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The Value of Exercise Treadmill Test in Evaluation of Coronary Artery Disease
Lili Mao,Xueqi Li,Lihua Zhong and Shipeng Wei
Russian Open Medical Journal , 2012,
Abstract: Objective: To evaluate the value of Exercise treadmill test (ETT) in the diagnosis of coronary artery disease (CAD). Methods: Here we reviewed 142 (men, 104, mean age, 52.7±8.6) consecutive patients admitted to the 4th Clinical Hospital of Harbin Medical University for suspicion of CAD and they underwent ETT before coronary angiography (CAG). Patients were divided into four groups to see the sensitivity of different ETT criteria: group I: ETT negative, group II: ETT positive (ST-segment depression ≥0.1mv for more than 2 minutes), group III: ETT positive (exercise induced chest pain), group IV: ETT positive (exercise induced chest pain and ST-segment depression). The severity of coronary artery stenosis was assessed by CAG, only those with >50% of narrowing in at least one of the three major arteries or their first-order branches was considered CAG positive. Results: The false negative rate was 30.6% and the accuracy rate was 69.4% in group I. In group II, III and IV, the accuracy rates and false positive rates were 53.7% and 46.3%, 78.6% and 21.4%, 86.7% and 13.3%, respectively, (p<0.05). Furthermore, we analyzed the data of male patients in each group and the accuracy rates were 67.9%, 60.7%, 76.9%, 100%, respectively, (p<0.05). Multivariate logistic regression results showed that ST-segment depression together with exercise induced chest pain were the most related factors in CAD diagnosis. Conclusion: ST-segment depression and exercise induced chest pain are the strongest factors in CAD diagnosis. Chest pain combined with ST-segment depression had a much higher accuracy rate than ST-segment depression alone.
Spontaneous coronary artery dissection: complete angiographic resolution without stenting
Abraham Pfeferman,Marco Aurelio Magalh?es,Fábio Sandoli Brito Júnior,César Nomura
Einstein (S?o Paulo) , 2007,
Abstract: A case of spontaneous coronary artery dissection in a 49-year-oldwoman is presented. She did not present the classical cardiovascular riskfactors. Etiology and treatment are discussed. She underwent primarypercutaneous coronary intervention of the left anterior descendingartery with no stenting and had complete angiographic resolution.
An Unusual Case of Dual Left Anterior Descending Artery with Coronary Computed Tomographic Angiographic Correlation  [PDF]
Kyle M. Moulton,Greg Kraushaar,Derek A. Fladeland
Case Reports in Radiology , 2013, DOI: 10.1155/2013/348624
Abstract: Dual left anterior descending artery (LAD) is a rare coronary anomaly that is important to recognize at coronary imaging as it may influence reperfusion strategies. Four types of dual LAD are described by the traditional literature. We present a novel case of dual LAD with coronary computed tomographic angiographic correlation that does not fit into this classification system. Rather, our case supports the recently proposed notion of adding a fifth variant to the traditional dual LAD classification system. 1. Introduction Dual left anterior descending artery (LAD) is an extremely rare coronary anomaly traditionally classified into one of four types. Recognition at coronary imaging is critical as both surgical and percutaneous reperfusion strategies may be altered by its presence [1]. 2. Case Presentation A 37-year-old Caucasian male presented with a 1-year history of atypical left-sided chest discomfort. Past medical history was negative for major cardiac risk factors but positive for borderline diabetes, increased body mass index, and gastroesophageal reflux. Physical exam was unremarkable. EKG demonstrated a left anterior fascicular block. Biochemical markers of cardiac ischemia were negative. Single photon emission computed tomography stress myocardial perfusion imaging (SPECT-MPI) revealed a heterogeneous inferolateral and apical myocardial perfusion defect with partial reversibility. Conventional coronary angiography identified an aberrant left anterior descending artery (LAD) originating from the right coronary cusp without evidence of atherosclerosis. To further characterize the anatomy of this aberrant artery, coronary computed tomography angiography (CTA) was performed. CTA revealed a novel case of dual LAD. The long LAD segment arises from a common coronary ostium on the right coronary cusp. It takes an aberrant course posterior to the right ventricular outflow tract. The long LAD has a hammock-like downward slope that closely resembles, on coronal imaging, the hammock sign described on conventional angiography [2]. The long LAD descends inferiorly from its origin and enters the superior aspect of the interventricular (IV) septum where it provides a small septal perforator. It reemerges in the epicardium of the IV groove distal to the pulmonary trunk to give off a diagonal branch. The septal course of the aberrant long LAD presumably mitigates against the risk of sudden cardiac death associated with a malignant interarterial LAD [3]. The short LAD segment originates at the left coronary cusp, gives off a diagonal branch, and terminates high in
