued surveillance is recommended because of the risk of adverse clinical events. Copyright © 2006 Wiley Periodicals, Inc. Wiley Periodicals, Inc. [source]

    Coronary angiography is still alive and well

    CLINICAL CARDIOLOGY, Issue 6 2002
    C. Richard Conti M.D., M.A.C.C. Editor-in-Chief
    No abstract is available for this article. [source]

    Does Mediastinitis Affect the Graft Patency?

    JOURNAL OF CARDIAC SURGERY, Issue 3 2005
    Denyan Mansuro, lu M.D.
    There are many studies that have focused on the graft patency. But, till now, no study has been done to detect the effects of mediastinitis to graft patency. So, we aimed to detect the effect of mediastinitis on the graft patency in patients who have undergone coronary artery bypass surgery. Sixteen of 45 patients who have been operated upon for coronary artery bypass surgery and developed mediastinitis, which was treated with open drainage and mediastinal irrigation with late wound closure, were included in the study. The mean age of the patients was 55 ± 11 (range 35,69) and nine of the patients were male. The graft patency was evaluated with control coronary angiographies after a mean period of 30.42 ± 43.17 months (range 1,132). The left internal thoracic artery was patent in all patients (100%). Right internal thoracic artery patency rate was 50% (1/2). One individual bypassed radial artery was patent, whereas the sequential bypassed graft was occluded. The patency ratio of radial artery anastomosis was 33% (1/3). Twelve of the 17 saphenous vein grafts were patent (70.58%). The total number of patent distal anastomosis was 30/38 (78.94%). When compared with the graft patency of patients without infection, it was found that mediastinitis does not affect the graft patency rates adversely. [source]

    Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

    AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5p1 2006
    F. Tona
    Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50 ± 12 years at HT), at 8 ± 4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of ,2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3 ± 0.7 vs. 3.2 ± 0.5, p < 0.0001). The ,2 cut point was 100% specific and 38% sensitive. The ,2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard ,2 cut point to 85% with the optimal cut point of ,2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated. [source]

    An increase in HbA1c after percutaneous coronary intervention raises the risk for restenosis in patients without Type 2 diabetes mellitus

    DIABETIC MEDICINE, Issue 2 2008
    H. Diedrichs
    Abstract Aims The influence of dynamic changes in glycated haemoglobin (HbA1c) on restenosis after elective percutaneous coronary intervention (PCI) in patients without diabetes has not been analysed. Therefore, the rate of restenosis was investigated after elective PCI in 101 consecutive patients without diabetes mellitus in relation to dynamic changes of HbA1c levels. Methods Follow-up angiography was performed in all patients 4,6 months after intervention. Results Multivariate analysis demonstrated that the change in HbA1c between first and second coronary angiography was the most powerful metabolic parameter for prediction of restenosis. The odds ratio for restenosis was 3.0 (95% CI 1.0,9.0) for any increase in HbA1c and 1.9 (95% CI 1.1,3.5) for an HbA1c increase of 0.2%. Conclusions Hence, chronic changes in the glucometabolic environment influence the incidence of restenosis after PCI in patients without diabetes. [source]

    Post-challenge glucose predicts coronary atherosclerotic progression in non-diabetic, post-menopausal women,

    DIABETIC MEDICINE, Issue 10 2007
    P. B. Mellen
    Abstract Aims, We sought to determine whether fasting or post-challenge glucose were associated with progression of coronary atherosclerosis in non-diabetic women. Methods, We performed a post-hoc analysis of 132 non-diabetic women who underwent 75-g oral glucose tolerance testing. The primary outcome of interest was progression of atherosclerosis determined by baseline and follow-up coronary angiography, a mean of 3.1 ± 0.9 years apart. We analysed the association of change in minimal vessel diameter (,MD) by quartile of fasting and post-challenge glucose using mixed models that included adjustment for age, systolic blood pressure, total : high-density lipoprotein cholesterol ratio, current smoking, lipid-lowering and anti-hypertensive medication use and other covariates. Results, At baseline, participants had a mean age of 65.7 ± 6.7 years and a mean body mass index of 27.9 ± 8.5 kg/m2. Although there were no significant differences in atherosclerotic progression by fasting glucose category (P for trend across quartiles = 0.99), there was a significant inverse association between post-challenge glucose and ,MD (in mm) (Q1 : 0.01 ± 0.03; Q2 : 0.08 ± 0.03; Q3 : 0.13 ± 0.03; Q4 : 0.11 ± 0.03; P for trend = 0.02). Conclusions, In post-menopausal women without diabetes, post-challenge glucose predicts angiographic disease progression. These findings suggest that even modest post-challenge hyperglycaemia influences the pathogenesis of atherosclerotic progression. [source]

