scholarly journals Relationship between Different Degrees of Compression and Clinical Symptoms in Patients with Myocardial Bridge and the Risk Factors of Proximal Atherosclerosis

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jiaxi Zhang ◽  
Fei Duan ◽  
Zhihong Zhou ◽  
Li Wang ◽  
Yang Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Clinical Symptoms ◽  
Proximal Part ◽  
Control Group ◽  
Myocardial Bridge ◽  
Atherosclerotic Stenosis ◽  
Proximal Coronary Artery ◽  
The Relationship

Objective. To explore the relationship between different degrees of compression and clinical symptoms in patients with the myocardial bridge and the risk factors of proximal atherosclerosis. Methods. The clinical data of 156 patients with the myocardial bridge who underwent selective coronary angiography in our hospital from December 2010 to December 2015 were collected. The patients were divided into Noble grade I group (102 cases) and Noble grades II-III group (54 cases) according to the degree of mural coronary artery systolic stenosis. According to the results of coronary angiography, 156 patients with the myocardial bridge were divided into an atherosclerosis group (the myocardial bridge combined with atherosclerosis at the proximal end of the myocardial bridge of simple wall coronary artery), 91 cases, and a control group (isolated myocardial bridge), 65 cases. The relationship between different degrees of compression and clinical symptoms in patients with the myocardial bridge was observed, and the logistic regression model was used to analyze the risk factors of proximal atherosclerosis in patients with the myocardial bridge. Results. The incidence of atherosclerotic stenosis, angina pectoris, and myocardial infarction in the proximal part of the myocardial bridge in the Noble grades II-III group was higher than that in the Noble grade I group ( P < 0.05 ). The differences in age, hypertension, and Noble classification between the two groups were statistically significant ( P < 0.05 ). The differences of total cholesterol (TC) and C-reactive protein (CRP) between the two groups were statistically significant ( P < 0.05 ). Multivariate analysis showed that age, hypertension, Noble grade, and CRP were all risk factors for proximal atherosclerosis in patients with the myocardial bridge ( P < 0.05 ). Conclusion. The more severe the compression of the myocardial bridge, the greater the risk of cardiovascular events for patients and the higher the incidence of atherosclerotic stenosis in the proximal part of the myocardial bridge. In addition, the occurrence of atherosclerosis in the proximal coronary artery of the myocardial bridge may be affected by age, hypertension, Noble grade, and CRP level.

Electrocardiographic predictors of proximal left anterior descending coronary artery occlusion

Open Medicine ◽  
2008 ◽  
Vol 3 (3) ◽  
pp. 294-299
Author(s):  
Javad Kojuri ◽  
Amir Vosoughi ◽  
Shahdad Khosropanah ◽  
Amir Aslani
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Proximal Part ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Control Group ◽  
Lower Sensitivity ◽  
Anterior Myocardial Infarction ◽  
St Depression

AbstractProximal occlusion of the left anterior descending coronary artery (LAD) results in a less favorable prognosis in coronary angiography. Therefore, it is important to determine whether there are significant lesions in LAD by electrocardiography (ECG) before coronary angiography. Twelve-lead ECG was compared in 130 patients with significant lesions (≥70% stenosis) confined to proximal part of the LAD (P LAD group) and 492 patients with normal coronary angiography (control group). Fifty-nine patients in the P LAD group and 18 patients in the control group had signs of anterior myocardial infarction as shown by ST elevation (≥1.0 mV) in two consecutive pericardial leads or the presence of a pathological Q wave. An inverted U wave (biphasic T wave) in leads V1 to V4 had a sensitivity of 49.3% (35/71) in P LAD patients without signs of anterior myocardial infarction (MI) and 96.6 % (57/59; specificity, 66.6%; positive predictive value, 90.9 %) in the P LAD patients with signs of anterior MI. In the P LAD patients with signs of anterior MI, T inversion in V4–V5 had a lower sensitivity (67.0% [40/59]) than an inverted U wave. ST depression in inferior leads and ST depression in V5 were not useful markers of proximal LAD occlusion. In conclusions, an inverted U wave in V1 to V4 (or in each of these leads) and T inversion in V4–V5 are the best predictors of significant proximal LAD lesion, especially in patients with ECG findings of anterior MI.

Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
S Boldueva ◽  
V Feoktistova ◽  
D Evdokimov
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Atherosclerotic Plaque ◽  
St Elevation ◽  
Spontaneous Dissection

Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process.  The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.

scholarly journals A case report of a symptomatic right anomalous coronary artery with concomitant atherosclerotic disease: the benefit of a sequential comprehensive non-invasive and invasive diagnostic approach

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Marius Reto Bigler ◽  
Adrian Thomas Huber ◽  
Lorenz Räber ◽  
Christoph Gräni
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Myocardial Ischaemia ◽  
Invasive Coronary Angiography ◽  
Atherosclerotic Disease ◽  
Diagnostic Approach ◽  
Anomalous Coronary Artery ◽  
Atherosclerotic Stenosis ◽  
Anomalous Coronary

Abstract Background  Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital disease associated with an increased risk of myocardial ischaemia, ventricular arrhythmias, and heart failure. Case summary  A 75-year-old Caucasian man was referred for invasive coronary angiography (ICA) due to atypical chest pain. Invasive coronary angiography demonstrated non-significant atherosclerotic disease of the left coronary artery and an anomalous origin of the right coronary artery (RCA); without selective intubation. Coronary computed tomography angiography (CCTA) revealed a right-AAOCA with interarterial and intramural course, and a soft plaque in the distal RCA. Subsequent physical-stress single-photon emissions computed tomography (SPECT) showed exercise-induced inferoapical myocardial ischaemia, giving a Class IC level of evidence for surgical correction of the AAOCA. Repeated ICA with selective R-AAOCA intubation confirmed an 80% distal atherosclerotic stenosis, which was treated with direct stenting. Subsequent invasive physiologic evaluation under maximal dobutamine-volume challenge (gradually increasing dose of dobutamine max. 40 μg/kg per body weight/min, 3000 mL ringer lactate and 1 mg atropine was given until the patient reached a maximum of 145 b.p.m.), revealed a haemodynamically non-relevant anomalous segment with a fractional flow reserve (FFR) of 0.91. A follow-up SPECT was normal, and the patient was completely symptom-free at 1 month. Discussion  We present the sequential diagnostic approach in a symptomatic patient with a right anomalous coronary artery and concomitant atherosclerotic disease. Using this approach, the patient could be deferred from guideline recommended open-heart surgery of the AAOCA, as direct invasive dobutamine/volume FFR revealed haemodynamic non-relevance of the anomalous segment after stenting the concomitant atherosclerotic stenosis in the distal segment within the same coronary artery.

scholarly journals A Study on the Relationship between Iron Reserves and the Intensity of Coronary Artery Stenosisin Angiography Candidates

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Khalil Mahmoodi
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Transferrin Saturation ◽  
Intervention Group ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Coronary Artery Stenos ◽  
The Impact ◽  
The Relationship

Various risk factors including blood iron may create coronary artery diseases and lead to myocardial infarction. There are controversies with regard to the impact of blood iron on myocardial infarction. Therefore, the aim of this paper was to investigate the relationship between iron reserves and the intensity of coronary artery stenos is among angiographic candidates in Zanjan, Iran. This was a cross sectional study. Samples were consisted of patients who were hospitalized for diagnostic coronary angiography in hospitals in an urban area of Iran. A convenient sampling method was used to recruit samples via interviews and laboratory examinations for FBS, iron, TIBC, ferritin, creatinine serum, CBC, cholesterol, HDL and LDL. The samples were divided into control and intervention groups. After coronary angiography, the intervention group was evaluated by four different methods including the extent score, stenos is score, vessel score and Duke CAN Index. The samples were consisted of 89 men (60.1%) and 59 women (39.9%). The levels of ferritin (p=0.003) and iron (p=0.002), and transferrin saturation percent (p=0.002) showed significant differences between males and females (p=0.004)

Sensitivity, specificity of pre-test probability and their use in the relation to syntax score and cardiovascular risk factors

