scholarly journals Subclinical Hypothyroidism with TSH>7 mIU/l and≤10 mIU/l and Coronary Artery Disease

2020 ◽  
Vol 52 (02) ◽  
pp. 85-88
Author(s):  
Pedro Weslley Souza Rosário ◽  
Maria Regina Calsolari
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Subclinical Hypothyroidism ◽  
Calcium Score ◽  
Thyroid Stimulating Hormone ◽  
Group A ◽  
Artery Disease ◽  
Group B ◽  
Low Cardiovascular Risk

AbstractThe association of subclinical hypothyroidism (SCH) with increased cardiovascular risk is controversial when thyroid-stimulating hormone (TSH) concentration is<10 mIU/l, as well as its association with a higher coronary artery calcium score (CACS) in individuals with low cardiovascular risk. This study evaluated coronary artery disease (CAD) by CACS in asymptomatic, low-cardiovascular risk women with SCH and TSH>7 mIU/l and≤10 mIU/l untreated for 5 years after diagnosis. The CACS was obtained for two groups of women with low cardiovascular risk. Group A consisted of 32 women with mild SCH (TSH>7 mIU/l and≤10 mIU/l) who remained untreated for 5 years, and group B consisted of 32 euthyroid women matched for age and body mass index to group A. The CACS ranged from 0 to 350 (median 0, 25–75% interval: 0–10) in group A and from 0 to 280 (median 0, 25–75% interval: 0–0) in group B. Scores>0 and≥10 were significantly more frequent in group A (40.6 vs. 12.5% and 25 vs. 3.1%, respectively). A CACS≥100 was also more frequent in group A (18.75 vs. 3.1%), but the difference was not significant (p=0.1). The results of the study suggest that long-term SCH with TSH>7 mIU/l and ≤ 10 mIU/l is associated with a higher risk of CAD in individuals≤65 years, even in those with low cardiovascular risk.

scholarly journals Exercise treadmill tests in patients with low cardiovascular risk: are we wasting our time?

2016 ◽  
Vol 8 (3) ◽  
pp. 250
Author(s):  
Sarah Dixon ◽  
Judy Searle ◽  
Rachel Forrest ◽  
Bob Marshall
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Risk Group ◽  
Pain Clinic ◽  
Treadmill Testing ◽  
Exercise Treadmill ◽  
Exercise Treadmill Testing ◽  
Artery Disease ◽  
Low Cardiovascular Risk

ABSTRACT INTRODUCTION The efficacy and cost-effectiveness of exercise treadmill testing for patients with low cardiovascular risk is unclear. This is due to the low incidence of coronary artery disease in this population and the potential for false-positive results leading to additional invasive and expensive investigation. AIM To investigate the value of exercise treadmill testing (ETT) as a predictor of coronary artery disease in patients with different levels of cardiovascular risk. METHODS An observational study was completed on an outpatient population from a chest pain clinic (n = 529). Cross-tabulations and binary logistic regressions were used to examine relationships between variables. RESULTS A negative ETT result was recorded for 72.5% of patients with low cardiovascular risk compared to 54.3% of those with moderate or high risk. Within the low cardiovascular risk group, patients with symptoms atypical for cardiac ischaemia were 11.1-fold more likely to have a negative ETT result. Of the patients with positive or equivocal ETT results, coronary artery disease was subsequently confirmed in only 23.1% of the low cardiovascular risk group compared to 77.2% of those with moderate or high cardiovascular risk. DISCUSSION Results show low cardiovascular risk patients are significantly more likely to return negative ETT results, particularly when associated with atypical symptoms. Similarly, positive or equivocal ETTs in this group are significantly more likely to be false positives. This suggests the ETT is not efficacious in predicting coronary artery disease in patients with low cardiovascular risk. Is it therefore appropriate to offer exercise testing to this cohort or should alternative management strategies be considered?

scholarly journals Relationship between Hemoglobin A1c Level and Severity of Coronary Artery Disease Among The Hospitalized Patients with Acute Coronary Syndrome

2018 ◽  
Vol 33 (2) ◽  
pp. 80-84
Author(s):  
Syed Dawood Md Taimur ◽  
Sahela Nasrin ◽  
M Maksumul Haq ◽  
MA Rashid ◽  
Hemanta I Gomes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hemoglobin A1c ◽  
Diabetic Patients ◽  
Age Group ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Group A ◽  
Artery Disease ◽  
Group B

