Home > December 2004 - Volume 15 - Issue 8

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December 2004 - Volume 15 - Issue 8

pp: 461-506

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Pathophysiology and Natural History

Exercise testing in asymptomatic patients with heterozygous familial hypercholesterolaemia

Michaelides, Andreas P.; Fourlas, Christos A.; Pitsavos, Christos; More

Michaelides, Andreas P.; Fourlas, Christos A.; Pitsavos, Christos; Andrikopoulos, George K.; Skoumas, Ioannis; Kartalis, Athanasios; Katsaros, Andreas; Stougiannos, Pavlos; Stefanadis, Christodoulos I. Less

Coronary Artery Disease. 15(8):461-465, December 2004.

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Familial hypercholesterolaemia (FH) is a frequent genetic disorder that is correlated with increased incidence of cardiovascular events. We investigated clinical and biochemical parameters possibly associated with the results of exercise testing (ET), as an indication of silent myocardial ischemia in asymptomatic patients with heterozygous FH. The study population was consisted of 194 patients with heterozygous FH, who had no medical history of coronary artery disease (CAD) or angina-like symptoms and had agreed to undergo ET. Among all the studied parameters, higher fibrinogen levels, arterial hypertension and family history of CAD were more frequent among patients with heterozygous FH. However, only high fibrinogen levels were significantly and independently associated with a positive result of ET. Thus, in asymptomatic patients with heterozygous FH, fibrinogen levels are an independent predictor of positive ET, while lipids and coronary risk factors profile do not seem to predict exercise-induced myocardial ischemia.

Can we identify vulnerable patients at risk for ST-segment elevation myocardial infarction based on their clinical characteristics?

Chou, Eric T.; Minutello, Robert M.; Parikh, Manish; More

Chou, Eric T.; Minutello, Robert M.; Parikh, Manish; Bergman, Geoffrey; Chiu Wong, S.; Hong, Mun K. Less

Coronary Artery Disease. 15(8):467-469, December 2004.

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In order to identify clinical predictors of first ST-segment elevation myocardial infarction (STEMI), we retrospectively compared 116 consecutive patients presenting with their first STEMI for primary angioplasty and 216 ambulatory patients with stable angina requiring their first coronary intervention. Patients with STEMI were younger, more likely to be smokers, but less likely to have hypertension or hypercholesterolemia. Diabetes was present equally between the two groups. Cardioprotective medication usage, such as aspirin and statin, was much lower among patients presenting with their first STEMI. Thus, patients with STEMI presumably from plaque rupture have fewer traditional risk factors compared with patients with stable angina. Identifying these vulnerable patients at risk for plaque rupture may enable early institution of cardioprotectivepharmacotherapy to prevent their first acute coronary syndrome occurrence.

Soluble CD40 ligand is an early initiator of inflammation after coronary intervention

Aggarwal, Atul; Blum, Arnon; Schneider, David J.; More

Aggarwal, Atul; Blum, Arnon; Schneider, David J.; Sobel, Burton E.; Dauerman, Harold L. Less

Coronary Artery Disease. 15(8):471-475, December 2004.

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In this prospective study of 75 patients undergoing coronary stenting, a systemic inflammatory response was evident within 10 min of coronary stenting. Soluble CD40 ligand had the greatest relative rise in the first 10 min after stenting suggesting a possible role for this cytokine in the initiation of the inflammatory response; predictors of this early rise included preprocedural white blood count, preprocedural soluble CD40 ligand level, use of multiple stents and randomization to eptifibatide.

Relation of C-reactive protein to extent and complexity of coronary narrowing in patients with non-ST elevation acute coronary syndromes. A prospective cohort study

Navarro Estrada, José L.; Gabay, José M.; Alvarez, José; More

Navarro Estrada, José L.; Gabay, José M.; Alvarez, José; Sztejfman, Carlos; Matas, Carlos Rojas; Farrás, Alejandra; Sarmiento, Ricardo; Tettamanzi, Alejandro; Rapallo, Carlos; Mrad, Jorge; Botto, Fernando; Hirschson-Prado, Alfredo; De Miguel, Raúl; Guzmán, Luis A.; on behalf of the PACS investigators Less

Coronary Artery Disease. 15(8):477-484, December 2004.

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The aim of the present study was to determine if the clinical prognostic value of C-reactive protein (CRP) in patients with acute coronary syndromes (ACS), was related to angiographic anatomical findings. Coronary angiography was performed in 633 patients. The presence of complex coronary lesions (CCL) and the extension of coronary disease were prospectively defined, and its relationship with CRP levels was investigated. CRP was found to be (+)(=3?mg/L), in 354 patients (60%),and CCL were present in 266 patients (46%). There was no association between the extension of coronary disease and lesion morphology with the CRP levels. Even though CRP is a strong predictor of worse clinical outcome in patients with ACS, this could not be explained by the angiographic anatomic findings.

