scholarly journals Reduced Sympathetic Reserve Detectable by Heart Rate Response after Dipyridamole in Anginal Patients with Normal Coronary Arteries

2021 ◽  
Vol 11 (1) ◽  
pp. 52
Author(s):  
Lauro Cortigiani ◽  
Clara Carpeggiani ◽  
Laura Meola ◽  
Ana Djordjevic-Dikic ◽  
Francesco Bovenzi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Coronary Arteries ◽  
Multivariable Analysis ◽  
Normal Coronary Arteries ◽  
Inducible Ischemia ◽  
Sympathetic Function ◽  
Permanent Atrial Fibrillation ◽  
Cardiac Sympathetic Function ◽  
Dipyridamole Stress Echocardiography

Background. Patients with ischemia and normal coronary arteries (INOCA) may show abnormal cardiac sympathetic function, which could be unmasked as a reduced heart rate reserve (HRR) during dipyridamole stress echocardiography (SE). Objectives. To assess whether HRR during dipyridamole SE predicts outcome. Methods. Dipyridamole SE was performed in 292 patients with INOCA. HRR was measured as peak/rest heart rate and considered abnormal when ≤1.22 (≤1.17 in presence of permanent atrial fibrillation). All-cause death was the only endpoint. Results. HRR during SE was normal in 183 (63%) and abnormal in 109 patients (37%). During a follow-up of 10.4 ± 5.5 years, 89 patients (30%) died. The 15-year mortality rate was 27% in patients with normal and 54% in those with abnormal HRR (p < 0.0001). In a multivariable analysis, a blunted HRR during SE was an independent predictor of outcome (hazard ratio 1.86, 95% confidence intervals 1.20–2.88; p = 0.006) outperforming inducible ischemia. Conclusions. A blunted HRR during dipyridamole SE predicts a worse survival in INOCA patients, independent of inducible ischemia.

scholarly journals Is Normal Coronary Arteries on Coronary Angiogram Truly Benign?

2017 ◽  
Vol 02 (04) ◽  
pp. 077-081
Author(s):  
Indrani Garre ◽  
Raju Nallagasu ◽  
Lalita Nemani ◽  
Sreebhushanraju Devaraju ◽  
Narendrakumar V. ◽  
...  
Keyword(s):  
Coronary Arteries ◽  
Statistical Significance ◽  
Chronic Stable Angina ◽  
Binary Logistic Regression ◽  
Standard Test ◽  
Left Ventricular ◽  
Normal Coronary Arteries ◽  
Coronary Syndrome ◽  
Lv Dysfunction

Abstract Background Heart disease is the leading cause of death in the world, and coronary angiography (CAG) is the standard test for detection of critical diseases. Nearly 25% patients undergoing angiography are found to have normal coronary arteries (NCAs). Recent publications say that the follow-up of the NCA patients is not benign. Aim The main objective of this study is to know outcomes of patients diagnosed with normal coronaries on conventional angiograms. Methods This is a single-center observational study. The authors collected the data of patients who came for CAG to their institute from January 1 to December 31, 2014. They included the patients who have normal coronaries in this study. The indication to do the CAG is chest pain (angina) for evaluation. The authors contacted every patient telephonically to know the outcomes after 2 years of CAG. The telephonic data were collected either from patients or from attendants by asking the questionnaire about the present status of patients. Results The authors collected the data of 1,526 patients who underwent the CAG during study period. Out of 1,526 patients, 201 patients with mean age of 52.45 ± 10.7 years met the inclusion criteria; 108 (53.73%) were hypertensives and 57 (28.36%) were diabetic. Acute coronary syndrome (ACS) was the presenting symptom in 28 (13.9%) of patients; the remaining patients presented with chronic stable angina (CSA). Left ventricular (LV) dysfunction was present in 15 (7.5%) of patients. At the 2-year follow-up, 12 (5.9%) patients were symptomatic, and out of them, 7 died (mortality 3.5%).The binary logistic regression showed that only blood urea (BU) was determinant factor for mortality (p = 0.022). Even LV dysfunction (p = 0.39) was not a contributor for mortality. A subanalysis of gender also showed similar findings (male, p = 0.02; female, p = 0.05). Conclusion In angina patients with NCA on CAG, the BU showed statistical significance for morality. This is true even on further sex-based analysis (male, p = 0.02; female, p = 0.05). This study helps understand that even the people with normal coronaries, they may have the symptomatic outcomes, not only because of coronaries and also with other associated diseases.

scholarly journals Anti-inflammatory effects of rosuvastatin treatment in coronary artery ectasia patients in different age groups