Background : Diabetes mellitus is one of the important risk factors for coronary artery disease. The hemoglobin A1c is used for evaluating glycemic control in diabetic patients. Here, we conducted the study to evaluate the relationship between HbA1c level and severity of coronary artery disease among the hospitalized patients with ACS. Materials & Methods : This cross sectional study was conducted in the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from September 2015 to December 2015. Total of one hundred patients were studied and they were grouped on the basis of their glycaemic status. One hundred patients with acute coronary syndrome were enrolled in this study. Out of them fifty were diabetic (HbA1c>6.5%) and rest of were nondiabetics (HbA1c<6.5%) ( group-A and B). Results: Out of one hundred patients fifty eight were male and fourty two were female. Mean age of patients in group-A was 58.54±10.22 years and mean age of patients in group-B was 54.52±13.69 years. Mean age of male and female was 57.72±11.48 years and 54.0±13.08 years respectively. Mean HbA1c of patients in group-A was 11.43±1.43% and group-B was 6.34±0.915%. 38% of group-A and 22% of group-B had triple vessel disease, 26% of group-A and 20% of group- B had double vessel disease and 28% of group-A and 18% of group-B had single vessel disease, and 8% of group-A and 40% of group-B had normal coronary arteries. 48% patients of age group 46-50 in group-A had more incidence in coronary artery disease than other age group which was statistically significant ( p=0.035). 61-75 years age group in group-B patients had coronary artery disease than other age groups which was statistically not significant(p=0.084). Patients of group-A was significantly relation with coronary artery disease (p>.001) and six times greater coronary artery disease than patients of group-B (OR= 6.15, 95% CI for OR =2.074 -18.289). Conclusions: In this way the importance of appropriate glycaemic control has been emphasized in diabetic patients. This study showed the relation between HbA1c levels and the severity of CAD in patient with type-II diabetes mellitus .Our findings demonstrate that elevated HbA1c level was risk factor for severity of coronary artery disease in ACS patients. Bangladesh Heart Journal 2018; 33(2) : 80-84

scholarly journals Intra-Femoral Sheath Time: Does it Increase a Patient's Risk for Developing a Hematoma?

2013 ◽  
Author(s):  
Colleen Planchon
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Femoral Artery ◽  
Percutaneous Coronary Interventions ◽  
Medication Therapy ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
Group A ◽  
Artery Disease ◽  
Group B

Despite advancements in technology and medication therapy, coronary artery disease continues to remain the number one cause of death. Treatment for coronary artery disease requires life style modifications, medication therapy, percutaneous coronary interventions, and sometimes coronary artery bypass surgery. Though percutaneous coronary interventions are considered safe and are commonly occurring procedures, there are still risks for complications. One of the most frequently occurring complications is hematoma of the femoral artery site. The purpose of this study was to determine if there was an increased incidence of hematomas in individuals undergoing percutaneous coronary intervention with associated sheath times of less than five hours (Group A) as compared to sheath time of greater than five hours (Group B). The study used a retrospective, two group design and was conducted at a tertiary care center that performs over 1500 PCI’s annually. Inclusion criteria included adults over the age of 18 who were hemodynamically stable, had no known bleeding disorders, and were punctured once at the femoral artery to perform the percutaneous intervention. Two hundred fifty medical records were reviewed utilizing a data collection tool designed by the researcher. Total sample size was 55, 21 in Group A and 34 in Group B. Six hematomas were documented as occurring, but were not reportable based on the ACC definition. Hematomas were documented in the medical record using the terms “small”, “medium,” and “large” versus an objective measurement. No hematomas were identified using the ACC definition, which was the measurement standard for this research hospital. Sheath times in Group A averaged 4.02 hours, and group B 7.42 hours. There was a higher incidence of descriptive hematoma that did not meet the criteria of this study in Group B. Results call for recommendations of on-going documentation of post procedure hematomas using a standardized, reliable, and valid measuring tool. APRN’s can be instrumental in implementing change in patient care , hospital policy and on the national level by assuring that hematomas are accurately and consistently documented. Further research is indicated related to sheath times and potential associated negative outcomes.

