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Sample records for artery disease longitudinal

  1. Peripheral Artery Disease

    MedlinePlus

    ... Physician Resources Professions Site Index A-Z Peripheral Artery Disease (PAD) Peripheral artery disease (PAD) refers to ... is peripheral artery disease treated? What is peripheral artery disease (PAD)? Peripheral artery disease, or PAD, refers ...

  2. Carotid Artery Disease

    MedlinePlus

    ... brain with blood. If you have carotid artery disease, the arteries become narrow, usually because of atherosclerosis. ... one of the causes of stroke. Carotid artery disease often does not cause symptoms, but there are ...

  3. Coronary Artery Disease

    MedlinePlus

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened ...

  4. What Is Peripheral Artery Disease?

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Peripheral Artery Disease? Peripheral artery disease (P.A.D.) is ... that affects blood flow to the legs. Normal Artery and Artery With Plaque Buildup The illustration shows ...

  5. Living with Carotid Artery Disease

    MedlinePlus

    ... from the NHLBI on Twitter. Living With Carotid Artery Disease If you have carotid artery disease, you can take steps to manage the ... treatment plan, and getting ongoing care. Having carotid artery disease raises your risk of having a stroke . ...

  6. What Is Carotid Artery Disease?

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Carotid Artery Disease? Carotid artery disease is a disease in ... blood to your face, scalp, and neck. Carotid Arteries Figure A shows the location of the right ...

  7. Peripheral Artery Disease and Diabetes

    MedlinePlus

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Peripheral Artery Disease & Diabetes Updated:Jan 26,2016 People with ... developing atherosclerosis, the most common cause of peripheral artery disease (PAD) . And individuals with PAD have a ...

  8. Coronary artery disease (image)

    MedlinePlus

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the ... blood to the heart can slow or stop, causing chest pain (stable ...

  9. Hypertensive Target Organ Damage and Longitudinal Changes in Brain Structure and Function: The Second Manifestations of Arterial Disease-Magnetic Resonance Study.

    PubMed

    van der Veen, Pieternella H; Geerlings, Mirjam I; Visseren, Frank L J; Nathoe, Hendrik M; Mali, Willem P T M; van der Graaf, Yolanda; Muller, Majon

    2015-12-01

    Hypertension has been related to structural and functional brain changes. In high-risk populations, hypertensive target organ damage might better represent exposure to high blood pressure than the blood pressure measurement itself. We examined the association of hypertensive target organ damage with longitudinal changes in brain structure and function within the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study. Renal function, albuminuria, and left ventricular hypertrophy on electrocardiography were measured in 663 patients with manifest arterial disease (mean age, 57±9 years; 81% men). Automated brain segmentation was used to quantify progression of global brain atrophy (change in brain parenchymal fraction) and progression of cerebral small vessel disease on 1.5T magnetic resonance imaging, and memory and executive functioning were assessed at baseline and after on average 3.9 years of follow-up. Regression analyses showed that an increasing number of signs of target organ damage was associated with more progression of global brain atrophy and more rapid decline in memory performance. Compared with no target organ damage, mean differences in change in brain parenchymal fraction (95% confidence interval) for 1 and ≥2 signs of organ damage were -0.12 (-0.30; 0.06) and -0.41 (-0.77; -0.05) % intracranial volume, and mean (95% confidence interval) differences in change in memory performance (z score) were -0.15 (-0.29; -0.00) and -0.27 (-0.54; -0.01). Results were independent of blood pressure, antihypertensive treatment, and other confounders. Hypertension target organ damage was not associated with progression of cerebral small vessel disease or change in executive functioning. Routinely assessed signs of hypertensive target organ damage, and in particular impaired renal function, could be used to identify patients at the highest risk of cognitive decline.

  10. Carotid artery disease

    MedlinePlus

    ... a stroke recover most or all of their functions. Others die of the stroke itself or from complications. About half of people ... patients with extracranial carotid and vertebral artery disease: executive summary: ... American Association of Neuroscience Nurses, American Association ...

  11. Diagnostic power of longitudinal strain at rest for the detection of obstructive coronary artery disease in patients with type 2 diabetes mellitus.

    PubMed

    Zuo, Houjuan; Yan, Jiangtao; Zeng, Hesong; Li, Wenyu; Li, Pengcheng; Liu, Zhengxiang; Cui, Guanglin; Lv, Jiagao; Wang, Daowen; Wang, Hong

    2015-01-01

    Global longitudinal strain (GLS) measured by 2-D speckle-tracking echocardiography (2-D STE) at rest has been recognized as a sensitive parameter in the detection of significant coronary artery disease (CAD). However, the diagnostic power of 2-D STE in the detection of significant CAD in patients with diabetes mellitus is unknown. Two-dimensional STE features were studied in total of 143 consecutive patients who underwent echocardiography and coronary angiography. Left ventricular global and segmental peak systolic longitudinal strains (PSLSs) were quantified by speckle-tracking imaging. In the presence of obstructive CAD (defined as stenosis ≥75%), global PSLS was significantly lower in patients with diabetes mellitus than in patients without (16.65 ± 2.29% vs. 17.32 ± 2.27%, p < 0.05). Receiver operating characteristic analysis revealed that global PSLS could effectively detect obstructive CAD in patients without diabetes mellitus (cutoff value: -18.35%, sensitivity: 78.8%, specificity: 77.5%). However, global PSLS could detect obstructive CAD in diabetic patients at a lower cutoff value with inadequate sensitivity and specificity (cutoff value: -17.15%; sensitivity: 61.1%, specificity: 52.9%). In addition, the results for segmental PSLS were similar to those for global PSLS. In conclusion, global and segmental PSLSs at rest were significantly lower in patients with both obstructive CAD and diabetes mellitus than in patients with obstructive CAD only; thus, PSLSs at rest might not be a useful parameter in the detection of obstructive CAD in patients with diabetes mellitus.

  12. How socioeconomic inequalities impact pathways of care for coronary artery disease among elderly patients: study protocol for a qualitative longitudinal study

    PubMed Central

    Schröder, Sara L; Fink, Astrid; Schumann, Nadine; Moor, Irene; Plehn, Alexander; Richter, Matthias

    2015-01-01

    Introduction Several studies have identified that socioeconomic inequalities in coronary artery disease (CAD) morbidity and mortality lead to a disadvantage in patients with low socioeconomic status (SES). International studies have shown that socioeconomic inequalities also exist in terms of access, utilisation and quality of cardiac care. The aim of this qualitative study is to provide information on the impact of socioeconomic inequalities on the pathway of care for CAD, and to establish which factors lead to socioeconomic inequality of care to form and expand existing scientific theories. Methods and analysis A longitudinal qualitative study with 48 patients with CAD, aged 60–80 years, is being conducted. Patients have been recruited consecutively at the University Hospital in Halle/Saale, Germany, and will be followed for a period of 6 months. Patients are interviewed two times face-to-face using semistructured interviews. Data are transcribed and analysed based on grounded theory. Ethics and dissemination Only participants who have been informed and who have signed a declaration of consent have been included in the study. The study complies rigorously with data protection legislation. Approval of the Ethical Review Committee at the Martin-Luther University Halle-Wittenberg, Germany was obtained. The results of the study will be presented at several congresses, and will be published in high-quality peer-reviewed international journals. Trial registration number This study has been registered with the German Clinical Trials Register and assigned DRKS00007839. PMID:26553827

  13. Cardiovascular Health and Arterial Stiffness: The Maine Syracuse Longitudinal Study

    PubMed Central

    Crichton, Georgina E; Elias, Merrill F; Robbins, Michael A

    2014-01-01

    Ideal cardiovascular health is a recently defined construct by the American Heart Association (AHA) to promote cardiovascular disease reduction. Arterial stiffness is a major risk factor for cardiovascular disease. The extent to which the presence of multiple prevalent cardiovascular risk factors and health behaviors is associated with arterial stiffness is unknown. The aim of this study was to examine the association between the AHA construct of cardiovascular health and arterial stiffness, as indexed by pulse wave velocity and pulse pressure. The AHA health metrics, comprising of four health behaviors (smoking, body mass index, physical activity, and diet) and three health factors (total cholesterol, blood pressure, and fasting plasma glucose) were evaluated among 505 participants in the Maine-Syracuse Longitudinal Study. Outcome measures were carotid-femoral pulse wave velocity (PWV) and pulse pressure measured at 4 to 5-year follow-up. Better cardiovascular health, comprising both health factors and behaviors, was associated with lower arterial stiffness, as indexed by pulse wave velocity and pulse pressure. Those with at least five health metrics at ideal levels had significantly lower PWV (9.8 m/s) than those with two or less ideal health metrics (11.7 m/s) (P<0.001). This finding remained with the addition of demographic and PWV-related variables (P=0.004). PMID:24384629

  14. Longitudinal changes in brain volumes and cerebrovascular lesions on MRI in patients with manifest arterial disease: the SMART-MR study.

    PubMed

    van der Veen, Pieternella H; Muller, Majon; Vincken, Koen L; Witkamp, Theo D; Mali, Willem P T M; van der Graaf, Yolanda; Geerlings, Mirjam I

    2014-02-15

    We estimated the progression of brain atrophy and cerebrovascular lesions on MRI in a prospective cohort of patients with various manifestations of arterial disease. Within the SMART-MR study, using brain MRI data from baseline and after on average 3.9 years of follow-up, intracranial volume (ICV), total brain, cortical gray matter, ventricular, white matter lesion volumes and visually rated infarcts were obtained from 663 patients (mean age 57 ± 9 years, 81% men). Global and cortical atrophy increased quadratically with age. Men showed more progression of global and cortical atrophy than women (mean difference in change (95% CI): -0.25 (-0.44; -0.06) and -0.94 (-1.35; -0.52)% ICV) and had an increased risk of new brain infarcts (OR = 2.7, 95% CI 1.2-6.1). Compared with coronary artery disease patients, cerebrovascular disease patients showed more progression of cortical and subcortical atrophy and an increased risk of new brain infarcts, and peripheral arterial disease patients showed more progression of cortical atrophy. These results were independent of cerebrovascular lesions and cardiovascular risk factors. In patients with manifest arterial disease, brain atrophy tended to accelerate with older age and men had more progression of brain atrophy and cerebrovascular lesions than women. Additionally, patients with cerebrovascular and peripheral arterial disease showed the most prominent progression of atrophy and lesions.

  15. Peripheral arterial disease

    PubMed Central

    2011-01-01

    Introduction Up to 20% of adults aged over 55 years have detectable peripheral arterial disease of the legs, but this may cause symptoms of intermittent claudication in only a small proportion of affected people. The main risk factors are smoking and diabetes mellitus, but other risk factors for cardiovascular disease are also associated with peripheral arterial disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for people with chronic peripheral arterial disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010. Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review. We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 70 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antiplatelet agents, bypass surgery, cilostazol, exercise, pentoxifylline, percutaneous transluminal angioplasty (PTA), prostaglandins, smoking cessation, and statins. PMID:21477401

  16. Peripheral arterial disease

    PubMed Central

    2009-01-01

    Introduction Up to 20% of adults aged over 55 years have detectable peripheral arterial disease of the legs, but this may cause symptoms of intermittent claudication in only a small proportion of affected people. The main risk factors are smoking and diabetes mellitus, but other risk factors for cardiovascular disease are also associated with peripheral arterial disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for people with chronic peripheral arterial disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2009. (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 59 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiplatelet agents; bypass surgery; cilostazol; exercise; pentoxifylline; percutaneous transluminal angioplasty (PTA); prostaglandins; smoking cessation; and statins. PMID:19454099

  17. Coronary artery disease

    MedlinePlus Videos and Cool Tools

    ... heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, a process called atherosclerosis ...

  18. Carotid Artery Disease

    MedlinePlus

    ... sites within the artery. This process is called atherosclerosis. Carotid arteries that are clogged with plaques are ... at greater risk of high blood pressure and atherosclerosis. High blood-fat levels. High levels of low- ...

  19. Epigenetics and Peripheral Artery Disease.

    PubMed

    Golledge, Jonathan; Biros, Erik; Bingley, John; Iyer, Vikram; Krishna, Smriti M

    2016-04-01

    The term epigenetics is usually used to describe inheritable changes in gene function which do not involve changes in the DNA sequence. These typically include non-coding RNAs, DNA methylation and histone modifications. Smoking and older age are recognised risk factors for peripheral artery diseases, such as occlusive lower limb artery disease and abdominal aortic aneurysm, and have been implicated in promoting epigenetic changes. This brief review describes studies that have associated epigenetic factors with peripheral artery diseases and investigations which have examined the effect of epigenetic modifications on the outcome of peripheral artery diseases in mouse models. Investigations have largely focused on microRNAs and have identified a number of circulating microRNAs associated with human peripheral artery diseases. Upregulating or antagonising a number of microRNAs has also been reported to limit aortic aneurysm development and hind limb ischemia in mouse models. The importance of DNA methylation and histone modifications in peripheral artery disease has been relatively little studied. Whether circulating microRNAs can be used to assist identification of patients with peripheral artery diseases and be modified in order to improve the outcome of peripheral artery disease will require further investigation.

  20. About Peripheral Artery Disease (PAD)

    MedlinePlus

    ... CAD). Both PAD and CAD are caused by atherosclerosis that narrows and blocks arteries in various critical ... can be managed with lifestyle changes and medication . Atherosclerosis and PAD Atherosclerosis is a disease in which ...

  1. How Is Carotid Artery Disease Treated?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Carotid Artery Disease Treated? Treatments for carotid artery disease may ... plaque removed and normal blood flow restored. Carotid Artery Angioplasty and Stenting Doctors use a procedure called ...

  2. How Can Carotid Artery Disease Be Prevented?

    MedlinePlus

    ... from the NHLBI on Twitter. How Can Carotid Artery Disease Be Prevented? Taking action to control your risk factors can help prevent or delay carotid artery disease and stroke . Your risk for carotid artery ...

  3. Peripheral Artery Disease

    MedlinePlus

    ... needed to restore blood flow: Angioplasty : In an angioplasty procedure, an interventional radiologist threads a catheter through a blood vessel to the affected artery and inflates a small balloon to reopen it. In some cases, the insertion ...

  4. Peripheral artery disease - legs

    MedlinePlus

    ... legs; Arterial insufficiency of the legs; Recurrent leg pain and cramping; Calf pain with exercise ... The main symptoms of PAD are pain, achiness, fatigue, burning, or ... or thighs. These symptoms most often appear during walking or ...

  5. Carotid Artery Disease

    MedlinePlus

    ... Kawasaki Disease Long Q-T Syndrome Marfan Syndrome Metabolic Syndrome Mitral Valve Prolapse Myocardial Bridge Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic Fever Sick Sinus Syndrome Silent Ischemia Stroke Sudden ...

  6. Wall tissue remodeling regulates longitudinal tension in arteries.

    PubMed

    Jackson, Zane S; Gotlieb, Avrum I; Langille, B Lowell

    2002-05-03

    Changes in blood pressure or flow induce arterial remodeling that normalizes mechanical loads that are imposed on arterial tissue. Arteries are also under substantial longitudinal stretch (axial strain) that may be altered by growth or atrophy of tissues to which they are attached. We therefore tested whether axial strain is also regulated in a negative feedback manner through arterial remodeling. Axial strain in rabbit carotid arteries was increased from 62+/-2% to 97+/-2% without altering other mechanical loads on wall tissues. Strain was reduced within 3 days and completely normalized by 7 days. Remodeling involved tissue elaboration, endothelial cell replication rates were increased by >50-fold and smooth muscle cell replication rates were increased by >15-fold, and substantially elevated DNA, elastin, and collagen contents were recorded. Also, increased rates of apoptosis were indicated by degradation of DNA into oligonucleosomes, and matrix remodeling was reflected in enlarged fenestrae in the internal elastic lamina and increased expression and activation of gelatinases, especially matrix metalloproteinase-2. Intriguingly, reduced axial strain was not normalized, presumably because remodeling processes, apart from cell contraction, are ineffective in decreasing strain, and arterial smooth muscle orientation precludes large effects of contraction on axial strain.

  7. [Progestins and arterial disease].

    PubMed

    Rozenbaum, H

    1985-01-01

    The role of estrogens in the etiology of vascular accidents was identified soon after oral contraceptives (OCs) came into use over 2 decades ago, but the role of progestins was only identified on the basis of systematic study. Reduction in the estrogen dose of OCs was accompained by a steady decline in venous accidents, but the rate of arterial accidents changed little. It is important to remember that the actual occurrence of vascular accidents in OC users is rare. Available statistics indicate that age and smoking are important risk factors for vascular accidents. Among nonsmokers and smokers respectively, the annual risk of death due to vascular accidents is 1 in 77,000 and 1 in 10,000 for women under 35, 1 in 67,000 and 1 in 2000 for women 35-44, and 1 in 2500 and 1 in 500 for women 45 and over. Some isolated cases of arterial vascular accidents in users of progestin only OCs have been published. The death rate from vascular accidents is 3 times as high when the levonorgestrel dose increases from 150 to 250 mcg, and twice as high when the norethisterone acetate dose increases from 1 to 4 mg. It is not known precisely how synthetic progestins can induce an arterial accident, but the factors involved may include elevation of blood pressure by potentiation of the modifications in renin-angiotensin system caused by ethinyl estradiol, reducing the level of high density lipoprotein (HDL) cholesterol, impairing glucose tolerance, altering the vascular walls directly, or modifying certain coagulation factors. Little data is available on progestin-caused modifications in coagulation factors, but a recent study reported that the effects of combined OCs on coagulation factors increased with the progestin dose. 2 groups of 19-norsteroids are currently used in contraception, the estranes including norethisterone and some prohormones that metabolize to norethisterone before becoming active, and the gonanes including norgestrel, levonorgestrel, and desogestrel. Early optimism

  8. Effect of comprehensive cardiovascular disease risk management on longitudinal changes in carotid artery intima-media thickness in a community-based prevention clinic

    PubMed Central

    Cheng, Henry G.; Patel, Birju S.; Martin, Seth S.; Blaha, Michael; Doneen, Amy; Bale, Brad

    2016-01-01

    Introduction The aim of the study was to examine changes in carotid intima-media thickness (CIMT) and carotid plaque morphology in patients receiving multifactorial cardiovascular disease (CVD) risk factor management in a community-based prevention clinic. Quantitative changes in CIMT and qualitative changes in carotid plaque morphology may be measured non-invasively by ultrasound. Material and methods This is a retrospective study on a cohort of 324 patients who received multifactorial cardiovascular risk reduction treatment at a community prevention clinic. All patients received lipid-lowering medications (statin, niacin, and/or ezetimibe) and lifestyle modification. All patients underwent at least one follow-up CIMT measurement after starting their regimen. Annual biomarker, CIMT, and plaque measurements were analyzed for associations with CVD risk reduction treatment. Results Median time to last CIMT was 3.0 years. Compared to baseline, follow-up analysis of all treatment groups at 2 years showed a 52.7% decrease in max CIMT, a 3.0% decrease in mean CIMT, and an 87.0% decrease in the difference between max and mean CIMT (p < 0.001). Plaque composition changes occurred, including a decrease in lipid-rich plaques of 78.4% within the first 2 years (p < 0.001). After the first 2 years, CIMT and lipid-rich plaques continued to decline at reduced rates. Conclusion In a cohort of patients receiving comprehensive CVD risk reduction therapy, delipidation of subclinical carotid plaque and reductions in CIMT predominantly occurred within 2 years, and correlated with changes in traditional biomarkers. These observations, generated from existing clinical data, provide unique insight into the longitudinal on-treatment changes in carotid plaque. PMID:27478452

  9. Antihypertensive Drug Use and New-Onset Diabetes in Female Patients with Coronary Artery Disease: A Population-based Longitudinal Cohort Study.

    PubMed

    Liou, Yi-Sheng; Chen, Hung-Yi; Tien, Lyun; Gu, Yi-Sian; Jong, Gwo-Ping

    2015-09-01

    Antihypertensives have been linked to new-onset diabetes (NOD) and different classes of antihypertensives may alter the risk for the development of NOD; however, the effect of different antihypertensives on the development of NOD in women with hypertension and coronary artery disease (CAD) has not been well studied. The purpose of this study is to investigate the association between usage of different antihypertensive drugs and the development of NOD in female patients with hypertension and CAD.Data in this retrospective cohort study were obtained from claim forms submitted to the Taiwan Bureau of National Health Insurance in central Taiwan during the period 2006-2011. We estimated the odds ratios (OR) to approximate the relative risk of NOD development associated with antihypertensive drug use.Of the 20,108 female patients with CAD at baseline, 2288 patients developed NOD during the 6-year follow-up. Subjects treated with angiotensin-converting enzyme (ACE) inhibitors (OR, 0.92; 95% confidence interval [CI], 0.84-1.00), angiotensin receptor blockers (OR, 0.92; 95% CI, 0.82-0.99), and alpha-blockers (OR, 0.88; 95% CI, 0.79-0.98) in the adjusted analyses had greater reductions of the risk than among nonusers. Patients who took diuretics (OR, 1.10; 95% CI, 1.01-1.20), beta-blockers (OR, 1.12; 95% CI, 1.04-1.21), and calcium channel blockers (OR, 1.10; 95% CI, 1.02-1.18) were at high risk of developing NOD than nonusers. Vasodilators were not associated with risk of NOD.We conclude that women with hypertension who take ACE inhibitors, angiotensin receptor blockers, and alpha-blockers are at lower risk of NOD and that use of diuretics, beta-blockers, and calcium channel blockers was associated with a significantly increased risk of developing NOD during the 6-year follow-up.

  10. Peripheral Arterial Disease

    MedlinePlus

    ... severe enough, blocked blood flow can cause tissue death and can sometimes lead to amputation of the foot or leg. The main risk factor for PAD is smoking. Other risk factors include older age and diseases ...

  11. Occlusive Peripheral Arterial Disease

    MedlinePlus

    ... legs (or rarely the arms), usually due to atherosclerosis and resulting in decreased blood flow. Symptoms depend ... among older people because it often results from atherosclerosis (plaque or disease buildup in the wall of ...

  12. Longitudinal trajectories of arterial stiffness and the role of blood pressure: the Baltimore Longitudinal Study of Aging.

    PubMed

    AlGhatrif, Majd; Strait, James B; Morrell, Chris H; Canepa, Marco; Wright, Jeanette; Elango, Palchamy; Scuteri, Angelo; Najjar, Samer S; Ferrucci, Luigi; Lakatta, Edward G

    2013-11-01

    Carotid-femoral pulse wave velocity (PWV), a marker of arterial stiffness, is an established independent cardiovascular risk factor. Little information is available on the pattern and determinants of the longitudinal change in PWV with aging. Such information is crucial to elucidating mechanisms underlying arterial stiffness and the design of interventions to retard it. Between 1988 and 2013, we collected 2 to 9 serial measures of PWV in 354 men and 423 women of the Baltimore Longitudinal Study of Aging, who were 21 to 94 years of age and free of clinically significant cardiovascular disease. Rates of PWV increase accelerated with advancing age in men more than women, leading to sex differences in PWV after the age of 50 years. In both sexes, not only systolic blood pressure (SBP) ≥140 mm Hg but also SBP of 120 to 139 mm Hg was associated with steeper rates of PWV increase compared with SBP<120 mm Hg. Furthermore, there was a dose-dependent effect of SBP in men with marked acceleration in PWV rate of increase with age at SBP ≥140 mm Hg compared with SBP of 120 to 139 mm Hg. Except for waist circumference in women, no other traditional cardiovascular risk factors predicted longitudinal PWV increase. In conclusion, the steeper longitudinal increase of PWV in men than women led to the sex difference that expanded with advancing age. Age and SBP are the main longitudinal determinants of PWV, and the effect of SBP on PWV trajectories exists even in the prehypertensive range.

  13. Signs and Symptoms of Artery Disease | Coronary Artery Disease | NIH MedlinePlus the Magazine

    MedlinePlus

    ... this page please turn Javascript on. Feature: Coronary Artery Disease Signs and Symptoms of Artery Disease Past Issues / Fall 2010 Table of Contents ... this depends on which arteries are affected. Coronary Arteries Coronary arteries supply oxygen-rich blood to the ...

  14. Peripheral Arterial Disease (P.A.D.)

    MedlinePlus

    ... turn Javascript on. Peripheral Artery Disease (P.A.D.) What is P.A.D.? Arteries Clogged With Plaque Peripheral arterial disease (P. ... button on your keyboard.) Why Is P.A.D. Dangerous? Click for more information Blocked blood flow ...

  15. Could Peripheral Arterial Disease Be Your Problem?

    MedlinePlus

    ... exercise and yoga classes and has returned to teaching. Fast Facts Peripheral arterial disease (P.A.D.) occurs when a fatty material called plaque (pronounced plak) builds up on the inside walls of the arteries that carry blood from ...

  16. Coronary Artery Disease | Coronary Artery Disease | NIH MedlinePlus the Magazine

    MedlinePlus

    ... your heart and other parts of your body. Atherosclerosis (ATH-er-oskler-O-sis) is a disease ... which plaque builds up inside your arteries. One atherosclerosis-related disease, coronary artery disease (CAD) is the ...

  17. Understanding Arteries | Coronary Artery Disease | NIH MedlinePlus the Magazine

    MedlinePlus

    ... this page please turn Javascript on. Feature: Coronary Artery Disease Understanding Arteries Past Issues / Fall 2010 Table of Contents Below: ... the arteries and veins are healthy. A Healthy Artery An artery is a muscular tube. It has ...

  18. [Risk factors for arterial disease].

    PubMed

    Madoery, Roberto; Rubin, Graciela; Luquez, Hugo; Luquez, Cecilia; Cravero, Cecilia

    2004-01-01

    The risk factors of arterial disease (FREA) predict a future damage over the vascular system of the human body. Its detection are considered a key for the diagnostic as well as for the preventive and even curative strategies. For a long time, scientist considered those factors originated as a consecuence of large studies during the middle of the last century, with current validity up to our days. A simple classification spoke of them as traditionals. Further investigations described the so called new or emergents.factors that where joint together accordingly to their actions: coagulation factors, psicosocial, inflamatories and infectious. A recent classification, taking into account the type of impact, divided them into; causatives, predisposals and conditionals. Also, it was described a mechanism, the oxidative power, with consecuences over the endothelium, in the last part of the process. Before, another mechanism was described: the insulin resistance and the hiperinsulinism, bases for the Metabolic Syndrome, that includes a number of traditional risk factors.

  19. MRI in coronary artery disease.

    PubMed

    Barkhausen, Jörg; Hunold, Peter; Waltering, Kai-Uwe

    2004-12-01

    Diagnosis of coronary artery disease (CAD) is a major challenge for medical imaging, because CAD is the leading cause of death in developed nations. Several non-invasive tests are used in clinical routine for the detection of CAD. However, due to limited sensitivity and specificity, the reliable diagnosis as well as the exclusion of CAD can only be established by catheter angiography. In patients with known CAD, therapeutic decisions require accurate information on myocardial function, ischemia and viability. Recently, magnetic resonance (MR) imaging has emerged as a non-invasive cardiac imaging technique that provides information on cardiac morphology, cardiac function, myocardial viability, and coronary morphology. This review discusses technical aspects and the clinical impact of different MR techniques.

  20. Peripheral Arterial Disease and Claudication

    MedlinePlus

    ... of fatty deposits inside them. This is called atherosclerosis. If you have PAD, your arms, and more ... also more likely in people who already have atherosclerosis in other arteries, such as the arteries in ...

  1. Radiation-induced coronary artery disease

    SciTech Connect

    Dunsmore, L.D.; LoPonte, M.A.; Dunsmore, R.A.

    1986-07-01

    This report describes three patients who developed myocardial infarction at an untimely age, 4 to 12 years after radiation therapy for Hodgkin's disease. These cases lend credence to the cause and effect relation of such therapy to coronary artery disease.

  2. [Clinical applications of arterial spin labeling technique in brain diseases].

    PubMed

    Wang, Li; Zheng, Gang; Zhao, Tiezhu; Guo, Chao; Li, Lin; Lu, Guangming

    2013-02-01

    Arterial spin labeling (ASL) technique is a kind of perfusion functional magnetic resonance imaging method that is based on endogenous contrast, and it can measure cerebral blood flow (CBF) noninvasively. The ASL technique has advantages of noninvasiveness, simplicity and relatively lower costs so that it is more suitable for longitudinal studies compared with previous perfusion methods, such as positron emission tomography (PET), single photon emission computed tomography (SPECT), CT and the contrast agent based magnetic resonance perfusion imaging. This paper mainly discusses the current clinical applications of ASL in brain diseases as cerebrovascular diseases, brain tumors, Alzheimer's disease and epilepsy, etc.

  3. Noninvasive Imaging in Coronary Artery Disease

    PubMed Central

    Heo, Ran; Nakazato, Ryo; Kalra, Dan; Min, James K.

    2014-01-01

    Noninvasive cardiac imaging is widely used to evaluate the presence of coronary artery disease. Recently, with improvements in imaging technology, noninvasive imaging has also been used for evaluation of the presence, severity, and prognosis of coronary artery disease. Coronary CT angiography and MRI of coronary arteries provide an anatomical assessment of coronary stenosis, whereas the hemodynamic significance of a coronary artery stenosis can be assessed by stress myocardial perfusion imaging, such as SPECT/PET and stress MRI. For appropriate use of multiple imaging modalities, the strengths and limitations of each modality are discussed in this review. PMID:25234083

  4. Diagnosis and therapy of coronary artery disease: Second edition

    SciTech Connect

    Cohn, P.F.

    1985-01-01

    This book contains 18 selections. Some of the titles are: Nuclear cardiology; Diagnosis of acute myocardial infarction; Therapy of angina pectoris; Psychosocial aspects of coronary artery disease; Nonatherosclerotic coronary artery disease; and The epidemiology of coronary artery disease.

  5. Computer measurement of arterial disease

    NASA Technical Reports Server (NTRS)

    Armstrong, J.; Selzer, R. H.; Barndt, R.; Blankenhorn, D. H.; Brooks, S.

    1980-01-01

    Image processing technique quantifies human atherosclerosis by computer analysis of arterial angiograms. X-ray film images are scanned and digitized, arterial shadow is tracked, and several quantitative measures of lumen irregularity are computed. In other tests, excellent agreement was found between computer evaluation of femoral angiograms on living subjects and evaluation by teams of trained angiographers.