    Prognostic significance of asymptomatic coronary artery disease in patients with diabetes and need for early revascularization therapy

    DIABETIC MEDICINE, Issue 9 2007
    E.-K. Choi
    Abstract Aims, Information on the clinical outcome of patients with diabetes with silent myocardial ischaemia is limited. We compared the clinical and angiographic characteristics, and the clinical outcomes of diabetic patients with asymptomatic or symptomatic coronary artery disease (CAD). Methods, Three hundred and ten consecutive diabetic patients with CAD were divided into two groups according to the presence of angina and followed for a mean of 5 years. Fifty-six asymptomatic patients with a positive stress test and CAD on coronary angiography were compared with 254 symptomatic patients, 167 with unstable angina and 87 with chronic stable angina. Results, Although the severity of coronary atherosclerosis was similar in asymptomatic and symptomatic patients, revascularization therapy was performed less frequently in the asymptomatic than the symptomatic patients (26.8 vs. 62.0%; P < 0.001). Asymptomatic patients experienced a similar number of major adverse cardiac events (MACEs; death, non-fatal myocardial infarction, and revascularization; 32 vs. 28%; P = 0.57), but had higher cardiac mortality than symptomatic patients (26 vs. 9%; P < 0.001). However, patients who underwent revascularization therapy at the time of CAD diagnosis in these two groups showed similar MACE and cardiac mortality (20.0 vs. 22.5%, 6.7 vs. 5.3%, respectively; all P > 0.05). Conclusions, This study suggests that diabetic patients with asymptomatic CAD have a higher cardiac mortality risk than those with symptomatic CAD, and that lack of revascularization therapy may be responsible for the poorer survival. [source]

    Prevalence of silent myocardial ischaemia in new-onset middle-aged Type 2 diabetic patients without other cardiovascular risk factors

    DIABETIC MEDICINE, Issue 7 2006
    P. Fornengo
    Abstract Aims Coronary artery disease (CAD) is the leading cause of death in patients with Type 2 diabetes and is often asymptomatic. Silent myocardial ischaemia (SMI) is frequent in diabetic subjects and is responsible for a late diagnosis of CAD; its early detection is important. There are some data about the prevalence of SMI in Type 2 diabetic patients at high risk for cardiovascular disease, while no data are available in subjects at the onset of diabetes without other cardiovascular risk factors. Methods We screened 274 consecutive patients (mean age 64.3 ± 8.4 years, 66% male) at the time of diagnosis of Type 2 diabetes; we enrolled 111 subjects without other cardiovascular disease risk factors (dyslipidaemia, hypertension, peripheral vascular disease, retinopathy, microalbuminuria, history of heart disease) and with normal resting electrocardiogram (ECG). Participants performed a maximal ECG exercise protocol and, if positive, underwent coronary angiography. Results The ECG exercise test was positive in 19 patients (17.1%); of those 14 (13%) had angiographic coronary disease (one with three-vessel disease, three with two vessels and 10 with one vessel involved). The positive predictive value of the exercise ECG for predicting angiographic coronary disease was 73%. Conclusions The prevalence of SMI was 17% and angiographic coronary disease was found in 13% of middle-aged subjects with new-onset Type 2 diabetes without other cardiovascular risk factors. This prevalence is similar to that observed in studies of subjects with long duration diabetes who have additional cardiovascular risk factors. [source]

    The vitamin D receptor gene variant is associated with the prevalence of Type 2 diabetes mellitus and coronary artery disease

    DIABETIC MEDICINE, Issue 10 2001
    J. R. Ortlepp
    Abstract Aims, Vitamin D can influence lipolysis and insulin secretion. A common genetic polymorphism of the vitamin D receptor, which has been found to be associated with bone mineral density, has also been reported to be associated with insulin-dependent diabetes mellitus. To test the influence of the vitamin D receptor polymorphism on the prevalence of Type 2 diabetes mellitus and coronary artery disease we studied a population of high-risk patients, who were referred to our clinic for diagnostic coronary angiography. Methods, A total of 293 patients considered at high risk for coronary artery disease because of angina pectoris and known hypercholesterolaemia underwent diagnostic coronary angiography. The BsmI vitamin D receptor polymorphism was analysed by polymerase chain reaction. Results, Prevalence of Type 2 diabetes mellitus and coronary artery disease was gradually dependent on the number of B alleles (BB 28%, Bb 13%, bb 8% for Type 2 diabetes mellitus, P = 0.002; BB 88% Bb 72%, bb 66% coronary artery disease, P = 0.01). Patients with the BB genotype had an odds ratio of 3.64 (95% confidence interval 1.53,8.55, P = 0.002) to have Type 2 diabetes mellitus compared with patients with the bb genotype. Conclusions, The genotype of the vitamin D receptor polymorphism determines the prevalence of Type 2 diabetes mellitus and coronary artery disease in a high-risk cohort population. Diabet. Med. 18, 842,845 (2001) [source]