Constituents of red wine other than alcohol improve endothelial function in patients with coronary artery disease

Karatzi, Kalliopi; Papamichael, Christos; Aznaouridis, Konstantinos; More

Karatzi, Kalliopi; Papamichael, Christos; Aznaouridis, Konstantinos; Karatzis, Emmanouil; Lekakis, John; Matsouka, Charis; Boskou, George; Chiou, Antonia; Sitara, Marietta; Feliou, Giorgia; Kontoyiannis, Dimitrios; Zampelas, Antonis; Mavrikakis, Myron Less

Coronary Artery Disease. 15(8):485-490, December 2004.

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The aim of the present study was to investigate the postprandial effects of alcohol content and the antioxidants of red wine on endothelial function and fibrinogen levels in CAD patients. Fifteen males with angiographicall y documented CAD ingested 250 ml of either red wine or dealcoholized red wine on two different days. Fibrinogen and flow mediated dilation (FMD)was determined before and 30,60 and 90 minutes following consumption of each beverage. Acute ingestion of red wine without alcohol led to higher FMD than ingestion of regular red wine in CAD patients. Fibrinogen concentrations were unaltered. The acute effect of red wine on endothelial function may be different than its long-term effect and it could be attributed to its constituents other than alcohol.

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Diagnostic Methods

Clinical impact of selective spasm provocation tests: comparisons between acetylcholine and ergonovine in 1508 examinations

Sueda, Shozo; Kohno, Hiroaki; Fukuda, Hiroshi; More

Sueda, Shozo; Kohno, Hiroaki; Fukuda, Hiroshi; Ochi, Naoto; Kawada, Hiroyuki; Hayashi, Yutaka; Uraoka, Tadao Less

Coronary Artery Disease. 15(8):491-497, December 2004.

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We compared the coronary arterial response and clinical usefulness between selective intracoronary injection of ACh and ER. We performed 1,508 selective spasm provocation tests, consisting of 873 ACh tests and 635 ER tests from 1991 to 2002. Intracoronary ACh provoked spasms in 36.0% of patients and intracoronary ER induced spasms in 29.8% of patients. In patients with ischemic heart disease, the incidence of provoked spasms was not different between ACh tests (50.9%) and ER tests (43.8%). In contrast, the frequency of provoked spasms with ACh tests was significantly higher than that with ER testings (11.0% vs. 6.4%, p<0.05) in patients without ischemic heart disease. Major complications were observed in 1.4% of patients with ACh tests and in 0.2% of patients with ER tests. However, no serious irreversible complications, such as death or acute myocardial infarction, were observed in this study. In conclusion, both selective ACh and ER tests were useful as spasm provocation tests.

Troponin I as a specific marker of myocardial injury: from theory to clinical practice in the diagnosis of acute coronary syndrome

Bucciarelli-Ducci, Chiara; Rasile, Cristina; Proietti, Paola; More

Bucciarelli-Ducci, Chiara; Rasile, Cristina; Proietti, Paola; Mancone, Massimo; Volponi, Cristina; Vestri, Annarita; Fedele, Francesco Less

Coronary Artery Disease. 15(8):499-504, December 2004.

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Troponins are the most specific markers of myocardial injury, but are not always synonymous of an ischemic mechanism of injury. Troponin increases may be observed in various clinical settings different than acute coronary syndrome and a misinterpretation of its rise may cause inappropriate diagnosis.

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Bibliography of current world literature

Bibliography Current world literature

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Coronary Artery Disease. 15(8):505-506, December 2004.

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Table of Contents Sections

Pathophysiology and Natural History
Diagnostic Methods
Bibliography of current world literature

Secondary Logo

Journal Logo

Pathophysiology and Natural History

Exercise testing in asymptomatic patients with heterozygous familial hypercholesterolaemia

In Brief:

Can we identify vulnerable patients at risk for ST-segment elevation myocardial infarction based on their clinical characteristics?

In Brief:

Soluble CD40 ligand is an early initiator of inflammation after coronary intervention

In Brief:

Relation of C-reactive protein to extent and complexity of coronary narrowing in patients with non-ST elevation acute coronary syndromes. A prospective cohort study

In Brief:

Constituents of red wine other than alcohol improve endothelial function in patients with coronary artery disease

In Brief:

Diagnostic Methods

Clinical impact of selective spasm provocation tests: comparisons between acetylcholine and ergonovine in 1508 examinations

In Brief:

Troponin I as a specific marker of myocardial injury: from theory to clinical practice in the diagnosis of acute coronary syndrome

In Brief:

Bibliography of current world literature

Bibliography Current world literature

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