  6. Patterns of disease distribution of lower extremity peripheral arterial disease.

    PubMed

    Chen, Qian; Shi, Yang; Wang, Yutang; Li, Xiaoying

    2015-03-01

    Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis that is associated with an increased risk of mortality and cardiovascular (CV) events. Peripheral arterial disease involves the arteries distal to the aortic bifurcation in a nonuniform manner. Studies have shown that symptoms and prognosis of patients with PAD vary according to the location and size of the affected artery. Several modalities have been used to identify the location of PAD, including noninvasive evaluations and invasive procedures. Peripheral arterial disease has a risk factor profile similar to that associated with coronary artery disease (ie, age, gender, diabetes, smoking, hypertension, and hyperlipidemia). Many studies have shown that the distribution, extent, and progression of PAD are influenced by CV risk factors but the findings are not consistent. Management strategies for PAD are different for proximal and distal PAD. The objective of this review is to discuss the patterns of diseases distribution in patients with PAD.

  7. Transfer Function Analysis of the Longitudinal Motion of the Common Carotid Artery Wall

    PubMed Central

    Yli-Ollila, Heikki; Tarvainen, Mika P.; Laitinen, Tomi P.; Laitinen, Tiina M.

    2016-01-01

    The longitudinal motion of the carotid wall is a potential new measure of arterial stiffness. Despite the over decade long research on the subject, the driving force and the specific longitudinal kinetics of the carotid wall has remained unclear. In this study, a transfer function analysis with 20 healthy subjects is presented to derive how the energy from the blood pressure moves the innermost arterial wall longitudinally and how the kinetic energy is then transferred to the outermost arterial layer. The power spectrums display that the main kinetic energy of the longitudinal motion is on band 0–3 Hz with a peak on the 1.1 Hz frequency. There is a large variation among the individuals, how the energy from the blood pressure transfers into the longitudinal motion of the arterial wall since the main direction of the longitudinal motion varies individually and because early arterial stiffening potentially has an effect on the time characteristics of the energy transfer. The energy transfer from the innermost to the outermost wall layer is more straightforward: on average, a 17% of the longitudinal amplitude is lost and an 18.9 ms delay is visible on the 1.0 Hz frequency. PMID:28082917

  8. Coronary Artery Disease: Angioplasty or Bypass Surgery?

    MedlinePlus

    Coronary artery disease: Angioplasty or bypass surgery? I'm getting a cardiac catheterization. If blockages are found, ... angioplasty or bypass surgery? Answers from Rekha Mankad, M.D. During cardiac catheterization, your doctor will examine ...

  9. What Are the Signs and Symptoms of Carotid Artery Disease?

    MedlinePlus

    ... What Are the Signs and Symptoms of Carotid Artery Disease? Carotid artery disease may not cause signs or symptoms until it severely narrows or blocks a carotid artery. Signs and symptoms may include a bruit, a ...

  10. [Reconstruction of foot arteries after injury in arterial occlusive disease].

    PubMed

    Flis, V; Tomazic, T

    1993-06-01

    At the Maribor Teaching Hospital two elderly with progressive atherosclerotic disease below the knee were treated between 1986-1992 for open fracture of ankle joint and pedal arterial trauma. The only patent atherosclerotic vessel (dorsal artery of the foot) that was disrupted was reconstructed in both cases by interposition of a part of the great and small saphenous vein in one case each. A termino-terminal anastomosis with a long, triangular patch was used, fixed with interrupted sutures. The fractures were stabilized with external fixators. Both extremities were saved.

  11. Computational fluid dynamics in coronary artery disease.

    PubMed

    Sun, Zhonghua; Xu, Lei

    2014-12-01

    Computational fluid dynamics (CFD) is a widely used method in mechanical engineering to solve complex problems by analysing fluid flow, heat transfer, and associated phenomena by using computer simulations. In recent years, CFD has been increasingly used in biomedical research of coronary artery disease because of its high performance hardware and software. CFD techniques have been applied to study cardiovascular haemodynamics through simulation tools to predict the behaviour of circulatory blood flow in the human body. CFD simulation based on 3D luminal reconstructions can be used to analyse the local flow fields and flow profiling due to changes of coronary artery geometry, thus, identifying risk factors for development and progression of coronary artery disease. This review aims to provide an overview of the CFD applications in coronary artery disease, including biomechanics of atherosclerotic plaques, plaque progression and rupture; regional haemodynamics relative to plaque location and composition. A critical appraisal is given to a more recently developed application, fractional flow reserve based on CFD computation with regard to its diagnostic accuracy in the detection of haemodynamically significant coronary artery disease.

  12. Passive biaxial mechanical properties and in vivo axial pre-stretch of the diseased human femoropopliteal and tibial arteries.

    PubMed

    Kamenskiy, Alexey V; Pipinos, Iraklis I; Dzenis, Yuris A; Lomneth, Carol S; Kazmi, Syed A Jaffar; Phillips, Nicholas Y; MacTaggart, Jason N

    2014-03-01

    Surgical and interventional therapies for atherosclerotic lesions of the infrainguinal arteries are notorious for high rates of failure. Frequently, this leads to expensive reinterventions, return of disabling symptoms or limb loss. Interaction between the artery and repair material likely plays an important role in reconstruction failure, but data describing the mechanical properties and functional characteristics of human femoropopliteal and tibial arteries are currently not available. Diseased superficial femoral (SFA, n = 10), popliteal (PA, n = 8) and tibial arteries (TA, n = 3) from 10 patients with critical limb ischemia were tested to determine passive mechanical properties using planar biaxial extension. All specimens exhibited large nonlinear deformations and anisotropy. Under equibiaxial loading, all arteries were stiffer in the circumferential direction than in the longitudinal direction. Anisotropy and longitudinal compliance decreased distally, but circumferential compliance increased, possibly to maintain a homeostatic multiaxial stress state. Constitutive parameters for a four-fiber family invariant-based model were determined for all tissues to calculate in vivo axial pre-stretch that allows the artery to function in the most energy efficient manner while also preventing buckling during extremity flexion. Calculated axial pre-stretch was found to decrease with age, disease severity and more distal arterial location. Histological analysis of the femoropopliteal artery demonstrated a distinct sub-adventitial layer of longitudinal elastin fibers that appeared thicker in healthier arteries. The femoropopliteal artery characteristics and properties determined in this study may assist in devising better diagnostic and treatment modalities for patients with peripheral arterial disease.

  13. PASSIVE BIAXIAL MECHANICAL PROPERTIES AND IN VIVO AXIAL PRE-STRETCH OF THE DISEASED HUMAN FEMOROPOPLITEAL AND TIBIAL ARTERIES

    PubMed Central

    Kamenskiy, Alexey V.; Pipinos, Iraklis I.; Dzenis, Yuris A.; Lomneth, Carol S.; Jaffar Kazmi, Syed A.; Phillips, Nicholas Y.; MacTaggart, Jason N.

    2015-01-01

    Surgical and interventional therapies for atherosclerotic lesions of the infrainguinal arteries are notorious for high rates of failure. Frequently, this leads to expensive reinterventions, return of disabling symptoms, or limb loss. Interaction between the artery and repair material likely plays an important role in reconstruction failure, but data describing the mechanical properties and functional characteristics of human femoropopliteal and tibial arteries are currently not available. Diseased superficial femoral (SFA, n=10), popliteal (PA, n=8), and tibial arteries (TA, n=3) from 10 patients with critical limb ischemia were tested to determine passive mechanical properties using planar biaxial extension. All specimens exhibited large non-linear deformations and anisotropy. Under equibiaxial loading, all arteries were stiffer in the circumferential direction than in the longitudinal direction. Anisotropy and longitudinal compliance decreased distally, but circumferential compliance increased, possibly to maintain a homeostatic multiaxial stress state. Constitutive parameters for a 4-fiber family invariant-based model were determined for all tissues to calculate in vivo axial pre-stretch that allows the artery to function in the most energy efficient manner while also preventing buckling during extremity flexion. Calculated axial pre-stretch was found to decrease with age, disease severity, and more distal arterial location. Histological analysis of the femoropopliteal artery demonstrated a distinct sub-adventitial layer of longitudinal elastin fibers that appeared thicker in healthier arteries. The femoropopliteal artery characteristics and properties determined in this study may assist in devising better diagnostic and treatment modalities for patients with peripheral arterial disease. PMID:24370640

  14. Living with Peripheral Arterial Disease

    MedlinePlus

    ... Living With Clinical Trials Links Related Topics Atherosclerosis Coronary Heart Disease Heart Attack Smoking and Your Heart Stroke Send ... D.), you’re more likely to also have coronary heart disease , heart attack , stroke , and transient ischemic attack ("mini- ...

  15. Cadmium Exposure and Incident Peripheral Arterial Disease

    PubMed Central

    Tellez-Plaza, Maria; Guallar, Eliseo; Fabsitz, Richard R.; Howard, Barbara V.; Umans, Jason G.; Francesconi, Kevin A.; Goessler, Walter; Devereux, Richard B.; Navas-Acien, Ana

    2014-01-01

    Background Cadmium has been associated with peripheral arterial disease in cross-sectional studies but prospective evidence is lacking. Our goal was to evaluate the association of urine cadmium concentrations with incident peripheral arterial disease in a large population-based cohort. Methods and Results A prospective cohort study was performed with 2,864 adult American Indians 45-74 years old from Arizona, Oklahoma and North and South Dakota who participated in the Strong Heart Study in 1989-91 and were followed through two follow-up examination visits in 1993-1995 and 1997-1999. Participants were free of peripheral arterial disease, defined as an ankle brachial index <0.9 or >1.4, at baseline and had complete baseline information on urine cadmium, potential confounders and ankle brachial index determinations in the follow-up examinations. Urine cadmium was measured using inductively coupled plasma mass spectrometry (ICPMS) and corrected for urinary dilution by normalization to urine creatinine.. Multivariable-adjusted hazard ratios (HR) were computed using Cox-proportional hazards models for interval-censored data. A total of 470 cases of incident peripheral arterial disease, defined as an ankle brachial index <0.9 or >1.4, were identified. After adjustment for cardiovascular disease risk factors including smoking status and pack-years, the hazard ratio comparing the 80th to the 20th percentile of urine cadmium concentrations was 1.41 (1.05, 1.81). The hazard ratio comparing the highest to the lowest tertile was 1.96 (1.32, 2.81). The associations persisted after excluding participants with ankle brachial index > 1.4 only as well as in subgroups defined by sex and smoking status. Conclusions Urine cadmium, a biomarker of long-term cadmium exposure, was independently associated with incident peripheral arterial disease, providing further support for cadmium as a cardiovascular disease risk factor. PMID:24255048

  16. Coronary artery disease and diabetes mellitus

    PubMed Central

    Aronson, Doron; Edelman, Elazer R.

    2015-01-01

    SUMMARY Coronary artery disease (CAD) is a major determinant of the long-term prognosis among patients with diabetes mellitus (DM). DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Furthermore, in patients with DM there is an increased mortality after MI, and worse overall prognosis with CAD. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes, and is an independent cause of excess morbidity and mortality. Statins are effective in reducing major coronary events, stroke, and the need for coronary revascularization. Selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial and requires a multidisciplinary team approach (‘heart team’). Large scale clinical trials have shown that for many patients with 1- or 2-vessel coronary artery disease, there is little prognostic benefit from any intervention over optimal medical therapy (OMT). PCI with drug-eluting or bare metal stents is appropriate for patients who remain symptomatic with OMT. Randomized trials comparing multivessel PCI to coronary artery bypass grafting (CABG) have consistently demonstrated the superiority of CABG in reducing mortality, myocardial infarctions and need for repeat revascularizations. PMID:25091969

  17. Carotid Artery Disease and Stroke

    MedlinePlus

    ... not a guaranteed way to detect for disease.  Doppler Ultrasound Imaging: A painless, noninvasive test in which ... intake. If lifestyle changes do not have an effect, blood thinning medications can be used to thin ...

  18. Optimal management of infrainguinal arterial occlusive disease

    PubMed Central

    Pennywell, David J; Tan, Tze-Woei; Zhang, Wayne W

    2014-01-01

    Peripheral arterial occlusive disease is becoming a major health problem in Western societies as the population continues to age. In addition to risk of limb loss, the complexity of the disease is magnified by its intimate association with medical comorbidity, especially cardiovascular and cerebrovascular disease. Risk factor modification and antiplatelet therapy are essential to improve long-term survival. Surgical intervention is indicated for intermittent claudication when a patient’s quality of life remains unacceptable after a trial of conservative therapy. Open reconstruction and endovascular revascularization are cornerstone for limb salvage in patients with critical limb ischemia. Recent advances in catheter-based technology have made endovascular intervention the preferred treatment approach for infrainguinal disease in many cases. Nevertheless, lower extremity bypass remains an important treatment strategy, especially for reasonable risk patients with a suitable bypass conduit. In this review, we present a summary of current knowledge about peripheral arterial disease followed by a review of current, evidence-based medical and surgical therapy for infrainguinal arterial occlusive disease. PMID:25368519

  19. Subclavian Artery Disease: Diagnosis and Therapy.

    PubMed

    Saha, Tisa; Naqvi, Syed Yaseen; Ayah, Omar Abine; McCormick, Daniel; Goldberg, Sheldon

    2017-04-01

    The diagnosis of brachiocephalic disease is often overlooked. Symptoms include arm claudication and vertebrobasilar insufficiency. In patients who have had the use of the internal mammary artery for coronary bypass surgery, the development of symptoms of myocardial ischemia should alert the clinician to the possibility of subclavian artery stenosis. Also, in patients who have had axillofemoral bypass, lower-extremity claudication may occur. Recognition involves physical examination and accurate noninvasive testing. Endovascular therapy has proven to be effective in alleviating symptoms in properly selected patients.

  20. Peripheral artery disease of the legs - self-care

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000577.htm Peripheral artery disease of the legs - self-care To use ... features on this page, please enable JavaScript. Peripheral artery disease (PAD) is a narrowing of the blood ...

  1. Coronary artery disease in women.

    PubMed

    Legato, M J

    1996-01-01

    Although most women cite breast and reproductive cancers as the diseases they most fear, in fact cardiovascular disease is much more likely to kill them: 500,000 American women die each year of diseases of the heart and blood vessels compared with 189,000 who die of all cancers combined. Women's focus on breast, uterine, and ovarian cancer is very much socially and culturally determined. It reflects an outmoded image of women as valuable principally by virtue of their ability to bear and raise children. While women died at about the age of 48 at the turn of the century, biomedical science was extended their life span to the point that a girl born today has an average life expectancy of 86 years. The focus of recent biomedical investigation reflects the changing experience and expectations of women, who will live a full third of their lives beyond the period of reproductive viability. Since 1988, a flood of new information established that the epidemiology, risk factors, clinical features, outcome and therapeutic choices physicians make for female patients with cardiovascular disease are significantly different from those of men. Regrettably, most of the new information we have acquired was almost exclusively harvested from data on Caucasian women: black women often are less than 10% of study populations. The information we do have, however, shows striking differences between women of different races in the severity and outcome of diseases of the heart and blood vessels: black women have significantly higher mortality rates from stroke and myocardial infarction than do white women. Intensive research has achieved gratifying corrections in the promptness with which physicians diagnose women with cardiovascular disease and in the aggressiveness of the therapy they offer to female patients. The result has been a reversal of the trend for women to have worse outcomes from revascularization procedures than men.

  2. [Noninvasive diagnostic of coronary artery disease].

    PubMed

    Zuber, Michel; Zellweger, Michael; Bremerich, Jens; Auf der Mauer, Christoph; Buser, Peter T

    2009-04-01

    Noninvasive imaging of coronary artery disease has extensively evolved during the last decade. Today, at least four imaging techniques with excellent image quality such as echocardiography, myocardial perfusion scintigraphy and PET, cardiac magnetic resonance and cardiac CT are widely available in order to estimate the risk for future ischemic events, to corroborate the suspected diagnosis of coronary artery disease, to demonstrate the extent and localisation of myocardial ischemia, to diagnose myocardial infarction and measure it's size, to identify the myocardium at risk during acute ischemia, to differentiate between viable and nonviable myocardium and thereby provide the basis for indications of revascularisations, to follow revascularized patients over long time, to assess the risk for sudden cardiac death and the development of heart failure after myocardial infarction and to depict atheromatosis and atherosclerosis of the coronary artery tree. Echocardiography is the most widely used imaging method in cardiology. It provides excellent information on morphology and function of nearly all cardiac structures. Stress echocardiography has been proven to be a reliable tool for the demonstration of myocardial ischemia and for the acquisition of prognostic data. Newer ultrasound techniques may further improve investigator dependence and thereby reproducibility. The completeness of echocardiography will always depend on acoustic windows, which are given in a specific patient. Myocardial perfusion scintigraphy provides the largest database especially on prognosis in coronary artery disease. It has been the for the depictions of ischemic and infarcted myocardium. Radiation exposure will always be an issue. Newer hybrid techniques combining nuclear methods with cardiac CT may add arguments, which will be needed for clinical decision-making. Cardiac magnetic resonance has evolved as an important tool in the diagnosis of cardiovascular diseases. It is

  3. Links between arterial and venous disease.

    PubMed

    Prandoni, P

    2007-09-01

    An increasing body of evidence suggests the likelihood of a link between arterial and venous disease. According to the results of recent studies, atherosclerosis and venous thromboembolism (VTE) share common risk factors, including age, obesity, diabetes mellitus and metabolic syndrome. Atherosclerosis has the potential to promote the development of thrombotic disorders in the venous system. Another scenario assumes that the two clinical conditions are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Several recent studies have consistently shown that patients with VTE of unknown origin are at a higher risk of cardiovascular diseases, including atherosclerotic complications, than patients with secondary VTE and matched control individuals. Future studies are needed to clarify the nature of this association, to assess its extent and to evaluate its implications for clinical practice.

  4. Pulmonary arterial hypertension in congenital heart diseases.

    PubMed

    Beghetti, Maurice; Tissot, Cecile

    2009-08-01

    Pulmonary hypertension complicates the course of many children and adults with congenital heart diseases (CHDs). The increase in pulmonary pressure associated with CHD is secondary to either increased pulmonary blood flow or increased postcapillary pressures. Pulmonary arterial hypertension is in the vast majority associated with congenital cardiac shunts. Despite major advances in the understanding of the regulation of the pulmonary vascular bed and the pulmonary endothelial lesions leading to pulmonary vascular disease, despite the advances in surgical repair and the discovery of potential therapies in the pre- and postoperative period, pulmonary hypertension still carries a significant mortality and morbidity in patients with CHD. The recent introduction of targeted therapies in other forms of pulmonary arterial hypertension has led to a renewed interest in pulmonary hypertension associated with CHD and this particularly for the most advanced form, the so-called Eisenmenger syndrome (ES). This review summarizes the current knowledge on pulmonary hypertension associated with CHD, focusing on the pathophysiology and treatment of ES.

  5. Adiposity, obesity, and arterial aging: longitudinal study of aortic stiffness in the Whitehall II cohort.

    PubMed

    Brunner, Eric J; Shipley, Martin J; Ahmadi-Abhari, Sara; Tabak, Adam G; McEniery, Carmel M; Wilkinson, Ian B; Marmot, Michael G; Singh-Manoux, Archana; Kivimaki, Mika

    2015-08-01

    We sought to determine whether adiposity in later midlife is an independent predictor of accelerated stiffening of the aorta. Whitehall II study participants (3789 men; 1383 women) underwent carotid-femoral applanation tonometry at the mean age of 66 and again 4 years later. General adiposity by body mass index, central adiposity by waist circumference and waist:hip ratio, and fat mass percent by body impedance were assessed 5 years before and at baseline. In linear mixed models adjusted for age, sex, ethnicity, and mean arterial pressure, all adiposity measures were associated with aortic stiffening measured as increase in pulse wave velocity (PWV) between baseline and follow-up. The associations were similar in the metabolically healthy and unhealthy, according to Adult Treatment Panel-III criteria excluding waist circumference. C-reactive protein and interleukin-6 levels accounted for part of the longitudinal association between adiposity and PWV change. Adjusting for chronic disease, antihypertensive medication and risk factors, standardized effects of general and central adiposity and fat mass percent on PWV increase (m/s) were similar (0.14, 95% confidence interval: 0.05-0.24, P=0.003; 0.17, 0.08-0.27, P<0.001; 0.14, 0.05-0.22, P=0.002, respectively). Previous adiposity was associated with aortic stiffening independent of change in adiposity, glycaemia, and lipid levels across PWV assessments. We estimated that the body mass index-linked PWV increase will account for 12% of the projected increase in cardiovascular risk because of high body mass index. General and central adiposity in later midlife were strong independent predictors of aortic stiffening. Our findings suggest that adiposity is an important and potentially modifiable determinant of arterial aging.

  6. [Pulmonary arterial hypertension in connective tissue diseases].

    PubMed

    Cordier, Jean-François

    2009-11-01

    Among connective tissue diseases, pulmonary arterial hypertension (PAH) is frequently associated with systemic sclerosis and systemic lupus erythematosus. PAH is less common in mixed connective tissue diseases and Sjögren's syndrome, and rare in rheumatoid arthritis. PAH in systemic sclerosis may be either isolated (prevalence about 8%) or associated with interstitial lung disease. Echocardiographic screening for PAH is worthwhile in patients with systemic sclerosis, especially as treatments for idiopathic PAH (endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostanoids) are effective in this setting. The prevalence of PAH among patients with systemic lupus erythematosus is poorly known; immunosuppressive treatment is sometimes effective by itself but most patients benefit from PAH treatment. PAH associated with connective tissue diseases has a worse prognosis than idiopathic PAH.

  7. Longitudinal Evaluation of Segmental Arterial Mediolysis in Splanchnic Arteries: Case Series and Systematic Review

    PubMed Central

    Kim, Hyun Soo; Min, Sang-il; Han, Ahram; Choi, Chanjoong; Min, Seung-Kee; Ha, Jongwon

    2016-01-01

    Background Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, non-inflammatory vascular disorder varying widely in clinical course. The purpose of this study is to analyze detailing clinical and imaging manifestations over time in patients with SAM through a literature review and to suggest an optimal management strategy. Methods A retrospective review of eight consecutive patients diagnosed with SAM between January, 2000 and January, 2012 was conducted. All presented with acute-onset abdominal or flank pain. Clinical features, imaging studies, and laboratory findings served as grounds for diagnosis, having excluded more common conditions (ie, fibromuscular dysplasia, collagen vascular disorders, or arteritis). CT angiography was done initially and repeated periodically (Week 1, Month 3, then yearly). Treatment was conservative, utilizing endovascular intervention as warranted by CT diagnostics. In a related systematic review, all English literature from 1976 to 2015 was screened via the PubMed database, assessing patient demographics, affected arteries, clinical presentations, and treatment methods. Findings Ultimately, 25 arterial lesions identified in eight patients (median age, 62.8 years; range, 40–84 years) were monitored for a median period of 26 months (range, 15–57 months). At baseline, celiac axis (3/8, 37.5%), superior mesenteric (4/8, 50%), and common hepatic (2/8, 25%) arteries were involved, in addition to isolated lesions of right renal, splenic, right colic, middle colic, gastroduodenal, left gastric, right gastroepiploic, proper hepatic, right hepatic, and left hepatic arteries. Compared with prior publications, celiac axis and superior mesenteric artery were more commonly affected in cohort. Arterial dissections (n = 8), aneurysms (n = 5), stenoses or occlusions (n = 4), and a single pseudoaneurysm were documented. Despite careful conservative management, new splanchnic arterial lesions (n = 4) arose during follow

  8. Antithrombotic Therapy in Peripheral Artery Disease

    PubMed Central

    Alonso-Coello, Pablo; Bellmunt, Sergi; McGorrian, Catherine; Anand, Sonia S.; Guzman, Randolph; Criqui, Michael H.; Akl, Elie A.; Olav Vandvik, Per; Lansberg, Maarten G.; Guyatt, Gordon H.

    2012-01-01

    Background: This guideline focuses on antithrombotic drug therapies for primary and secondary prevention of cardiovascular disease as well as for the relief of lower-extremity symptoms and critical ischemia in persons with peripheral arterial disease (PAD). Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: The most important of our 20 recommendations are as follows. In patients aged ≥ 50 years with asymptomatic PAD or asymptomatic carotid stenosis, we suggest aspirin (75-100 mg/d) over no therapy (Grade 2B) for the primary prevention of cardiovascular events. For secondary prevention of cardiovascular disease in patients with symptomatic PAD (including patients before and after peripheral arterial bypass surgery or percutaneous transluminal angioplasty), we recommend long-term aspirin (75-100 mg/d) or clopidogrel (75 mg/d) (Grade 1A). We recommend against the use of warfarin plus aspirin in patients with symptomatic PAD (Grade 1B). For patients undergoing peripheral artery percutaneous transluminal angioplasty with stenting, we suggest single rather than dual antiplatelet therapy (Grade 2C). For patients with refractory claudication despite exercise therapy and smoking cessation, we suggest addition of cilostazol (100 mg bid) to aspirin (75-100 mg/d) or clopidogrel (75 mg/d) (Grade 2C). In patients with critical limb ischemia and rest pain unable to undergo revascularization, we suggest the use of prostanoids (Grade 2C). In patients with acute limb ischemia due to acute thrombosis or embolism, we recommend surgery over peripheral arterial thrombolysis (Grade 1B). Conclusions: Recommendations continue to favor single antiplatelet therapy for primary and secondary prevention of

  9. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFRCT: outcome and resource impacts study

    PubMed Central

    Douglas, Pamela S.; Pontone, Gianluca; Hlatky, Mark A.; Patel, Manesh R.; Norgaard, Bjarne L.; Byrne, Robert A.; Curzen, Nick; Purcell, Ian; Gutberlet, Matthias; Rioufol, Gilles; Hink, Ulrich; Schuchlenz, Herwig Walter; Feuchtner, Gudrun; Gilard, Martine; Andreini, Daniele; Jensen, Jesper M.; Hadamitzky, Martin; Chiswell, Karen; Cyr, Derek; Wilk, Alan; Wang, Furong; Rogers, Campbell; De Bruyne, Bernard

    2015-01-01

    Aims In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFRCT) is unknown. Methods and results At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing (n = 287) or CTA/FFRCT (n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFRCT-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFRCT arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53–69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFRCT results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFRCT) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFRCT arms. Conclusions Computed tomographic angiography/fractional flow reserve by CTA was a feasible and safe alternative to ICA and was associated with a significantly lower rate of invasive angiography showing no obstructive CAD. PMID:26330417

  10. Progressive attenuation of the longitudinal kinetics in the common carotid artery: preliminary in vivo assessment.

    PubMed

    Zahnd, Guillaume; Balocco, Simone; Sérusclat, André; Moulin, Philippe; Orkisz, Maciej; Vray, Didier

    2015-01-01

    Longitudinal kinetics (LOKI) of the arterial wall consists of the shearing motion of the intima-media complex over the adventitia layer in the direction parallel to the blood flow during the cardiac cycle. The aim of this study was to investigate the local variability of LOKI amplitude along the length of the vessel. By use of a previously validated motion-estimation framework, 35 in vivo longitudinal B-mode ultrasound cine loops of healthy common carotid arteries were analyzed. Results indicated that LOKI amplitude is progressively attenuated along the length of the artery, as it is larger in regions located on the proximal side of the image (i.e., toward the heart) and smaller in regions located on the distal side of the image (i.e., toward the head), with an average attenuation coefficient of -2.5 ± 2.0%/mm. Reported for the first time in this study, this phenomenon is likely to be of great importance in improving understanding of atherosclerosis mechanisms, and has the potential to be a novel index of arterial stiffness.

  11. Haemostatic function in coronary artery disease (CAD).

    PubMed

    Gupta, A; Sikka, M; Madan, N; Dwidedi, S; Rusia, U; Sharma, S

    1997-04-01

    Tests to evaluate haemostatic function bleeding time (BT), prothrombin time (PT) partial thromboplastin time with kaolin (PTTK), thrombin time (TT), platelet count, platelet function tests (platelet adhesiveness and microthrombus index) and plasma fibrinogen levels were performed in 30 patients of coronary artery disease (14 myocardial infarction, 16 angina pectoris) and 20 age and sex matched controls. There was no statistically significant difference in platelet adhesiveness and mean microthrombus index in patients and controls. The BT, PT, PTTK and TT were normal in all patients and controls. Stepwise logistic regression analysis showed that plasma fibrinogen was an independent risk factor in the production of CAD.

  12. Unusual Systemic Artery to Pulmonary Artery Malformation Without Evidence of Systemic Disease, Trauma or Surgery

    SciTech Connect

    Geyik, Serdar; Yavuz, Kivilcim; Keller, Frederick S.

    2006-10-15

    Connections between the systemic and pulmonary arterial systems are rare conditions that can be due to either congenital or acquired diseases such as anomalous systemic arterial supply to normal lung, pulmonary sequestration, and systemic supply to pulmonary arteriovenous malformations. Herein, a unique case of systemic artery to pulmonary arterial malformation and its endovascular treatment in a patient with no history of the usual etiologies is reported.

  13. Extracellular vesicles in coronary artery disease.

    PubMed

    Boulanger, Chantal M; Loyer, Xavier; Rautou, Pierre-Emmanuel; Amabile, Nicolas

    2017-02-02

    Membrane vesicles released in the extracellular space are composed of a lipid bilayer enclosing soluble cytosolic material and nuclear components. Extracellular vesicles include apoptotic bodies, exosomes, and microvesicles (also known previously as microparticles). Originating from different subcellular compartments, the role of extracellular vesicles as regulators of transfer of biological information, acting locally and remotely, is now acknowledged. Circulating vesicles released from platelets, erythrocytes, leukocytes, and endothelial cells contain potential valuable biological information for biomarker discovery in primary and secondary prevention of coronary artery disease. Extracellular vesicles also accumulate in human atherosclerotic plaques, where they affect major biological pathways, including inflammation, proliferation, thrombosis, calcification, and vasoactive responses. Extracellular vesicles also recapitulate the beneficial effect of stem cells to treat cardiac consequences of acute myocardial infarction, and now emerge as an attractive alternative to cell therapy, opening new avenues to vectorize biological information to target tissues. Although interest in microvesicles in the cardiovascular field emerged about 2 decades ago, that for extracellular vesicles, in particular exosomes, started to unfold a decade ago, opening new research and therapeutic avenues. This Review summarizes current knowledge on the role of extracellular vesicles in coronary artery disease, and their emerging potential as biomarkers and therapeutic agents.

