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Coronary artery ectasia is associated with atrial electrical and mechanical dysfunction: an observational study  [cached]
Serkan ?ztürk,Mehmet ?zya?ar,Selim Suzi Ayhan,Mehmet Fatih ?zlü
Anadolu Kardiyoloji Dergisi , 2012,
Abstract: Objective: The aim of our study was to investigate total atrial conduction time and left atrial (LA) mechanical function in patients with isolated coronary artery ectasia (ICAE).Methods: Sixty patients with ICAE without any visible coronary stenosis were enrolled to this cross-sectional observational study. The control group consisted of 40 age- and gender-matched patients. Left atrial mechanical functions were measured by the method of discs in the apical-four chamber echocardiographic view. LA mechanical function parameters were calculated. P wave dispersion was measured on electrocardiography (ECG). The total atrial conduction time (PA-tissue Doppler imaging (TDI) duration) was assessed by measuring the time interval between the beginning of the P wave on the surface ECG and point of the peak A wave on TDI from LA lateral wall just over the mitral annulus. Student t, Mann-Whitney U, Pearson’s, and Spearman’s correlation analysis and multiple regression analysis were used for statistical analysis. Results: The clinical and laboratory characteristics were similar in two groups. Both groups were similar in terms of Vmax and LA total emptying volume (29.0±7.3 vs. 31.9±6.5 mL/m2, p=0.082 and 19.9±5.1 vs. 20.0±5.2 mL/m2, p=0.821). However, LA passive emptying volume and LA passive emptying fraction were significantly decreased with ICAE patients (11.1±3.2 vs. 13.5±3.8 ml/m2, p=0.005 and 35.2±7.2 vs. 47.8±9.4 mL/m2, p<0.001). But LA active emptying volume and LA active emptying fraction were significantly increased in ICAE patients (9.1±2.6 vs. 6.4±3.0 mL/m2, p<0.001 and 45.3±8.1 vs. 40.7±6.7 mL/m2, p=0.002). PA-TDI duration was measured significantly higher in patients with ICAE than control group (131.8±5.7 vs. 114.4±9.1 ms, p<0.001). Multiple linear regression analyses showed that ectatic segment number was an independent factor of PA-TDI duration (β=0.581, 95% CI=4.046-6.295, p<0.001).Conclusion: Our study demonstrated presence of LA electrical and mechanical dysfunction in patients with ICAE. LA dysfunction may be associated with cardiac pathologies as arrhythmias, decrease in cardiac output and congestive failure.
Successful Percutaneous Treatment of Coronary Artery Ectasia with Drug-Eluting Stent  [PDF]
Bhupesh Rajanikant Shah, Ashok S. Thakkar
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.520161
Abstract: Coronary artery ectasia is well-known but relatively uncommon finding with prevalence ranging from 1.2% to 5.3%. Coronary artery ectasia has been associated with atherosclerosis in approximately half of the cases. Here, we are presenting a case of male patient who experienced myocardial infarction and was diagnosed with coronary artery ectasia in proximal-mid junction of left anterior descending artery with stenotic lesion. The patient was successfully treated with percutaneous transluminal coronary angioplasty.
