Predictors of Significant Coronary Artery Disease in Patients with Cerebral Artery Atherosclerosis

2019 ◽  
Vol 48 (3-6) ◽  
pp. 226-235
Author(s):  
Ji Woong Roh ◽  
Beom-Jun Kwon ◽  
Sang-Hyun Ihm ◽  
Sungmin Lim ◽  
Chan-Seok Park ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Angiography ◽  
Cerebral Artery ◽  
Cerebral Angiography ◽  
Troponin I ◽  
Left Ventricular ◽  
Atherosclerotic Change ◽  
Artery Disease ◽  
Complex Features

Objective: There are few existing data on the status of coronary artery disease (CAD) in patients with atherosclerosis of the cerebral artery detected by brain imaging studies. We aimed to analyze the predictors of asymptomatic angiographically significant CAD detected by simultaneous cerebral and coronary angiography. Methods: This retrospective cohort study screened data obtained between August 2009 and April 2019; 11,047 patients underwent cerebral angiography for atherosclerotic change (>50% stenosis or aneurysm) seen in brain magnetic resonance angiography (MRA) or computed tomography angiography (CTA) at a single center by endovascular neurosurgeon’s decision. Of these, 700 patients including 622 patients who underwent simultaneous coronary and cerebral angiography and 78 patients who underwent coronary angiography within a month were enrolled. We investigated the characteristics and predictors of angiographically significant CAD (>50% stenosis). Furthermore, we also analyzed the major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, myocardial infarction, and stroke for 5 years. Results: The frequency of significant CAD was 59% (413/700), the mean age was 68.9 ± 10.3 years, and 60.6% were male. During mean follow-up of 50 months, the MACCE rate of our whole cohort was significantly higher in the CAD group (21.5%) than in the non-CAD group (14.6%; hazard ratio 1.65, 95% CI 1.17–2.33, p value = 0.005). Considering that the embolic stroke is less associated with atherosclerotic change, our predictive model of significant CAD was made without embolic stroke (n = 599). In our multivariate model 2 including univariate <0.1, the independent predictors of significant CAD were male (OR 1.62, 95% CI 1.11–2.35, p = 0.012), diabetes mellitus (OR 1.81, 95% CI 1.22–2.68, p = 0.003), previous stroke (OR 1.63, 95% CI 1.02–2.60, p = 0.039), low ankle-brachial index (ABI; <0.9; OR 3.25, 95% CI 1.21–8.73, p = 0.019), left ventricular ejection fraction (EF) <50% on echocardiography (OR 2.82, 95% CI 1.25–6.35, p = 0.012), troponin I or T positive (OR 2.76, 95% CI 1.69–4.53, p < 0.001), and complex features on cerebral angiography (OR 2.73, 95% CI 1.78–4.19, p < 0.001). Conclusions: Accurate coronary evaluation by coronary angiography might be considered when patients with atherosclerotic cerebral artery detected on brain MRA or CTA planned cerebral angiography were male or have diabetes mellitus, previous stroke, low ABI (<0.9), left ventricular EF <50% on echocardiography, troponin I or T positivity, and complex features on cerebral angiography.

scholarly journals Diabetes mellitus influences left ventricular and arterial stuffiness in patients with suspected coronary artery disease

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P2727-P2727
Author(s):  
K. Yoneyama ◽  
K. Kida ◽  
M. Izumo ◽  
Y. Ishibashi ◽  
R. Kamijima ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Suspected Coronary Artery Disease ◽  
Left Ventricular ◽  
Artery Disease

scholarly journals Distinct Characteristics of VEGF‐D and VEGF‐C to Predict Mortality in Patients With Suspected or Known Coronary Artery Disease

2020 ◽  
Vol 9 (9) ◽  
Author(s):  
Hiromichi Wada ◽  
Masahiro Suzuki ◽  
Morihiro Matsuda ◽  
Yoichi Ajiro ◽  
Tsuyoshi Shinozaki ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiovascular Events ◽  
Troponin I ◽  
Cardiovascular Death ◽  
Major Adverse Cardiovascular Events ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Cardiovascular Biomarkers