  14. Cutaneous markers of coronary artery disease

    PubMed Central

    Dwivedi, Shridhar; Jhamb, Rajat

    2010-01-01

    Coronary artery disease (CAD) is rapidly increasing in prevalence across the world and particularly in south Asians at a relatively younger age. As atherosclerosis starts in early childhood, the process of risk evaluation must start quite early. The present review addresses the issue of cutaneous markers associated with atherosclerosis, and the strengths and weaknesses of the markers in identifying early coronary atherosclerosis. A diligent search for such clinical markers, namely xanthelasma, xanthoma, arcus juvenilis, acanthosis nigricans, skin tags, ear lobe crease, nicotine stains, premature graying in smokers, hyperpigmented hands in betel quid sellers, central obesity, and signs of peripheral vascular disease may prove to be a rewarding exercise in identifying asymptomatic CAD in high risk individuals. PMID:21160602

  15. Intravascular ultrasound for angiographically indeterminant left main coronary artery disease.

    PubMed

    Parashara, D K; Jacobs, L E; Ledley, G S; Yazdanfar, S; Oline, J; Kotler, M N

    1994-01-01

    The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography.

  16. Arterial spin labeling perfusion predicts longitudinal decline in semantic variant primary progressive aphasia.

    PubMed

    Olm, Christopher A; Kandel, Benjamin M; Avants, Brian B; Detre, John A; Gee, James C; Grossman, Murray; McMillan, Corey T

    2016-10-01

    The objective of the study was to evaluate the prognostic value of regional cerebral blood flow (CBF) measured by arterial spin labeled (ASL) perfusion MRI in patients with semantic variant primary progressive aphasia (svPPA). We acquired pseudo-continuous ASL (pCASL) MRI and whole-brain T1-weighted structural MRI in svPPA patients (N = 13) with cerebrospinal fluid biomarkers consistent with frontotemporal lobar degeneration pathology. Follow-up T1-weighted MRI was available in a subset of patients (N = 8). We performed whole-brain comparisons of partial volume-corrected CBF and cortical thickness between svPPA and controls, and compared baseline and follow-up cortical thickness in regions of significant hypoperfusion and hyperperfusion. Patients with svPPA showed partial volume-corrected hypoperfusion relative to controls in left temporal lobe and insula. svPPA patients also had typical cortical thinning in anterior temporal, insula, and inferior frontal regions at baseline. Volume-corrected hypoperfusion was seen in areas of significant cortical thinning such as the left temporal lobe and insula. Additional regions of hypoperfusion corresponded to areas without cortical thinning. We also observed regions of hyperperfusion, some associated with cortical thinning and others without cortical thinning, including right superior temporal, inferior parietal, and orbitofrontal cortices. Regions of hypoperfusion and hyperperfusion near cortical thinning at baseline had significant longitudinal thinning between baseline and follow-up scans, but perfusion changes in distant areas did not show progressive thinning. Our findings suggest ASL MRI may be sensitive to functional changes not readily apparent in structural MRI, and specific changes in perfusion may be prognostic markers of disease progression in a manner consistent with cell-to-cell spreading pathology.

  17. Opiate Dependence as an Independent and Interactive Risk Factor for Arterial Stiffness and Cardiovascular Ageing - A Longitudinal Study in Females

    PubMed Central

    Reece, Albert Stuart; Hulse, Gary Kenneth

    2013-01-01

    Background Despite intriguing observational cross-sectional data there are no longitudinal studies of opiate related arterial disease. As opiates act via P16INK4A/CDKN2A, and vascular ageing has been thought to be a surrogate for organismal ageing, the subject has far-reaching implications. Methods Pulse Wave Analysis (PWA) by radial arterial tonometry (SphygmoCor) was performed on control and opiate dependent patients. Results A total of 37 controls were compared with 93 opiate dependents. They were studied on 117 and 275 occasions respectively up to 1,797 days. The mean (± S.E.M.) ages were 38.72 ± 2.64 and 33.78 ± 0.90 years (P = 0.0260), 91.4% and 10.8% smoked (P < 0.0001). Body mass index rose more in controls (P = 0.0185) and in interaction with time (P = 0.0025). When controlled for time and BMI, opiate dependency status was shown to be associated with vascular age and central arterial stiffness and pressure indices (all P < 0.05). When repeated measures multiple regression was performed on all traditional cardiovascular risk factors, the opiate dose-duration interaction was significant and appeared in 12 terms in the final model. It was also independently significant (P = 0.0153). Opiate dose or duration appeared in a further 15 terms. The model was shown to be significantly improved by the inclusion of terms for opiate dependency (A.I.C. 71.10 v 54.31, P < 0.0001). Conclusion These data confirm increased vascular stiffness and ageing in a longitudinal study, and thereby imply advanced organismal ageing. These multivariate studies are consistent with opiate dependency as an interactive and multivariate cardiovascular risk factor and emphasize the role of treatment duration. PMID:23976908

  18. Association factor analysis between osteoporosis with cerebral artery disease

    PubMed Central

    Jin, Eun-Sun; Jeong, Je Hoon; Lee, Bora; Im, Soo Bin

    2017-01-01

    Abstract The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified

  19. Coronary artery disease in Bangladesh: A review

    PubMed Central

    Islam, A.K.M. Monwarul; Majumder, A.A.S.

    2013-01-01

    Coronary artery disease (CAD) is an increasingly important medical and public health problem, and is the leading cause of mortality in Bangladesh. Like other South Asians, Bangladeshis are unduly prone to develop CAD, which is often premature in onset, follows a rapidly progressive course and angiographically more severe. The underlying pathophysiology is poorly understood. Genetic predisposition, high prevalence of metabolic syndrome and conventional risk factors play important role. Lifestyle related factors, including poor dietary habits, excess saturated and trans fat, high salt intake, and low-level physical activity may be important as well. Some novel risk factors, including hypovitaminosis D, arsenic contamination in water and food-stuff, particulate matter air pollution may play unique role. At the advent of the new millennium, we know little about our real situation. Largescale epidemiological, genetic and clinical researches are needed to explore the different aspects of CAD in Bangladesh. PMID:23993003

  20. Gene Therapy Techniques for Peripheral Arterial Disease

    SciTech Connect

    Manninen, Hannu I.; Maekinen, Kimmo

    2002-03-15

    Somatic gene therapy is the introduction of new genetic material into selective somatic cells with resulting therapeutic benefits. Vascular wall and, subsequently, cardiovascular diseases have become an interesting target for gene therapy studies.Arteries are an attractive target for gene therapy since vascular interventions, both open surgical and endovascular, are well suited for minimally invasive, easily monitored gene delivery. Promising therapeutic effects have been obtained in animal models in preventing post-angioplasty restenosis and vein graft thickening, as well as increasing blood flow and collateral development in ischemic limbs.First clinical trials suggest a beneficial effect of vascular endothelial growth factor in achieving therapeutic angiogenesis in chronic limb ischemia and the efficacy of decoy oligonucleotides to prevent infrainguinal vein graft stenosis. However, further studies are mandatory to clarify the safety issues, to develop better gene delivery vectors and delivery catheters, to improve transgene expression, as well as to find the most effective and safe treatment genes.

  1. How Is Peripheral Arterial Disease Treated?

    MedlinePlus

    ... of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ... artery. The balloon is then inflated, which pushes plaque outward against the artery wall. This widens the ...

  2. Longitudinal incision in surgical release of De Quervain disease.

    PubMed

    Gundes, Hakan; Tosun, Bilgehan

    2005-09-01

    The objective of this paper is to contrast the use of a longitudinal incision in surgical decompression of De Quervain disease with a transverse incision. The advantages are ease in recognition of compartment variations and superficial branches of radial nerve and prevention of palmar tendon subluxation by permitting a more dorsal release of the compartment sheath. Since 2002, we have used a longitudinal skin incision instead of the classic transverse incision to release the first dorsal compartment.

  3. Cystic adventitial disease of popliteal artery with significant stenosis

    PubMed Central

    Gupta, Ranjana; Mittal, Puneet; Gupta, Praveen; Jindal, Nancy

    2013-01-01

    Cystic adventitial disease of popliteal artery is a rare condition of unknown etiology which usually presents in middle-aged men. We present Doppler and computed tomography angiography findings in a case of cystic adventitial disease with significant obstruction of popliteal artery, with secondary narrowing of popliteal vein. PMID:24082480

  4. Hormones and arterial stiffness in patients with chronic kidney disease.

    PubMed

    Gungor, Ozkan; Kircelli, Fatih; Voroneanu, Luminita; Covic, Adrian; Ok, Ercan

    2013-01-01

    Cardiovascular disease constitutes the major cause of mortality in patients with chronic kidney disease. Arterial stiffness is an important contributor to the occurrence and progression of cardiovascular disease. Various risk factors, including altered hormone levels, have been suggested to be associated with arterial stiffness. Based on the background that chronic kidney disease predisposes individuals to a wide range of hormonal changes, we herein review the available data on the association between arterial stiffness and hormones in patients with chronic kidney disease and summarize the data for the general population.

  5. Noninvasive assessment of coronary artery disease.

    PubMed

    DePace, N L; Hakki, A H; Weinreich, D J; Iskandrian, A S

    1983-10-01

    This study determines whether a mathematical model can be used to assess noninvasively the extent of coronary artery disease (CAD). The model was based on stepwise multivariate discriminant analysis of data obtained in 99 patients from clinical and nonhemodynamic exercise variables, or from radionuclide determination of left ventricular function at rest or during exercise, or both. The extent of CAD was assessed by a scoring system and by the number of diseased vessels. The variables selected by this method (Q-wave infarction, exercise LV ejection fraction, change in systolic blood pressure from rest to exercise, sex and diabetes mellitus) yielded a predictive accuracy of 82% for the identification of patients with extensive CAD (score greater than or equal to 35). Slightly better results were achieved by a subgroup of 77 patients who had adequate exercise end points (exercise heart rate greater than or equal to 120 beats/min, or angina or ST depression during exercise). In these patients, the predictive accuracy was 84%. The model also identified patients with "light" CAD (score less than or equal to 10) with a predictive accuracy of 82%. Thus, noninvasive assessment of the extent of CAD is possible with a stepwise multivariate discriminant analysis of clinical, electrocardiographic and left ventricular function assessed by radionuclide ventriculography at rest and during exercise. The scoring system was superior to the conventional method of classifying patients according to the number of diseased vessels.

  6. Endovascular Intervention for Peripheral Artery Disease

    PubMed Central

    Thukkani, Arun K.; Kinlay, Scott

    2015-01-01

    Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb. PMID:25908731

  7. Hemodynamic response to treatment of iron deficiency anemia in pulmonary arterial hypertension: longitudinal insights from an implantable hemodynamic monitor

    PubMed Central

    2016-01-01

    Abstract Despite new therapeutic options, pulmonary arterial hypertension (PAH) remains a progressive disease associated with substantial morbidity and mortality. As such, additional strategies for monitoring and adjunctive management of this disease are important. A 59-year-old woman with scleroderma-associated PAH received an implantable hemodynamic monitor (IHM) as part of a research protocol at our institution. Pulmonary artery pressures, heart rate, and cardiac output (sensor-based algorithm) were measured on a daily basis, and parameters of right ventricular (RV) performance and afterload were calculated. At the time of IHM implant, the patient had functional class III symptoms, was receiving triple-drug therapy, and had normal hemoglobin levels. Four months after implant, and with further optimization of prostacyclin therapy, she had improvement in her symptoms. However, shortly thereafter, while the patient was receiving stable drug therapy, her case regressed with worsening symptoms, and the patient received a new diagnosis of iron deficiency anemia. Oral iron supplementation resulted in normalization of hemoglobin levels and improvement in the patient’s iron profile. A gradual and sustained reduction in pulmonary pressures was noted after initiation of oral iron accompanied by increased RV performance and favorable reduction in RV afterload. The patient had significant symptomatic improvement. Iron deficiency is an underappreciated yet easily treatable risk factor in PAH. Use of IHM in this case longitudinally illustrates the optimization of pulmonary hemodynamics and RV afterload in tandem with clinical improvement achieved by a simple therapy. PMID:28090307

  8. Hemodynamic response to treatment of iron deficiency anemia in pulmonary arterial hypertension: longitudinal insights from an implantable hemodynamic monitor.

    PubMed

    Mehmood, Muddassir; Agarwal, Richa; Raina, Amresh; Correa-Jaque, Priscilla; Benza, Raymond L

    2016-12-01

    Despite new therapeutic options, pulmonary arterial hypertension (PAH) remains a progressive disease associated with substantial morbidity and mortality. As such, additional strategies for monitoring and adjunctive management of this disease are important. A 59-year-old woman with scleroderma-associated PAH received an implantable hemodynamic monitor (IHM) as part of a research protocol at our institution. Pulmonary artery pressures, heart rate, and cardiac output (sensor-based algorithm) were measured on a daily basis, and parameters of right ventricular (RV) performance and afterload were calculated. At the time of IHM implant, the patient had functional class III symptoms, was receiving triple-drug therapy, and had normal hemoglobin levels. Four months after implant, and with further optimization of prostacyclin therapy, she had improvement in her symptoms. However, shortly thereafter, while the patient was receiving stable drug therapy, her case regressed with worsening symptoms, and the patient received a new diagnosis of iron deficiency anemia. Oral iron supplementation resulted in normalization of hemoglobin levels and improvement in the patient's iron profile. A gradual and sustained reduction in pulmonary pressures was noted after initiation of oral iron accompanied by increased RV performance and favorable reduction in RV afterload. The patient had significant symptomatic improvement. Iron deficiency is an underappreciated yet easily treatable risk factor in PAH. Use of IHM in this case longitudinally illustrates the optimization of pulmonary hemodynamics and RV afterload in tandem with clinical improvement achieved by a simple therapy.

  9. [Renal artery stenosis : atheromatous disease and fibromuscular dysplasia].

    PubMed

    Halimi, Jean-Michel

    2009-04-01

    Renal artery stenosis may be due to atheromatous disease or renal fibromuscular dysplasia (FMD). Management of both diseases requires treatment of hypertension usually observed in such patients; however, clinical presentation, mechanism and treatment of these 2 diseases are usually different. Renal FMD is now considered as a systemic disease, the cause of which may be genetic (although the exact cause is still elusive). Renal arteries are the most frequent localizations of FMD, but extra renal arteries may also be involved (usually carotid arteries). Risk factors of hypertension-induced renal FMD include estrogen treatment and smoking. Renal FMD are mostly found in young women and in children who present with recent severe and/or refractory symptomatic hypertension. Diagnosis is usually easy (Doppler, CT-scan), and treatment of renal FMD is angioplasty in most cases. Atheromatous renal artery stenosis is usually found in patients with other atheromatous disease (peripheral artery disease, carotid, coronary artery disease...). Clinical presentation include severe or refractory hypertension, recurrent flash pulmonary edema in a patient with hypertension, progressive renal dysfunction spontaneously or after medical treatment with converting-enzyme inhibition or angiotensin II blockade, hypertension in a patient (usually smoker or ex-smoker) with diffuse atheromatous vascular disease. Management of atheromatous renal artery disease is medical treatment in all patients (aggressive treatment of cardiovascular risk factors, control of arterial pressure); revascularization is required in some patients only since it rarely cures hypertension: the goal of revascularization is mostly renal function protection, which may be observed in selected patients. Revascularization must be decided by physicians or teams involved in the care of such patients. Patients with atheromatous renal artery disease are at very high renal and cardiovascular risk : aggressive management of

  10. Effects of residual coronary artery disease on results of coronary artery bypass grafting.

    PubMed

    Iskandrian, A S; Hakki, A H; Nestico, P F; DePace, N L; Goel, I P; Kane, S

    1984-10-01

    To assess the effects of residual coronary artery disease (non-revascularized coronary vessels) after coronary artery bypass grafting on symptoms and exercise left ventricular function, we categorized 77 patients into 3 groups according to the extent of residual coronary artery disease: group I (n = 17) had no residual coronary artery disease (residual score = 0); group II (n = 30) had light residual coronary artery disease (score of 1 to 9, mean 4.7); and group III (n = 30) had moderate residual coronary artery disease (score greater than or equal to 10, mean 23). Sixty patients were asymptomatic after coronary artery bypass grafting (14 in group I, 24 in group II, and 22 in group III), but the remaining patients had occasional angina pectoris. The resting left ventricular ejection fraction was significantly higher in group I than in the remaining 2 groups (56 +/- 18% in group I, 47 +/- 19% in group II, and 43 +/- 16% in group III, P less than 0.05). The exercise left ventricular ejection fraction was also significantly higher in group I (61 +/- 16% in group I, 51 +/- 18% in group II and 45 +/- 18% in group III, P less than 0.01). The ejection fraction response to exercise was abnormal in 5 patients in group I, 15 patients in group II, and 19 patients in group III. Thus, coronary artery bypass grafting results in symptomatic improvement, even in patients with residual coronary artery disease. The presence of residual coronary artery disease, however, may be a determinant of exercise left ventricular function in these patients.

  11. Exercise training and peripheral arterial disease.

    PubMed

    Haas, Tara L; Lloyd, Pamela G; Yang, Hsiao-Tung; Terjung, Ronald L

    2012-10-01

    Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12 to 15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50% to 1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking approximately five times per week, at a significant intensity that requires frequent rest periods, are most significant. Preclinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, and mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a lifestyle pattern that includes enhanced physical activity prior to the advance of PAD limitations is the most desirable and beneficial.

  12. Exercise Training and Peripheral Arterial Disease

    PubMed Central

    Haas, Tara L.; Lloyd, Pamela G.; Yang, Hsiao-Tung; Terjung, Ronald L.

    2013-01-01

    Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12–15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50–1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking ~5 times/wk, at a significant intensity that requires frequent rest periods, are most significant. Pre-clinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including: improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a life style pattern, that includes enhanced physical activity prior to the advance of PAD limitations, is the most desirable and beneficial. PMID:23720270

  13. Life Psychosocial Stresses and Coronary Artery Disease

    PubMed Central

    Bagheri, Babak; Meshkini, Fatemeh; Dinarvand, Kolsoum; Alikhani, Zahra; Haysom, Mal; Rasouli, Mehdi

    2016-01-01

    Background: It is hypothesized that the impacts of life events accumulate and can trigger and promote atherosclerosis in susceptible individuals. In the current study, the correlation of total life stressors during 1 year was investigated relative to coronary artery disease (CAD). Methods: The study population consisted of 148 males and 152 females aged 35–76 years. The subjects were classified as CAD cases and controls according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and the extent of lesions at coronary arteries. The stressful events of life were assessed using Holmes-Rahe Questionnaire and was presented as total psychological stress scores per year (TPSS). Results: The frequency of cigarette smoking, diabetes mellitus, and hypertension was more prevalent in CAD cases than control subjects. The levels of TPSS were increased in patients with CAD compared to the controls (160.3 ± 71.3 vs. 139.8 ± 66.5, P = 0.020). TPSS was also associated positively with the levels of uric acid, erythrocytes counts, erythrocyte sedimentation rate, aspirin consumption, and negatively with high-density lipoprotein-cholesterol and apo-AI. In logistic regression analysis, TPSS correlated with the occurrence of CAD by the odds ratio of 1.773 (1.073–2.930), P = 0.025, but the association was weakened after adjustment for classical risk factors, especially hypertension. TPSS exhibited significant association with the severity of CAD [F (3,274) = 2.6, P = 0.051]. Conclusions: The results suggest that TPSS are associated with the occurrence and severity of CAD significantly, but the association is not independent. PMID:27833720

  14. Carotid artery disease following external cervical irradiation

    SciTech Connect

    Elerding, S.C.; Fernandez, R.N.; Grotta, J.C.; Lindberg, R.D.; Causay, L.C.; McMurtrey, M.J.

    1981-01-01

    A retrospective study of 910 patients surviving at least five years after cervical irradiation for Hodgkin's disease, non-Hodgkin's lymphoma, or primary head an neck neoplasms showed the incidence of stroke following cervical irradiation was 63 of 910 patients (6.3%) during a mean period of observation of nine years. This represents a trend toward an increased risk for this population observed over the same period of time (p . 0.39). A prospective study of 118 similar patients currently living five years after cervical radiotherapy was performed to determine the incidence of carotid artery disease occurring as a consequence of neck irradiation. Abnormal carotid phonangiograms (CPA) were found in 25% of the patients and abnormal oculoplethysmographs (OPG) were found in 17%. These studies represent significant carotid lesions that are not expected in such a population. It is concluded that the carotid stenoses demonstrated are most likely a consequence of prior irradiation. Patients that are five-year survivors of cervical irradiation should have noninvasive vascular laboratory studies performed as part of their routine follow-up examinations in order to detect these carotid lesions while they are occult.

  15. Carotid artery disease following external cervical irradiation

    SciTech Connect

    Elerding, S.C.; Fernandez, R.N.; Grotta, J.C.; Lindberg, R.D.; Causay, L.C.; McMurtrey, M.J.

    1981-11-01

    A retrospective study of 910 patients surviving at least five years after cervical irradiation for Hodgkin's disease, non-Hodgkin's lymphoma, or primary head and neck neoplasms showed the incidence of stroke following cervical irradiation was 63 of 910 patients (6.3%) during a mean period of observation of nine years. This represents a trend toward an increased risk for this population over the expected incidence of 38 strokes for a matched population observed over the same period of time (p = 0.39). A prospective study of 118 similar patients currently living five years after cervical radiotherapy was performed to determine the incidence of carotid artery disease occurring as a consequence of neck irradiation. Abnormal carotid phonoangiograms (CPA) were found in 25% of the patients and abnormal oculoplethysmographs (OPG) were found in 17%. These studies represent significant carotid lesions that are not expected in such a population. It is concluded that the carotid stenoses demonstrated are most likely a consequence of prior irradiation. Patients that are five-year survivors of cervical irradiation should have noninvasive vascular laboratory studies performed as part of their routine follow-up examinations in order to detect these carotid lesions while they are occult.

  16. [Aftermaths of lesions of coronary arteries in Kawasaki disease].

    PubMed

    Vostokova, A A; Grunina, E A; Klemenov, A V

    2016-01-01

    Kawasaki disease, also known as cutaneous-mucous-glandular mucocutaneous glandular syndrome, is acute systemic vasculitis of small-to-medium calibre arteries, frequently involving coronary arteries, affect almost exceptionally children, with reports concerning cases of Kawasaki syndrome in 20-to-30-year-old adults being extremely rare. The most serious manifestation of Kawasaki disease is coronaritis and formation of coronary artery aneurysms. The dynamics of the formed coronary aneurysms and, consequently, the fate of patients may be different. Thrombosis of an aneurysm in the early period of the disease and stenosing of the affected coronary artery later on present possible complications of Kawasaki disease and potential causes of myocardial infection in young adults. Increased risk of coronary artery thromboses in Kawasaki disease is conditioned by a decrease in velocity of blood flow and its turbulent pattern in the aneurysms, endothelial dysfunction due to currently existing or endured coronaritis and thrombocytosis typical of this pathology. Predisposing factors of coronary artery stenosing are unfavourable haemodynamic conditions appearing at the sites of the "entry" and "exit" of the aneurysm. Described herein are two case reports of myocardial infarction, one of which being a complication of an acute case of Kawasaki disease in a 29-year-old patient, with the second one being a consequence of coronary artery stenosing in a 25-year-old patient who had endured Kawasaki disease in his childhood.

  17. Echocardiographic evaluation of external iliac artery Doppler waveform in patients with coronary artery disease.

    PubMed

    Styczynski, Grzegorz; Szmigielski, Cezary; Kaczynska, Anna; Kuch-Wocial, Agnieszka

    2014-04-01

    Visual interpretation of the Doppler waveform in the common femoral or distal external iliac artery (EIA) was reported to be useful in screening for proximal peripheral artery occlusive disease (PAOD) in patients with lower limb ischemia. Commonly patients with coronary artery disease (CAD) referred for echocardiography have coexistent arterial pathology. Therefore, we decided to study whether echocardiographic evaluation of the distal EIA flow can be useful for detection of PAOD in patients with CAD. We studied 150 consecutive patients (pts) with CAD referred for echocardiography. At the end of an echocardiographic examination, evaluation of the flow in the distal EIA with an echocardiographic probe was performed. The Doppler waveform was classified as normal-with early diastolic flow reversal or abnormal-without early diastolic flow reversal. Echocardiographic findings were compared in a blinded fashion with the results of the ankle brachial index measurements (ABI). Based on the ABI ≤ 0.9, peripheral artery disease was diagnosed in 54 pts (36%) and abnormal external iliac Doppler waveform was found in 27 pts (18%). Sensitivity of abnormal external iliac Doppler waveform in predicting PAOD was 48%, specificity 99%, positive predictive value (PPV) 96%, and negative predictive value 77%. Peripheral arterial occlusive disease is common in patients with CAD referred for echocardiographic study. Echocardiographic assessment of distal EIA Doppler waveform has low sensitivity, but high specificity and high PPV in the diagnosis of peripheral arterial occlusive disease.

  18. [Is coronary artery disease different in women?].

    PubMed

    Schiele, François; Chopard, Romain

    2014-01-01

    Coronary artery disease (CAD) is the primary cause of death in women. Although acute coronary syndrome (ACS) is relatively infrequent in young women, failure to recognize ACS in this population can incur a major risk and registry data show that there is still plenty of room for improvement in this area. Women may suffer from "classical" CAD with development of atherosclerosis with a delay of about 10 years as compared to men, reflecting hormonal protection in women. Besides this classical presentation, angina in women often corresponds to impaired microcirculation, a syndrome known to associate typical angina, demonstrable myocardial ischemia, but no lesions on the coronary angiography. Finally, spasm, spontaneous dissection or coronary thrombosis through endothelial rupture are more frequent in women. The influence of risk factors on the development of CAD is comparable in both women and men. Recent registry studies show that in France, in particular, diabetes, obesity, and smoking are all risk factors that are on the rise in women. In addition, certain other risk factors are more specific to women, namely psycho-social stress. The methods to evaluate risk and detect CAD were mainly developed in male study populations, and these tools thus perform less well in female patients. In case of ACS, women benefit just as much from invasive management, but are at greater risk of iatrogenic complications, particularly with anti-thrombotic therapy or during revascularization procedures.

  19. Suppression of ischemia in arterial occlusive disease by JNK-promoted native collateral artery development

    PubMed Central

    Ramo, Kasmir; Sugamura, Koichi; Craige, Siobhan; Keaney, John F; Davis, Roger J

    2016-01-01

    Arterial occlusive diseases are major causes of morbidity and mortality. Blood flow to the affected tissue must be restored quickly if viability and function are to be preserved. We report that disruption of the mixed-lineage protein kinase (MLK) - cJun NH2-terminal kinase (JNK) signaling pathway in endothelial cells causes severe blockade of blood flow and failure to recover in the murine femoral artery ligation model of hindlimb ischemia. We show that the MLK-JNK pathway is required for the formation of native collateral arteries that can restore circulation following arterial occlusion. Disruption of the MLK-JNK pathway causes decreased Dll4/Notch signaling, excessive sprouting angiogenesis, and defects in developmental vascular morphogenesis. Our analysis demonstrates that the MLK-JNK signaling pathway is a key regulatory mechanism that protects against ischemia in arterial occlusive disease. DOI: http://dx.doi.org/10.7554/eLife.18414.001 PMID:27504807

  20. Detection of coronary artery disease with MCG.

    PubMed

    Hailer, B; Van Leeuwen, P

    2004-11-30

    The diagnosis of cardiac ischemia related to coronary artery disease (CAD) is a clinical challenge. Despite many methods clinically available, the predictive value of each is still limited. Magnetocardiography (MCG) offers new insights in the electrogenesis of the disease. In the last decade a number of studies using biomagnetometers have dealt with the identification of CAD patients using coronary angiography as a gold standard. As the availability of these systems is limited, studies have focused either on exercise-induced ischemia or on chronic ischemia and the infarct scar at rest. Different parameters have been developed based on signal morphology, time intervals, source parameters or magnetic field map analysis. Concerning signal morphology, main work concentrates on ST-depression, ST-T signal amplitude as well as QRS and ST-T integrals. Dealing with time intervals, most studies focus on the QT interval. The evaluation of of QT dispersion spatially in the MCG, reflecting regional heterogeneity of repolarization, improved the identification of CAD patients. Besides the calculation of the equivalent current dipole during de- and repolarization, parameters of the magnetic field orientation were used to identify CAD patients and localize exercise-induced ischemic regions. Heart rate adjusted alteration in the magnetic field orientation allowed the quantification of ischemia-induced changes in MCG. The estimation of current density (CDV) further enabled to separate healthy subjects from CAD patients at rest. In the course of interventional therapy CDV maps returned toward that of healthy subjects.Thus, there is justification for routine clinical use of the MCG in the diagnosis of CAD.

  1. Leptospirosis and Peripheral Artery Occlusive Disease

    PubMed Central

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-01-01

    Abstract Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44–1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58–1.95). The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population. PMID:26986166

  2. Exercise testing in suspected coronary artery disease.

    PubMed

    Sox, H C

    1985-12-01

    stenosis or three-vessel disease with poor ventricular function. The exercise ECG can identify groups of older men with a relatively high risk of having left main coronary artery stenosis. Physicians should be cautious when applying these recommendations to a primary care practice. The foregoing analysis is based on data obtained from patients who had been selected for coronary arteriography. There are two principal effects of biased selection of study patients: The pretest probability of CAD in clinical subgroups is probably lower than as shown here.(ABSTRACT TRUNCATED AT 400 WORDS)

  3. Peripheral arterial disease and revascularization of the diabetic foot.

    PubMed

    Forsythe, R O; Brownrigg, J; Hinchliffe, R J

    2015-05-01

    Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration. In addition to peripheral arterial disease, functional changes in the microcirculation also contribute to the development of a diabetic foot ulcer, along with other factors such as infection, oedema and abnormal biomechanical loading. Peripheral arterial disease typically affects the distal vessels, resulting in multi-level occlusions and diffuse disease, which often necessitates challenging distal revascularisation surgery or angioplasty in order to improve blood flow. However, technically successful revascularisation does not always result in wound healing. The confounding effects of microvascular dysfunction must be recognised--treatment of a patient with a diabetic foot ulcer and peripheral arterial disease should address this complex interplay of pathophysiological changes. In the case of non-revascularisable peripheral arterial disease or poor response to conventional treatment, alternative approaches such as cell-based treatment, hyperbaric oxygen therapy and the use of vasodilators may appear attractive, however more robust evidence is required to justify these novel approaches.