Effect of Prophylactic Low Dose of Methylprednisolone on Postoperative New Atrial Fibrillation and Early Complications in Patients with Severe LV Dysfunction Undergoing Elective Off-Pump Coronary Artery Bypass Surgery  [PDF]
Seyed Jalil Mirhosseini,Seyed Khalil Forouzannia,Ali Hassan Sayegh,Mehdi Sanatkar
Acta Medica Iranica , 2011,
Abstract: Atrial fibrillation (AF) is the most common arrhythmia after cardiothoracic surgery. AF following coronary artery bypass graft (CABG) is associated with an increase in morbidity, mortality, hemodynamic instability, thromboembolic events, severity of heart failure and ICU and hospital stay. Corticosteroids have a variety of beneficial effects on recovery after elective surgery. This study was designed to test the hypothesis that low dose of Methylprednisolone (MP) can affect post-CABG AF and early complications in patients with severe left ventricle dysfunction who underwent elective off-pump coronary artery bypass. A total of 120 patients with LV dysfunction undergoing elective off- pump CABG randomly received either MP or placebo. Diabetic patients and those who were receiving corticosteroids were excluded. The MP group received 5mg/kg of MP intravenously after induction of anesthesia and the placebo group received an equal volume of normal saline. We evaluated Post-CABG variables including incidence, duration and frequency of AF recurrence and early morbidity such as bleeding, infection, vomiting, renal and respiratory dysfunctions, ICU or hospital stay and early mortality. The mean age of patients was 62.11 ± 12.34 years with the 2.4 male to female ratio. AF occurred in 23(19.2%) patients. No significant difference in the incidence of new AF was found between the placebo (21.7%) and MP group (16.7%) (P=0.47). MP did not affect postoperative bleeding, infection, vomiting, renal and respiratory dysfunction and mortality; however, MP significantly reduced ICU and hospital length of stay. MP did not affect the incidence, duration and frequency of AF recurrence in patients with severe LV dysfunction undergoing off-pump CABG. However, MP could reduce ICU and hospital stay significantly in these patients.
Coronary artery disease, left ventricular hypertrophy and diastolic dysfunction are associated with stroke in patients affected by persistent non-valvular atrial fibrillation: a case-control study  [cached]
Pasquale Palmiero,Maria Maiello,Andrea Passantino
Heart International , 2009, DOI: 10.4081/hi.2009.e2
Abstract: Persistent non-valvular atrial fibrillation (NVAF) is associated with an increased risk of cardiovascular events such as stroke, and its rate is expected to rise because of the ageing population. The absolute rate of stroke depends on age and comorbidity. Risk stratification for stroke in patients with NVAF derives from populations enrolled in randomized clinical trials. However, participants in clinical trials are often not representative of the general population. Many stroke risk stratification scores have been used, but they do not include transthoracic echocardiogram (TTE), pulsate wave Doppler (PWD) and tissue Doppler imaging (TDI), simple and non-invasive diagnostic tools. The role of TTE, PWD and TDI findings has not been previously determined. Our study goal was to determine the association between TTE and PWD findings and stroke prevalence in a population of NVAF prone outpatients. Patients were divided into two groups: P for stroke prone and F for stroke free. There were no statistically significant differences between the two groups concerning cardiovascular risk factors, age (p=0.2), sex (p=0.2), smoking (p=0.3), diabetes (p=0.1) and hypercholesterolemia (p=0.2); hypertension was statistically significant (p less than 0.001). There were statistically significant differences concerning coronary artery disease, previous acute myocardial infarction (AMI) (p less than 0.05) and non- AMI coronaropathy (p less than 0.04), a higher rate being in the P group. Concerning echo-Doppler findings, a higher statistically significant rate of left ventricular hypertrophy (LVH) (p less than 0.05) and left ventricular diastolic dysfunction (p less than 0.001) was found in the P group and dilated left atrium (p less than 0.04) in the F group, the difference was not significant for mitral regurgitation (p=0.7). Stroke prone NVAF patients have a higher rate of hypertension, coronary artery disease, with and without AMI, LVH and left ventricular diastolic dysfunction, but not left atrial dilatation. M-B mode echocardiography and PWD examination help to identify high-risk stroke patients among NVAF subjects; therefore, they may help in the selection of appropriate therapy for each patient.
Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis
V Aerra, M Kuduvalli, AN Moloto, AK Srinivasan, AD Grayson, BM Fabri, AY Oo
Journal of Cardiothoracic Surgery , 2006, DOI: 10.1186/1749-8090-1-6
Abstract: We retrospectively analysed 103 consecutive coronary surgery patients under the care of one surgeon between April 2003 and September 2003. These patients received 40 mg of sotalol orally twice daily from the first post-operative day for 6 weeks and 2 g of magnesium intravenously immediately post surgery and on the first post-operative day. We developed a propensity score for the probability of receiving sotalol and magnesium after coronary surgery. 89 patients from the sotalol and magnesium group were successfully matched with 89 unique coronary surgery patients who did not receive either sotalol or magnesium with an identical propensity score.Preoperative characteristics were well matched between groups. There was no significant difference with respect to in-hospital mortality between groups (sotalol and magnesium 1.1% versus control 4.5%; p = 0.17). The incidence of atrial fibrillation in the sotalol and magnesium group was 13.5% compared to 27.0% in the controls (p = 0.025).The combination of sotalol and magnesium can significantly reduce the incidence of post-operative atrial fibrillation following coronary surgery.Atrial Fibrillation is the most common complication following cardiac surgery with a reported incidence between 20% and 40% [1,2]. It usually occurs between the second and fourth post-operative day. However, although this complication occurs frequently, the mechanism behind its development is less understood.Numerous studies have identified and enumerated a variety of risk factors for the development of atrial fibrillation. These include increased age, male gender, history of atrial fibrillation, discontinuation of preoperative βeta-blocker therapy, congestive heart failure, electrolyte depletion (low potassium and magnesium), cardiopulmonary bypass, left atrial dysfunction, severity of coronary artery disease, respiratory disease, and pulmonary vein venting [1-7].In an effort to prevent the occurrence of atrial fibrillation in the post-operative peri
The Level of hs-CRP in Coronary Artery Ectasia and Its Response to Statin and Angiotensin-Converting Enzyme Inhibitor Treatment  [PDF]
Yilmaz Ozbay,Mehmet Akbulut,Mehmet Balin,Hidayet Kayancicek,Adil Baydas,Hasan Korkmaz
Mediators of Inflammation , 2007, DOI: 10.1155/2007/89649
Abstract: Background/Aim. Coronary artery ectasia (CAE) was thought of as a variant of atherosclerosis. C-reactive protein (CRP) which is among the most sensitive markers of systemic inflammation, and elevation of systemic and local levels of this inflammatory marker which has been associated with an increased risk for cardiovascular disease in the obstructive coronary artery disease (O-CAD) are well known, but little was known in CAE. The anti-inflammatory effects of statins and the effect of angiotensin-converting enzyme (ACE) inhibitors on endothelial dysfunction are well established in atherosclerosis. The aim of the present study was to investigate CRP level and its response to statin and ACE inhibitor treatment in CAE. Materials and method. We measured serum hs-CRP level in 40 CAE (26 males, mean age: 56.32±9 years) and 41 O-CAD (34 males, mean age: 57.19±10 years) patients referred for elective coronary angiography at baseline and after 3-month statin and ACE inhibitor treatment. Results. Plasma hs-CRP levels were significantly higher in CAE group than O-CAD group at baseline (2.68±66 mg/L versus 1,64±64, resp., P<.0001). Plasma hs-CRP levels significantly decreased from baseline 3 months later in the CE (from 2.68±0.66 mg/L to 1.2±0.53 mg/L, P<.0001) as well as in the O-CAD group (from 1.64±0.64 mg/L to 1.01±0.56 mg/L, P<.001). Conclusion. We think that hs-CRP measurement may be a good prognostic value in CAE patients as in stenotic ones. Further placebo-controlled studies are needed to evaluate the clinical significance of this decrease in hs-CRP.
Aerobic Interval Training Partly Reverse Contractile Dysfunction and Impaired Ca2+ Handling in Atrial Myocytes from Rats with Post Infarction Heart Failure  [PDF]
Anne Berit Johnsen, Morten H?ydal, Ragnhild R?sbj?rgen, Tomas St?len, Ulrik Wisl?ff
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0066288
Abstract: Background There is limited knowledge about atrial myocyte Ca2+ handling in the failing hearts. The aim of this study was to examine atrial myocyte contractile function and Ca2+ handling in rats with post-infarction heart failure (HF) and to examine whether aerobic interval training could reverse a potential dysfunction. Methods and results Post-infarction HF was induced in Sprague Dawley rats by ligation of the left descending coronary artery. Atrial myocyte shortening was depressed (p<0.01) and time to relaxation was prolonged (p<0.01) in sedentary HF-rats compared to healthy controls. This was associated with decreased Ca2+ amplitude, decreased SR Ca2+ content, and slower Ca2+ transient decay. Atrial myocytes from HF-rats had reduced sarcoplasmic reticulum Ca2+ ATPase activity, increased Na+/Ca2+-exchanger activity and increased diastolic Ca2+ leak through ryanodine receptors. High intensity aerobic interval training in HF-rats restored atrial myocyte contractile function and reversed changes in atrial Ca2+ handling in HF. Conclusion Post infarction HF in rats causes profound impairment in atrial myocyte contractile function and Ca2+ handling. The observed dysfunction in atrial myocytes was partly reversed after aerobic interval training.