Performance of coronary calcium score and epicardial fat volume in early diagnostic of coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Agoston Coldea ◽  
A Zlibut ◽  
C Cionca ◽  
I Muresan ◽  
D Horvat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Calcium Score ◽  
Coronary Calcium ◽  
Coronary Calcium Score ◽  
Epicardial Fat Volume ◽  
Artery Disease ◽  
Fat Volume

Abstract Background Coronary artery disease (CAD) remains a world leading cause of death, despite the development of traditional risk scores based on the quantification of cardiovascular risk factors. Coronary calcium score (CCS) determined by cardiac computed tomography (CCT) is a noninvasive tool with major implications in early diagnosis and in outcome prediction in CAD patients. Epicardial fat volume (EFV) is a recently described CCT-based diagnostic and prognostic tool of CAD and outcome. Purpose This study sought to investigate the performance of coronary calcium score and EFV in early diagnosing CAD. Methods We conducted a prospective, single-center, cross-sectional study on patients suspected of CAD. All patients were submitted to detailed clinical data, 12-lead electrocardiogram, estimating pretest probability, stress test, echocardiography, CCT imaging. In the study subjects was assessed CCS, EFV and the number of calcified plaques (NoP). The total CCS load was then ranked in the following scoring groups: 0 (no evidence of coronary calcium; reference group), 1–99 (minimal to mild), 100–399 (moderate), and 400–999 (extensive) and ≥1000 (very extensive). The subjects in the study were classified according to the NoP derived from their CCS scans (no plaques, 1–5, 6–10 and more than 10 calcified plaques). CAD was defined as coronary stenosis over 50% of the vessel. Results Among 540 patients (55.8±11.2 years of age; 52% women) met the enrollment criteria, 98 patients presented CAD. Spearman correlation analysis revealed strong correlations between EFV index and CCS (r=0.45; p&lt;0.0001) and between EFV index and NoP (r=0.44; p&lt;0.0001), after adjustment for age, sex, body mass index, hypertension, diabetes and low-density lipoprotein cholesterol. The area under the curve of the receiver-operator curve for CAD prediction by CCS &gt;70.3 UH (cut-off value) was significantly higher (AUC=0.927; p&lt;0.0001) by comparison with EFV index &gt;40.8 ml/m2 (AUC=0.816; p&lt;0.0001) and NoP &gt;4 (AUC=0.928; p&lt;0.0001). The association of all three parameter, CCS, EFV and NoP, increases the prediction power of CAD, providing an AUC of 0.969 with a 0.70 sensibility and 0.95 specificity. Conclusion The combined use of EPV, CCS and NoP has a very high predictive capacity for CAD, regardless of the classic cardiovascular risk factors. This increases the diagnostic capacity of CAD beyond every parameter used alone. Funding Acknowledgement Type of funding source: None

scholarly journals Effect of Body Mass Index on Morbidity and Mortality in Patients Undergoing Coronary Artery Bypass Grafting

2019 ◽  
Vol 1 (2) ◽  
pp. 69-74
Author(s):  
Mohamed Shawky ◽  
Yousry Elsaied Rizk ◽  
Mohammed Mohammed Mohammed Saffan ◽  
Ashraf Mostafa Elnahas Wahdan ◽  
Mohamed Ahmed Gouda Elgazzar
Keyword(s):  
Coronary Artery Disease ◽  
Body Mass Index ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Morbidity And Mortality ◽  
Bypass Grafting ◽  
Group A ◽  
Artery Disease ◽  
Group B