    Psychiatric morbidity and the presence and absence of angiographic coronary disease in patients with chest pain

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2001
    M. Valkamo
    Objective: ,To assess psychiatric morbidity in coronary angiogram patients. Method: ,A psychiatric assessment of 200 consecutive chest-pain patients was performed the day before coronary angiography in a double-blind study design. The sample included 132 men (mean age 57.2 years, SD 9.5) and 68 women (mean age 59.8 years, SD 8.9). A Structured Clinical Interview for DSM-III-R was used to obtain psychiatric diagnosis. The 21-item Beck Depression Inventory, the 20-item Toronto Alexithymia Scale and a four-item Life Satisfaction Scale were used to assess mental symptoms. A coronary angiography with obstruction of a coronary artery by more than 50% was considered to indicate angiographic coronary disease. Results: ,Mental disorders were found in 28% (95% CI 14,41) of the patients with normal angiographic findings (n=47) and in 24% (95% CI 17 , 30) of the patients with angiographic coronary disease (n=153). Furthermore, no difference was found between these two groups in other rating scales assessing mental symptoms even when adjusted for the New York Heart Association class, duration of chest-pain symptoms or exercise capacity. Conclusion: ,Psychiatric morbidity may not be associated with angiographic findings in patients with chest pain. [source]

    The Relation between the Color M-Mode Propagation Velocity of the Descending Aorta and Coronary and Carotid Atherosclerosis and Flow-Mediated Dilatation

    ECHOCARDIOGRAPHY, Issue 3 2010
    Yilmaz Gunes M.D.
    Background: To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). Methods: CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. Results: Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 ± 8.1 vs. 47.5 ± 16.8 cm/sec, P < 0.001) and FMD (5.3 ± 1.9 vs. 11.4 ± 5.8%, P < 0.001) and higher CIMT (0.94 ± 0.05 vs. 0.83 ± 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =,0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =,0.530, P < 0.001). Conclusions: The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function. (Echocardiography 2010;27:300-305) [source]

    Evaluation of Subendocardial and Subepicardial Left Ventricular Functions Using Tissue Doppler Imaging after Complete Revascularization

    ECHOCARDIOGRAPHY, Issue 2 2009
    Hüseyin Sürücü M.D.
    Objective: We aim to evaluate subepicardial and subendocardial left ventricular (LV) functions in patient single coronary artery lesion at early stage after percutaneous coronary intervention (PCI). Additionally, a comparison of LV functions between patients and control cases was aimed. Method: Patients with culprit left anterior descending (LAD) lesion (n = 25) and subjects with normal coronary angiography (n = 25) were evaluated. Patients underwent PCI and at least one coronary stent was placed. After PCI, the pulsed-wave tissue Doppler imaging (pw-TDI) parameters taken from subepicardial and subepicardial layers were compared among the patients. Results: Left atrium (P = 0.050), LV end-diastolic (P = 0.049), and end-systolic (P = 0.006) diameters were larger compared to the control group. LV inflow velocities were not different between the patient and the control group. But, the myocardial performance index was different (P = 0.049). The systolic and diastolic pw-TDI parameters were apparently different between the patient and the control group. While the systolic pw-TDI parameters did not change, the diastolic pw-TDI parameters taken from both subepicardial (circumferential contraction) and subendocardial layers (longitudinal contraction) improved after PCI. After PCI, it was shown that while Ea velocity (P = 0.012) taken from the subendocardial layer increased, IVRa velocity (P < 0.001) taken from the subepicardial layer decreased. Conclusion: In our study, it could be said that LV, left atrium, and aortic valve diameter increase in patients with coronary artery disease. The systolic and diastolic functions were impaired at subendocardial and subepicardial layers. These dysfunctions can be easily presented with pw-TDI. Although systolic dysfunction persists, diastolic dysfunction improves at early stage after PCI. [source]

    Transthoracic Doppler Echocardiographic Coronary Flow Imaging in Identification of Left Anterior Descending Coronary Artery Stenosis in Patients with Left Bundle Branch Block

    ECHOCARDIOGRAPHY, Issue 10 2008
    Ozer Soylu M.D.
    Background: Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Methods: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56,0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. Results: The hyperemic diastolic peak velocity (44 ± 9 cm/sec vs 62 ± 2 cm/sec; P=0.01) and diastolic CFR (1.38 ± 0.17 vs 1.93 ± 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of <1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. Conclusions: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB. [source]