2021 ◽  
Author(s):  
Anh Binh Ho
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiovascular Risk Factors ◽  
European Society ◽  
Syntax Score ◽  
Model Group ◽  
European Society Of Cardiology ◽  
Test Probability

Overview: Coronary angiography is the gold standard for definitive diagnosis of obstructive ischemic coronary disease. However, this is an invasive, expensive test, and may have a number of complications. Models of pre-test probability (PTP) in the guideline of the European Society of Cardiology 2013 and 2019 are easy to use and apply even to doctors who are not cardiologists, and can be implemented at the medical facilities. We aim to assess the sensitivity and specificity of different PTP stratification models follow ESC2013 and 2019; and their use in the relation to SYNTAX score and cardiovascular risk factors. Materials and Methods: Patients (n=108) with chest pain had been treated at Ninh Thuan Provincial Hospital from January 2019 to May 2020. The PTP stratification models were calculated according to the recommendations of the European Society of Cardiology (ESC) 2013 and 2019. Coronary angiography was enrolled for the diagnosis, Quantitative coronary analyzed (QCA) - based stenosis assessment was used with a cut-off of ≥ 50% diameter reduction for significant lesions of coronary artery and SYNTAX score were calculated.Diagnostic accuracy was calculated by usingsensitivity, specificitywhich were analyzed by using statistical software SPSS version 20.0. Results: In the 2013 pre-test probability model,group withmedium PTP andhigh PTPhad the sensitivity of 57.14%, 100% respectively; the overall sensitivity for both groups (the medium and high pre-test) was 59.36%; and the specificity was 58.33%. In the 2019PTP model, group withmedium PTP and high PTP had the sensitivity of 41.67%, of 67.57% respectively;the overall sensitivity for both groups (the medium and high scores PTP) was 61.22%; and the specificity was 80%. The group of low SYNTAXscore (<23) had at most 93 cases, accounting for 86.1%; the lowest was the group of high SYNTAX score (≥ 33 points) accounting for 2.8%. There were statistically significant differences in patients with and without smoking, history of hypertension for both PTP model 2013 and 2019. Conclusion: Sensitivity and specificity of the 2013 and 2019 PTP were quite high in the relation to the severity of coronary artery which were evaluated by SYNTAX score.

scholarly journals Screening for proximal coronary artery anomalies with 3-dimensional MR coronary angiography

2010 ◽  
Vol 26 (6) ◽  
pp. 701-710 ◽  
Author(s):  
Niek H. Prakken ◽  
Maarten J. Cramer ◽  
Marlon A. Olimulder ◽  
Pierfrancesco Agostoni ◽  
Willem P. Mali ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Anomalies ◽  
3 Dimensional ◽  
Mr Coronary Angiography ◽  
Proximal Coronary Artery

scholarly journals Association of Lipoprotein-Associated Phospholipase A2 with Coronary Artery Disease in African-Americans and Caucasians

2010 ◽  
Vol 95 (5) ◽  
pp. 2376-2383 ◽  
Author(s):  
Erdembileg Anuurad ◽  
Zeynep Ozturk ◽  
Byambaa Enkhmaa ◽  
Thomas A. Pearson ◽  
Lars Berglund
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
African American ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
African Americans ◽  
Coronary Angiography ◽  
Pla2 Activity ◽  
Artery Disease