  4. Skin autofluorescence is increased in patients with carotid artery stenosis and peripheral artery disease.

    PubMed

    Noordzij, Marjon J; Lefrandt, Joop D; Loeffen, Erik A H; Saleem, Ben R; Meerwaldt, Robbert; Lutgers, Helen L; Smit, Andries J; Zeebregts, Clark J

    2012-02-01

    Advanced glycation end products (AGEs) have a pivotal role in atherosclerosis. We evaluated skin autofluorescence (SAF), a non-invasive measurement of tissue AGE accumulation, in patients with carotid artery stenosis with and without coexisting peripheral artery occlusive disease (PAOD). SAF was measured using the AGE Reader™ in 56 patients with carotid artery stenosis and in 56 age- and sex-matched healthy controls without diabetes, renal dysfunction or known atherosclerotic disease. SAF was higher in patients with carotid artery stenosis compared to the control group: mean 2.81 versus 2.46 (P = 0.002), but especially in the younger age group of 50-60 years old: mean 2.82 versus 1.94 (P = 0.000). Patients with carotid artery stenosis and PAOD proved to have an even higher SAF than patients with carotid artery stenosis only: mean 3.28 versus 2.66 (P = 0.003). Backward linear regression analysis showed that age, smoking, diabetes mellitus, renal function and the presence of PAOD were the determinants of SAF, but carotid artery stenosis was not. SAF is increased in patients with carotid artery stenosis and PAOD. The univariate and multivariate associations of SAF with age, smoking, diabetes, renal insufficiency and PAOD suggest that increased SAF can be seen as an indicator of widespread atherosclerosis.

  5. Genetically Determined Height and Coronary Artery Disease

    PubMed Central

    Nelson, C.P.; Hamby, S.E.; Saleheen, D.; Hopewell, J.C.; Zeng, L.; Assimes, T.L.; Kanoni, S.; Willenborg, C.; Burgess, S.; Amouyel, P.; Anand, S.; Blankenberg, S.; Boehm, B.O.; Clarke, R.J.; Collins, R.; Dedoussis, G.; Farrall, M.; Franks, P.W.; Groop, L.; Hall, A.S.; Hamsten, A.; Hengstenberg, C.; Hovingh, G. Kees; Ingelsson, E.; Kathiresan, S.; Kee, F.; König, I.R.; Kooner, J.; Lehtimäki, T.; März, W.; McPherson, R.; Metspalu, A.; Nieminen, M.S.; O’Donnell, C.J.; Palmer, C.N.A.; Peters, A.; Perola, M.; Reilly, M.P.; Ripatti, S.; Roberts, R.; Salomaa, V.; Shah, S.H.; Schreiber, S.; Siegbahn, A.; Thorsteinsdottir, U.; Veronesi, G.; Wareham, N.; Willer, C.J.; Zalloua, P.A.; Erdmann, J.; Deloukas, P.; Watkins, H.; Schunkert, H.; Danesh, J.; Thompson, J.R.; Samani, N.J.

    2015-01-01

    BACKGROUND The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease (CAD) are unclear. METHODS We used a genetic approach to investigate the association between height and CAD, using 180 height-associated genetic variants. We tested the association between a change in genetically determined height of 1 SD (6.5 cm) with the risk of CAD in 65,066 cases and 128,383 controls. Using individual-level genotype data from 18,249 persons, we also examined the risk of CAD associated with the presence of various numbers of height-associated alleles. To identify putative mechanisms, we analyzed whether genetically determined height was associated with known cardiovascular risk factors and performed a pathway analysis of the height-associated genes. RESULTS We observed a relative increase of 13.5% (95% confidence interval [CI], 5.4 to 22.1; P<0.001) in the risk of CAD per 1-SD decrease in genetically determined height. There was a graded relationship between the presence of an increased number of height-raising variants and a reduced risk of CAD (odds ratio for height quartile 4 versus quartile 1, 0.74; 95% CI, 0.68 to 0.84; P<0.001). Of the 12 risk factors that we studied, we observed significant associations only with levels of low-density lipoprotein cholesterol and triglycerides (accounting for approximately 30% of the association). We identified several overlapping pathways involving genes associated with both development and atherosclerosis. CONCLUSIONS There is a primary association between a genetically determined shorter height and an increased risk of CAD, a link that is partly explained by the association between shorter height and an adverse lipid profile. Shared biologic processes that determine achieved height and the development of atherosclerosis may explain some of the association. PMID:25853659

  6. Metals in urine and peripheral arterial disease.

    PubMed

    Navas-Acien, Ana; Silbergeld, Ellen K; Sharrett, Richey; Calderon-Aranda, Emma; Selvin, Elizabeth; Guallar, Eliseo

    2005-02-01

    Exposure to metals may promote atherosclerosis. Blood cadmium and lead were associated with peripheral arterial disease (PAD) in the 1999-2000 National Health and Nutrition Examination Survey (NHANES). In the present study we evaluated the association between urinary levels of cadmium, lead, barium, cobalt, cesium, molybdenum, antimony, thallium, and tungsten with PAD in a cross-sectional analysis of 790 participants > or =40 years of age in NHANES 1999-2000. PAD was defined as a blood pressure ankle brachial index < 0.9 in at least one leg. Metals were measured in casual (spot) urine specimens by inductively coupled plasma-mass spectrometry. After multivariable adjustment, subjects with PAD had 36% higher levels of cadmium in urine and 49% higher levels of tungsten compared with noncases. The adjusted odds ratio for PAD comparing the 75th to the 25th percentile of the cadmium distribution was 3.05 [95% confidence interval (CI), 0.97 to 9.58]; that for tungsten was 2.25 (95% CI, 0.97 to 5.24). PAD risk increased sharply at low levels of antimony and remained elevated beyond 0.1 microg/L. PAD was not associated with other metals. In conclusion, urinary cadmium, tungsten, and possibly antimony were associated with PAD in a representative sample of the U.S. population. For cadmium, these results strengthen previous findings using blood cadmium as a biomarker, and they support its role in atherosclerosis. For tungsten and antimony, these results need to be interpreted cautiously in the context of an exploratory analysis but deserve further study. Other metals in urine were not associated with PAD at the levels found in the general population.

  7. Metals in Urine and Peripheral Arterial Disease

    PubMed Central

    Navas-Acien, Ana; Silbergeld, Ellen K.; Sharrett, A. Richey; Calderon-Aranda, Emma; Selvin, Elizabeth; Guallar, Eliseo

    2005-01-01

    Exposure to metals may promote atherosclerosis. Blood cadmium and lead were associated with peripheral arterial disease (PAD) in the 1999–2000 National Health and Nutrition Examination Survey (NHANES). In the present study we evaluated the association between urinary levels of cadmium, lead, barium, cobalt, cesium, molybdenum, antimony, thallium, and tungsten with PAD in a cross-sectional analysis of 790 participants ≥40 years of age in NHANES 1999–2000. PAD was defined as a blood pressure ankle brachial index < 0.9 in at least one leg. Metals were measured in casual (spot) urine specimens by inductively coupled plasma–mass spectrometry. After multivariable adjustment, subjects with PAD had 36% higher levels of cadmium in urine and 49% higher levels of tungsten compared with noncases. The adjusted odds ratio for PAD comparing the 75th to the 25th percentile of the cadmium distribution was 3.05 [95% confidence interval (CI), 0.97 to 9.58]; that for tungsten was 2.25 (95% CI, 0.97 to 5.24). PAD risk increased sharply at low levels of antimony and remained elevated beyond 0.1 μg/L. PAD was not associated with other metals. In conclusion, urinary cadmium, tungsten, and possibly antimony were associated with PAD in a representative sample of the U.S. population. For cadmium, these results strengthen previous findings using blood cadmium as a biomarker, and they support its role in atherosclerosis. For tungsten and antimony, these results need to be interpreted cautiously in the context of an exploratory analysis but deserve further study. Other metals in urine were not associated with PAD at the levels found in the general population. PMID:15687053

  8. Developmental origin of age-related coronary artery disease

    PubMed Central

    Wei, Ke; Díaz-Trelles, Ramon; Liu, Qiaozhen; Diez-Cuñado, Marta; Scimia, Maria-Cecilia; Cai, Wenqing; Sawada, Junko; Komatsu, Masanobu; Boyle, Joseph J.; Zhou, Bin; Ruiz-Lozano, Pilar; Mercola, Mark

    2015-01-01

    Aim Age and injury cause structural and functional changes in coronary artery smooth muscle cells (caSMCs) that influence the pathogenesis of coronary artery disease. Although paracrine signalling is widely believed to drive phenotypic changes in caSMCs, here we show that developmental origin within the fetal epicardium can have a profound effect as well. Methods and results Fluorescent dye and transgene pulse-labelling techniques in mice revealed that the majority of caSMCs are derived from Wt1+, Gata5-Cre+ cells that migrate before E12.5, whereas a minority of cells are derived from a later-emigrating, Wt1+, Gata5-Cre− population. We functionally evaluated the influence of early emigrating cells on coronary artery development and disease by Gata5-Cre excision of Rbpj, which prevents their contribution to coronary artery smooth muscle cells. Ablation of the Gata5-Cre+ population resulted in coronary arteries consisting solely of Gata5-Cre− caSMCs. These coronary arteries appeared normal into early adulthood; however, by 5–8 months of age, they became progressively fibrotic, lost the adventitial outer elastin layer, were dysfunctional and leaky, and animals showed early mortality. Conclusion Taken together, these data reveal heterogeneity in the fetal epicardium that is linked to coronary artery integrity, and that distortion of the coronaries epicardial origin predisposes to adult onset disease. PMID:26054850

  9. Bilateral pulmonary artery aneurysms, coronary artery aneurysm, and ventricular pseudoaneurysm in Behçet disease.

    PubMed

    Lai, Ying-Rong; Hong, Jun-Mou; Liu, Zhen-Guo; Deng, Zhen-Sheng; Yeung, Sai-Ching J; Cheng, Chao

    2014-04-01

    Massive hemoptysis in Behçet disease (BD) is rare but often fatal. This report presents a 28-year-old man with recurrent massive hemoptysis. He was diagnosed with bilateral multiple pulmonary artery aneurysms (PAAs), coronary artery aneurysm, and ventricular pseudoaneurysm from BD. The patient underwent emergency right lower lobectomy with no obvious complications. No hemoptysis recurred during an 18-month follow-up. This report also reviews the occurrence of PAAs in BD, with an emphasis on the treatment approaches.

  10. Lower extremity and carotid artery disease in COPD

    PubMed Central

    Linnhoff, Fabian; van Essen, Fabian; Pingel, Simon; Schaefer, Christian Alexander; Schahab, Nadjib; Fimmers, Rolf; Nickenig, Georg; Skowasch, Dirk

    2016-01-01

    In view of their common chronic inflammatory process, we sought to determine the linkage between peripheral artery disease and chronic obstructive pulmonary disease (COPD). 107 COPD patients (mean±sd age 64.6±10.4 years, 52.2% male) and 22 control smokers without previously diagnosed peripheral artery disease underwent standardised angiological examination for lower extremity artery disease (LEAD) and carotid artery disease. LEAD was significantly more prevalent in COPD patients than in controls (80.4% versus 54.5%, p=0.002). Among COPD patients, 57.0%, 12.2%, 10.3% and 0.9% were found to be in Fontaine stages I, IIA, IIB and III, respectively. As with carotid artery disease, its frequency increased from 36.4% in controls to 58.9% in COPD patients (p=0.003). Carotid plaque burden, LEAD Fontaine degrees as well as pulse wave index and ankle–brachial index manifested significant impairment over percentage predicted forced expiratory volume in 1 s (FEV1 % pred) (p=0.02, p<0.001, p=0.01 and p<0.001, respectively). Multivariate analysis revealed that COPD Global Initiative for Chronic Obstructive Lung Disease status was the strongest independent predictor for the presence of plaque in lower extremity arteries (odds ratio 1.63, 95% CI 1.19–2.25, p=0.003) and carotids (odds ratio 1.66, 95% CI 1.14–2.44, p=0.009). As compared with control smokers, peripheral artery disease is diagnosed in a sizeable proportion of COPD patients and exhibits significant distributive differences over FEV1 % pred that exceed the susceptibility conferred by common cardiovascular stressors. PMID:28053972

  11. Lower extremity and carotid artery disease in COPD.

    PubMed

    Pizarro, Carmen; Linnhoff, Fabian; van Essen, Fabian; Pingel, Simon; Schaefer, Christian Alexander; Schahab, Nadjib; Fimmers, Rolf; Nickenig, Georg; Skowasch, Dirk

    2016-10-01

    In view of their common chronic inflammatory process, we sought to determine the linkage between peripheral artery disease and chronic obstructive pulmonary disease (COPD). 107 COPD patients (mean±sd age 64.6±10.4 years, 52.2% male) and 22 control smokers without previously diagnosed peripheral artery disease underwent standardised angiological examination for lower extremity artery disease (LEAD) and carotid artery disease. LEAD was significantly more prevalent in COPD patients than in controls (80.4% versus 54.5%, p=0.002). Among COPD patients, 57.0%, 12.2%, 10.3% and 0.9% were found to be in Fontaine stages I, IIA, IIB and III, respectively. As with carotid artery disease, its frequency increased from 36.4% in controls to 58.9% in COPD patients (p=0.003). Carotid plaque burden, LEAD Fontaine degrees as well as pulse wave index and ankle-brachial index manifested significant impairment over percentage predicted forced expiratory volume in 1 s (FEV1 % pred) (p=0.02, p<0.001, p=0.01 and p<0.001, respectively). Multivariate analysis revealed that COPD Global Initiative for Chronic Obstructive Lung Disease status was the strongest independent predictor for the presence of plaque in lower extremity arteries (odds ratio 1.63, 95% CI 1.19-2.25, p=0.003) and carotids (odds ratio 1.66, 95% CI 1.14-2.44, p=0.009). As compared with control smokers, peripheral artery disease is diagnosed in a sizeable proportion of COPD patients and exhibits significant distributive differences over FEV1 % pred that exceed the susceptibility conferred by common cardiovascular stressors.

  12. Acute Limb Ischemia and Coronary Artery Disease in a Case of Kimura’s Disease

    PubMed Central

    Heo, Woon; Jun, Hee Jae; Kang, Do Kyun; Min, Ho-Ki; Hwang, Youn-Ho; Kim, Ji Yong; Nam, Kyung Han

    2017-01-01

    Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion. KD is a systemic disease that affects many organs and presents with thromboembolism and vasculitis. In a patient with KD, physicians should evaluate the vascular system, including the coronary arteries. PMID:28382271

  13. Longitudinal study of heart disease in a Jamaican rural population

    PubMed Central

    Miall, W. E.; Del Campo, E.; Fodor, J.; Rhode, J. R. Nava; Ruiz, L.; Standard, K. L.; Swan, A. V.

    1972-01-01

    A long-term epidemiological study of heart disease in a representative rural community in Jamaica was started in 1962-63 and the first follow-up survey was carried out in 1967-68. This report describes the prevalence of several cardiovascular characteristics at each survey, and their associations with other measurements. The nature of the electrocardiographic abnormalities and their relationship with symptoms of effort pain and prolonged chest pain suggests that much of the disease seen in this population is ultimately ischaemic in origin despite evidence that classical myocardial infarction and severe coronary atheroma are relatively infrequent. Nevertheless both the symptoms and the electrocardiographic abnormalities had features that were not completely typical of occlusive disease of extramural coronary arteries. These findings are discussed in terms of the four conditions—hypertension, conventional coronary heart disease, small artery disease, and cardiomyopathy—that are believed to account for most cases of heart disease in this community, and it is concluded that the overall pattern of disease cannot be explained by any single disorder of overriding importance. The evidence suggests that all may be important contributors. PMID:4538187

  14. Coronary Artery Disease Risk Factors, Coronary Artery Calcification and Coronary Bypass Surgery

    PubMed Central

    Ulusoy, Fatih Rifat; Ipek, Emrah; Korkmaz, Ali Fuat; Gurler, Mehmet Yavuz; Gulbaran, Murat

    2015-01-01

    Introduction Atherosclerosis is an intimal disease which affects large and medium size arteries including aorta and carotid, coronary, cerebral and radial arteries. Calcium accumulated in the coronary arterial plaques have substantial contribution to the plaque volume. The aim of our study is to investigate the relationship between coronary artery disease (CAD) risk factors and coronary arterial calcification, and to delineate the importance of CACS in coronary artery bypass surgery. Materials and Methods The current study is retrospective and 410 patients admitted to our clinic with atypical chest pain and without known CAD were included. These individuals were evaluated by 16 slice electron beam computed tomography with suspicion of CAD and their calcium scores were calculated. Detailed demographic and medical history were obtained from all of the patients. Results In our study, we employed five different analyses using different coronary arterial calcification score (CACS) thresold levels reported in previous studies. All of the analyses, performed according to the previously defined thresold levels, showed that risk factors had strong positive relationship with CACS as mentioned in previous studies. Conclusion Coronary arterial calcification is part of the athero-sclerotic process and although it can be detected in atherosclerotic vessel, it is absent in a normal vessel. It can be concluded that the clinical scores, even they are helpful, have some limitations in a significant part of the population for cardiovascular risk determination. It is important for an anastomosis region to be noncalcified in coronary bypass surgery. In a coronary artery, it will be helpness for showing of calcific field and anostomosis spot. PMID:26155507

  15. Cardiovascular Events in Patients with Atherothrombotic Disease: A Population-Based Longitudinal Study in Taiwan

    PubMed Central

    Lee, Wen-Hsien; Hsu, Po-Chao; Chu, Chun-Yuan; Su, Ho-Ming; Lee, Chee-Siong; Yen, Hsueh-Wei; Lin, Tsung-Hsien; Voon, Wen-Chol; Lai, Wen-Ter; Sheu, Sheng-Hsiung

    2014-01-01

    Background Atherothrombotic diseases including cerebrovascular disease (CVD), coronary artery disease (CAD), and peripheral arterial disease (PAD), contribute to the major causes of death in the world. Although several studies showed the association between polyvascular disease and poor cardiovascular (CV) outcomes in Asian population, there was no large-scale study to validate this relationship in this population. Methods and Results This retrospective cohort study included patients with a diagnosis of CVD, CAD, or PAD from the database contained in the Taiwan National Health Insurance Bureau during 2001–2004. A total of 19954 patients were enrolled in this study. The atherothrombotic disease score was defined according to the number of atherothrombotic disease. The study endpoints included acute coronary syndrome (ACS), all strokes, vascular procedures, in hospital mortality, and so on. The event rate of ischemic stroke (18.2%) was higher than that of acute myocardial infarction (5.7%) in our patients (P = 0.0006). In the multivariate Cox regression analyses, the adjusted hazard ratios (HRs) of each increment of atherothrombotic disease score in predicting ACS, all strokes, vascular procedures, and in hospital mortality were 1.41, 1.66, 1.30, and 1.14, respectively (P≦0.0169). Conclusions This large population-based longitudinal study in patients with atherothrombotic disease demonstrated the risk of subsequent ischemic stroke was higher than that of subsequent AMI. In addition, the subsequent adverse CV events including ACS, all stroke, vascular procedures, and in hospital mortality were progressively increased as the increase of atherothrombotic disease score. PMID:24647769

  16. Internal carotid artery occlusion: association with atherosclerotic disease in other arterial beds and vascular risk factors.

    PubMed

    Paraskevas, Kosmas I; Mikhailidis, Dimitri P; Liapis, Christos D

    2007-01-01

    The aim of this article is to investigate the association between internal carotid artery occlusion (ICAO) and the presence of atherosclerotic disease and vascular risk factors. The clinical characteristics and risk factors of 120 patients presenting with ICAO were retrospectively reviewed. All patients (n = 120) had at least 1 of the 4 vascular risk factor (diabetes, smoking, hypercholesterolemia, and hypertension); 2, 3, or all 4 risk factors were present in 14 to 82 of the patients (11.7% to 68.3%), 10 to 39 of the patients (8.3% to 32.5%), and 9 of the patients (7.5%), respectively. A total of 84 patients (70%) with ICAO had disease in at least 1 additional vascular bed (aorta, coronary or lower limb arteries). In addition to ICAO, vascular disease was present in 2 and all 3 of these arterial beds in 42 (35%) and 9 (7.5%) patients, respectively. Furthermore, stenosis or occlusion of the ipsilateral or contralateral vertebral arteries was recorded in 19 of 120 patients (15.8%). Regarding the contralateral carotid artery, 1 patient had bilateral ICAO. One patient had contralateral common carotid artery occlusion, and 1 patient was excluded from the analysis because of surgery to the contralateral carotid artery. Of the remaining 117 patients, 34 (29.0%) had less than 50% contralateral carotid artery stenosis. Thirty-two patients (27.4%) had 50% to 69%, and 51 (43.6%) had 70% to 99% stenosis. Ultrasonographic imaging of the carotid plaque of the contralateral carotid artery revealed that 52 of the 120 arteries (43.3%) were uniformly or predominantly echolucent (types I and II, respectively). Fifty-nine (49.2%) were predominantly or uniformly echogenic (types III and IV), and 9 (7.5%) could not be classified. A similar distribution of echomorphology was observed on the occluded side. ICAO is associated with widespread atherosclerotic disease and a high prevalence of vascular risk factors. Detection of ICAO should prompt the investigation of other arterial beds and

  17. Carotid artery disease after head and neck radiotherapy.

    PubMed

    Thalhammer, Christoph; Husmann, Marc; Glanzmann, Christoph; Studer, Gabriela; Amann-Vesti, Beatrice R

    2015-01-01

    Radiation induced atherosclerosis of the carotid artery is a clinically relevant late complication after head and neck radiotherapy. Improved long-term survival after multimodality therapy in neck malignancies result in an increased risk of carotid artery disease in patients after radiotherapy (RT). This review focuses on the current knowledge of occlusive carotid disease after head and neck radiotherapy and highlights the exceeding morphologic post-radiation vessel wall pathologies. More severe and extensive carotid artery atherosclerosis with plaque in all segments including the common carotid artery is a frequent finding after RT. Therefore, colour coded duplex ultrasound surveillance in patients after head and neck RT is recommended. Some histopathological studies indicate differences to “classical” atherosclerosis, and pathogenesis of chronic radiation vasculopathy is still under discussion.

  18. Extracranial carotid artery aneurysm due to Behcet's disease.

    PubMed

    Albeyoglu, Sebnem; Cinar, Bayer; Eren, Tunc; Filizcan, Ugur; Bayserke, Olgar; Aslan, Cenk

    2010-12-01

    Behçet's disease is a chronic systemic inflammatory disorder associated with recurrent oral and genital ulcers and iritis. Vascular lesions are encountered in 7%-29% of patients, gravely affecting the course of the disease. Extracranial carotid aneurysms due to Behçet's disease are extremely rare. We describe a surgically treated case of Behçet's disease in a 28-year-old man who presented with a rapidly enlarging left common carotid artery aneurysm.

  19. Endovascular Treatment of the Internal Iliac Artery in Peripheral Arterial Disease

    SciTech Connect

    Huetink, K. Steijling, J.J.F.; Mali, W.P.T.M.

    2008-03-15

    In patients with peripheral arterial disease not much is known about the relationship between the localization of the pain and the localization of arterial occlusions in the iliac arteries. Occlusions high in the iliac arteries are assumed to be able to induce pain in the buttocks and upper leg as well as pain in the calves. Several case reports show that the symptoms of arteriosclerotic lesions in the internal iliac artery are often atypical and not easy to diagnose. In this report, 3 patients with internal iliac artery occlusions who were treated with percutaneous transluminal angioplasty (PTA) are described. One patient had isolated pain in the buttock region. In the other 2 patients the initial pain was focused on the buttock region with extension to the calves during exercise. After PTA, 2 patients were free of symptoms, while in the other patient the symptoms improved but did not disappear. Future research should clarify the relation between certain arterial occlusions and the location of the pain.

  20. Pulmonary artery aneurysm in Behcet's disease: a case report.

    PubMed

    Kasikcioglu, Erdem; Akhan, Hulya; Cuhadaroglu, Caglar; Erkan, Feyza

    2004-05-01

    The pulmonary artery is the second most common site of arterial involvement in Behcet's disease. A 32-year-old man presented with bilateral ankle edema, abdominal discomfort, and hemoptysis. He had a history of recurrent oral and genital aphthous ulcerations for 1 year. The diagnosis of Behcet's disease was made on the basis of the criteria published by the International Study Group for Behcet's Disease. His chest X-ray revealed left hilar enlargement. A helical computed tomography (CT) scan showed a pulmonary aneurysm with intramural thrombosis in the left pulmonary artery and enlarged hepatic veins. Treatment with colchicine and cyclophosphamide was given for 24 months, and helical thoracic CT was performed again. Helical CT showed that the pulmonary aneurysm was reduced by treatment. Helical CT could be used in Behcet's disease for the diagnosis and follow-up of pulmonary involvement.

  1. Pulmonary artery aneurysms in Behçet's disease.

    PubMed

    Yilmaz, Sema; Cimen, Kadriye Akar

    2010-08-01

    Behçet's disease is the most common cause of pulmonary artery aneurysms. Pulmonary artery aneurysms are rare, but they are life-threatening because of their high tendency to rupture. However, there is also a chance that the aneurysms may completely resolve with immunosuppressive therapy. A 30-year-old man was admitted with chest pain, painful oral and genital ulcers, skin rash, weakness, and intermittent hemoptysis. He had a history of Behçet's disease for 6 years. The chest radiography showed a round opacity superior part of hilus on right. The helical thoracic computed tomography (CT) angiography demonstrated pulmonary aneurysms associated with Behçet's disease. The patient was successfully treated with colchicine, corticosteroids, and cyclophosphamide. A discussion about pulmonary artery aneurysms associated with Behçet's disease is provided in this case.

  2. Isolated supraclinoid occlusive disease of the internal carotid artery.

    PubMed

    Lagrèze, H L; Hartmann, A; Ries, F; Wappenschmidt, J; Hanisch, E

    1987-01-01

    Isolated supraclinoid occlusive disease of the internal carotid artery is a rare cause of cerebral ischemia. The authors of the only review of this subject concluded that it is caused predominantly by factors other than atherosclerosis. We examined 6 patients with isolated supraclinoid occlusive lesions. Five of them had one or more risk factors for atherosclerosis. Thus, the isolated stenosis of that part of the internal carotid artery does not seem to represent a particular pathologic entity.

  3. Duplex ultrasound in the assessment of peripheral arterial disease

    NASA Astrophysics Data System (ADS)

    Aly, Sayed A. A. F.

    Arteriography plays a central role in the assessment of peripheral arterial disease. Arteriography is associated with the risk of damage to the artery, peripheral embolisation, hazards of intra-arterial injection and exposure to ionising radiation. Arteriography provides an anatomical assessment of arterial stenosis but does not measure the functional results of the stenosis. Modern high resolution ultrasound imaging technology enables non-invasive assessment of vascular diseases and allows functional assessment of blood flow. This investigation is of proven value in studying carotid disease. The aim of the study was to determine the accuracy of duplex ultrasonography (DUS) in assessment of lower limb arterial disease in comparison with arteriography (IA DSA). A technical comparison has been made between the description of arterial lesion as indicated by DUS and IA DSA. In addition, the sensitivity of DUS in assessing multisegmental arterial disease has been determined. The clinical decision has been investigated in a further study in which five surgeons were asked to determine patient management based on IA DSA and DUS data in the same patient group. Concordance between management strategies was assessed. DUS was used as the primary method of investigation in further series of patients. Criteria were established to determine which patients would require angiography. The computer-assisted image analysis was used to study the ultrasound images of arterial stenosis and a method of analysing such images objectively was established. Two studies have been included in this section. These assess the technical accuracy of ultrasound image analysis compared with histological examination of plaque. The reproducibility of the image analysis has also been tested. I have developed a classification for peripheral arterial disease to be used to facilitate the communication between vascular laboratory staff who perform the duplex ultrasonography and surgeons who use this

  4. [Coronary artery disease in patient 80 years and older].

    PubMed

    Hanon, Olivier

    2008-09-30

    The prevalence of coronary artery disease increases with age. Its clinical presentation is even less typical and its prognosis even more severe that it occurs in frail subjects with several co-morbidities. These atypical symptoms are often associated with a delayed diagnosis and therapy. The presence of comorbidities requires a comprehensive geriatric assessment to detect the existence of "frailty". Evidence based medicine available for coronary artery disease is based on studies that involve very few subjects over 80 years and recommendations are extrapolated from data based on evidence obtained in younger populations. Basically the strategy of treatments of coronary artery disease in octogenarians remains identical to the youngest subject. However, epidemiological studies indicate an under-prescription of recommended drugs whereas this older population is likely to derive the greatest benefit because of its elevated cardiovascular risk. Cautions for use of cardio-vascular therapies are necessary in octogenarian people because of comorbidities and pharmacokinetic and pharmacodynamic changes related to aging. Globally, the therapeutic strategy of coronary artery disease should be based not on the age but on an individual analysis that takes into account the severity of coronary artery disease, the existence of comorbidities, the iatrogenic risk, the expectancy and the quality of life of the patient.

  5. Subintimal Angioplasty for Peripheral Arterial Occlusive Disease: A Systematic Review

    SciTech Connect

    Met, Rosemarie Lienden, Krijn P. Van; Koelemay, Mark J. W.; Bipat, Shandra; Legemate, Dink A.; Reekers, Jim A.

    2008-07-15

    The objective of this study was to summarize outcomes of subintimal angioplasty (SA) for peripheral arterial occlusive disease. The Cochrane Library, Medline and Embase databases were searched to perform a systematic review of the literature from 1966 through May 2007 on outcomes of SA for peripheral arterial occlusive disease of the infrainguinal vessels. The keywords 'percutaneous intentional extraluminal revascularization,' 'subintimal angioplasty,' 'peripheral arterial disease,' 'femoral artery,' 'popliteal artery,' and 'tibial artery' were used. Assessment of study quality was done using a form based on a checklist of the Dutch Cochrane Centre. The recorded outcomes were technical and clinical success, primary (assisted) patency, limb salvage, complications, and survival, in relation to the clinical grade of disease (intermittent claudication or critical limb ischemia [CLI] or mixed) and location of lesion (femoropopliteal, crural, or mixed). Twenty-three cohort studies including a total of 1549 patients (range, 27 to 148) were included in this review. Methodological and reporting quality were moderate, e.g., there was selection bias and reporting was not done according to the reporting standards. These and significant clinical heterogeneity obstructed a meta-analysis. Reports about length of the lesion and TASC classification were too various to summarize or were not mentioned at all. The technical success rates varied between 80% and 90%, with lower rates for crural lesions compared with femoral lesions. Complication rates ranged between 8% and 17% and most complications were minor. After 1 year, clinical success was between 50% and 70%, primary patency was around 50% and limb salvage varied from 80% to 90%. In conclusion, taking into account the methodological shortcomings of the included studies, SA can play an important role in the treatment of peripheral arterial disease, especially in the case of critical limb ischemia. Despite the moderate patency

  6. Selective arterial distribution of cerebral hyperperfusion in Fabry disease.

    PubMed

    Moore, D F; Herscovitch, P; Schiffmann, R

    2001-07-01

    Fabry disease is an X-linked recessive deficiency of lysosomal alpha-galactosidase A associated with an increased risk of early onset cerebrovascular disease. The disorder is reported to affect the posterior circulation predominantly. This hypothesis was investigated directly by the measurement of regional cerebral blood flow with positron emission tomography (PET). Resting regional cerebral blood flow (rCBF) in 26 hemizygous patients with Fabry disease and 10 control participants was examined using H(2)15O and PET. Statistical parametric mapping (SPM(t), SPM99) and PET images of patients and controls were produced. Significantly increased SPM(t) clusters were then color coded and blended with a coregistered T1 magnetic resonance imaging (MRI) template. Cerebral arterial territory maps were digitized and rescaled. Custom OpenGL and ImageVision Library C++ code was written to allow a first-order affine transformation of the blended SPM(t) and MRI template onto the arterial territory map. The affine transformation was constrained by choosing corresponding cerebral landmark "tie points" between the SPM(t) [symbol: see text] MRI template images and the cerebral arterial territory maps. The data demonstrated that the posterior circulation is the predominant arterial territory with a significantly increased rCBF in Fabry disease. No arterial distribution had a decreased rCBF.