Systemic Correlates of Angiographic Coronary Artery Disease  [PDF]
José Pedro L. Nunes, Jo?o Carlos Silva
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0004322
Abstract: Coronary angiography allows a direct evaluation of coronary anatomy. The aim of the present investigation was to search for correlations between the magnitude of coronary artery disease, as assessed by angiography, and a number of systemic parameters. A group of 116 patients (80 male, 36 female) with coronary heart disease diagnosed by angiography, aged 62.0±10.5 years, was the subject of an observational study. Correlation and linear regression analysis using coronary artery disease burden (CADB - sum of the percentage of the luminal stenosis encountered in all the lesions of the coronary arterial trees) as dependent variable, and age, sex, plasma calcium, phosphorus, magnesium, glucose, HDL cholesterol, LDL cholesterol, triglycerides, uric acid, estimated glomerular filtration rate and body mass index as independent variables, were carried out. Significant correlation values versus CADB were seen with age (r 0.19, p 0.04), uric acid (r 0.18, p 0.048) and fasting plasma glucose (r 0.33, p<0.001). Linear regression analysis, yielding a global significance level of 0.002, showed a significant value for glucose (p 0.018) and for sex (0.008). In conclusion, among several systemic parameters studied, plasma glucose was found to be correlated to coronary artery atherosclerosis lesions.
Angiographic Studies of Coronary Artery Disease in Dhulikhel Hospital  [PDF]
R Koju,S Humagain
Nepalese Heart Journal , 2012, DOI: 10.3126/njh.v9i1.8348
Abstract: Background Coronary Artery Diseases (CAD), one of the the leading causes of death, is increasing globally. The number of CAD is also increasing in Nepal. Dhulikhel Hospital is also providing cardiovascular services to populations from semiurban and rural population of mid region of country. It started coronary angiography services from April 2012. This paper aims to analyze pattern of coronary artery occlusion in patients undergoing coronary angiography during April to September months of 2012. Methods There were a total of 36 cases of diagnostic angiography and coronary interventions done in Dhulikhel Hospital from April to September 2012. Among them 32 cases of coronary angiography done for Acute Coronary Syndrome and Stable Angina, were analyzed using SPSS 17. Results Males were higher in number than females and majority of the patients were above 55 years. Out of 32 cases, 13 (40.6%) had Acute Coronary Syndrome (ACS) and 19(59.4%) had Stable Angina. Six out of 32 were found to have normal coronaries. One patient with ACS had normal coronary. Out of all the patients with coronary stenosis, four had left main disease, 14 had LAD stenosis, 7 had LCX stenosis and 12 patients had RCA stenosis. Thirteen had severe coronary stenosis. Nine out of 12 ACS patients had more than one coronary artery involved, which is significantly higher than the stable angina group ( P<0.01 ). Severe stenosis was found to be more common in ACS group ( p<0.001 ) when compared to the stable angina group. Conclusion Coronary angiography is a useful diagnostic and therapeutic tool for CAD. Coronary status is significantly different in ACS and stable angina. ACS has more chance of having multivessel stenosis whereas stable angina has single vessel, less severe or normal coronaries. Severity of stenosis is also high in ACS than in stable angina. DOI: http://dx.doi.org/10.3126/njh.v9i1.8348 Nepalese Heart Journal Vol.9(1) 2012 pp.43-46
Late angiographic evaluation of radial artery grafts used in surgical myocardial revascularization
Alves, Siderval Ferreira;Albuquerque, Dolores Cristina M.;Pelloso, Eraldo Antonio;Silveira, Wesley Ferraz;Labrunie, Andre;Barros, Christiano Roberto;Barros, Rubens T.;Penna, Antonio C.;
Revista Brasileira de Cirurgia Cardiovascular , 2003, DOI: 10.1590/S0102-76382003000100008
Abstract: objective: to evaluate the late patency of the radial artery used as a conduit in coronary artery bypass grafting through a selective catheterization. method:a group of 109 patients operated on for coronary artery bypass grafting used radial artery as grafts, from september 1995 to october 1996, were re-studied in the immediate post-operative period. among these patients, 91 (83.5%) were contacted either by phone or through outpatient follow-ups, and 34 underwent a late angiographic study. twenty-two patients were male (65%). the average age of the patients was 57.4 years old (37-70). the average time of the restudy was of 51.2 months (41-63). thirty-eight distal anastomoses were performed using the radial artery, with an average of 1.12 distal anastomoses per patient. the analysis of these