Background VEGF‐D (vascular endothelial growth factor D) and VEGF‐C are secreted glycoproteins that can induce lymphangiogenesis and angiogenesis. They exhibit structural homology but have differential receptor binding and regulatory mechanisms. We recently demonstrated that the serum VEGF‐C level is inversely and independently associated with all‐cause mortality in patients with suspected or known coronary artery disease. We investigated whether VEGF‐D had distinct relationships with mortality and cardiovascular events in those patients. Methods and Results We performed a multicenter, prospective cohort study of 2418 patients with suspected or known coronary artery disease undergoing elective coronary angiography. The serum level of VEGF‐D was measured. The primary outcome was all‐cause death. The secondary outcomes were cardiovascular death and major adverse cardiovascular events defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. During the 3‐year follow‐up, 254 patients died from any cause, 88 died from cardiovascular disease, and 165 developed major adverse cardiovascular events. After adjustment for possible clinical confounders, cardiovascular biomarkers (N‐terminal pro‐B‐type natriuretic peptide, cardiac troponin‐I, and high‐sensitivity C‐reactive protein), and VEGF‐C, the VEGF‐D level was significantly associated with all‐cause death and cardiovascular death but not with major adverse cardiovascular events.. Moreover, the addition of VEGF‐D, either alone or in combination with VEGF‐C, to the model with possible clinical confounders and cardiovascular biomarkers significantly improved the prediction of all‐cause death but not that of cardiovascular death or major adverse cardiovascular events. Consistent results were observed within patients over 75 years old. Conclusions In patients with suspected or known coronary artery disease undergoing elective coronary angiography, an elevated VEGF‐D value seems to independently predict all‐cause mortality.

scholarly journals Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study

2019 ◽  
Vol 21 (11) ◽  
pp. 1273-1282 ◽  
Author(s):  
Danilo Neglia ◽  
Riccardo Liga ◽  
Chiara Caselli ◽  
Clara Carpeggiani ◽  
Valentina Lorenzoni ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Clinical Outcome ◽  
Functional Imaging ◽  
Left Ventricular ◽  
Early Management ◽  
Long Term Outcome ◽  
Early Revascularization ◽  
Artery Disease

Abstract Aims To investigate the prognostic relevance of coronary anatomy, coronary function, and early revascularization in patients with stable coronary artery disease (CAD). Methods and results From March 2009 to June 2012, 430 patients with suspected CAD (61 ± 9 years, 62% men) underwent coronary anatomical imaging by computed tomography coronary angiography (CTCA) and coronary functional imaging followed by invasive coronary angiography (ICA) if at least one non-invasive test was abnormal. Obstructive CAD was documented by ICA in 119 patients and 90 were revascularized within 90 days of enrolment. Core laboratory analysis showed that 134 patients had obstructive CAD by CTCA (&gt;50% stenosis in major coronary vessels) and 79 significant ischaemia by functional imaging [&gt;10% left ventricular (LV) myocardium]. Over mean follow-up of 4.4 years, major adverse events (AEs) (all-cause death, non-fatal myocardial infarction, or hospital admission for unstable angina or heart failure) or AEs plus late revascularization (LR) occurred in 40 (9.3%) and 58 (13.5%) patients, respectively. Obstructive CAD at CTCA was the only independent imaging predictor of AEs [hazard ratio (HR) 3.2, 95% confidence interval (CI) 1.10–9.30; P = 0.033] and AEs plus LR (HR 4.3, 95% CI 1.56–11.81; P = 0.005). Patients with CAD in whom early revascularization was performed in the presence of ischaemia and deferred in its absence had fewer AEs, similar to patients without CAD (HR 2.0, 95% CI 0.71–5.51; P = 0.195). Conclusion Obstructive CAD imaged by CTCA is an independent predictor of clinical outcome. Early management of CAD targeted to the combined anatomical and functional disease phenotype improves clinical outcome.

scholarly journals P673Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medicationP674Clinical presentation, echocardiographic findings and complications in patients with typical and atypical form of takotsubo cardiomyopathyP675Left ventricular mass/end-diastolic volume ratio with tridimensional echocardiography in newly-diagnosed hypertensive patients: which relation between left ventricular geometry and stroke volume?P676Endothelial dysfunction: the link between arterial hypertension, diabetes mellitus and heart diseaseP677Dynamic of changes of arterial stiffness evaluated by cardio-ankle vascular index(CAVI) during the growth and development of children and adolescentsP678Peripheral arterial stiffness in pulmonary hypertension and pulmonary embolism: assessment with cardio ankle vascular index, noninvasive markers of vascular diseaseP679Early detection and prediction of CHOP-induced cardiotoxicity in nonHodgkin lymphoma by 4D echocardiography, vascular ultrasound, and cardiac biomarkersP680Right ventricular remodeling in children engaged in endurance sports: a longitudinal study in preadolescent athletesP681Electrocardiographic criteria for atria enlargement are not useful in the evaluation of junior high-dynamic high-static athletesP682Prognostic value of right ventricle, pulmonary arterial pressure and biomarkers in patients with acute heart failure: one year follow upP683One-point carotid stiffness parameters by echo-tracking method in a wide-age range of healthy population. A single center experienceP684Role of bidimensional speckle tracking longitudinal strain in the evaluation of right and left ventricular function in adult patients with transposition of the great arteriesP685Interfaces between FBN1 gene polymorphism and biomechanical parameters estimated by speckle-tracking echocardiography of dilative pathology of ascending aorta P686Layer-specific speckle tracking analysis for the detection of coronary artery disease during dipyridamole stress echoP687Stress echo in Italy: state-of-the art 2015P688The declining frequency of Inducible myocardial ischemia during stress echocardiography over 27 consecutive years (1983-2009)P689Global longitudinal strain can unmask inducible myocardial ischemia at submaximal heart rate during dobutamine stress echocardiography.P690Low risk syntax score predicted by wall motion score index during dobutamine stress echocardiographyP691Outdoor stress echo by lung ultrasound for subclinical detection of high altitude pulmonary edema with B-linesP692Predictors and consequences of infective endocarditis with perivalvular extension - a subgroup with worse short and medium-term prognosisP693Analysis of left atrial auricle morphology and function to detect considerable risk factors regarding the prevention of strokeP694LAA closure - does size really matter?P695Real assessment of mitral regurgitation by three-dimensional transesophageal echocardiographyP696Myocardial contrast dobutamine stress echocardiography for detection of coronary artery disease