2020 ◽  
Author(s):  
Chenghui Fan ◽  
Ying Hao ◽  
Yonghua Liu ◽  
Xiaolin Li ◽  
Zhenhao Huang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Inflammatory Markers ◽  
Age Groups ◽  
High Sensitivity ◽  
Coronary Artery Ectasia ◽  
Normal Coronary Arteries ◽  
Anti Inflammatory ◽  
Hs Crp

Abstract Background: Coronary artery ectasia (CAE) is an angiographic finding of abnormal coronary dilatation. The role of inflammation in atherosclerosis is becoming increasingly well known. This study investigated the relationship between CAE and serum levels of high-sensitivity C-reactive protein (Hs-CRP) and interleukin-6 (IL-6) to test our hypothesis that patient age is associated with the efficacy of anti-inflammatory therapy for CAE. Methods: We conducted a prospective analysis of 217 patients with CAE treated at the Department of Cardiology, Shanghai East Hospital, Shanghai East Hospital (Ji'an Campus), and Cardiovascular Medicine of Baoshan People’s Hospital of Yunnan Province, from January 1, 2015 to July 30, 2019. Baseline data of patients, including sex, age, hypertension, hyperlipidemia, and diabetes, were collected from patient medical records. Study participants were grouped by age as follows: CAE-A (age ≤50 years), CAE-B (50 years <age ≤70 years), and CAE-C (age >70). Additionally, there was a normal control (NC) group with normal coronary arteries.Results: All patients received oral rosuvastatin therapy (10 mg, QN quaque nocte) when they were diagnosed with CAE and maintained good follow-up, with a loss rate of 0.0% at the 6-month follow-up. The NC group (n = 73, with normal coronary arteries) received regular symptom-relieving treatments and rosuvastatin therapy. Among these four groups, the inflammatory markers were significantly higher in patients with CAE than in the NCs (p<0.01). Logistic regression analysis showed that Hs-CRP (OR=1.782, 95% CI: 1.124-2.014, P=0.021) and IL-6 (OR=1.584, 95% CI: 1.112-1.986, P=0.030) were independent predictors of CAE. The inflammatory markers in the CAE-A group were higher than those in the CAE-B group, which were higher than those in the CAE-C group. Follow-up after 6 months of rosuvastatin therapy showed a significantly greater reduction in Hs-CRP and IL-6 levels in the CAE-A group than in the CAE-B group, which, again, were higher than those in the CAE-C group. Conclusions: Anti-inflammatory therapy using rosuvastatin was more effective in younger CAE patients, indicating the need for early statin therapy in CAE patients.

Abstract 2036: Severe Autonomic Failure in Diabetic Postinfarction-Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Georg Schmidt ◽  
Petra Barthel ◽  
Raphael Schneider ◽  
Axel Bauer ◽  
Elisabeth Arnoldi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Proportional Hazards ◽  
Autonomic Failure ◽  
Multivariable Analysis ◽  
Total Mortality ◽  
Holter Monitoring ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Mean Heart Rate

Background: Diabetic post-infarction patients are at high risk of subsequent death. Deceleration Capacity (DC) and Heart Rate Turbulence (HRT) are a risk predictors that quantify different aspects of autonomic performance (tone and reflex function). Sever Autonomic Failure (SAF) was assumed if DC and HRT were compromised. This study investigates the predictive value SAF in diabetic post-infarction patients. Patients: 416 consecutive diabetic post-infarction patients, age < <26> 75 years, in sinus rhythm were enrolled. Primary endpoint was total mortality at 5 years. Mean follow-up period was 4.4 years. Methods: DC and HRT were determined according to the published methodology. Severe autonomic failure (SAF) was defined as DC < <26> 4.5 ms and HRT category 2. Cox-proportional hazards analyses were performed with respect to age, history of previous myocardial infarction, mean heart rate, HRV index and arrhythmia count during 24-h Holter monitoring, QRS duration and LVEF, all with prospectively defined dichotomies. Results: During follow-up, 61 patients died. There were 36 cardiac deaths, out of which 23 occurred suddenly. 24 patients presented with SAF, 13 patients with LVEF < <26> 30%. Five-year all-cause mortality rates of patients with and without SAF were 63% and 11%, respectively (Figure , left panel). For LVEF 30%, these figures were 51% and 15% (Figure , right panel). Similar figures were observed for cardiac mortality. In multivariable analysis, presence of SAF indicated a hazard ratio of 5.1 (LVEF 4.2; age 3.5, mean heart rate 1.9). Conclusion: Diabetic post-infarction patients with SAF have a poor outcome, whereas mortality rates of patients without SAF were low.

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