data is the basis for the present study. results: the radial artery was patent in 30 patients (34 distal anastomoses - 89.5%), and had a lesion in only one patient along with the proximal anastomosis in the aorta. out of the four patients who presented total graft obstruction, two were male. we observed inadequate indications in two patients, and no justifiable occlusions in the others. from the 91 re-studied patients in the immediate post-operative period, there was late mortality in 6 patients (6.6%), one adenocarcinoma of the lung, and the others by cardiac causes. the only patient who presented a lesion at the radial artery underwent angioplasty with a stent implantation and had a satisfactory outcome. conclusions: the radial artery, used as a conduit for coronary artery bypass grafting, shows satisfactory angiographic aspects and also a satisfactory patency, similar to those of the left internal thoracic artery, when evaluated in this time of follow-up.
Late angiographic evaluation of radial artery grafts used in surgical myocardial revascularization
Alves Siderval Ferreira,Albuquerque Dolores Cristina M.,Pelloso Eraldo Antonio,Silveira Wesley Ferraz
Revista Brasileira de Cirurgia Cardiovascular , 2003,
Abstract: OBJECTIVE: To evaluate the late patency of the radial artery used as a conduit in coronary artery bypass grafting through a selective catheterization. METHOD:A group of 109 patients operated on for coronary artery bypass grafting used radial artery as grafts, from September 1995 to October 1996, were re-studied in the immediate post-operative period. Among these patients, 91 (83.5%) were contacted either by phone or through outpatient follow-ups, and 34 underwent a late angiographic study. Twenty-two patients were male (65%). The average age of the patients was 57.4 years old (37-70). The average time of the restudy was of 51.2 months (41-63). Thirty-eight distal anastomoses were performed using the radial artery, with an average of 1.12 distal anastomoses per patient. The analysis of these data is the basis for the present study. RESULTS: The radial artery was patent in 30 patients (34 distal anastomoses - 89.5%), and had a lesion in only one patient along with the proximal anastomosis in the aorta. Out of the four patients who presented total graft obstruction, two were male. We observed inadequate indications in two patients, and no justifiable occlusions in the others. From the 91 re-studied patients in the immediate post-operative period, there was late mortality in 6 patients (6.6%), one adenocarcinoma of the lung, and the others by cardiac causes. The only patient who presented a lesion at the radial artery underwent angioplasty with a stent implantation and had a satisfactory outcome. CONCLUSIONS: The radial artery, used as a conduit for coronary artery bypass grafting, shows satisfactory angiographic aspects and also a satisfactory patency, similar to those of the left internal thoracic artery, when evaluated in this time of follow-up.
Renal artery stenosis in patients with coronary artery disease: the prevalence and risk factors, an angiographic study
Edalati fard M,Khatami SMR,Sadeghian S,Salari far M
Tehran University Medical Journal , 2010,
Abstract: "nBackground: The relationship between Coronary Artery Disease (CAD) and the prevalence of Renal Artery Stenosis (RAS) has been demonstrated. Despite high incidence of heart diseases and high frequency of CAD risk factors among Iranian population, this relation has not been clearly determined. This study estimated the prevalence of RAS and its determinants in Iranian angiographic candidates. We also tried to find which risk factors of atherosclerosis are associated more frequently with renal artery stenosis."n "nMethods: In a cross-sectional study that was performed at the Tehran Heart Center, in Tehran, Iran, 146 patients who were candidate for angiography with suspected CAD were consecutively included. Selective renal angiography was performed following coronary angiography in all patients with established coronary artery stenosis and the presence and severity of RAS was evaluated."n "nResults: Prevalence of RAS in study patients was 25.3% (men, 13.7% and women 47.1%, (p<0.001). We found that only 6.2% of the patients had bilateral R.A.S. Also, RAS≥50% was found in 17.1% of patients. Regarding number of defected coronary vessels, two- and three-vessel diseases were found in 30.0% and 39.0% of participants, respectively. No significant relationship was found between the number of involved coronaries and the severity as well as side of RAS (p=0.716) Significant multivariate predictors of RAS were female gender (p=0.001), advanced age, (p=0.046) duration of hypertension (p=0.032) and baseline serum creatinine concentration (p=0.018). "n "nConclusions: Routine angiographic assessment of renal arteries following coronary angiography is recommended especially in women as well as those with long-term duration of hypertension or renal dysfunction.