Coronary Collateral Circulation in Patients of Coronary Ectasia with Significant Coronary Artery Disease  [PDF]
Po-Chao Hsu, Ho-Ming Su, Hsiang-Chun Lee, Suh-Hang Juo, Tsung-Hsien Lin, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087001
Abstract: Objectives Patients with coronary ectasia (CE) usually have coexisting coronary stenosis resulting in myoischemia. Coronary collateral plays an important role in protecting myocardium from ischemia and reducing cardiovascular events. However, limited studies investigate the role of CE in coronary collaterals development. Methods We evaluated 1020 consecutive patients undergoing coronary angiography and 552 patients with significant coronary artery disease (SCAD), defined as diameter stenosis more than 70%, were finally analyzed. CE is defined as the ectatic diameter 1.5 times larger than adjacent reference segment. Rentrop collateral score was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group. Results 73 patients (13.2%) had CE lesions which were most located in the right coronary artery (53.4%). Patients with CE had a lower incidence of diabetes (43.8% vs 30.1%, p = 0.03), higher body mass index (25.4±3.5 vs 26.7±4.6, p = 0.027) and poorer coronary collateral (58.2% vs 71.2%, p = 0.040). Patients with poor collateral (n = 331) had a higher incidence of CE (15.7% vs 9.5%, p = 0.040) and fewer diseased vessels numbers (1.96±0.84 vs 2.48±0.69, p<0.001). Multivariate analysis showed diabetes (odd ratio (OR) 0.630, p = 0.026), CE (OR = 0.544, p = 0.048), and number of diseased vessels (OR = 2.488, p<0.001) were significant predictors of coronary collaterals development. Conclusion The presence of CE was associated with poorer coronary collateral development in patients with SCAD.
Three Vessel Coronary Cameral Fistulae Associated with New Onset Atrial Fibrillation and Angina Pectoris  [PDF]
Murat Yuksel,Abdulkadir Yildiz,Mustafa Oylumlu,Nihat Polat,Halit Acet,Necdet Ozaydogdu
Case Reports in Vascular Medicine , 2014, DOI: 10.1155/2014/475325
Abstract: Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient’s symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement. 1. Introduction Coronary cameral fistulas (CCFs) are abnormal communications between a coronary artery and a heart chamber which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography [1]. The patients are usually asymptomatic so these fistulas are detected incidentally during coronary angiography most of the time. However, if fistulas are widespread, they may cause exertional angina due to coronary steal phenomenon concomitant with left ventricular volume overload and left atrial enlargement. All three major coronary arteries are even less frequently involved in fistula formation. 2. Case Report A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Physical examination was unremarkable except for irregular beats. Standard 12-lead electrocardiogram (ECG) revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations (Figure 1). The patient underwent transthoracic echocardiography (TTE) for the investigation of
Atrial Myxoma with a Dual Coronary Artery Supply  [PDF]
Massar Omar, Jesper Eske Sindby, Asta Blaskauskaite, Tomas Zaremba, Svend Eggert Jensen
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.86034
Abstract: Primary cardiac tumours are rare, with myxoma being the most common benign heart tumour. The prevalence of coronary disease or neovascular in patients with atrial myxomas is high, yet angiography is not routinely performed. Echocardiography is preferred for evaluation of myxoma, where coronary angiography clarifies the vascular supply of the tumour and may alter the surgical planning. We here report an interesting and rare case of a left atrial myxoma hyper vascularised by two anomalous arteries, from right coronary artery and circumflex artery demonstrated by preoperative coronary angiography. The mass was successfully excised and the diagnosis of cardiac myxoma was confirmed via histopathology. A review of the value of coronary angiography in detecting myxoma neovascularization is provided. Offering additional valuable information, coronary angiography can alter the surgical approach and may therefore be considered prior to myxoma resection.
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