  7. Drug-Coated Balloons for Infrainguinal Peripheral Artery Disease.

    PubMed

    Sethi, Sanjum S; Lee, Michael S

    2016-07-01

    Revascularization of infrainguinal peripheral artery disease has traditionally been accomplished via percutaneous transluminal angioplasty. However, long-term results have been hampered by high rates of restenosis. Along with the advent of stents, paclitaxel-coated balloons are an emerging therapeutic option for the invasive management of infrainguinal peripheral artery disease. Paclitaxel has been successful in inhibiting neointimal hyperplasia, the main mechanism for in-stent restenosis. Technological advances have facilitated the development of paclitaxel-coated balloons, which show promise in early trials for femoropopliteal stenosis relative to uncoated balloons. For infrapopliteal stenoses, the data remain scant and conflicted. Therefore, large-scale randomized clinical trials with long-term follow-up evaluating safety and effectiveness between various strategies need to be performed to determine the optimal invasive management strategy for infrainguinal peripheral artery disease.

  8. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

    MedlinePlus

    Understanding Task Force Recommendations Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults The U.S. Preventive Services Task Force (Task Force) has issued a ...

  9. Dynamic diffuse optical tomography imaging of peripheral arterial disease.

    PubMed

    Khalil, Michael A; Kim, Hyun K; Kim, In-Kyong; Flexman, Molly; Dayal, Rajeev; Shrikhande, Gautam; Hielscher, Andreas H

    2012-09-01

    Peripheral arterial disease (PAD) is the narrowing of arteries due to plaque accumulation in the vascular walls. This leads to insufficient blood supply to the extremities and can ultimately cause cell death. Currently available methods are ineffective in diagnosing PAD in patients with calcified arteries, such as those with diabetes. In this paper we investigate the potential of dynamic diffuse optical tomography (DDOT) as an alternative way to assess PAD in the lower extremities. DDOT is a non-invasive, non-ionizing imaging modality that uses near-infrared light to create spatio-temporal maps of oxy- and deoxy-hemoglobin in tissue. We present three case studies in which we used DDOT to visualize vascular perfusion of a healthy volunteer, a PAD patient and a diabetic PAD patient with calcified arteries. These preliminary results show significant differences in DDOT time-traces and images between all three cases, underscoring the potential of DDOT as a new diagnostic tool.

  10. Ultrasound speckle tracking for radial, longitudinal and circumferential strain estimation of the carotid artery--an in vitro validation via sonomicrometry using clinical and high-frequency ultrasound.

    PubMed

    Larsson, Matilda; Heyde, Brecht; Kremer, Florence; Brodin, Lars-Åke; D'hooge, Jan

    2015-02-01

    Ultrasound speckle tracking for carotid strain assessment has in the past decade gained interest in studies of arterial stiffness and cardiovascular diseases. The aim of this study was to validate and directly contrast carotid strain assessment by speckle tracking applied on clinical and high-frequency ultrasound images in vitro. Four polyvinyl alcohol phantoms mimicking the carotid artery were constructed with different mechanical properties and connected to a pump generating carotid flow profiles. Gray-scale ultrasound long- and short-axis images of the phantoms were obtained using a standard clinical ultrasound system, Vivid 7 (GE Healthcare, Horten, Norway) and a high-frequency ultrasound system, Vevo 2100 (FUJIFILM, VisualSonics, Toronto, Canada) with linear-array transducers (12L/MS250). Radial, longitudinal and circumferential strains were estimated using an in-house speckle tracking algorithm and compared with reference strain acquired by sonomicrometry. Overall, the estimated strain corresponded well with the reference strain. The correlation between estimated peak strain in clinical ultrasound images and reference strain was 0.91 (p<0.001) for radial strain, 0.73 (p<0.001) for longitudinal strain and 0.90 (p<0.001) for circumferential strain and for high-frequency ultrasound images 0.95 (p<0.001) for radial strain, 0.93 (p<0.001) for longitudinal strain and 0.90 (p<0.001) for circumferential strain. A significant larger bias and root mean square error was found for circumferential strain estimation on clinical ultrasound images compared to high frequency ultrasound images, but no significant difference in bias and root mean square error was found for radial and longitudinal strain when comparing estimation on clinical and high-frequency ultrasound images. The agreement between sonomicrometry and speckle tracking demonstrates that carotid strain assessment by ultrasound speckle tracking is feasible.

  11. Giant aneurysm of the left anterior descending coronary artery in a pediatric patient with Behcet's disease.

    PubMed

    Cook, Amanda L; Rouster-Stevens, Kelly; Williams, Derek A; Hines, Michael H

    2010-07-01

    Behcet's disease is a rare autoimmune vasculitis characterized by oral aphthosis, genital ulcers, and ocular and cutaneous lesions. Vascular involvement usually affects the veins more commonly than the arteries, and coronary arterial involvement is extremely rare. We report an adolescent with Behcet's disease who developed a large pseudoaneurysm of the left anterior descending coronary artery requiring a coronary arterial bypass graft.

  12. Arterial blood gas anomaly in canine hepatobiliary disease.

    PubMed

    Kaneko, Yasuyuki; Torisu, Shidow; Kobayashi, Takumi; Mizutani, Shinya; Tsuzuki, Nao; Sonoda, Hiroko; Ikeda, Masahiro; Naganobu, Kiyokazu

    2016-01-01

    Arterial blood gas analysis is an important diagnostic and monitoring tool for respiratory abnormalities. In human medicine, lung complications often occur as a result of liver disease. Although pulmonary complications of liver disease have not been reported in dogs, we have frequently encountered hypoxemia in dogs with liver disorders, especially extrahepatic biliary obstruction. In addition, respiratory disorders account for 20% of perioperative fatalities in dogs. Therefore, in this study, we evaluated the respiratory status in dogs with hepatobiliary disease by arterial blood gas analysis. PaO2 and PaCO2 were measured. Alveolar-arterial oxygen difference (AaDO2), the indicator of gas exchange efficiency, was calculated. Compared to healthy dogs (control group), hepatobiliary disease dogs had significantly lower PaO2 and higher AaDO2. Hypoxemia (PaO2 of ≤80 mmHg) was observed in 28/71 dogs with hepatobiliary disease. AaDO2 was higher (≥30 mmHg) than the control group range (11.6 to 26.4 mmHg) in 32/71 hepatobiliary disease dogs. By classifying type of hepatobiliary disease, dogs with extrahepatic biliary obstruction and chronic hepatitis showed significantly lower PaO2 and higher AaDO2 than in a control group. Dogs with chronic hepatitis also had significantly lower PaCO2. The present study shows that dogs with hepatobiliary disease have respiratory abnormalities more than healthy dogs. Preanesthetic or routine arterial blood gas analysis is likely beneficial to detect the respiratory abnormalities in dogs with hepatobiliary disease, especially extrahepatic biliary obstruction and chronic hepatitis.

  13. Factors Influencing Smoking Cessation in Patients with Coronary Artery Disease.

    ERIC Educational Resources Information Center

    McKenna, Kryss; Higgins, Helen

    1997-01-01

    Ten sociodemographic, clinical, and psychological characteristics considered predictors of difficulty with smoking cessation in patients with coronary artery disease are reviewed. The compounding effects of nicotine addiction are discussed. Consideration of these factors may result in individualized programs for smoking cessation. A brief overview…

  14. Learning Style Preferences of Elderly Coronary Artery Disease Patients.

    ERIC Educational Resources Information Center

    Theis, Saundra L.; Merritt, Sharon L.

    1992-01-01

    The Patient Learning Styles Questionnaire derived from Canfield and administered to 134 elderly coronary artery disease patients revealed the following order of learning preferences: structure, iconics, listening, direct experience, reading, achievement, affiliation, and eminence. Level of education significantly influenced preferred learning…

  15. Childhood Antecedents to Adult Coronary Artery Diseases. Special Reference Briefs.

    ERIC Educational Resources Information Center

    Winick, Myron

    This reference brief deals with the childhood antecedents to atherosclerosis and hypertension. While diet is related to the development of coronary artery diseases, there is some disagreement about what dietary changes are necessary or desirable in children to prevent their development, and at what age such changes should be made. Fifty-five…

  16. Genetic contribution of the leukotriene pathway to coronary artery disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We evaluated the genetic contribution of the leukotriene (LT) pathway to risk of coronary artery disease (CAD) in 4,512 Caucasian and African American subjects ascertained through elective cardiac evaluation. Of the three previously associated variants, the shorter "3" and "4" alleles of a promoter ...

  17. Coronary artery bypass is superior to drug-eluting stents in multivessel coronary artery disease.

    PubMed

    Guyton, Robert A

    2006-06-01

    Percutaneous intervention for the treatment of multivessel coronary artery disease continues to displace coronary artery bypass graft surgery. But controlled trials of percutaneous intervention versus coronary bypass, in meta-analysis, have shown a significant survival advantage for coronary bypass. Studies of bare metal stents have not presented any data to prompt reversal of this conclusion for all but the small portion of patients most suited for stenting. Drug-eluting stents have no survival advantage compared with bare metal stents. Data from real-world registries have shown that the current therapy of multivessel disease patients has resulted in a relative excess mortality of as much as 46% in patients with initial stenting compared with patients with initial coronary bypass. Ethical considerations demand that patients with multivessel disease be informed of the documented mortality benefit of coronary bypass graft surgery.

  18. Ozonized autohemotransfusion does not affect arterial vasodilation in patients with peripheral arterial disease

    PubMed Central

    Coppola, Antonino; Coppola, Ludovico; Luongo, Carlo; Arciello, Alessandro; Cacciapuoti, Federico; Lama, Diana; Luongo, Margherita; Ruggiero, Luigi; Pastore, Agostino; Gombos, Giorgio

    2007-01-01

    Ozonized autohemotransfusion has been used as a complementary therapy in patients with peripheral arterial disease (PAD). To determine whether ozone therapy could acutely modify artery vasodilatory capacity, a flow-mediated dilation test was performed at the brachial artery level before and after an ozonized autohemotransfusion in 16 patients with PAD, mean (± SD) age 55±1.8 years, and 14 healthy volunteers matched for age, sex and body mass index. Before ozonized autohemotransfusion, the mean baseline diameter of the brachial artery was higher in PAD patients than in healthy subjects (4.6±0.54 mm versus 3.6±0.54 mm, P<0.001) while mean flow-mediated brachial artery dilation and percentage of increase in flow were significantly lower in PAD patients than in controls (6.3±6.1% versus 11.8±2.4%, P<0.02; 433±61% versus 580±46%, P<0.02, respectively). No significant changes were observed after ozonized autohemotransfusion, indicating that ozonized autohemotransfusion does not modify endothelium-dependent ischemia-induced vascular reactivity. PMID:22477241

  19. Overview of Functional Peripheral Arterial Disease

    MedlinePlus

    ... Feb. 28, 2017 (HealthDay News) -- Young people with type 2 diabetes are much more likely to show signs of ... to help the world be well. From developing new therapies that treat and prevent disease to helping people ...

  20. How Is Peripheral Arterial Disease Diagnosed?

    MedlinePlus

    ... Names Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Atherosclerosis Coronary Heart Disease Heart Attack Smoking and Your Heart Stroke Send a link ...

  1. Revascularization therapy for coronary artery disease. Coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty.

    PubMed Central

    Wilson, J M; Ferguson, J J

    1995-01-01

    Coronary artery bypass surgery relieves the symptoms of myocardial ischemia and prolongs survival of patients with more severe coronary artery disease. Randomized trials of surgical therapy have consistently shown that the benefits of surgical revascularization are proportional to the amount of myocardium affected by, or at risk for, ischemic injury. This risk is inferred from angiographically delineated coronary anatomy, estimates of left ventricular function, and physiologic testing. The population that may see a survival benefit from surgical revascularization has probably been expanded beyond that reported in the VA, CASS, and ECSS trials, due to improved perioperative care, longer graft survival, and the use of internal mammary artery grafts. Percutaneous transluminal coronary angioplasty revascularizes myocardium by dilating a stenotic segment of coronary artery. While successful in relieving the symptoms of myocardial ischemia, PTCA is hindered by the occurrence of abrupt vessel closure and the frequent development of restenosis. Furthermore, firm proof of a survival benefit, outside of emergency therapy for acute myocardial infarction, is not yet available. However, because the risk of procedure-related death or serious complication is lower than that seen with bypass surgery, PTCA provides a useful alternative revascularization method for patients with less extensive disease, in whom the risk of surgery may equal or exceed any beneficial effect. New technology and growing experience are widening the scope of percutaneous revascularization by extending the hope of symptomatic relief and survival benefit even to patients with extensive, severe coronary artery disease. Comparisons between surgical therapy and PTCA in select populations with single- and multivessel coronary artery disease have shown that PTCA is not as effective as surgery for long-term symptomatic control, and that it often requires repeat PTCA or cross-over to bypass surgery; however, long

  2. Longitudinal evaluation of bronchopulmonary disease in children with cystic fibrosis.

    PubMed

    Farrell, Philip M; Li, Zhanhai; Kosorok, Michael R; Laxova, Anita; Green, Christopher G; Collins, Jannette; Lai, Hui-Chuan; Makholm, Linda M; Rock, Michael J; Splaingard, Mark L

    2003-09-01

    Children with cystic fibrosis (CF) develop bronchopulmonary disease at variable ages. Determining the epidemiology of chronic lung disease and quantifying its severity, however, have been difficult in infants and young children. As part of the Wisconsin CF Neonatal Screening Project, we were presented with an ideal opportunity to assess longitudinally the evolution of symptoms, signs, and quantitative measures of CF respiratory disease. After newborn screening test results led to early recognition, 64 patients diagnosed at a median age of 6.71 weeks were enrolled and studied systematically at a median age of 11.3 years to obtain clinical information, chest radiographs, and pulmonary function tests. Our observations revealed that a frequent cough by history is evident by 10.5 months of age in half the patients. Quantitative chest radiology (CXR scoring) demonstrated that potentially irreversible abnormalities are present in half the children by 2 years. The severity of Wisconsin and Brasfield CXR scores increased in association with respiratory infections. Longitudinal progression of Wisconsin CXR scores was related to age (P < 0.001), pancreatic insufficiency (P = 0.005), and respiratory secretion cultures positive for Staphylococus aureas (P = 0.039). In contrast, serial spirometry showed limited sensitivity, as did lung volume determinations; neither was satisfactory as repeated measures with acceptable quality control until after 7 years of age. Time to event analyses revealed that half the patients had % predicted FEF(25-75) and FEV(1)/FVC values greater than 80% until 10.7 and 9.9 years, respectively. We conclude that of the methods evaluated, quantitative chest radiology is currently the best procedure for frequent assessment of bronchopulmonary disease in CF, and that radiographic progression is evident in approximately 85% of patients by 5 years of age. Our results also suggest that bronchiectasis and other radiographic evidence of chronic infection are

  3. Multimodality Imaging in Coronary Artery Disease: Focus on Computed Tomography

    PubMed Central

    Lee, Ji Hyun; Han, Donghee; Danad, Ibrahim; Hartaigh, Bríain ó; Lin, Fay Y.

    2016-01-01

    Coronary artery disease (CAD) is the leading cause of mortality worldwide, and various cardiovascular imaging modalities have been introduced for the purpose of diagnosing and determining the severity of CAD. More recently, advances in computed tomography (CT) technology have contributed to the widespread clinical application of cardiac CT for accurate and noninvasive evaluation of CAD. In this review, we focus on imaging assessment of CAD based upon CT, which includes coronary artery calcium screening, coronary CT angiography, myocardial CT perfusion, and fractional flow reserve CT. Further, we provide a discussion regarding the potential implications, benefits and limitations, as well as the possible future directions according to each modality. PMID:27081438

  4. Vitamin D deficiency and coronary artery disease: a review of the evidence.

    PubMed

    Kunadian, Vijay; Ford, Gary A; Bawamia, Bilal; Qiu, Weiliang; Manson, JoAnn E

    2014-03-01

    Coronary artery disease remains the leading cause of death in developed countries despite significant progress in primary prevention and treatment strategies. Older patients are at particularly high risk of poor outcomes following acute coronary syndrome and impaired nutrition, including low vitamin D levels, may play a role. The extraskeletal effects of vitamin D, in particular, its role in maintaining a healthy cardiovascular system are receiving increased attention. Longitudinal studies have demonstrated increased cardiovascular mortality and morbidity associated with vitamin D deficiency. Low vitamin D levels have been linked to inflammation, higher coronary artery calcium scores, impaired endothelial function and increased vascular stiffness. However, so far, few randomized controlled trials have investigated the potential benefits of vitamin D supplementation in preventing cardiovascular events, and most available trials have tested low doses of supplementation in relatively low-risk populations. Whether vitamin D supplementation will be beneficial among patients with coronary artery disease, including high risk older patients presenting with acute coronary syndrome, is unknown and warrants further investigation.

  5. Relation between coronary artery disease, risk factors and intima-media thickness of carotid artery, arterial distensibility, and stiffness index.

    PubMed

    Alan, Sait; Ulgen, Mehmet S; Ozturk, Onder; Alan, Bircan; Ozdemir, Levent; Toprak, Nizamettin

    2003-01-01

    Atherosclerosis is a diffuse process that involves vessel structures. In recent years, the relation of noninvasive parameters such as intima-media thickening (IMT), arterial distensibility (AD), and stiffness index (SI) to cardiovascular diseases has been researched. However, we have not found any study that has included all these parameters. The aim of this study is to examine the relation between the presence of coronary artery disease (CAD) and its risk factors to AD, SI, and IMT, which are the noninvasive predictors of atherosclerotic process in the carotid artery. Included in the study were 180 patients who were diagnosed as having CAD by coronary angiography (those with at least > or = 30% stenosis in the coronary arteries) and, as a control group, 53 persons who had normal appearing coronary angiographies. IMT, AD, and SI values of all the patients in the study were measured by echo-Doppler imaging (AD formula = 2 x (AoS - AoD)/PP x AoD, SI formula = (SBP/DBP)/([AoS - AoD]/AoD). Significantly increased IMT (0.82 +/- 0.1, 0.57 +/- 0.1, p<0.05), decreased AD (0.25 +/- 0.9, 0.37 +/- 0.1, p<0.05), and increased SI (13 +/- 4, 8 +/- 3, p<0.05) values were detected in the CAD group compared to the control group. A significant correlation was found between IMT and presence of diabetes mellitus (DM), systolic blood pressure, total cholesterol, and presence of plaque in carotids, and age. In the coronary artery disease group there was a significant correlation between AD and age, systolic blood pressure, and HDL cholesterol levels, while there was no significant correlation with plaque development. A significant correlation was also found between stiffness index and systolic blood pressure and age; however, there was no relation between number of involved vessels and IMT, AD, and SI. We found sensitivity, specificity, and positive predictive and negative predictive values for CAD diagnosis to be 70%, 75%, 77%, and 66%, respectively. In CAD cases, according to data in

  6. Outcome in one-vessel coronary artery disease.

    PubMed

    Califf, R M; Tomabechi, Y; Lee, K L; Phillips, H; Pryor, D B; Harrell, F E; Harris, P J; Peter, R H; Behar, V S; Kong, Y; Rosati, R A

    1983-02-01

    We analyzed the clinical outcomes in 688 patients with isolated stenosis of one major coronary artery. The survival rate among patients with disease of the right coronary artery (RCA) was higher than that among patients with left anterior descending (LAD) or left circumflex coronary artery (LCA) disease. The survival rate among patients in all three anatomic subgroups exceeded 90% at 5 years. The presence of a lesion proximal to the first septal perforator of the LAD was associated with decreased survival compared with the presence of a more distal lesion. For the entire group of one-vessel disease patients, total ischemic events (death and nonfatal infarction) occurred at similar rates regardless of the anatomic location of the lesion. Left ventricular ejection fraction was the baseline descriptor most strongly associated with survival, and the characteristics of the angina had the strongest relationship with nonfatal myocardial infarction. No differences in survival or total cardiac event rates were found with surgical or nonsurgical therapy. The relief of angina was superior with surgical therapy, although the majority of nonsurgically treated patients had significant relief of angina. The survival rate of patients with one-vessel coronary disease is excellent, and the risk of nonfatal infarction is low. Clinical strategies for the care of these patients must consider the long-term clinical course of one-vessel coronary disease.

  7. Consultations on patients with venous or arterial diseases.

    PubMed

    Alving, Barbara M; Francis, Charles W; Hiatt, William R; Jackson, Mark R

    2003-01-01

    Advances in vascular biology and drug development, as well as improved interventional techniques, are yielding multiple new treatments for patients with venous and/or arterial thrombosis. Hematologists who are providing consultations for these patients often participate in a multidisciplinary approach to provide optimal care. New anticoagulants, simplified and validated tests for detecting vascular disease, and improved interventional procedures can all reduce the morbidity and mortality that result from venous and arterial thrombosis. In this chapter, different aspects of the diagnosis and treatment of these disorders are addressed by a hematologist, an expert in vascular medicine, and a vascular surgeon. The key to the prevention and treatment of venous and arterial thrombosis is anticoagulant and antiplatelet therapy. In Section I, Dr. Charles Francis, a hematologist with expertise in thrombosis and hemostasis, describes the clinical trials that have resulted in the approval of newer anticoagulants such as fondaparinux and the thrombin- specific inhibitors. He also reviews the clinical trials that have shown the efficacy of the new oral anticoagulant ximelagatran. Although currently under study primarily for the prevention and treatment of venous thrombosis, these anticoagulants are likely to undergo evaluation for use in arterial thrombosis. Peripheral arterial disease (PAD), which affects as many as 12% of individuals over the age of 65 years, provides a diagnostic and therapeutic challenge to physicians across multiple subspecialties. Dr. William Hiatt, a specialist in vascular medicine, discusses in Section II the epidemiology and manifestations of PAD, the best ways in which to diagnose this disorder and determine its severity, and the most appropriate pharmacologic treatment. In Section III, Dr. Mark Jackson, a vascular surgeon, describes interventional procedures that have been developed or are under development to treat arterial thrombosis. He also

  8. Anomalous origin of the right coronary artery from the pulmonary artery: an autopsied sudden death case with severe atherosclerotic disease of the left coronary artery.

    PubMed

    Nagai, T; Mukai, T; Takahashi, S; Takada, A; Saito, K; Harada, K; Mori, S; Abe, N

    2014-03-01

    Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the "coronary steal" phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of "coronary steal" due to atherosclerotic obstructive coronary disease might have contributed to the patient's death.

  9. Incremental value of resting three-dimensional speckle-tracking echocardiography in detecting coronary artery disease.

    PubMed

    Sun, You-Jing; Wang, Fang; Zhang, Rui-Sheng; Wang, Hai-Yan; Yang, Chen-Guang; Cai, Jie; Zang, Wei-Er; Li, Ming-Zhou; Qi, Xin; Li, Jing

    2015-06-01

    The aim of the present study was to investigate the incremental value of resting three-dimensional speckle-tracking echocardiography (3D-STE) in the detection of early-stage left ventricular dysfunction in patients with coronary artery disease (CAD). A total of 110 patients suspected of having CAD were recruited. All patients underwent 3D-STE and coronary artery angiography (CAG). They were divided to a CAD group and a normal group according to the results of CAG. Using 3D-STE software, the peak values of longitudinal strain (LS), circumferential strain (CS), radial strain (RS) and area strain (AS) and the time to peak value of these strains (T-LS, T-CS, T-RS and T-AS) were measured. A receiver operator characteristic curve (ROC) was used to analyze the sensitivity of these strains for the diagnosis of CAD. ROC analysis indicated that T-LS and composite indices combining the peak strain value and time to peak of LS, CS and AS have diagnostic value for the early detection of CAD; the area under the curve (AUC) values were 0.667, 0.692, 0.621 and 0.672 respectively (P<0.005). The composite index of longitudinal strain demonstrated the highest diagnostic value for CAD with 62% sensitivity and 76% specificity. These results indicate that 3D-STE has incremental value for the diagnosis of CAD in patients at rest.

  10. Plasma viscosity increase with progression of peripheral arterial atherosclerotic disease.

    PubMed

    Poredos, P; Zizek, B

    1996-03-01

    Increased blood and plasma viscosity has been described in patients with coronary and peripheral arterial disease. However, the relation of viscosity to the extent of arterial wall deterioration--the most important determinant of clinical manifestation and prognosis of the disease--is not well known. Therefore, the authors studied plasma viscosity as one of the major determinants of blood viscosity in patients with different stages of arterial disease of lower limbs (according to Fontaine) and its relation to the presence of some risk factors of atherosclerosis. The study encompassed four groups of subjects: 19 healthy volunteers (group A), 18 patients with intermittent claudication up to 200 m (stage II; group B), 15 patients with critical ischemia of lower limbs (stage III and IV; group C), and 16 patients with recanalization procedures on peripheral arteries. Venous blood samples were collected from an antecubital vein without stasis for the determination of plasma viscosity (with a rotational capillary microviscometer, PAAR), fibrinogen, total cholesterol, alpha-2-macroglobulin, and glucose concentrations. In patients with recanalization procedure local plasma viscosity was also determined from blood samples taken from a vein on the dorsum of the foot. Plasma viscosity was most significantly elevated in the patients with critical ischemia (1.78 mPa.sec) and was significantly higher than in the claudicants (1.68 mPa.sec), and the claudicants also had significantly higher viscosity than the controls (1.58 mPa.sec). In patients in whom a recanalization procedure was performed, no differences in systemic and local plasma viscosity were detected, neither before nor after recanalization of the diseased artery. In all groups plasma viscosity was correlated with fibrinogen concentration (r=0.70, P < 0.01) and total cholesterol concentration (r=0.24, P < 0.05), but in group C (critical ischemia) plasma viscosity was most closely linked to the concentration of alpha-2

  11. Pathophysiology of carotid artery disease and related clinical syndromes.

    PubMed

    De Reuck, J L

    2004-02-01

    The severity of internal carotid artery lesion per se is a poor indicator of the cerebral haemodynamic status of the brain. Positron emission tomography (PET) of the brain allows to study the different pathophysiological changes related to carotid artery disease. Several stages of impairment of cerebral blood flow and metabolism can be shown such as the compensatory phases by the haemodynamic and the metabolic reserve, the transition to reversible (penumbra) and irreversible ischaemia and the phase of luxury perfusion. Distinct PET patterns correlate with certain clinical outcomes. PET studies found evidence for an embolic origin rather than for a low-flow status as most frequent cause of stroke in severe carotid artery disease. Except for deep borderzone infarcts in the centrum semi-ovale, most cortical borderzone infarcts are not due to chronic misery perfusion. Recent silent and recurrent infarcts can be demonstrated with Cobalt-55 PET, which is of importance for the therapeutical decision. The PET studies argue that carotid endarterectomy is successful probably by removing the source of emboli rather than by restoring the cerebral perfusion in severe carotid artery stenosis.

  12. Arterial gene transfer for therapeutic angiogenesis in patients with peripheral artery disease.

    PubMed

    Isner, J M; Walsh, K; Symes, J; Pieczek, A; Takeshita, S; Lowry, J; Rosenfield, K; Weir, L; Brogi, E; Jurayj, D

    1996-05-20

    The age-adjusted prevalence of peripheral arterial disease (PAD) in the U.S. population has been estimated to approach 12%. The clinical consequences of occlusive peripheral arterial disease (PAD) include pain on walking (claudication), pain at rest, and loss of tissue integrity in the distal limbs; the latter may ultimately lead to amputation of a portion of the lower extremity. Surgical bypass techniques and percutaneous catheter-based interventions may be used to successfully revascularize the limbs of certain patients with PAD. In many patients, however, the anatomic extent and distribution of arterial occlusion is too severe to permit relief of pain and/or healing of ischemic ulcers. No effective medical therapy is available for the treatment of such patients. The purpose of this clinical protocol is to document the safety of therapeutic angiogenesis achieved in this case by percutaneous catheter-based delivery of the gene encoding vascular endothelial growth factor (VEGF) in patients with PAD; and, as secondary objectives, investigate the bioactivity of this strategy to relieve rest pain and heal ischemic ulcers of the lower extremities. The rationale for this human protocol is based upon preclinical studies performed in a rabbit model of hindlimb ischemia. These studies are described in detail below and in the manuscripts enclosed in the Appendix to this proposal. In brief, a single intra-arterial bolus of VEGF recombinant human protein, delivered percutaneously to the ischemic limb via an intravascular catheter, resulted in angiographic, hemodynamic, physiologic, and histologic evidence of augmented collateral artery development. Subsequently, similar results were achieved using an angioplasty catheter with a hydrogel-coated balloon to deliver 400 micrograms of a plasmid containing the cDNA for VEGF to the internal iliac artery in the same animal model. Accordingly, we propose to administer arterial gene (VEGF) therapy to patients with rest pain and

  13. Association of Peripheral Arterial and Cardiovascular Diseases in Familial Hypercholesterolemia

    PubMed Central

    Pereira, Carolina; Miname, Marcio; Makdisse, Marcia; Kalil, Roberto; Santos, Raul D.

    2014-01-01

    Background Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c). Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD). Objective This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD), such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. Methods The diagnosis of PAD was established by ankle-brachial index (ABI) values ≤ 0.90. This study assessed 202 patients (35% of men) with heterozygous FH (90.6% with LDL receptor mutations), mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. Results The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049). Conclusion Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients. PMID:25029472

  14. Facial expression recognition in Alzheimer's disease: a longitudinal study.

    PubMed

    Torres, Bianca; Santos, Raquel Luiza; Sousa, Maria Fernanda Barroso de; Simões Neto, José Pedro; Nogueira, Marcela Moreira Lima; Belfort, Tatiana T; Dias, Rachel; Dourado, Marcia Cristina Nascimento

    2015-05-01

    Facial recognition is one of the most important aspects of social cognition. In this study, we investigate the patterns of change and the factors involved in the ability to recognize emotion in mild Alzheimer's disease (AD). Through a longitudinal design, we assessed 30 people with AD. We used an experimental task that includes matching expressions with picture stimuli, labelling emotions and emotionally recognizing a stimulus situation. We observed a significant difference in the situational recognition task (p ≤ 0.05) between baseline and the second evaluation. The linear regression showed that cognition is a predictor of emotion recognition impairment (p ≤ 0.05). The ability to perceive emotions from facial expressions was impaired, particularly when the emotions presented were relatively subtle. Cognition is recruited to comprehend emotional situations in cases of mild dementia.