Comparison of exercise electrocardiography and stress perfusion CMR for the detection of coronary artery disease in women
Simon Greulich, Oliver Bruder, Michele Parker, Julia Schumm, Stefan Grün, Steffen Schneider, Igor Klem, Udo Sechtem, Heiko Mahrholdt
Journal of Cardiovascular Magnetic Resonance , 2012, DOI: 10.1186/1532-429x-14-36
Abstract: We prospectively enrolled 88 consecutive women with chest pain or other symptoms suggestive of CAD. Patients underwent a comprehensive clinical evaluation, exercise ECG, a CMR stress test including perfusion and infarct imaging, and x-ray coronary angiography (CA) within 24 hours. CAD was defined as stenosis ≥70% on quantitative analysis of CA.Exercise ECG, CMR and CA was completed in 68 females (age 66.4?±?8.8?years, number of CAD risk factors 3.5?±?1.4). The prevalence of CAD on CA was 29%. The Duke treadmill score (DTS) in the entire group was ?3.0?±?5.4 and was similar in those with and without CAD (?4.5?±?5.8 and ?2.4?±?5.1; P?=?0.12). Sensitivity, specificity and accuracy for CAD diagnosis was higher for CMR compared with exercise ECG (sensitivities 85% and 50%, P?=?0.02, specificities 94% and 73%, P?=?0.01, and accuracies 91% and 66%, P?=?0.0007, respectively). Even after applying the DTS the accuracy of CMR was higher compared to exercise ECG (area under ROC curve 0.94?±?0.03 vs 0.56?±?0.07; P?=?0.0001).In women with intermediate-to-high risk for CAD who are able to exercise and have interpretable resting ECG, CMR stress perfusion imaging has higher accuracy for the detection of relevant obstruction of the epicardial coronaries when directly compared to exercise ECG.
Coronary artery dissection and acute myocardial infarction following blunt chest trauma
Johannes L Bj?rnstad, Johan Pillgram-Larsen, Theis T?nnessen
World Journal of Emergency Surgery , 2009, DOI: 10.1186/1749-7922-4-14
Abstract: Blunt chest trauma might lead to cardiac injury ranging from simple arrhythmias to lethal conditions such as cardiac rupture. Acute myocardial infarction (AMI) may be induced by blunt chest trauma [1-3]. We experienced a case of coronary artery dissection with subsequent myocardial infarction from blunt chest trauma. We will give an overview of relevant literature regarding this topic.Parmley reported on 546 autopsy cases of blunt heart injury, and there were nine cases of coronary artery rupture and one case of intimal laceration [4]. None of the cases, however, showed signs of coronary artery occlusion. AMI as a result of coronary artery dissection has been considered rare [3], however coronary artery dissection from blunt trauma has been more frequently described recently [5-15]. This might indicate that this condition previously has been underdiagnosed or is increasing in incidence. The left anterior descending coronary artery (LAD) is the vessel most often affected, and road traffic accidents are the usual cause of traumatic myocardial infarction [3,16]. This susceptibility is attributable to the LAD's anatomic relation to the anterior chest wall allowing both direct trauma and deceleration as possible mechanisms of trauma [16]. In our case the patient suffered blunt chest trauma as his car collided with a moose. He experienced dissection of the middle part of the LAD (Figure 1). Both coronary artery dissection, intimal tear, plaque rupture or epicardial hematoma might lead to AMI after blunt trauma. However, in 12 published cases of traumatic AMI the coronary angiograms were completely normal [3]. Spasm or lysis of a thrombus might explain AMI in these cases. It should be noted that AMI also has been reported after mild trauma [13,17,18].In traumatic AMI, the diagnosis might be masked by chest pain originating from other thoracic injuries. ECG may be normal [18], but usually demonstrates abnormalities [15,16,19]. Our patient presented with right bundle branch
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