Background: Obesity affects cardiovascular morbidity and mortality, and it increases the risk of coronary artery disease. Despite that, several cardiac surgery risk stratification scores do not consider the effect of obesity on the outcomes. The objective of this research is to study the impact of body mass index (BMI) on morbidity and mortality after coronary artery bypass grafting (CABG) in Egyptian patients. Methods: This prospective cohort study included 200 patients who underwent CABG for atherosclerotic coronary artery disease. Patients were divided into two groups, group A: patients with BMI ≥ 25 Kg/m2 and group B: patients with BMI < 25 Kg/m2. The mean age in group A was 56± 4.95 years vs. 54± 5.5 years in group B (p= 0.102). Male patients presented 58% of the population in group A vs 74% in group B (p= 0.017). 60% of patients were hypertensive in group A compared to 63% in group B (p= 0.66) and 62%, and 48% were diabetics in group A and B respectively (p= 0.04). Results: Postoperatively, there was a significant increase in wound infection (40% vs 8%; p< 0.001), chest infection (47% vs. 10% p< 0.001), surgical re-exploration (28% vs. 1%; p< 0.001), prolonged ICU stays (5.3 ± 2.88 vs. 3.93 ± 1.71 days; p< 0.001), ward stay (11.28 ±8.9 vs. 5.48 ± 2.45 days; p< 0.001), mediastinitis (34% vs. 6%; p< 0.001), the occurrence of sternal wound sinus within 8 months (26% vs. 7%; p< 0.001), in group A more compared to group B. There was no difference in ejection fraction (54.2 ±7.38 vs. 54.7 ± 9.1%; p= 0.69) and mortality (4% vs. 2%; p= 0.68) between groups. Conclusions: BMI 25 Kg/m2 or higher is associated with increased infectious complications and prolonged stay after CABG; however, it did not affect mortality. Optimizing body weight is recommended before elective surgery.

scholarly journals Complete Revascularisation is associated with Improved Survival after Out of Hospital Cardiac Arrest

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Kanyal ◽  
N Pareek ◽  
D Sarma ◽  
A Bharucha ◽  
R Dworakowski ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Final Analysis ◽  
Syntax Score ◽  
Group A ◽  
Artery Disease ◽  
Complete Revascularisation ◽  
Group B ◽  
Hospital Cardiac Arrest

Abstract Introduction Coronary artery disease (CAD) is common in patients with Out of Hospital Cardiac Arrest (OOHCA) but the clinical relevance of burden of CAD and evidence for revascularisation strategies in relation to outcomes and modes of death remains unclear. Purpose This study sought to assess the extent of CAD as defined by the SYNTAX score and prognostic value of complete compared with incomplete revascularisation by evaluating the SYNTAX revascularisation index (SRI) in patients with OOHCA. Methods 619 patients with OOHCA were admitted at our centre between 1st May 2012 and 31st December 2017. 237 were excluded for having a non-cardiac aetiology or prior neurological disability. 398 patients were included into the study and of these 272 (68.3%) had early coronary angiography (CAG) and were included in the final analysis. The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from the coronary angiograms by a cardiologist blinded to the outcome. Patients were subdivided into 4 subgroups according to quartiles of the baseline syntax score (bSS) of 0, Group A: 1–10, Group B: 11–20 and Group C: ≥21. Complete revascularisation (CR) was defined as SRI of 1 and incomplete (IR) as SRI &lt;1 where the SRI=(1-[rSS/bSS]) ×100 (Figure 1). Results Patients with a bSS of 0 were younger, had less shockable initial arrest rhythms and worse lactate and pH on arrival.Patients with bSS&gt;0 (i.e., those with coronary artery disease) had similar cardiac arrest circumstances in terms of rates of witnessed, bystander CPR and shockable rhythms. Admission metabolic status reflected by pH and lactate and rates of ST elevation/LBBB were also identical for all three groups. However, LVEF on admission decreased significantly as coronary complexity increased (P&lt;0.0001). While early angiography was more preferentially performed in those with higher coronary complexity, paradoxically, those with bSS 1–4 had highest rates of culprit lesions which was reflected in higher rates of PCI (Figure 1). 124 (45.4%) had CR compared with 54.2% with IR. CR was most likely to be achieved as the coronary complexity reduced (Group A – 71.7%, Group B – 41.1%, Group C - 23.3%). There was no difference in rates of cardiogenic shock between both groups (CR 61.1% vs. IR 69% p=ns), but patients with complete revascularisation were younger (58.8 vs 67.8, p&lt;0.0001), lower rates of hypertension and previous CABG (16.2% vs 3.2%, p≤0.0001) CR was associated with decreased mortality at 30 days (45.9% vs 34.6%, p=0.046) and 12 months (49.3% vs 35.4%, p=0.022). The lower mortality rate in CR appeared to partly be driven by lower cardiac deaths though this was not statistically significant (22% vs 7%, p=0.1) (Figure 2). Conclusions CR in a primary coronary aetiology OOHCA group is associated with reduced early and long-term mortality, which may be driven by a reduction in cardiac deaths. Prospective randomised trials in this population are warranted. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals STUDY OF PLATELET VOLUME INDICES IN PATIENTS OF CORONARY ARTERY DISEASE