  15. Coronary heart disease index based on longitudinal electrocardiography

    NASA Technical Reports Server (NTRS)

    Townsend, J. C.; Cronin, J. P.

    1977-01-01

    A coronary heart disease index was developed from longitudinal ECG (LCG) tracings to serve as a cardiac health measure in studies of working and, essentially, asymptomatic populations, such as pilots and executives. For a given subject, the index consisted of a composite score based on the presence of LCG aberrations and weighted values previously assigned to them. The index was validated by correlating it with the known presence or absence of CHD as determined by a complete physical examination, including treadmill, resting ECG, and risk factor information. The validating sample consisted of 111 subjects drawn by a stratified-random procedure from 5000 available case histories. The CHD index was found to be significantly more valid as a sole indicator of CHD than the LCG without the use of the index. The index consistently produced higher validity coefficients in identifying CHD than did treadmill testing, resting ECG, or risk factor analysis.

  16. Fluid Mechanics, Arterial Disease, and Gene Expression

    PubMed Central

    Tarbell, John M.; Shi, Zhong-Dong; Dunn, Jessilyn; Jo, Hanjoong

    2014-01-01

    This review places modern research developments in vascular mechanobiology in the context of hemodynamic phenomena in the cardiovascular system and the discrete localization of vascular disease. The modern origins of this field are traced, beginning in the 1960s when associations between flow characteristics, particularly blood flow–induced wall shear stress, and the localization of atherosclerotic plaques were uncovered, and continuing to fluid shear stress effects on the vascular lining endothelial) cells (ECs), including their effects on EC morphology, biochemical production, and gene expression. The earliest single-gene studies and genome-wide analyses are considered. The final section moves from the ECs lining the vessel wall to the smooth muscle cells and fibroblasts within the wall that are fluid me chanically activated by interstitial flow that imposes shear stresses on their surfaces comparable with those of flowing blood on EC surfaces. Interstitial flow stimulates biochemical production and gene expression, much like blood flow on ECs. PMID:25360054

  17. Fluid Mechanics, Arterial Disease, and Gene Expression.

    PubMed

    Tarbell, John M; Shi, Zhong-Dong; Dunn, Jessilyn; Jo, Hanjoong

    2014-01-01

    This review places modern research developments in vascular mechanobiology in the context of hemodynamic phenomena in the cardiovascular system and the discrete localization of vascular disease. The modern origins of this field are traced, beginning in the 1960s when associations between flow characteristics, particularly blood flow-induced wall shear stress, and the localization of atherosclerotic plaques were uncovered, and continuing to fluid shear stress effects on the vascular lining endothelial) cells (ECs), including their effects on EC morphology, biochemical production, and gene expression. The earliest single-gene studies and genome-wide analyses are considered. The final section moves from the ECs lining the vessel wall to the smooth muscle cells and fibroblasts within the wall that are fluid me chanically activated by interstitial flow that imposes shear stresses on their surfaces comparable with those of flowing blood on EC surfaces. Interstitial flow stimulates biochemical production and gene expression, much like blood flow on ECs.

  18. Longitudinal evaluation of economic and physical impact of Parkinson's disease.

    PubMed

    Schenkman, M; Wei Zhu, C; Cutson, T M; Whetten-Goldstein, K

    2001-09-01

    The cost of parkinsonism and Parkinson's disease (PD) is largely unknown although clinical experience suggests that the impact of this disease is substantial. Longitudinal data is presented for health status, disease symptoms, functional status, and financial costs for 70 participants with PD or parkinsonism. The sample was dichotomized into those rating their health as excellent, good, or very good ('good health') and those rating their health as fair or poor ('poor health'). The 'poor health' group were significantly more disabled at baseline. Symptoms increased between year 1 and 3 with greatest increases in fatigue, pain, and depression for the 'good health' group. At year 1, total direct cost/capita was about dollars 5000/year for both groups; indirect costs were dollars 5000 for the 'good health' group and dollars 15,000/year for the 'poor health' group. By year 3, total expenditures increased over 25% for the 'good health' group and nearly doubled for the 'poor health' group, while percent costs that were compensated declined for groups. Out of pocket, expenses were as high as dollars 3000/year for the 'poor health' group by year 3. Through analysis of the broad impact of PD, including non-neurological symptoms and economic ramifications, it is possible to better appreciate the impact of this chronic condition on overall quality of life.

  19. Stenting for Peripheral Artery Disease of the Lower Extremities

    PubMed Central

    2010-01-01

    Executive Summary Background Objective In January 2010, the Medical Advisory Secretariat received an application from University Health Network to provide an evidentiary platform on stenting as a treatment management for peripheral artery disease. The purpose of this health technology assessment is to examine the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities. Clinical Need: Condition and Target Population Peripheral artery disease (PAD) is a progressive disease occurring as a result of plaque accumulation (atherosclerosis) in the arterial system that carries blood to the extremities (arms and legs) as well as vital organs. The vessels that are most affected by PAD are the arteries of the lower extremities, the aorta, the visceral arterial branches, the carotid arteries and the arteries of the upper limbs. In the lower extremities, PAD affects three major arterial segments i) aortic-iliac, ii) femoro-popliteal (FP) and iii) infra-popliteal (primarily tibial) arteries. The disease is commonly classified clinically as asymptomatic claudication, rest pain and critical ischemia. Although the prevalence of PAD in Canada is not known, it is estimated that 800,000 Canadians have PAD. The 2007 Trans Atlantic Intersociety Consensus (TASC) II Working Group for the Management of Peripheral Disease estimated that the prevalence of PAD in Europe and North America to be 27 million, of whom 88,000 are hospitalizations involving lower extremities. A higher prevalence of PAD among elderly individuals has been reported to range from 12% to 29%. The National Health and Nutrition Examination Survey (NHANES) estimated that the prevalence of PAD is 14.5% among individuals 70 years of age and over. Modifiable and non-modifiable risk factors associated with PAD include advanced age, male gender, family history, smoking, diabetes, hypertension and hyperlipidemia. PAD is a strong predictor of myocardial infarction (MI

  20. Coronary Artery Disease - Multiple Languages: MedlinePlus

    MedlinePlus

    ... sharing features on this page, please enable JavaScript. Arabic (العربية) Bosnian (Bosanski) Chinese - Simplified (简体中文) Chinese - Traditional ( ... español) Tagalog (Tagalog) Ukrainian (Українська) Vietnamese (Tiếng Việt) Arabic (العربية) Coronary Artery Disease (CAD) (Arabic) (CAD) تصلب ...

  1. [Sulodexide in conservative treatment of peripheral arterial diseases].

    PubMed

    Kuznetsov, M R; Kosykh, I V; Yu, Tolstikhin V; Kuznetsova, V F; Magnitsky, I A

    2015-01-01

    Presented in the article is a review of the literature, analysing principles of conservative therapy of patients with obliterating diseases of lower limb arteries and most commonly used drugs to treat them, followed by discussing the mechanisms of action and efficacy of such pharmacological agents as pentoxyphyllin, cilostazol, naphthidrofuryl, aktovegin, sulodexide. Described in details are subtle mechanisms of action of sulodexide as an endothelioprotector, its clinical efficacy in intermittent claudication.

  2. Hypertriglyceridaemia and risk of coronary artery disease.

    PubMed

    Reiner, Željko

    2017-03-16

    An elevated serum level of LDL cholesterol is a well-known risk factor for cardiovascular disease (CVD), but the role of elevated triglyceride levels is debated. Controversies regarding hypertriglyceridaemia as an independent risk factor for CVD have occurred partly because elevated triglyceride levels are often a component of atherogenic dyslipidaemia - they are associated with decreased levels of HDL cholesterol and increased levels of small dense LDL particles, which are highly atherogenic. Findings from several large studies indicate that elevated levels of triglycerides (either fasting or nonfasting) or, more specifically, triglyceride-rich lipoproteins and their remnants, are independently associated with increased risk of CVD. Possible mechanisms for this association include excessive free fatty acid release, production of proinflammatory cytokines, coagulation factors, and impairment of fibrinolysis. Therapeutic targeting of hypertriglyceridaemia could, therefore, reduce CVD and cardiovascular events, beyond the reduction achieved by LDL-cholesterol lowering. Elevated triglyceride levels are reduced with lifestyle interventions and fibrates, which can be combined with omega-3 fatty acids. Some new drugs are on the horizon, such as volanesorsen (which targets apolipoprotein C-III), pemafibrate, and others. However, CVD outcome studies with triglyceride-lowering agents have produced inconsistent results, meaning that no convincing evidence is available that lowering triglycerides by any approach can reduce mortality.

  3. Coronary artery disease in patients with cerebrovascular disease: a prospective study

    SciTech Connect

    Rokey, R.; Rolak, L.A.; Harati, Y.; Kutka, N.; Verani, M.S.

    1984-07-01

    Coronary artery disease is the cause of death in most patients who have transient ischemic attacks or stroke. Evaluation for this condition is not routinely performed in such patients, and no prospective studies have been reported. We prospectively examined 50 consecutive patients with transient ischemic attacks or mild stroke to determine the prevalence and importance of coronary artery disease. All patients were examined by a cardiologist and underwent both exercise thallium-201 scintigraphy and exercise radionuclide ventriculography. Sixteen patients were suspected to have coronary artery disease on the basis of clinical evaluation. In 15 of these the was confirmed by the nuclear scans. The remaining 34 patients had no clinical evidence of heart disease, yet 14 had abnormal cardiac scans. Twenty of 22 patients with abnormal scans who underwent cardiac catheterization had significant coronary artery disease or a cardiomyopathy. The discovery of heart disease altered clinical management in 13 patients. Overall, 29 of 50 patients had significant coronary artery disease, compared with a 7% prevalence of the condition in other patients of similar age at the same institution.

  4. Longitudinal change in regional brain volumes in prodromal Huntington disease

    PubMed Central

    Aylward, Elizabeth H.; Nopoulos, Peggy C.; Ross, Christopher A.; Langbehn, Douglas R.; Pierson, Ronald K.; Mills, James A.; Johnson, Hans J.; Magnotta, Vincent A.; Juhl, Andrew R.; Paulsen, Jane S.

    2011-01-01

    Objective As therapeutics are being developed to target the underlying neuropathology of Huntington disease (HD), interest is increasing in methodologies for conducting clinical trials in the prodromal phase. This study was designed to examine the potential utility of structural MRI measures as outcome measures for such trials. Methods Data are presented from 211 prodromal individuals and 60 controls, scanned both at baseline and two-year follow-up. Prodromal participants were divided into groups based on proximity to estimated onset of diagnosable clinical disease: Far (>15 years from estimated onset); Mid (9–15 years); and Near (<9 years). Volumetric measurements of caudate, putamen, total striatum, globus pallidus, thalamus, total gray and white matter, and CSF were performed. Results All prodromal groups showed a faster rate of atrophy than Controls in striatum, total brain, and cerebral white matter (especially in the frontal lobe). Neither prodromal participants nor Controls showed significant longitudinal change in cortex (either total cortical gray or within individual lobes). When normal age-related atrophy (i.e., change observed in the Control group) was taken into account, there was more statistically significant disease-related atrophy in white matter than in striatum. Conclusion Measures of volume change in striatum and white matter volume, particularly in the frontal lobe, may serve as excellent outcome measures for future clinical trials in prodromal HD. Clinical trials using white matter or striatal volume change as an outcome measure will be most efficient if the sample is restricted to individuals who are within 15 years of estimated onset of diagnosable disease. PMID:20884680

  5. Surgical revascularization for premature coronary artery disease in second and third decade of life.

    PubMed

    Reddy, SriKrishna Modugula; Byrapaneni, Ramesh Babu; Rangappa, ChandraMohan; Gouni, Uday Kumar; Vakati, Chakravarthy; Suryavanshi, Satish; Kola, Prabhakar Reddy

    2017-01-01

    Coronary artery bypass grafting surgery may be needed in children and young adults for significant premature coronary artery occlusive disease. We report a case series of seven patients who underwent surgical revascularization in their second and third decade of life for significant multivessel coronary artery occlusive disease due to unusual causes.

  6. Imaging popliteal artery disease in young adults with claudication: self-assessment module.

    PubMed

    Chew, Felix S; Bui-Mansfield, Liem T

    2007-09-01

    The educational objectives of this self-assessment module on imaging popliteal artery disease in young adults with intermittent claudication are for the participant to exercise, self-assess, and improve his or her knowledge of the imaging and clinical features of popliteal artery entrapment syndrome, cystic adventitial disease,and masses associated with popliteal artery obstruction.

  7. Detection of coronary artery disease by analysis of ventricular filling

    SciTech Connect

    Miller, T.R.; Fountos, A.; Biello, D.R.; Ludbrook, P.A.

    1987-05-01

    Rapid left-ventricular (LV) diastolic filling assessed by radionuclide ventriculography is reevaluated in patients with coronary artery disease and normal LV systolic function considering the effects of age and heart rate. Thirty normal subjects were studied along with 44 patients with coronary artery disease and normal LV ejection fractions. The peak filling rate was not quite significantly different between the controls and patients (2.67 +/- 0.95 EDV/sec versus 2.25 +/- 0.65 EDV/sec, p = 0.08), and the time to peak filling rate was not different. When an inappropriate young control group was compared with coronary disease patients aged 40-65 yr, large differences in peak filling rate were seen. Sensitivity for detection of disease was very low (0%-9%) except when the inappropriate young control group was used. Thus, analysis of rapid diastolic filling cannot detect individual patients with coronary disease who have normal LV ejection fractions. Previous reports to the contrary may have suffered from failure to include the effects of age and heart rate.

  8. Exercise thallium-201 myocardial imaging in left main coronary artery disease: sensitive but not specific

    SciTech Connect

    Rehn, T.; Griffith, L.S.; Achuff, S.C.; Bailey, I.K.; Bulkley, B.H.; Burow, R.; Pitt, B.; Becker, L.C.

    1981-08-01

    To determine the usefulness of thallium-201 scintigraphy for identifying left main coronary artery disease, the results of scintigraphy at rest and during exercise were compared in 24 patients with 50 percent or greater narrowing of the left main coronary artery and 80 patients with 50 percent or greater narrowing of one or more of the major coronary arteries but without left main coronary involvement. By segmental analysis of the scintigrams, perfusion defects were assigned to the left anterior descending, left circumflex or right coronary artery, singly or in combination, and the pattern of simultaneous left anterior descending and circumflex arterial defects was used to identify left main coronary artery disease. Of the 24 patients with left main coronary artery disease, 22 (92 percent) had abnormal exercise scintigrams. Despite this high sensitivity, the pattern of perfusion defects was not specific; the ''left main pattern'' was found in 3 patients (13 percent) with left main coronary artery disease but also in 3 (33 percent) of 9 patients with combined left anterior descending and left circumflex arterial disease, 4 (19 percent) of 21 patients with three vessel disease and 3 (6 percent) of 50 patients with one or two vessel disease but excluding the group with left anterior descending plus left circumflex arterial disease. The pattern of perfusion defects in the patients with left main coronary artery disease was determined by the location and severity of narrowings in the coronary arteries downstream from the left main arterial lesion. Concomitant lesions in other arteries were found in all patients with left main coronary disease (one vessel in 1 patient, two vessels in 7 patients and three vessels in 16). For this reason, it is unlikely that even with improvements in radiopharmaceutical agents and imaging techniques, myocardial perfusion scintigraphy will be sufficiently specific for definitive identification of left main coronary artery disease.

  9. Relationship of Inflammatory Biomarkers with Severity of Peripheral Arterial Disease

    PubMed Central

    Toyofuku, Takahiro; Inoue, Yoshinori

    2016-01-01

    Objective. The pentraxin family, including high-sensitivity C-reactive protein (hs-CRP), serum amyloid P (SAP), and pentraxin 3 (PTX3), has been identified as playing a key role in inflammatory reactions such as in atherosclerosis and cardiovascular disease. In this study, we examined the relationship between peripheral arterial disease (PAD) and serum levels of pentraxins. Methods. This study was undertaken via a retrospective review of PAD patients with surgical intervention for lesions of the common femoral artery. We evaluated the preoperative patient conditions, hemodynamic status, such as ankle brachial index (ABI), and clinical ischemic conditions according to Rutherford classification. Preoperatively, we collected blood samples for determining the serum levels of hs-CRP, SAP, and PTX3. Results. Twelve PAD patients with common femoral arterial lesions were treated and examined. The hemodynamic severity of PAD was not negatively correlated with hs-CRP, SAP, or PTX3. The clinical severity evaluated by Rutherford classification was significantly positively correlated with the serum level of PTX3 (p = 0.019). Conclusion. We demonstrated that PTX3 might be a better marker of PAD than hs-CRP and SAP. Furthermore, PTX3 might be a prognostic marker to evaluate the severity of PAD. PMID:27559483

  10. Coronary artery calcification in chronic kidney disease: An update

    PubMed Central

    Stompór, Tomasz

    2014-01-01

    Arterial calcification is a well-recognized complication of advanced atherosclerosis. Chronic kidney disease (CKD) is characterized by significantly more pronounced, disseminated and fast-progressing calcification of the vascular system, including the coronary arteries. New computed tomography-based imaging techniques allow for the noninvasive assessment and monitoring of calcification in different vascular sites. Coronary artery calcification (CAC) develops early in the course of CKD and is tightly associated with mineral and bone disorders, which include but are not limited to secondary hyperparathyroidism. In this review, recent data on the pathogenesis of CAC development and progression are discussed, with a special emphasis on fibroblast growth factor 23 and its co-receptor, klotho. The prevalence, progression and prognostic significance of CAC are reviewed separately for patients with end-stage renal disease treated with dialysis, kidney transplant recipients and patients with earlier stages of CKD. In the last section, therapeutic considerations are discussed, with special attention paid to the importance of treatment that addresses mineral and bone disorders of CKD. PMID:24772252

  11. Transcatheter Arterial Infusion of Autologous CD133+ Cells for Diabetic Peripheral Artery Disease

    PubMed Central

    Zhang, Xiaoping; Lian, Weishuai; Lou, Wensheng; Han, Shilong; Lu, Chenhui; Zuo, Keqiang; Su, Haobo; Xu, Jichong; Cao, Chuanwu; Tang, Tao; Jia, Zhongzhi; Jin, Tao; Uzan, Georges; Gu, Jianping; Li, Maoquan

    2016-01-01

    Microvascular lesion in diabetic peripheral arterial disease (PAD) still cannot be resolved by current surgical and interventional technique. Endothelial cells have the therapeutic potential to cure microvascular lesion. To evaluate the efficacy and immune-regulatory impact of intra-arterial infusion of autologous CD133+ cells, we recruited 53 patients with diabetic PAD (27 of CD133+ group and 26 of control group). CD133+ cells enriched from patients' PB-MNCs were reinfused intra-arterially. The ulcer healing followed up till 18 months was 100% (3/3) in CD133+ group and 60% (3/5) in control group. The amputation rate was 0 (0/27) in CD133+ group and 11.54% (3/26) in control group. Compared with the control group, TcPO2 and ABI showed obvious improvement at 18 months and significant increasing VEGF and decreasing IL-6 level in the CD133+ group within 4 weeks. A reducing trend of proangiogenesis and anti-inflammatory regulation function at 4 weeks after the cells infusion was also found. These results indicated that autologous CD133+ cell treatment can effectively improve the perfusion of morbid limb and exert proangiogenesis and anti-inflammatory immune-regulatory impacts by paracrine on tissue microenvironment. The CD133+ progenitor cell therapy may be repeated at a fixed interval according to cell life span and immune-regulatory function. PMID:26981134

  12. Current options for treatment of chronic coronary artery disease

    PubMed Central

    Prapas, Sotirios N.; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Tsiouda, Theodora; Sakkas, Antonios; Zarogoulidis, Konstantinos

    2014-01-01

    The primary issues must be discussed regarding the decision making of treating a patient with chronic coronary artery disease (CAD), are the appropriateness of revascularization and the method which will be applied. The criteria will be the symptoms, the evidence of ischemia and the anatomical complexity of the coronary bed. Main indications are persistence of symptoms, despite oral medical treatment and the prognosis of any intervention. The prognosis is based on left ventricular function, on the number of coronary arteries with significant stenosis and the ischemic burden. For patients with symptoms and no evidence of ischemia, there is no benefit from revascularization. If ischemia is proven, revascularization is beneficial. If revascularization is decided, the next important issue must be taken under consideration is the choice of the appropriate method to be applied, surgical or interventional approach. Current treatment options will be presented. PMID:24672695

  13. Advances in Nanotechnology for the Management of Coronary Artery Disease

    PubMed Central

    Rhee, June-Wha; Wu, Joseph C.

    2013-01-01

    Nanotechnology holds tremendous potential to advance the current treatment of coronary artery disease. Nanotechnology may assist medical therapies by providing a safe and efficacious delivery platform for a variety of drugs aimed at modulating lipid disorders, decreasing inflammation and angiogenesis within atherosclerotic plaques, and preventing plaque thrombosis. Nanotechnology may improve coronary stent applications by promoting endothelial recovery on a stent surface utilizing bio-mimetic nanofibrous scaffolds, and also by preventing in-stent restenosis using nanoparticle-based delivery of drugs that are decoupled from stents. Additionally, nanotechnology may enhance tissue-engineered graft materials for application in coronary artery bypass grafting by facilitating cellular infiltration and remodeling of a graft matrix. PMID:23245913

  14. [Pulmonary arterial hypertension in adult patients with congenital heart disease].

    PubMed

    Serino, G; Giacomazzi, F

    2010-01-01

    Pulmonary Hypertension (PH) is definited by a mean pulmonary artery pressure (PAPm) >25 mmHg at rest. The Dana Point 2008 Revised Classification System represents the most recent classification system update with respect of various etiologies of PH. About 10 % of adolescents or adults with uncorrected congenital heart disease (CHD) with left-to-right shunt and high pulmonary blood flow develop Pulmonary Arterial Hypertension (PAH) . Progressive vascular remodeling and increase in pulmonary vascular resistance (PVR) may ultimately lead to reversal of the shunt (pulmonary to systemic) causing cyanosis and determining the so-called Eisenmenger Syndrome (ES). Recent advances in the early diagnosis and medical targeted treatment of adult patients with CHD-PAH and ES can improve PAP, PVR and exercise tolerance, together with NYHA Class and survival, and may potentially reverse the vascular remodeling process in selected patients.

  15. Association between arterial stiffness, cerebral small vessel disease and cognitive impairment: a systematic review and meta-analysis

    PubMed Central

    van Sloten, Thomas T; Protogerou, Athanase D; Henry, Ronald MA; Schram, Miranda T; Launer, Lenore J; Stehouwer, Coen DA

    2017-01-01

    Arterial stiffness may be a cause of cerebral small vessel disease and cognitive impairment. We therefore performed a systematic review and meta-analysis of studies on the association between stiffness, cerebral small vessel disease and cognitive impairment. For the associations between stiffness (i.e. carotid-femoral pulse wave velocity (cfPWV), brachial-ankle PWV (baPWV), carotid stiffness and pulse pressure) on the one hand and cerebral small vessel disease and cognitive impairment on the other, we identified 23 (n=15,666/22 cross-sectional/3 longitudinal) and 41 studies (n=57,671/30 cross-sectional/15 longitudinal), respectively. Pooled analyses of cross-sectional studies showed that greater stiffness was associated with markers of cerebral small vessel disease with odds ratios, per +1 SD, of 1.29 to 1.32 (P<.001). Studies on cognitive impairment could not be pooled due to large heterogeneity. Some (but not all) studies showed an association between greater stiffness and cognitive impairment, and the strength of this association was relatively weak. The present study supports the hypothesis that greater arterial stiffness is a contributor to microvascular brain disease. PMID:25827412

  16. Peripheral Arterial Disease Assessment Wall, Perfusion, and Spectroscopy

    PubMed Central

    Kramer, Christopher M.

    2010-01-01

    Introduction Peripheral arterial disease (PAD) is characterized by lower limb arterial obstruction due to atherosclerosis and is increasingly common. Presently used methods for diagnosis and follow-up as well as for assessment of novel therapies are limited. Materials and Methods Three distinct magnetic resonance examinations were developed. The first was high-resolution black-blood atherosclerotic plaque imaging of the superficial femoral artery using a surface coil and flow saturation. Second, first-pass contrast-enhanced dual-contrast perfusion imaging of the calf muscle was performed at peak exercise using a magnetic resonance (MR)–compatible pedal ergometer. Lastly, 31P MR spectroscopy was also performed at peak exercise to measure phosphocreatine (PCr) recovery kinetics. Results Seventeen patients (age, 63 ± 10 yrs) with mild to moderate PAD were studied with black-blood atherosclerotic plaque imaging. Mean atherosclerotic plaque volume measured was 7.27 ± 3.73 cm3. Eleven patients (age, 61 ± 11 yrs) with mild to moderate symptomatic PAD and 22 normal control subjects were studied with first-pass contrast-enhanced perfusion imaging. Perfusion index was stepwise increased from patients to normal subjects with matched workload to normal subjects at maximal exercise. For PCr recovery kinetics, 20 patients with mild to moderate PAD and 14 controls were studied. The median recovery time constant of PCr was 34.7 seconds in the controls and 91.0 seconds in the PAD patients (P < 0.0001). Conclusions Three distinct MR examinations of different aspects of peripheral arterial disease have been developed and tested and shown to differentiate patients with mild to moderate PAD from normal controls. Taken together, these tests are potential quantitative end points for clinical trials of novel therapies in PAD. PMID:18025990

  17. Relationship Between Brachial Artery Flow-Mediated Dilation, Carotid Artery Intima-Media Thickness and Coronary Flow Reserve in Patients With Coronary Artery Disease

    PubMed Central

    Oz, Fahrettin; Elitok, Ali; Bilge, Ahmet Kaya; Mercanoglu, Fehmi; Oflaz, Huseyin

    2012-01-01

    Background The aim of this study was to assess the relationship between brachial artery flow mediated dilation (FMD), carotid artery intima-media thickness (IMT) and coronary flow reserve (CFR) in patients with coronary artery disease (CAD). Methods Fifty patients with coronary artery disease, except left anterior descending artery (LAD), who showed no cardiac symptoms and 45 control subjects underwent assessment of brachial artery FMD, carotid artery intima-media thickness by high-resolution ultrasound. In addition, transthoracic second harmonic Doppler echocardiography was used to measure CFR. Results All of the parameters were found to be correlated with each other. CFR correlated with brachial artery FMD (r = 0.232, P < 0.05) and with carotid IMT (r = -0.403, P < 0.001). Carotid IMT correlated with brachial artery FMD (r = -0.211, P < 0.05). Conclusion Transthoracic CFR correlated with well-established noninvasive predictors of atherosclerosis and we suggest that it can be used as a surrogate for coronary atherosclerosis.

  18. Peripheral arterial disease and chronic heart failure: a dangerous mix.

    PubMed

    Inglis, Sally C; Hermis, Adriana; Shehab, Sajad; Newton, Phillip J; Lal, Sara; Davidson, Patricia M

    2013-07-01

    Chronic heart failure (CHF) is associated with a high comorbidity burden, adverse impact on quality of life and high health care utilisation. Peripheral arterial disease (PAD) and CHF share many risk, pathophysiological and prognostic features, and each has been associated with increased morbidity and mortality. PAD often goes undetected, and yet in spite of the availability of screening tools, this is not commonly considered in CHF care. A review of the electronic databases Medline, CINAHL and Cochrane CENTRAL was undertaken using the MeSH terms peripheral arterial disease, peripheral vascular disease, intermittent claudication and heart failure to identify studies examining the prevalence and clinical outcomes of coexisting PAD in patients with CHF. Five studies were identified. There are limited data describing the impact of PAD on CHF outcomes. As PAD may contribute to decreased capacity to exercise and other self-care behaviours, identifying those at risk and providing appropriate therapy are important. Based on this review, patients who are smokers and those with diagnosed coronary heart disease and diabetes should be targeted for the screening of PAD.

  19. Elasticity imaging of arterial wall with transcutaneous ultrasound both in longitudinal-axis and short-axis planes

    NASA Astrophysics Data System (ADS)

    Kanai, Hiroshi; Hasegawa, Hideyuki

    2001-05-01

    A method for measuring regional elasticity of tissue surrounding atherosclerotic plaque is described. An ultrasonic beam was scanned with a conventional linear-type probe, and multiple layers were preset from luminal surface to adventitia of the common carotid artery (CCA) with intervals of 375 μm. By applying the method [IEEE Trans. UFFC 46, 1229-1241 (1999)], a minute decrease of several tenths of a micrometer in thickness of each layer resulting from arrival of the pressure wave was determined. By assuming that the arterial wall is incompressible and that the blood pressure is applied normal to each layer, the elastic modulus in the circumferential direction of each layer was estimated at intervals of 75 μm in the radial direction and 150-300 μm in longitudinal direction. On the other hand, by designing the directions of ultrasonic beams so that each beam always passes through the center of the artery, the cross-sectional elasticity image in the short-axis plane was also obtained. Based on the elasticity library determined by comparing the elasticity distribution and their pathological images, each point was statistically categorized as lipid, a mixture of smooth muscle and collagen fiber, or other. By applying the method to the CCAs, soft inclusion of lipid was found for plaques.

  20. [Screening and management of coronary artery disease in diabetic patients].

    PubMed

    Kraiem, Sondos; Abassi, Chedly; Annabi, Nizar; Smaali, Ibtissem; Issaa, Inès; Wali, Mouin; Malou, Monia; Hannachi, Sofiane; Longo, Selma; Battikh, Kaies; Slimane, Mohamed Lotfi

    2006-10-01

    Diabetes represents as independent risk factor for coronary artery disease (CAD) and the prognosis in term of survival rates is worse for diabetic patients who have CAD with report to those with CAD but no diabetes. The coronary artery disease in diabetes has specificities and, in particular, more extensive atherosclerosis. Diabetic patients are also more frequently asymptomatic. Due to the extreme complexity of ischemic vascular disease in patients with diabetes, an optimal therapeutic strategy is based on the correction of elevated blood glucose and lipid levels, of blood pressure, of platelet and coagulation abnormalities. Diabetic patients benefit from secondary prevention by drug therapy(aspirin, lipid lowering with statines, beta blocker and ACE inhibitors) to the same extent as, or more than, non-diabetic patients. Both percutaneous and surgical myocardial revascularization have been proved equally effective for CAD treatment in diabetes. A recent randomized trial has shown a significantly improved outcome after surgical revascularization. But, the effects of drug-eluting stents, which dramatically decrease the incidence of re-stenosis, seem promising.