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii136-ii143
Author(s):  
I. Ikonomidis ◽  
M. Budnik ◽  
M. Lembo ◽  
A-M Vintila ◽  
T. Jurko ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Arterial Stiffness ◽  
Speckle Tracking ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Artery Disease

scholarly journals P1399 Global longitudinal systolic deformation of the left ventricle during stress echocardiography with physical exercise may identify patients with severe coronary artery disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Stepanova ◽  
M N Alekhin
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Left Ventricle ◽  
Stress Echocardiography ◽  
Left Ventricular ◽  
Gensini Score ◽  
Treadmill Test ◽  
Artery Disease ◽  
Diagnostic Capabilities

Abstract Background Assessment of longitudinal systolic deformation of the left ventricular myocardium during speckle tracking stress echocardiography can potentially be significant in the diagnosis of transient myocardial ischemia. In this regard, determination of the global longitudinal systolic deformation (GLSD) of the left ventricle during stress echocardiography is challenging and its diagnostic capabilities can be assessed by comparing them with the data obtained with invasive methods for diagnosing coronary artery disease (CAD). Aim of the study The aim of this study was to determine the diagnostic capabilities of the left ventricular GLSD obtained during stress echocardiography with exercise on the treadmill in defining the presence and significance of CAD. Methods The study included 80 patients (mean age 68.3 ± 7.8 years; 29 females). All patients underwent stress echocardiography with exercise on the treadmill. At rest and after treadmill-test, all patients were measured for the values of the left ventricular GLSD using the AFI (Automated functional imaging) algorithm. The delta of the left ventricular GLSD values was counted. The delta of the left ventricular GLSD values was counted as the difference of the left ventricular GLSD values at rest and after the exercise. All patients underwent coronary angiography, assessment of the severity of CAD was counted according to the Gensini score. According to the results of coronary angiography, the patients were divided into 3 groups: 21 patients without CAD, 45 patients with moderate CAD (&lt;34 points on the Gensini score) and 14 patients with severe CAD (&gt; 34 points on the Gensini score). Results In the group of patients with severe CAD, the value of the left ventricular GLSD delta at rest and after treadmill-test significantly differed from the groups of patients with moderate CAD and without CAD (-0.56 compared with 2.17; p = 0,009). In the group of patients without CAD, the value of the left ventricular GLSD delta at rest and after treadmill-test did not significantly differ from the group of patients with CAD (0.23 compared to -0.95; p = 0.199). Conclusions The delta of the left ventricular GLSD obtained during stress echocardiography with exercise on the treadmill showed a reliable significance in determining severe CAD, but did not demonstrate a reliable significance in identifying the absence of CAD.

scholarly journals Incidence of coronary artery disease before valvular replacement in isolated severe aortic stenosis patients in Western Rajasthan

2021 ◽  
Vol 9 (11) ◽  
pp. 3347
Author(s):  
Ramesh Patel ◽  
Sandeep Aggarwal
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Background: The aim of the study was to evaluate the incidence of Coronary artery disease (CAD) and predictors of CAD in patients with severe AS in western Rajasthan population.Methods: Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Udaipur were entered in a prospective registry beginning in 2015. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.Results: Mean age of 55 enrolled patients was 52.64±15.5 years. Diabetes mellitus and hypertension were present in 3.64% and 5.45% of patients, respectively. Moderate and severe Left ventricular ejection fraction (LVEF) was found in 16.36% and 10.91% patients, respectively. Only 5.45% patient had severe CAD and thus underwent AVR and coronary artery bypass grafting, and rest 94.55% patients underwent AVR. Mean age of patients who underwent AVR was 51.75±15.36 years and who underwent AVR and CABG was 68±11.14 years with no significant association (p=0.078). Proportion of patients requiring AVR and CABG was significantly higher in moderate (22.22%) and severe LVEF (16.67%) as compared to normal or mild (p=0.034).Conclusions: Coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients above 68 years of age without risk factors for cardiovascular disease. However, larger studies on heterogeneous population are required to prove our findings. 

Sign in / Sign up

Export Citation Format

Share Document