Biomarker levels, left ventricular dysfunction, and severity of coronary pathology in elderly patients with coronary heart disease

Aim. To assess the levels of selected biomarkers and the type of left ventricular (LV) dysfunction in geriatric patients, in regard to their age, gender, and the severity of coronary artery pathology. Material and methods. In total, 135 geriatric patients with coronary heart disease (CHD) were examined. The diagnostic algorithm was based on the results of coagulogram, blood biochemistry, measurement of C-reactive protein (CRP) levels, treadmill test, echocardiography (EchoCG), coronary angiography (CA), and LV ventriculography (LVG). Results. Decreased hematocrit levels (p<0,05), increased levels of urea (p<0,05) and creatinine (p<0,05), reduced LV ejection fraction (p<0,05), increased end-diastolic volume (p<0,05), as well as restrictive type of LV dysfunction, were among age-dependent determinants of angina progression in elderly patients. The major determinant of ischemia severity was multi-vessel coronary pathology, manifested in higher angina classes, reduced exercise capacity (p<0,05), and impaired local LV contractility (p<0,05). Conclusion. To objectively assess the severity of clinical course of CHD in elderly patients, the following data should be taken into account: hematocrit and CRP levels, increased levels of creatinine and urea, and the results of EchoCG, CA, and LVG.

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Study on correlation between property of coronary artery lesion and degree of coronary artery stenosis of elderly patients with coronary heart disease

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.225 ◽

2019 ◽

Vol 35 (1) ◽

Author(s):

Wang Chao ◽

Xiang Tian ◽

Wei Xia ◽

Qianmei Liu

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Elderly Patients ◽

Ventricular Remodeling ◽

Left Ventricular Remodeling ◽

Left Ventricular ◽

Coronary Artery Lesion ◽

Single Vessel ◽

Calcified Plaque

Objective: To discuss the influence of coronary artery lesion of elderly patients with coronary heart disease (CHD) on left ventricular remodeling. Methods: Retrospective selection method was used to choose 80 elderly CHD patients who received coronary angiogram examination in Baoding First Central Hospital from January 2014 to February 2018 as the objects of study. According to coronary artery lesion, the patients were classified into single vessel lesion group (single vessel group) and multi-vessel lesion group (multi-vessel group, the number of lesion vessels ≥2). Single vessel group included 60 patients, and multi-vessel group includes 20 patients. Intravascular unltrasound was applied to record coronary plaque property of all patients and transthoracic echocardiography was used to record left ventricular remodeling. Later correlation analysis was carried out. Results: The proportion of calcified plaque and mixed plaque was higher than that of single vessel group, and the differences had statistical significance (P<0.05). Left ventricular end diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) of multi-vessel group were higher than that of single vessel group, while left ventricular ejection fraction (LVEF) was lower than that of single vessel group. The differences had statistical significance (P<0.05). Linear correlation analysis showed coronary artery lesion was positively correlated with LVEF and calcified plaque (r=0.287, 0.371, P<0.05). Multiple linear regression analysis showed LVEF, calcified plaque and LDL-C were independent risk factors of multi-vessel coronary artery lesion of old CHD patients (P<0.05). Conclusion: The number of coronary artery lesions is significantly correlated with left ventricular remodeling, and can increase the proportion of calcified plaque and mixed plaque, thus leading to left ventricular remodeling abnormity. How to cite this:Wang C, Tian X, Xia W, Liu Q. Study on correlation between property of coronary artery lesion and degree of coronary artery stenosis of elderly patients with coronary heart disease. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.225 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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P2687Impact of cardiovascular risk factors on effectiveness of remote ischemic preconditioning in the setting of ischemia/reperfusion-injury in a langendorff heart model

European Heart Journal ◽

10.1093/eurheartj/ehz748.1005 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Hidalgo Pareja ◽

J M Muessig ◽

A M Nia ◽

M Masyuk ◽

M Kelm ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Elderly Patients ◽

Infarct Size ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Ventricular Volume ◽

Left Ventricular ◽

Protective Effects ◽

Heart Model

Abstract Introduction Cardiovascular diseases are the most frequent cause of death in the western world. During myocardial infarction both, ischemia and reperfusion after therapeutic intervention cause myocardial damages, resulting in ischemia/reperfusion-injury (I/R-injury). Research therefore searches cardio protective interventions, aiming to reduce myocardial injury and following consequences such as heart failure. A promising method, named Remote Ischemic Preconditioning (RIPC), consists of transient local ischemia distant from the heart. Its cardio-protective effects were already proved in basic research but failed in clinical trials. Purpose The aim of the study is to examine the impact of cardiac risk factors like diabetes mellitus (DM) or age on effectiveness of RIPC in order to identify distinct groups of patients who might benefit from RIPC in the clinical setting and to reveal the effectiveness of cardioprotection delivered by plasma samples of these groups of patients. Methods RIPC (3 x 5 min arm ischemia, induced by an inflated blood pressure cuff) was performed on young and healthy volunteers and elderly patients with coronary heart disease with or without diabetes mellitus. Blood was taken before (Baseline) and 30 minutes after the intervention. The coronary system of murine hearts in a Langendorff heart model was perfused using dialysate from the human plasma obtained before and after RIPC. This was followed by 40 minutes of global ischemia. After 60 minutes of reperfusion left ventricular function was analysed. The infarct size was measured after 120 minutes reperfusion time using a TTC staining. Results Addition of dialysate of plasma obtained from healthy volunteers after RIPC to the coronary system of Langendorff perfused murine hearts significantly improved the recovery of left ventricular developed pressure (39±15.1 vs 26±8.5% of baseline levels, p=0.04) and reduced the infarct size (37.5±15.6 vs 21.2±11.4% of the ventricular volume, p=0.03) compared to baseline-dialysate treated controls. While plasma dialysate obtained from elderly patients with DM undergoing RIPC failed to show significant cardio protective effects of RIPC, murine hearts treated with plasma dialysate of elderly patients with coronary heart disease without diabetes after undergoing RIPC showed significant improvement of cardiac function (20±6.5 vs 24±7% of baseline levels, p=0.02) and infarct size (33.2±8.0 vs 11.1±2.5% of the ventricular volume, p=0.01). Conclusion The cardio-protective effect of RIPC on myocardial function and infarct size after I/R is influenced by diabetes but not by age or the presence of coronary heart disease. In consequence, RIPC might protect patients with coronary heart disease without DM but not diabetic patients from cardiac I/R injury. This important finding potentially explains why RIPC yielded promising results in various basic science experiments but failed to show cardio protective effects in clinical trials. Acknowledgement/Funding Forschungskommission of the Faculty of Medicine of the Heinrich-Heine-University Düsseldorf

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