  1. Ear lobe crease: a marker of coronary artery disease?

    PubMed Central

    Agouridis, Aris P.; Elisaf, Moses S.; Nair, Devaki R.

    2015-01-01

    The ear lobe crease (ELC) has been defined as a deep wrinkle that extends backwards from the tragus to the auricle. It has been proposed that ELC is a predictor of coronary artery disease (CAD). In this review, we consider the possible association between ELC and CAD. Our aim is to systematically address all the relevant evidence in this field. There are many studies that support an association between ELC and CAD. However, other studies did not find such an association. A recent meta-analysis supports the hypothesis that ELC could be a marker of CAD. However, several limitations raise doubts as to whether we should accept this link. PMID:26788075

  2. Ticagrelor versus Clopidogrel in Symptomatic Peripheral Artery Disease.

    PubMed

    Hiatt, William R; Fowkes, F Gerry R; Heizer, Gretchen; Berger, Jeffrey S; Baumgartner, Iris; Held, Peter; Katona, Brian G; Mahaffey, Kenneth W; Norgren, Lars; Jones, W Schuyler; Blomster, Juuso; Millegård, Marcus; Reist, Craig; Patel, Manesh R

    2017-01-05

    Background Peripheral artery disease is considered to be a manifestation of systemic atherosclerosis with associated adverse cardiovascular and limb events. Data from previous trials have suggested that patients receiving clopidogrel monotherapy had a lower risk of cardiovascular events than those receiving aspirin. We wanted to compare clopidogrel with ticagrelor, a potent antiplatelet agent, in patients with peripheral artery disease. Methods In this double-blind, event-driven trial, we randomly assigned 13,885 patients with symptomatic peripheral artery disease to receive monotherapy with ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily). Patients were eligible if they had an ankle-brachial index (ABI) of 0.80 or less or had undergone previous revascularization of the lower limbs. The primary efficacy end point was a composite of adjudicated cardiovascular death, myocardial infarction, or ischemic stroke. The primary safety end point was major bleeding. The median follow-up was 30 months. Results The median age of the patients was 66 years, and 72% were men; 43% were enrolled on the basis of the ABI and 57% on the basis of previous revascularization. The mean baseline ABI in all patients was 0.71, 76.6% of the patients had claudication, and 4.6% had critical limb ischemia. The primary efficacy end point occurred in 751 of 6930 patients (10.8%) receiving ticagrelor and in 740 of 6955 (10.6%) receiving clopidogrel (hazard ratio, 1.02; 95% confidence interval [CI], 0.92 to 1.13; P=0.65). In each group, acute limb ischemia occurred in 1.7% of the patients (hazard ratio, 1.03; 95% CI, 0.79 to 1.33; P=0.85) and major bleeding in 1.6% (hazard ratio, 1.10; 95% CI, 0.84 to 1.43; P=0.49). Conclusions In patients with symptomatic peripheral artery disease, ticagrelor was not shown to be superior to clopidogrel for the reduction of cardiovascular events. Major bleeding occurred at similar rates among the patients in the two trial groups. (Funded by Astra

  3. Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry

    PubMed Central

    Fauchier, Laurent; Greenlaw, Nicola; Ferrari, Roberto; Ford, Ian; Fox, Kim M.; Tardif, Jean-Claude; Tendera, Michal; Steg, Ph. Gabriel

    2015-01-01

    Background Few data are available regarding the use of antithrombotic strategies in coronary artery disease patients with atrial fibrillation (AF) in everyday practice. We sought to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease. Methods and Findings CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary artery disease, defined as prior (≥12 months) myocardial infarction, revascularization procedure, coronary stenosis >50%, or chest pain associated with evidence of myocardial ischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available for analysis at baseline; of these 2,229 (6.7%) had a history of AF. Median (interquartile range) CHA2DS2-VASc score was 4 (3, 5). Oral anticoagulation alone was used in 25.7%, antiplatelet therapy alone in 52.8% (single 41.8%, dual 11.0%), and both in 21.5%. OAC use was independently associated with permanent AF (p<0.001), CHA2DS2-VASc score (p=0.006), pacemaker (p<0.001), stroke (p=0.04), absence of angina (p=0.004), decreased left ventricular ejection fraction (p<0.001), increased waist circumference (p=0.005), and longer history of coronary artery disease (p=0.008). History of percutaneous coronary intervention (p=0.004) and no/partial reimbursement for cardiovascular medication (p=0.01, p<0.001, respectively) were associated with reduced oral anticoagulant use. Conclusions In this contemporary cohort of patients with stable coronary artery disease and AF, most of whom are theoretical candidates for anticoagulation, oral anticoagulants were used in only 47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received both antiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelines in these patients. Trial Registration ISRCTN registry of clinical trials: ISRCTN43070564. PMID:25915904

  4. Arterial spin labelling reveals prolonged arterial arrival time in idiopathic Parkinson's disease

    PubMed Central

    Al-Bachari, Sarah; Parkes, Laura M.; Vidyasagar, Rishma; Hanby, Martha F.; Tharaken, Vivek; Leroi, Iracema; Emsley, Hedley C.A.

    2014-01-01

    Idiopathic Parkinson's disease (IPD) is the second most common neurodegenerative disease, yet effective disease modifying treatments are still lacking. Neurodegeneration involves multiple interacting pathological pathways. The extent to which neurovascular mechanisms are involved is not well defined in IPD. We aimed to determine whether novel magnetic resonance imaging (MRI) techniques, including arterial spin labelling (ASL) quantification of cerebral perfusion, can reveal altered neurovascular status (NVS) in IPD. Fourteen participants with IPD (mean ± SD age 65.1 ± 5.9 years) and 14 age and cardiovascular risk factor matched control participants (mean ± SD age 64.6 ± 4.2 years) underwent a 3T MRI scan protocol. ASL images were collected before, during and after a 6 minute hypercapnic challenge. FLAIR images were used to determine white matter lesion score. Quantitative images of cerebral blood flow (CBF) and arterial arrival time (AAT) were calculated from the ASL data both at rest and during hypercapnia. Cerebrovascular reactivity (CVR) images were calculated, depicting the change in CBF and AAT relative to the change in end-tidal CO2. A significant (p = 0.005) increase in whole brain averaged baseline AAT was observed in IPD participants (mean ± SD age 1532 ± 138 ms) compared to controls (mean ± SD age 1335 ± 165 ms). Voxel-wise analysis revealed this to be widespread across the brain. However, there were no statistically significant differences in white matter lesion score, CBF, or CVR between patients and controls. Regional CBF, but not AAT, in the IPD group was found to correlate positively with Montreal cognitive assessment (MoCA) scores. These findings provide further evidence of alterations in NVS in IPD. PMID:25379411

  5. Comparison of Cardiovascular Risk Factors for Peripheral Artery Disease and Coronary Artery Disease in the Korean Population

    PubMed Central

    Jang, Shin Yi; Ju, Eun Young; Cho, Sung-Il; Lee, Seung Wook

    2013-01-01

    Background and Objectives The objective of this study was to analyze and compare risk factors for peripheral artery disease (PAD) and coronary artery disease (CAD). Subjects and Methods The sample included 7936 Korean patients aged ≥20 years who were hospitalized from 1994 to 2004. Of the 7936 subjects, PAD (n=415), CAD (n=3686), and normal controls (Control) (n=3835) were examined at the Health Promotion Center, Samsung Medical Center. Results The mean age (years) of PAD subjects was 64.4 (±9.3), while CAD subjects was 61.2 (±9.9), and Control subjects was 59.9 (±9.1) (p<0.01). The proportion of males was 90.6% for PAD, 71.4% for CAD, and 75.5% for Control subjects (p<0.01). The adjusted odds ratios (ORs) for hypertension, diabetes mellitus, hypercholesterolemia, smoking, metabolic syndrome and chronic kidney disease were significantly higher in subjects with PAD or CAD compared to those in Control. However, the ORs for high density lipoprotein, being overweight, and being obese were significantly lower in PAD subjects compared to those in Control. Conclusion We found that cardiovascular risk factors were in fact risk factors for both PAD and CAD. PMID:23755078

  6. Molecular Mechanisms and Treatment Strategies for Obesity-Associated Coronary Artery Disease, an Imminent Military Epidemic

    DTIC Science & Technology

    2007-12-01

    syndrome and type 2 diabetes. The major cause of death in people with insulin resistance syndromes is atherothrombotic vascular disease , including...Strategies for Obesity-Associated Coronary Artery Disease , an Imminent Military Epidemic PRINCIPAL INVESTIGATOR: Ira Tabas, M.D., Ph.D...CONTRACT NUMBER Molecular Mechanisms and Treatment Strategies for Obesity-Associated Coronary Artery Disease , an Imminent Military Epidemic 5b

  7. Nanotechnology in diagnosis and treatment of coronary artery disease

    PubMed Central

    Karimi, Mahdi; Zare, Hossein; Bakhshian Nik, Amirala; Yazdani, Narges; Hamrang, Mohammad; Mohamed, Elmira; Sahandi Zangabad, Parham; Moosavi Basri, Seyed Masoud; Bakhtiari, Leila; Hamblin, Michael R

    2016-01-01

    Nanotechnology could provide a new complementary approach to treat coronary artery disease (CAD) which is now one of the biggest killers in the Western world. The course of events, which leads to atherosclerosis and CAD, involves many biological factors and cellular disease processes which may be mitigated by therapeutic methods enhanced by nanotechnology. Nanoparticles can provide a variety of delivery systems for cargoes such as drugs and genes that can address many problems within the arteries. In order to improve the performance of current stents, nanotechnology provides different nanomaterial coatings, in addition to controlled-release nanocarriers, to prevent in-stent restenosis. Nanotechnology can increase the efficiency of drugs, improve local and systematic delivery to atherosclerotic plaques and reduce the inflammatory or angiogenic response after intravascular intervention. Nanocarriers have potential for delivery of imaging and diagnostic agents to precisely targeted destinations. This review paper will cover the current applications and future outlook of nanotechnology, as well as the main diagnostic methods, in the treatment of CAD. PMID:26906471

  8. Nanotechnology in diagnosis and treatment of coronary artery disease.

    PubMed

    Karimi, Mahdi; Zare, Hossein; Bakhshian Nik, Amirala; Yazdani, Narges; Hamrang, Mohammad; Mohamed, Elmira; Sahandi Zangabad, Parham; Moosavi Basri, Seyed Masoud; Bakhtiari, Leila; Hamblin, Michael R

    2016-01-01

    Nanotechnology could provide a new complementary approach to treat coronary artery disease (CAD) which is now one of the biggest killers in the Western world. The course of events, which leads to atherosclerosis and CAD, involves many biological factors and cellular disease processes which may be mitigated by therapeutic methods enhanced by nanotechnology. Nanoparticles can provide a variety of delivery systems for cargoes such as drugs and genes that can address many problems within the arteries. In order to improve the performance of current stents, nanotechnology provides different nanomaterial coatings, in addition to controlled-release nanocarriers, to prevent in-stent restenosis. Nanotechnology can increase the efficiency of drugs, improve local and systematic delivery to atherosclerotic plaques and reduce the inflammatory or angiogenic response after intravascular intervention. Nanocarriers have potential for delivery of imaging and diagnostic agents to precisely targeted destinations. This review paper will cover the current applications and future outlook of nanotechnology, as well as the main diagnostic methods, in the treatment of CAD.

  9. Lack of MEF2A mutations in coronary artery disease

    SciTech Connect

    Weng, Li; Kavaslar, Nihan; Ustaszewska, Anna; Doelle, Heather; Schackwitz, Wendy; Hebert, Sybil; Cohen, Jonathan; McPherson, Ruth; Pennacchio, Len A.

    2004-12-01

    Mutations in MEF2A have been implicated in an autosomal dominant form of coronary artery disease (adCAD1). In this study we sought to determine whether severe mutations in MEF2A might also explain sporadic cases of coronary artery disease (CAD). To do this, we resequenced the coding sequence and splice sites of MEF2A in {approx}300 patients with premature CAD and failed to find causative mutations in the CAD cohort. However, we did identify the 21 base pair (bp) MEF2A coding sequence deletion originally implicated in adCAD1 in one of 300 elderly control subjects without CAD. Further screening of an additional {approx}1,500 non-CAD patients revealed two more subjects with the MEF2A 21 bp deletion. Genotyping of 19 family members of the three probands with the 21 bp deletion in MEF2A revealed that the mutation did not co-segregate with early CAD. These studies demonstrate that MEF2A mutations are not a common cause of CAD and cast serious doubt on the role of the MEF2A 21 bp deletion in adCAD1.

  10. The exercise pressor reflex and peripheral artery disease.

    PubMed

    Stone, Audrey J; Kaufman, Marc P

    2015-03-01

    The exercise pressor reflex contributes to increases in cardiovascular and ventilatory function during exercise. These reflexive increases are caused by both mechanical stimulation and metabolic stimulation of group III and IV afferents with endings in contracting skeletal muscle. Patients with peripheral artery disease (PAD) have an augmented exercise pressor reflex. Recently, an animal model of PAD was established which allows further investigation of possible mechanisms involved in this augmented reflex. Earlier studies have identified ASIC3 channels, bradykinin receptors, P2X receptors, endoperoxide receptors, and thromboxane receptors as playing a role in evoking the exercise pressor reflex in healthy rats. This review focuses on recent studies using a rat model of PAD in order to determine possible mechanisms contributing to the exaggerated exercise pressor reflex seen in patients with this disease.

  11. Tissue Doppler Imaging in Coronary Artery Diseases and Heart Failure

    PubMed Central

    Correale, Michele; Totaro, Antonio; Ieva, Riccardo; Ferraretti, Armando; Musaico, Francesco; Biase, Matteo Di

    2012-01-01

    Recent studies have explored the prognostic role of TDI-derived parameters in major cardiac diseases, such as coronary artery disease (CAD) and heart failure (HF). In these conditions, myocardial mitral annular systolic (S’) and early diastolic (E’) velocities have been shown to predict mortality or cardiovascular events. In heart failure non invasive assessment of LV diastolic pressure by transmitral to mitral annular early diastolic velocity ratio (E/E’) is a strong prognosticator, especially when E/E’ is > or =15. Moreover, other parameters derived by TDI, as cardiac time intervals and Myocardial Performance Index, might play a role in the prognostic stratification in CAD and HF. Recently, a three-dimensional (3-D) TDI imaging modality, triplane TDI, has become available, and this allows calculation of 3-Dvolumes and LV ejection fraction. We present a brief update of TDI. PMID:22845815

  12. Multisite artery disease: a common and challenging clinical condition calling for specific management.

    PubMed

    Di Noi, Paola; Brancati, Marta Francesca; Burzotta, Francesco; Trani, Carlo

    2014-05-01

    'Multisite' artery disease is defined as the simultaneous presence of clinically significant atherosclerotic lesions in at least two major vascular territories. The management of patients with multisite artery disease represents a common challenge in clinical practice, since they are at increased risk for both vascular and coronary surgery. Preliminary experiences suggest that percutaneous treatment may represent a promising strategy for patients with multisite artery disease. In this review, the prevalence and management of multisite artery disease are discussed with particular attention to coronary and peripheral revascularization related issues.

  13. Huge Left Atrial Myxoma and Concomitant Silent Coronary Artery Disease in a Young Man

    PubMed Central

    Gennari, Marco; Rubino, Mara; Andreini, Daniele; Polvani, Gianluca; Agrifoglio, Marco

    2016-01-01

    Severe but silent coronary artery disease may rarely exist in young patients with a low-risk profile but with a family history of coronary artery disease. We describe the case of a 33-year-old Caucasian male with progressive shortness of breath caused by a huge left atrial myxoma who was diagnosed to have significant coronary artery disease in the preoperative assessment. After investigations, the patient underwent resection of the left atrial tumor and coronary artery bypass grafting (CABG) with a successful outcome. Even in the case of a young male, it may be prudent to investigate silent coronary artery disease in the presence of cardiovascular risk factors and family history of coronary artery disease. The learning objective of this case is to debate about the usefulness of a preoperative coronary study even in the young population with cardiac nonischemic pathologies (ie, valve pathology, cardiac tumors, etc.). PMID:28096692

  14. Clinical signs of androgen excess as risk factors for coronary artery disease.

    PubMed

    Wild, R A; Grubb, B; Hartz, A; Van Nort, J J; Bachman, W; Bartholomew, M

    1990-08-01

    Women with androgen excess have been found to have higher triglycerides and lower high-density lipoprotein cholesterol concentrations than nonhirsute women and are presumed to be at increased risk of coronary artery disease. However, definitive data linking androgen excess with coronary artery disease is lacking. We evaluated 102 women coming to coronary artery catheterization for signs and symptoms of androgen excess. Hirsutism was found more commonly in those women with confirmed coronary artery disease (chi 2 = 10.11). Waist:hip ratio (an index of android fat distribution) was associated with hirsutism (by ANOVA, F-test) and with coronary artery disease (t-test). The strongest associations were found in older women (aged greater than or equal to 60). Androgen excess in women may signal risk for coronary artery disease.

  15. Electrical and mechanical activity of the longitudinal muscle of the anterior mesenteric artery of the domestic fowl

    PubMed Central

    Bolton, T. B.

    1968-01-01

    1. The electrical activity and changes in tension of the longitudinal muscle of the anterior mesenteric artery (LMAMA) of the domestic fowl were recorded simultaneously using the sucrose-gap method. 2. Spontaneous activity consisted of recurring contractions each accompanied by a burst of action potentials. 3. In quiescent preparations, brief electrical stimuli, acetylcholine, or barium chloride produced contractions with the appearance of action potentials. Larger concentrations of barium chloride or acetylcholine produced depolarization and action potentials ceased although contraction was maintained. Whenever depolarization without action potentials occurred, it was associated with a smooth contraction, whereas action potentials were always accompanied by small rapid contractions super-imposed upon the main contraction. 4. When the tone was raised with barium chloride (and in the presence of hyoscine) continuous action potentials occurred; under these circumstances brief electrical stimuli or noradrenaline produced relaxation, cessation of action potentials, and hyperpolarization. PMID:5652877

  16. Treating patients with peripheral arterial disease and claudication.

    PubMed

    Treat-Jacobson, Diane; Walsh, M Eileen

    2003-03-01

    The vascular nurse plays an important role in the treatment of patients with peripheral arterial disease (PAD), a prevalent atherosclerotic occlusive disease that affects approximately 8 to 12 million people in the United States. Approximately 4 to 5 million individuals with PAD experience claudication, the exercise-induced ischemic pain in the lower extremities that is relieved upon rest. Both PAD and claudication are associated with increased morbidity and mortality, limitations in functional capacity, and a decreased quality of life. Despite its prevalence, PAD is often undiagnosed and, therefore, increases the risk for cardiovascular ischemic events, disease progression, functional disability, amputation, and death. Risk factors for PAD and claudication are similar to those for other atherosclerotic diseases, including age, cigarette smoking, diabetes mellitus, hypertension, dyslipidemia, and hyperhomocysteinemia. Effective treatment to normalize these risk factors can reduce disease progression and the incidence of cardiovascular ischemic events. Claudication symptoms can be improved most effectively through exercise training, which may be used in conjunction with medications specifically indicated to improve these symptoms. Vascular nurses, practicing in a multitude of inpatient and outpatient settings, can assist patients with risk-factor modifications and behavioral changes to help them stop smoking, maintain glycemic control, normalize high blood pressure and lipid levels, and ensure initiation of lifelong antiplatelet therapy and participation in exercise rehabilitation programs, thus, promoting positive outcomes for patients with claudication.

  17. Illness perception patterns in patients with Coronary Artery Disease.

    PubMed

    Kunschitz, E; Friedrich, O; Schöppl, Ch; Maitz, J; Sipötz, J

    2016-12-23

    The purpose of this study is to identify patterns of illness perception in patients with angiografically verified Coronary Artery Disease. A total of 166 patients (age: 64.4 ± 12.1, 80.7% male) were recruited after angiography. Cluster analysis on the items of the Brief Illness Perception Questionnaire was used to identify patterns of illness perception. The resulting groups were characterized with regard to Quality of Life (MacNew), anxiety and depression (GAD-7 and PHQ-9) and resilience (RS-13). The analysis revealed 4 distinct groups differing with regard to the items covering the perception of the physical and emotional impact of disease. Stronger perceptions in these domains were associated with lower Health Related Quality of Life and higher levels of emotional distress. Group 1 (33.1%) reported the strongest perceptions of the physical and emotional impact of disease and expressed low treatment control, high chronic timeline and significantly higher levels of depression than the other groups. Group 2 (27.7%) was characterized by more moderate perceptions of the emotional and physical impact of disease together with low scores on illness coherence and chronic timeline. Groups 3 (25.3%) and 4 (13.9%) reported smaller physical and emotional impact of illness but differed in chronic timeline. Our results correspond largely to recent findings in patients with other chronic diseases. Further research is needed to explore if stratification of patients according patterns of illness perception can help to inform patient-physician communication strategies.

  18. Radiologic evaluation of coronary artery disease in adults with congenital heart disease.

    PubMed

    Valenzuela, David M; Ordovas, Karen G

    2016-01-01

    Improved surgical and medical therapy have prolonged survival in patients with congenital heart disease (CHD) such that general medical conditions like coronary artery disease (CAD) are now the main determinants of mortality. A summary of the association of CAD with CHD, as well as a discussion of the radiologic evaluation of the coronary arteries in adults with CHD is described herein. Cross sectional imaging to evaluate CAD in adults with CHD should follow the same appropriateness criteria as gender and aged matched patients without CHD. Coronary CT imaging may be particularly valuable in evaluating the coronary arteries in this patient population as invasive coronary angiography may prove challenging secondary to complicated or unconventional anatomy of the coronary arteries. Further, typical methods for evaluating CAD such as stress or echocardiography may be impractical in adults with CHD. Finally, delineating the anatomic relationship of the coronary arteries and their relationship with the sternum, chest wall, conduits, grafts, and valves is highly recommended in patients with CHD prior to reintervention to avoid iatrogenic complications.

  19. Association of Vitamin D Deficiency with Coronary Artery Disease

    PubMed Central

    Sharma, Yash Paul; Bhadada, Sanjay Kumar; Sachdeva, Naresh; Sahu, Kamal Kant

    2016-01-01

    Introduction Coronary Artery Disease (CAD) is a major global health problem. Recent studies demonstrated that lower vitamin D level (<30ng/ml) is associated with higher blood pressure and directly or indirectly with CAD, due to vascular endothelial damage. However the results are inconsistent. Aim To find the association of vitamin D deficiency with CAD Materials and Methods In this cross-sectional observational study, serum vitamin D level was measured in 315 patients who underwent coronary angiography. Result The mean (±SD) vitamin D was 13.40ng/ml (±10.40). However, the patients with normal coronary artery had much lower mean vitamin D (11.30ng/ml±9.50) as compared to the patients with CAD (14.10ng/ml±10.70). The mean (±SD) vitamin D levels were 19.00ng/ml (±16.50), 14.10ng/ml (±11.10) and 13.20ng/ml (±8.80) in patients with CAD with 50%-70%, >70%-90% and >90% stenosis respectively (p= 0.46) and 15.20ng/ml (±13.00), 15.50ng/ml (±11.30) and 11.80ng/ml (±7.00) in patients with CAD with single, double and triple vessels disease respectively (p= 0.14). The frequency of vitamin D deficiency were 66.70%, 83.20 % and 83.10% in patients with CAD with 50% -70%, >70%-90% and >90% stenosis respectively and 81.40%, 80.00% and 83.50% in patients with single, double and triple vessel disease respectively, as compared to 89.30% in patients with normal coronary artery (p= 0.41 and 0.075). So, all the study groups of CAD had low serum vitamin D level and high frequency of vitamin D deficiency, which was statistically insignificant. Conclusion Prevalence of vitamin D deficiency is very high in CAD, but it does not correlate with the angiographic severity of CAD. PMID:27790488

  20. Budd-chiari syndrome and renal arterial neurysms due to Behcet disease: a rare association.

    PubMed

    Batur, Abdussamet; Dorum, Meltem; Yüksekkaya, Hasan Ali; Koc, Osman

    2015-01-01

    Behcet's disease is a multisystemic vasculitis of unknown etiology with a chronic relapsing course. Vasculitis in Behcet's disease with predominant vascular involvement is the only vasculitis that affects both arteries and veins of any size. Involvement of the renal artery and inferior vena cava is rare among the arteries and veins, respectively. When disease affect the veins, it is in the form of thrombosis. Arterial complications include aneurysms, stenosis and occlusions. Both rupture of arterial aneurysm and occlusion of suprahepatic veins, causing Budd-Chiari syndrome, are associated with a high mortality rate. Vascular involvement is more common in male patients than in female patients. Men and patients with a younger age of onset present with a more severe prognosis. In this case report, we describe a very rare cause of intrarenal arterial aneurysm's rupture with previous Budd-Chiari syndrome due to Behcet's disease and successful angiographic embolization of actively bleeding aneurysm.

  1. Role of digital artery adrenoceptors in Raynaud's disease.

    PubMed

    Cooke, J P; Creager, S J; Scales, K M; Ren, C; Tsapatsaris, N P; Beetham, W P; Creager, M A

    1997-01-01

    Raynaud's disease is characterized by excessive cutaneous vasoconstriction in response to ambient cold. A functional disturbance in the local regulation of digital vasomotion has been proposed. The purpose of this study was to determine whether there is an alteration in the postjunctional adrenergic receptors in the digital circulation of patients with Raynaud's disease. Furthermore, we sought to determine whether this abnormality was responsible for the excessive cold-induced vasoconstriction in these patients. Finger blood flow was measured by strain-gauge venous occlusion plethysmography in 10 patients with Raynaud's disease and in 10 normal volunteers in a 22 degrees C room. Measurements of finger blood flow and mean systemic arterial pressure were made during intra-arterial infusions of the alpha 1-adrenergic antagonist, prazosin, or the alpha 2-adrenergic antagonist, yohimbine, at room temperature and during local cooling of the hand. Basal finger blood flow in normal subjects was significantly greater than that of patients (8.6 +/- 2.7 vs 1.7 +/- 0.5 ml/100 ml per min; normal vs Raynaud's subjects; p < 0.05). In normal subjects, either prazosin or yohimbine induced dose-dependent increases in finger blood flow. The maximal increase in finger blood flow induced by prazosin was significantly greater than that in response to yohimbine (29.2 +/- 10.1 vs 2.8 +/- 2.1 ml/100 ml per min; prazosin vs yohimbine; p < 0.05). By contrast, in the Raynaud's patients, prazosin or yohimbine induced maximal increases in finger blood flow that were not significant (7.1 +/- 1.8 vs 5.0 +/- 2.2 ml/100 ml per min; prazosin vs yohimbine; p = NS). The response to prazosin in Raynaud's patients was significantly less than that of the normal volunteers (p < 0.05). In normal subjects, during intra-arterial infusion of vehicle alone, cooling induced a 52.6 +/- 5.8% reduction in finger blood flow. This cold-induced vasoconstriction was blunted, but not qualitatively altered, by either

  2. Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease

    PubMed Central

    Rontoyanni, Victoria G.; Nunez Lopez, Omar; Fankhauser, Grant T.; Cheema, Zulfiqar F.; Rasmussen, Blake B.; Porter, Craig

    2017-01-01

    Peripheral artery disease (PAD) is a serious but relatively underdiagnosed and undertreated clinical condition associated with a marked reduction in functional capacity and a heightened risk of morbidity and mortality. The pathophysiology of lower extremity PAD is complex, and extends beyond the atherosclerotic arterial occlusion and subsequent mismatch between oxygen demand and delivery to skeletal muscle mitochondria. In this review, we evaluate and summarize the available evidence implicating mitochondria in the metabolic myopathy that accompanies PAD. Following a short discussion of the available in vivo and in vitro methodologies to quantitate indices of muscle mitochondrial function, we review the current evidence implicating skeletal muscle mitochondrial dysfunction in the pathophysiology of PAD myopathy, while attempting to highlight questions that remain unanswered. Given the rising prevalence of PAD, the detriment in quality of life for patients, and the associated significant healthcare resource utilization, new alternate therapies that ameliorate lower limb symptoms and the functional impairment associated with PAD are needed. A clear understanding of the role of mitochondria in the pathophysiology of PAD may contribute to the development of novel therapeutic interventions. PMID:28348531

  3. Association factor analysis between osteoporosis with cerebral artery disease: The STROBE study.

    PubMed

    Jin, Eun-Sun; Jeong, Je Hoon; Lee, Bora; Im, Soo Bin

    2017-03-01

    The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified cerebral artery

  4. The effects of direct renin inhibitor, aliskiren, on arterial hypertension, chronic kidney disease and cardiovascular disease: optimal pharmacotherapy.

    PubMed

    Morishita, Yoshiyuki; Kusano, Eiji

    2013-03-01

    The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of progression of arterial hypertension, chronic kidney disease (CKD) and cardiovascular disease (CVD). Previous studies suggested that a direct renin inhibitor, aliskiren, may be effective for blood pressure lowering, renoprotection and cardiovascular protection. This review focuses on the effects of aliskiren for arterial hypertension, CKD and CVD.

  5. Endovascular treatment strategies for supra-aortic arterial occlusive disease.

    PubMed

    Peeters, P; Verbist, J; Deloose, K; Bosiers, M

    2005-06-01

    Because of the focal nature of stenoses or occlusions in the supra-aortic vasculature, the high blood-pressures in this area and the very low morbidity rates related to percutaneous therapy have largely replaced surgical revascularization as the initial treatment of choice for patients with supra-aortic arterial occlusive disease. The initial technical success and durability of percutaneous angioplasty (PTA) and stenting in these lesions is excellent. Nevertheless several factors can make PTA and stenting a complex procedure that requires advanced endovascular skills for a successful outcome. Profound knowledge of surgical reconstruction techniques or extra-anatomic bypasses remains mandatory, as it is occasionally required for failure of endovascular techniques or if contraindications exist.