2021 ◽  
pp. 10-12
Author(s):  
Bhatt Payal ◽  
Joshi Mauli ◽  
Inaniya Kailash ◽  
Chaudhari Sanjay
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Treatment Group ◽  
Coronary Event ◽  
Platelet Volume ◽  
Group A ◽  
Artery Disease ◽  
Group B

Background: Various relations have been found out regarding the role of platelets in thrombosis and coronary heart disease. This study is an earnest attempt to delineate the relations between the various platelet volume indices (PVI) and their role in coronary heart disease. Method: During the study period of April 2014 to March 2015, total 180 subjects were studied. Out of them 120 were cases and 60 were controls. The cases of coronary artery disease were divided in to two groups A and B, according to their treatment. Group A included 60 patients with acute coronary syndromes, mainly AMI and UA with medical treatment. Group B included 60 patients with any percutaneous coronary interventions (PCI) for previous ischemic event. Group C included 60 healthy individuals from health check-up unit. A brief and relevant clinical history and laboratory investigations will be taken on the prepared Performa for the subjects. The EDTA and plain samples of 180 subjects were processed in the Central Diagnostic Laboratory. Results: The present study showed higher PVI in the group A and group B when compared to the control group. MPV, PDW and P-LCR were signicantly reduced after treatment in both groups A and B. The mortality was more in those with higher PVI. Conclusion: Coronary artery disease is associated with signicant morbidity and mortality. Platelet volume indices in histograms are easily generated by automated cell counter. Thus, by assessment of it we can predict an impending coronary event. We can prevent reinfarction by monitoring of it. The risk of acute coronary event is also decreased after treatment.

scholarly journals Significance of ST-segment Depression during Paroxysmal Supraventricular Tachycardia

2015 ◽  
Vol 7 (2) ◽  
pp. 93-97
Author(s):  
Shahana Zaman ◽  
Lima Asrin Sayami ◽  
Muhammad Abdur Rahim ◽  
AKM Monwarul Islam ◽  
Mohammad Ullah ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Supraventricular Tachycardia ◽  
Electrophysiological Study ◽  
Paroxysmal Supraventricular Tachycardia ◽  
St Segment ◽  
Number Of Patients ◽  
Group A ◽  
Artery Disease ◽  
Group B

Background: ST-segment depression in ECG is a common finding during paroxysmal supraventricular tachycardia. The exact mechanism and etiology of this ST-segment depression is not always evident. In this study we have tried to evaluate the significance of ST-segment depression during supraventricular tachycardia. Methods: Hospitalized patients for elective electrophysiological study with previous (EPS) history of supraventricular tachycardia with or without ST-segment depression were evaluated clinically, by coronary angiogram and EPS. Data were analyzed by appropriate statistical methods and comparison made between groups with ST-segment depression (Group A) and without ST-segment depression (Group B). Results: Total number of patients was 66. Equal number of patients (33) was in each group. The mean age of patients was 43.8 years. There was female predominance (M:F ratio 2:3). The mean heart rate during supraventricular tachycardia was 161 beats/min. Age, sex, coronary artery disease risk factors and heart rate during an episode of supraventricular tachycardia did not have any significant influence on ST-segment depression. Significant coronary artery disease was found in two patients in Group A and one patient in Group B. Electrophysiological study revealed that Atrio ventricular reentry tachycardia (AVRT) and AV nodal reentry tachycardia (AVNRT) were present in 28 (42.4%) and 38 (57.6%) cases respectively. Patients of group A exhibit AVRT significantly more than patients of group B.The sensitivity of ST-segment depression in correctly diagnosing coronary artery disease (CAD) was 66.7% while the specificity was 50.8%. The sensitivity of ST-segment depression in correctly differentiating AVRT was 83.3% while the specificity was 66.7%. The positive predictive value (PPV) and Negative predictive value (NPV) of the test were 75% and 76.9% respectively. Conclusion: ST-segment depression during episode of supraventricular tachycardia is a poor indicator of coronary artery disease. Presence of ST-segment depression can differentiate AVRT from AVNRT. However, >2 mm ST-segment depression was proved to be an excellent predictor of AVRT. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22249 Cardiovasc. j. 2015; 7(2): 93-97

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