Abstract Context: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is bound predominately to low-density lipoprotein and has been implicated as a risk factor for coronary artery disease (CAD). Objective: We investigated the association between Lp-PLA2 and CAD in a biethnic African-American and Caucasian population. Design: Lp-PLA2 mass, activity, and index, an integrated measure of mass and activity, and other cardiovascular risk factors were determined in 224 African-Americans and 336 Caucasians undergoing coronary angiography. Main Outcome Measures: We assessed the distribution of Lp-PLA2 levels and determined the predictive role of Lp-PLA2 as a risk factor for CAD. Results: Levels of Lp-PLA2 mass and activity were higher among Caucasians compared with African-Americans (293 ± 75 vs. 232 ± 76 ng/ml, P &lt; 0.001 for mass and 173 ± 41 vs. 141 ± 39 nmol/min/ml, P &lt; 0.001 for activity, respectively). However, Lp-PLA2 index was similar in the two groups (0.61 ± 0.17 vs. 0.64 ± 0.19, P = NS). In both ethnic groups, Lp-PLA2 activity and index was significantly higher among subjects with CAD. African-American subjects with CAD had significantly higher Lp-PLA2 index than corresponding Caucasian subjects (0.69 ± 0.20 vs. 0.63 ± 0.18, P = 0.028). In multivariate regression analyses, after adjusting for other risk factors, Lp-PLA2 index was independently (odds ratio 6.7, P = 0.047) associated with CAD in African-Americans but not Caucasians. Conclusions: Lp-PLA2 activity and index was associated with presence of CAD among African-Americans and Caucasians undergoing coronary angiography. The findings suggest an independent impact of vascular inflammation among African-Americans as contributory to CAD risk and underscore the importance of Lp-PLA2 as a cardiovascular risk factor.

scholarly journals P243 A rare association of isolated persistent left superior vena cava(PLSVC) with anomalous right coronary artery (RCA) in a symptomatic patient. Role of saline contrast echo (SCE) with multimodal imaging

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Fady ◽  
A M Komaranchath ◽  
F B Al Bakshy ◽  
M G Gibreel
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Superior Vena Cava ◽  
Multimodal Imaging ◽  
Superior Vena ◽  
Vena Cava ◽  
Exercise Stress ◽  
Chest Discomfort ◽  
Myocardial Bridge

Abstract Funding Acknowledgements Nil Introduction PLSVC with absent right superior vena cava (RSVC) is an extremely rare venous anomaly. Most of the patients with this anomaly have other associated cardiac anomalies. However, presence of an anomalous RCA has not been one of these anomalies. Case report A 36-year-old Asian healthy female with no significant medical history presented with over 3 years symptoms of chest heaviness and shortness of breath on walking two blocks. Examination was unremarkable. 2D echocardiogram revealed a 36mm dilated coronary sinus (CS), grade II tricuspid regurgitation (TR) with estimated right ventricular systolic pressure (RVSP) of 40 mmhg. Normal right and left side of the heart. SCE using 50:50 agitated saline and Gelofusine injected intravenously through the left arm showed opacification of the dilated CS first before opacifying the right atrium (RA). Right arm injection depicted the same pattern of contrast opacification which denotes presence of PLSVC with congenital absence of RSVC. No detected intracardiac shunts by SCE. No partial anomalous pulmonary venous connection (PAPVC). However, findings did not justify patient’s symptoms. Seven days loop recorder ruled out any arrhythmias that might be associated with isolated PLSVC. An exercise stress ECG was equivocal with chest discomfort but no ECG changes. We opted for CT coronary angiography (CTCA) to rule out obstructive coronary artery disease (CAD). CTCA confirmed our diagnosis of isolated PLSVC with absence of RSVC with huge CS. In addition, there was an anomalous origin of RCA from sinotubular junction above the commissure between left and right aortic CS and not from LM CS proper, taking a malignant interarterial course of a slit origin RCA with first part of it showing intramural course within the aortic wall. In view of symptoms we as a heart team explained the present risk of sudden cardiac death and possible indication for corrective surgery. A month later patient again presented with chest discomfort. We decided to do Coronary angiography to delineate actual size and dominance of RCA. RCA was a non-dominant small 1.75 mm vessel. There was a left anterior descending artery myocardial bridge. We started a beta blocker (BB) for the patient after which her symptoms improved. Patient followed up for two years later with no symptoms. We attributed her chest pain to the myocardial bridge since she improved on BB. We found there was no solid role for surgery in view of a very small non dominant RCA with no further chest pain. Conclusions Isolated PLSVC is a very rare condition. It is usually asymptomatic. But since our patient had symptoms, a search for another diagnosis was convenient. A dilated CS should always alert us to search for PLSVC. SCE is a simple, inexpensive and reproducible diagnostic tool that might help in solving a challenging diagnosis. Multimodal imaging has a leading role in both proper diagnosis and in management of this condition Abstract P243 Figure. Anomls. RCA - PLSVC to CS -Contrast echo

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