  6. Conditions Presenting with Symptoms of Peripheral Arterial Disease

    PubMed Central

    Sharma, Aditya M.; Norton, Patrick T.; Zhu, Daisy

    2014-01-01

    Peripheral artery disease (PAD) is estimated to affect more than 20% of people older than 65 years. The vast majority of patients with symptoms suggestive of PAD have atherosclerosis often associated with conventional vascular risk factors such as smoking, diabetes, dyslipidemia, and inflammation. A minority of people presenting with symptoms suggesting PAD have an alternative etiology. These groups of disorders are often underdiagnosed, and if diagnosed correctly the diagnosis may be delayed. Understanding these pathologies well is important, as they can be very debilitating and optimal treatment may vary significantly. Inappropriate treatment of these disorders can lead to worsening morbidity and mortality. This article discusses the underlying causes of nonatherosclerotic PAD, including the diagnosis and treatment of these disorders. PMID:25435652

  7. Bilirubin in coronary artery disease: Cytotoxic or protective?

    PubMed Central

    Gupta, Nancy; Singh, Tavankit; Chaudhary, Rahul; Garg, Sushil K; Sandhu, Gurprataap Singh; Mittal, Varun; Gupta, Rahul; Bodin, Roxana; Sule, Sachin

    2016-01-01

    Bilirubin has traditionally been considered a cytotoxic waste product. However, recent studies have shown bilirubin to have anti-oxidant, anti-inflammatory, vasodilatory, anti-apoptotic and anti-proliferative functions. These properties potentially confer bilirubin a new role of protection especially in coronary artery disease (CAD), which is a low grade inflammatory process exacerbated by oxidative stress. In fact, recent literature reports an inverse relationship between serum concentration of bilirubin and the presence of CAD. In this article, we review the current literature exploring the association between levels of bilirubin and risk of CAD. We conclude that current evidence is inconclusive regarding the protective effect of bilirubin on CAD. A causal relationship between low serum bilirubin level and increased risk of CAD is not currently established. PMID:27867680

  8. DIETARY INTAKE OF SUBJECTS WITH PERIPHERAL ARTERY DISEASE AND CLAUDICATION

    PubMed Central

    Gardner, Andrew W.; Bright, Brianna C.; Ort, Kelly A.; Montgomery, Polly S.

    2013-01-01

    We compared the dietary intakes of subjects with peripheral artery disease (PAD) and claudication with diet recommendations of the National Cholesterol Education Program (NCEP) and dietary reference intake values recommended by the Institute of Medicine (IOM) of the National Academy of Sciences. Forty-six subjects consumed a mean macronutrient composition of 17% protein, 51% carbohydrate, and 30% fat. Compared to the NCEP and IOM recommendations, few subjects met the recommended daily intakes for sodium (0%), vitamin E (0%), folate (13%), saturated fat (20%), fiber (26%), and cholesterol (39%). Subjects with PAD and claudication have poor nutrition, with diets particularly high in saturated fat, sodium, and cholesterol, and low in fiber, vitamin E and folate intakes. Subjects should be encouraged to reduce consumption of dietary fat, saturated fat, cholesterol, and sodium, and to increase fiber and vitamin intakes to meet recommendations of the NCEP and IOM. PMID:21406424

  9. Endovascular surgery for peripheral arterial occlusive disease. A critical review.

    PubMed Central

    Ahn, S S; Eton, D; Moore, W S

    1992-01-01

    Endovascular surgery is a new multidisciplinary field that applies the recently innovated techniques of angioscopy, intraluminal ultrasound, balloon angioplasty, laser, mechanical atherectomy, and stents. This field can be defined as a diagnostic and therapeutic discipline that uses catheter-based systems to treat vascular disease. As such, it integrates the subspecialties of vascular surgery, interventional radiology, interventional cardiology, and biomedical engineering for the common purpose of improving arterial hemodynamics. Endovascular surgery offers many potential benefits: long incisions are replaced with a puncture wound, the need for postoperative intensive care is significantly reduced, major cardiac and pulmonary complications from general anesthesia are side stepped, and the dollar savings could be dramatic as the need for intensive care unit and in-hospital stay diminishes. Despite these technological advancements, endovascular surgery is still in its infancy and currently has limited applications. This review provides an updated summary of endovascular surgery today and addresses some of the obstacles still preventing its widespread use. PMID:1385944

  10. [Exrercise tolerance in patients with coronary artery disease after coronary artery stenting].

    PubMed

    Tseluyko, V; Kreyndel, K; Vashakidze, Z

    2014-01-01

    The aim of the research is to investigate the impact of coronary stenting on exercise tolerance after 4-8 week and after 12-15 months. The study involved total 90 patients with coronary artery disease, who underwent coronary stenting. All patients underwent clinical examination, including an assessment of their condition, the frequency of angina attacks, echocardioscopy, resting ECG was recorded in all the patients in the standard 12 -lead veloergometry. Statistical processing was performed using Statistica 6.0 for Windows, the method of Wald - Wolfowitz . Data are presented as arithmetic means and error average M ± m. We used a statistical method of calculation - the median ranks (with the median calculated by the usual rules of statistics - the arithmetic mean of the central members of the ordered series). Significant differences were assessed by t-test . The level of significance was considered significant when p <0,05. According to the monitoring data of patients have a significant increase in exercise tolerance: threshold power increased by 63% and in 12-15 months by 58 % compared with the original. The duration of the test conducted after stenting increased by almost 2 -fold. In addition, significantly reduced the proportion of patients whose test results were evaluated as positive. Stenting of the coronary arteries after 4-8 weeks promotes the significant increase in exercise tolerance that persists after 12-15 months. The factors of associated with insufficient increase in exercise tolerance after stenting according veloergometry are: female gender, diabetes, smoking cessation further contributes to the increase in the threshold of physical activity.

  11. Risk factor reduction in progression of angiographic coronary artery disease

    PubMed Central

    Lai, Hoang M.; Mercando, Anthony D.; Kalen, Phoenix; Desai, Harit V.; Gandhi, Kaushang; Sharma, Mala; Amin, Harshad; Lai, Trung M.

    2012-01-01

    Introduction To investigate differences between outpatients with progressive and nonprogressive coronary artery disease (CAD) measured by coronary angiography. Material and methods Chart reviews were performed in patients in an outpatient cardiology practice having ≥ 2 coronary angiographies ≥ 1 year apart. Progressive CAD was defined as 1) new non-obstructive or obstructive CAD in a previously disease-free vessel; or 2) new obstruction in a previously non-obstructive vessel. Coronary risk factors, comorbidities, cardiovascular events, medication use, serum low-density lipoprotein cholesterol (LDL-C), and blood pressure were used for analysis. Results The study included 183 patients, mean age 71 years. Mean follow-up duration was 11 years. Mean follow-up between coronary angiographies was 58 months. Of 183 patients, 108 (59%) had progressive CAD, and 75 (41%) had nonprogressive CAD. The use of statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aspirin was not significantly different in patient with progressive CAD or nonprogressive CAD Mean arterial pressure was higher in patients with progressive CAD than in patients with nonprogressive CAD (97±13 mm Hg vs. 92±12 mm Hg) (p<0.05). Serum LDL-C was insignificantly higher in patients with progressive CAD (94±40 mg/dl) than in patients with nonprogressive CAD (81±34 mg/dl) (p=0.09). Conclusions Our data suggest that in addition to using appropriate medical therapy, control of blood pressure and serum LDL-C level may reduce progression of CAD. PMID:22851998

  12. Dual-Energy CT Angiography in Peripheral Arterial Occlusive Disease

    SciTech Connect

    Brockmann, Carolin Jochum, Susanne; Sadick, Maliha; Huck, Kurt; Ziegler, Peter; Fink, Christian; Schoenberg, Stefan O.; Diehl, Steffen J.

    2009-07-15

    We sought to study the accuracy of dual-energy computed tomographic angiography (DE-CTA) for the assessment of symptomatic peripheral arterial occlusive disease of the lower extremity by using the dual-energy bone removal technique compared with a commercially available conventional bone removal tool. Twenty patients underwent selective digital subtraction angiography and DE-CTA of the pelvis and lower extremities. CTA data were postprocessed with two different applications: conventional bone removal and dual-energy bone removal. All data were reconstructed and evaluated as 3D maximum-intensity projections. Time requirements for reconstruction were documented. Sensitivity, specificity, accuracy, and concordance of DE-CTA regarding degree of stenosis and vessel wall calcification were calculated. A total of 359 vascular segments were analyzed. Compared with digital subtraction angiography, sensitivity, specificity, and accuracy, respectively, of CTA was 97.2%, 94.1%, and 94.7% by the dual-energy bone removal technique. The conventional bone removal tool delivered a sensitivity of 77.1%, a specificity of 70.7%, and an accuracy of 72.0%. Best results for both postprocessing methods were achieved in the vascular segments of the upper leg. In severely calcified segments, sensitivity, specificity, and accuracy stayed above 90% by the dual-energy bone removal technique, whereas the conventional bone removal technique showed a substantial decrease of sensitivity, specificity, and accuracy. DE-CTA is a feasible and accurate diagnostic method in the assessment of symptomatic peripheral arterial occlusive disease. Results obtained by DE-CTA are superior to the conventional bone removal technique and less dependent on vessel wall calcifications.

  13. [Hemoptysis caused by pulmonary arterial aneurysm, disclosing Behçet disease. Apropos of 2 cases].

    PubMed

    Kooli, C; Salem, M; Hamzaoui, A; Fredj, M; Kaouache, Z; Khalfallah, N; Chabbou, A; Haddad, A

    1997-01-01

    Behçet's disease, frequent in our region, can have many clinical presentations. Arterial lesions generally lead to poor prognosis. We report two cases of pulmonary artery aneurysm in two young adults whose Behçet's disease was revealed by hemoptysia.

  14. Radiotherapy-induced concomitant coronary artery stenosis and mitral valve disease.

    PubMed

    Akboga, Mehmet Kadri; Akyel, Ahmet; Sahinarslan, Asife; Cengel, Atiye

    2014-04-01

    Radiotherapy is extensively used in the treatment of Hodgkin's disease. One of its untoward effects is on heart. Coronary arteries and heart valves can be adversely affected from radiotherapy. However, co-existence of both conditions is very rare. In this report, we present a patient with Hodgkin's disease who developed both coronary artery stenosis and severe mitral valve regurgitation after radiotherapy.

  15. Kawasaki disease and the emerging coronary artery disease epidemic in India: is there a correlation?

    PubMed

    Singh, Surjit; Aulakh, Roosy; Kawasaki, Tomisaku

    2014-04-01

    Although Kawasaki disease (KD) is now being increasingly reported from India, the vast majority of children with KD are still not being diagnosed and treated. A recent study from Chandigarh has shown that the incidence of KD is at least 4.54/100,000 children below 15 y of age. Extrapolations of this figure suggest that a minimum of 17,417 new cases of KD would be occurring every year in our country. A significant proportion of these children may develop coronary artery abnormalities. These children would then be at risk of developing myocardial ischemia as young adults. It is authors' contention that (undiagnosed) KD in childhood may be contributing to the growing pool of coronary artery disease (CAD) in India. Similarly, a missed diagnosis of KD in childhood should be considered as a possibility while evaluating adults with CAD, especially when there are no overt risk factors and no family history of the disease.

  16. Posterior Cerebral Artery Insufficiency in Pediatric Moyamoya Disease

    PubMed Central

    Lee, Ji Yeoun; Kim, Seung-Ki; Phi, Ji Hoon

    2015-01-01

    The majority of clinical studies on moyamoya disease (MMD) have focused on anterior circulation. The disease involvement of posterior circulation in MMD, mainly in the posterior cerebral artery (PCA), has been mentioned since the early 1980s, and it has been repeatedly emphasized as one of the most important factors related to poor prognosis in MMD. However, its clinical features and outcome have only been elucidated during the last few years. In this review, the angiographic definition of PCA stenosis is summarized. The clinical features are elucidated as being either early-onset or delayed-onset, according to the time of PCA stenosis diagnosis in reference to the anterior circulation revascularization surgeries. The surgical strategy and hypothesis on the mechanism of PCA stenosis is also briefly mentioned. It appears that some MMD patients may show PCA stenosis during the early or late course of the disease and that the presenting symptoms may vary. Because the hemodynamic compromise caused by PCA stenosis may respond well to surgical treatment, clinicians should be aware of the condition, especially during follow-up of MMD patients. PMID:26180612

  17. The genetic basis for survivorship in coronary artery disease

    PubMed Central

    Dungan, Jennifer R.; Hauser, Elizabeth R.; Qin, Xuejun; Kraus, William E.

    2013-01-01

    Survivorship is a trait characterized by endurance and virility in the face of hardship. It is largely considered a psychosocial attribute developed during fatal conditions, rather than a biological trait for robustness in the context of complex, age-dependent diseases like coronary artery disease (CAD). The purpose of this paper is to present the novel phenotype, survivorship in CAD as an observed survival advantage concurrent with clinically significant CAD. We present a model for characterizing survivorship in CAD and its relationships with overlapping time- and clinically-related phenotypes. We offer an optimal measurement interval for investigating survivorship in CAD. We hypothesize genetic contributions to this construct and review the literature for evidence of genetic contribution to overlapping phenotypes in support of our hypothesis. We also present preliminary evidence of genetic effects on survival in people with clinically significant CAD from a primary case-control study of symptomatic coronary disease. Identifying gene variants that confer improved survival in the context of clinically appreciable CAD may improve our understanding of cardioprotective mechanisms acting at the gene level and potentially impact patients clinically in the future. Further, characterizing other survival-variant genetic effects may improve signal-to-noise ratio in detecting gene associations for CAD. PMID:24143143

  18. ADAM12: a genetic modifier of preclinical peripheral arterial disease

    PubMed Central

    Chen, Lingdan; Okutsu, Mitsuharu; Farber, Charles R.; Hazarika, Surovi; Jones, W. Schuyler; Craig, Damian; Marchuk, Douglas A.; Lye, R. John; Shah, Svati H.; Annex, Brian H.

    2015-01-01

    In prior studies from multiple groups, outcomes following experimental peripheral arterial disease (PAD) differed considerably across inbred mouse strains. Similarly, in humans with PAD, disease outcomes differ, even when there are similarities in risk factors, disease anatomy, arteriosclerotic burden, and hemodynamic measures. Previously, we identified a locus on mouse chromosome 7, limb salvage-associated quantitative trait locus 1 (LSq-1), which was sufficient to modify outcomes following experimental PAD. We compared expression of genes within LSq-1 in Balb/c mice, which normally show poor outcomes following experimental PAD, with that in C57Bl/6 mice, which normally show favorable outcomes, and found that a disintegrin and metalloproteinase gene 12 (ADAM12) had the most differential expression. Augmentation of ADAM12 expression in vivo improved outcomes following experimental PAD in Balb/c mice, whereas knockdown of ADAM12 made outcomes worse in C57Bl/6 mice. In vitro, ADAM12 expression modulates endothelial cell proliferation, survival, and angiogenesis in ischemia, and this appeared to be dependent on tyrosine kinase with Ig-like and EGF-like domain 2 (Tie2) activation. ADAM12 is sufficient to modify PAD severity in mice, and this likely occurs through regulation of Tie2. PMID:26163448

  19. Genetic epidemiology of coronary artery disease: an Asian Indian perspective.

    PubMed

    Jayashree, Shanker; Arindam, Maitra; Vijay, Kakkar V

    2015-09-01

    Coronary artery disease (CAD) has emerged as a major cause of morbidity and mortality worldwide. Recent findings on the role of genetic factors in the aetiopathology of CAD have implicated novel genes and variants in addition to those involved in lipid and lipoprotein metabolism. However, our present knowledge is limited due to lack of clarity on their exact identity and the quantum of impact on disease susceptibility, and incident risk. It is a matter of great interest to understand the role of genetic factors in ethnic populations that have a strong underlying predisposition to CAD such as the South Asian populations, particularly among Asian Indians living in India and abroad. Although, a number of isolated studies do implicate certain gene polymorphisms towards enhanced disease susceptibility, the available data remains scanty and inconclusive as they have not been validated in large, prospective cohorts. The present review aims to consolidate the available literature on the genetics of CAD in Asian Indians and seeks to provide insights on the concerns that need to be addressed in future studies to generate information having clinical value.

  20. Evaluation of ventricular function in patients with coronary artery disease

    SciTech Connect

    Rocco, T.P.; Dilsizian, V.; Fischman, A.J.; Strauss, H.W.

    1989-07-01

    The recent expansion of interventional cardiovascular technologies has stimulated a concomitant expansion of noninvasive cardiac studies, both to assist in diagnosis and to evaluate treatment outcomes. Radionuclide ventricular function studies provide a reliable, reproducible means to quantify global left ventricular systolic performance, a critical determinant of prognosis in patients with cardiovascular disease. In addition, the ability to evaluate regional left ventricular wall motion and to assess ventricular performance during exercise have secured a fundamental role for such studies in the screening and treatment of patients with coronary artery disease. Radionuclide techniques have been extended to the evaluation of left ventricular relaxation/filling events, left ventricular systolic/diastolic function in the ambulatory setting, and with appropriate technical modifications, to the assessment of right ventricular performance at rest and with exercise. As a complement to radionuclide perfusion studies, cardiac blood-pool imaging allows for thorough noninvasive description of cardiac physiology and function in both normal subjects and in patients with a broad range of cardiovascular diseases. 122 references.

  1. ADAM12: a genetic modifier of preclinical peripheral arterial disease.

    PubMed

    Dokun, Ayotunde O; Chen, Lingdan; Okutsu, Mitsuharu; Farber, Charles R; Hazarika, Surovi; Jones, W Schuyler; Craig, Damian; Marchuk, Douglas A; Lye, R John; Shah, Svati H; Annex, Brian H

    2015-09-01

    In prior studies from multiple groups, outcomes following experimental peripheral arterial disease (PAD) differed considerably across inbred mouse strains. Similarly, in humans with PAD, disease outcomes differ, even when there are similarities in risk factors, disease anatomy, arteriosclerotic burden, and hemodynamic measures. Previously, we identified a locus on mouse chromosome 7, limb salvage-associated quantitative trait locus 1 (LSq-1), which was sufficient to modify outcomes following experimental PAD. We compared expression of genes within LSq-1 in Balb/c mice, which normally show poor outcomes following experimental PAD, with that in C57Bl/6 mice, which normally show favorable outcomes, and found that a disintegrin and metalloproteinase gene 12 (ADAM12) had the most differential expression. Augmentation of ADAM12 expression in vivo improved outcomes following experimental PAD in Balb/c mice, whereas knockdown of ADAM12 made outcomes worse in C57Bl/6 mice. In vitro, ADAM12 expression modulates endothelial cell proliferation, survival, and angiogenesis in ischemia, and this appeared to be dependent on tyrosine kinase with Ig-like and EGF-like domain 2 (Tie2) activation. ADAM12 is sufficient to modify PAD severity in mice, and this likely occurs through regulation of Tie2.

  2. Prognostic Value of Coronary Artery Calcium Score for Determination of Presence and Severity of Coronary Artery Disease

    PubMed Central

    Moradi, Maryam; Nouri, Shadi; Nourozi, Ali; Golbidi, Danial

    2017-01-01

    Summary Background There are controversies regarding the usefulness of coronary artery calcium score (CACS) for predicting coronary artery stenosis. The aim of this study was to determine the prognostic value of CACS for determining the presence and severity of coronary artery disease (CAD) in patients with sign and symptoms of the disease. Material/Methods In this cross-sectional study, 748 consecutive patients with suspected CAD, referred for coronary computed tomography angiography (CCTA), were enrolled. The mean CACS was compared between patients with different severities of coronary artery stenosis. The association between CACS and different CAD risk factors was determined as well. Different cutoff points of CACS for discriminating between different levels of coronary artery stenosis was determined using receiver operating characteristic (ROC) curves. Results The mean CACS was significantly different between different levels of coronary artery stenosis (P<0.001) and there was a significant positive association between the severity of CAD and CACS (P<0.001,r=0.781). ROC curve analysis indicated that the optimal cutoff point for discriminating between CAD (presence of stenosis) and the non-stenosis condition was 5.35 with 88.6% sensitivity and 86.2% specificity. Area under the curve for different levels of coronary artery stenosis did not have sufficient sensitivity and specificity for discriminating between different levels of CAD severity (<70%). Conclusions The study demonstrated that there is a significant association between CACS and the presence as well as the severity of CAD. CACS could have an appropriate prognostic value for the determination of coronary artery stenosis but not for discriminating between different severities of stenoses.

  3. Arterial aging and arterial disease: interplay between central hemodynamics, cardiac work, and organ flow—implications for CKD and cardiovascular disease

    PubMed Central

    London, Gerard; Covic, Adrian; Goldsmith, David; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Lindholm, Bengt; Martinez-Castelao, Alberto; Fliser, Danilo; Agarwal, Rajiv; Jager, Kitty J; Dekker, Friedo W; Blankestijn, Peter J; Zoccali, Carmine

    2011-01-01

    Cardiovascular disease is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). All epidemiological studies have clearly shown that accelerated arterial and cardiac aging is characteristic of these populations. Arterial premature aging is heterogeneous. It principally involves the aorta and central capacitive arteries, and is characterized by preferential aortic stiffening and disappearance of stiffness/impedance gradients between the central and peripheral arteries. These changes have a double impact: on the heart, upstream, with left ventricular hypertrophy and decreased coronary perfusion; and, downstream, on renal and brain microcirculation (decrease in glomerular filtration and cognitive functions). Multifactorial at origin, the pathophysiology of aortic ‘progeria' and microvascular disorders in CKD/ESRD is not well understood and should be the focus of interest in future studies. PMID:25018896

  4. Coronary artery compliance and adaptive vessel remodelling in patients with stable and unstable coronary artery disease

    PubMed Central

    Jeremias, A; Spies, C; Herity, N; Pomerantsev, E; Yock, P; Fitzgerald, P; Yeung, A

    2000-01-01

    .001). Negative remodelling occurred only in two patients with unstable symptoms (9%) but in 17 (74%) with stable symptoms. At the proximal reference segment, the difference in LA between systole and diastole was 0.99 (0.66) mm2 in the unstable group and 0.39 (0.3) mm2 in the stable group (p < 0.001), and the calculated coronary artery distensibility was 3.09 (2.69) and 0.94 (0.83) per mm Hg in unstable and stable patients, respectively (p < 0.001). The stiffness index β was lower in patients with unstable angina (1.95 (0.94) v 3.1 (0.96), p < 0.001).
CONCLUSIONS—Compensatory vessel enlargement occurs to a greater degree in patients with unstable than with stable coronary syndromes, and is associated with increased coronary artery distensibility.


Keywords: coronary artery disease; remodelling; compliance; angina pectoris PMID:10956298

  5. Computerized analysis of coronary artery disease: Performance evaluation of segmentation and tracking of coronary arteries in CT angiograms

    SciTech Connect

    Zhou, Chuan Chan, Heang-Ping; Chughtai, Aamer; Kuriakose, Jean; Agarwal, Prachi; Kazerooni, Ella A.; Hadjiiski, Lubomir M.; Patel, Smita; Wei, Jun

    2014-08-15

    Purpose: The authors are developing a computer-aided detection system to assist radiologists in analysis of coronary artery disease in coronary CT angiograms (cCTA). This study evaluated the accuracy of the authors’ coronary artery segmentation and tracking method which are the essential steps to define the search space for the detection of atherosclerotic plaques. Methods: The heart region in cCTA is segmented and the vascular structures are enhanced using the authors’ multiscale coronary artery response (MSCAR) method that performed 3D multiscale filtering and analysis of the eigenvalues of Hessian matrices. Starting from seed points at the origins of the left and right coronary arteries, a 3D rolling balloon region growing (RBG) method that adapts to the local vessel size segmented and tracked each of the coronary arteries and identifies the branches along the tracked vessels. The branches are queued and subsequently tracked until the queue is exhausted. With Institutional Review Board approval, 62 cCTA were collected retrospectively from the authors’ patient files. Three experienced cardiothoracic radiologists manually tracked and marked center points of the coronary arteries as reference standard following the 17-segment model that includes clinically significant coronary arteries. Two radiologists visually examined the computer-segmented vessels and marked the mistakenly tracked veins and noisy structures as false positives (FPs). For the 62 cases, the radiologists marked a total of 10191 center points on 865 visible coronary artery segments. Results: The computer-segmented vessels overlapped with 83.6% (8520/10191) of the center points. Relative to the 865 radiologist-marked segments, the sensitivity reached 91.9% (795/865) if a true positive is defined as a computer-segmented vessel that overlapped with at least 10% of the reference center points marked on the segment. When the overlap threshold is increased to 50% and 100%, the sensitivities were 86

  6. Genetic variants associated with celiac disease and the risk for coronary artery disease.

    PubMed

    Jansen, Henning; Willenborg, Christina; Schlesinger, Sabrina; Ferrario, Paola G; König, Inke R; Erdmann, Jeanette; Samani, Nilesh J; Lieb, Wolfgang; Schunkert, Heribert

    2015-10-01

    Epidemiological evidence suggests that patients with celiac disease are at increased risk for coronary artery disease (CAD). Genetic-epidemiological analyses identified many single nucleotide polymorphisms (SNPs) associated with celiac disease. If there is a causal relation between celiac disease and CAD, one might expect that risk alleles primarily associated with celiac disease also increase the risk of CAD. In this study we identified from literature 41 SNPs that have been previously described to be genome-wide associated with celiac disease (p < 5 × 10(-08)). These SNPs were evaluated for their association with CAD in the Coronary ARtery DIsease Genome-wide Replication and Meta-analysis (CARDIoGRAM) dataset, a meta-analysis comprising genome-wide SNP association data from 22,233 CAD cases and 64,762 controls. 24 out of 41 (58.5 %) risk alleles for celiac disease displayed a positive association with CAD (CAD-OR range 1.001-1.081). The remaining risk alleles for celiac disease (n = 16) revealed CAD-ORs of ≤1.0 (range 0.951-1.0). The proportion of CAD associated alleles was greater but did not differ significantly from the proportion of 50 % expected by chance (p = 0.069). One SNP (rs653178 at the SH2B3/ATXN2 locus) displayed study-wise statistically significant association with CAD with directionality consistent effects on celiac disease and CAD. However, the effect of this locus is most likely driven by pleiotropic effects on multiple other diseases. In conclusion, this genetically based approach provided no convincing evidence that SNPs associated with celiac disease contribute to the risk of CAD. Hence, common non-genetic factors may play a more important role explaining the coincidence of these two complex disease conditions.

  7. Cold pressor /sup 201/Tl myocardial scintigraphy in the diagnosis of coronary artery disease

    SciTech Connect

    Ahmad, M.; Dubiel, J.P.; Haibach, H.

    1982-12-01

    /sup 201/Tl myocardial scintigraphy was performed during cold pressor stimulation in 36 patients aged 36 to 69 years. Thirty-one patients had coronary artery disease and 5 patients did not, as confirmed by coronary cineangiography. /sup 201/Tl (1.5 to 2 mCi) was injected at 30 seconds of the cold pressor stimulation. The product of systolic pressure X heart rate increased from a baseline of 77.4 +/- 16 (standard deviation (SD)) to 103.6 +/- 17 at 30 seconds of the cold pressor test (p less than 0.0005). Transient perfusion deficits developed in 24 of 31 patients with coronary artery disease (sensitivity 77%), and all 5 patients without coronary artery disease had normal scintigrams. The sensitivity in detecting coronary artery disease was 40% in patients with 1 vessel disease, 91% in patients with 2 vessel disease, and 100% in patients with 3 vessel disease. Exercise electrocardiograms (available in 29 of 36 patients) were positive for ischemia in 18 of 24 patients with coronary artery disease and in 1 of 5 patients without coronary artery disease (sensitivity 75% and specificity less than 80%). Exercise /sup 201/Tl scintigrams, obtained in 16 patients, were positive in 11 patients with coronary artery disease and positive cold pressor /sup 201/Tl scintigrams. Five patients without coronary artery disease and with normal cold pressor /sup 201/Tl scintigrams had normal exercise /sup 201/Tl scintigrams. Coronary cineangiography performed during cold pressor stimulation in 6 patients who had positive cold pressor and exercise /sup 201/Tl scintigrams did not show coronary spasm. Our data indicate that cold pressor thallium-201 scintigraphy offers promise as a noninvasive test in the diagnosis of coronary artery disease and may be used in patients in whom exercise testing is not feasible.

  8. Value of left ventricular ejection fraction during exercise in predicting the extent of coronary artery disease.

    PubMed

    DePace, N L; Iskandrian, A S; Hakki, A H; Kane, S A; Segal, B L

    1983-04-01

    To determine the relation between left ventricular performance during exercise and the extent of coronary artery disease, the results of exercise radionuclide ventriculography were analyzed in 65 patients who also underwent cardiac catheterization. A scoring system was used to quantitate the extent of coronary artery disease. This system takes into account the number and site of stenoses of the major coronary vessels and their secondary branches. The conventional method of interpreting the coronary angiograms indicated that 26 patients had significant coronary artery disease (defined as 70% or more narrowing of luminal diameter) of one vessel, 21 had multivessel disease and 18 had no significant coronary artery disease. Although the exercise left ventricular ejection fraction was significantly higher in patients with no coronary artery disease than in patients with one or multivessel disease (probability [p] less than 0.001), there was considerable overlap among the three groups. With the scoring system, a good correlation was found between the coronary artery disease score and the exercise left ventricular ejection fraction (r = -0.70; p less than 0.001). If the exercise heart rate was 130 beats/min or greater or the age of the patient was 50 years or less, an even better correlation was found (r = -0.73 and r = -0.82, respectively). The exercise ejection fraction (but not the change in ejection fraction, end-diastolic volume and end-systolic volume from rest to exercise) correlated with the extent of coronary artery disease. The exercise ejection fraction is the most important exercise variable that correlates with the extent of coronary artery disease when the latter is assessed quantitatively by a scoring system rather than the conventional method of reporting coronary angiograms. Young age and greater exercise heart rate strengthened the correlation. The change in ejection fraction from rest to exercise is useful in the diagnosis of coronary artery disease

  9. New technologies for the treatment of obstructive arterial disease.

    PubMed

    Fischell, T A; Stadius, M L

    1991-03-01

    The well-known limitations of balloon angioplasty include unpredictable abrupt closure, chronic total occlusion, diffuse disease, and restenosis, among other factors. These limitations have prompted the development of new technologic approaches to angioplasty including laser applications for plaque ablation, mechanical device applications for plaque removal/debridement, and stent devices for structural maintenance of vascular lumen patency. Devices which directly apply laser energy for ablation of plaque material include a balloon-centered laser angioplasty system, excimer laser ablation catheter systems, and a fluorescence-guided spectral feedback laser system. Experience with these devices indicates that plaque can be successfully ablated by using laser energy. Vessel perforation and dissection are complications reported with these devices and the effects of laser angioplasty on restenosis remain unclear. Indirect application of laser energy has been tested by using a "hot tip" catheter and a laser balloon angioplasty system. Although the hot tip device has received FDA approval for use in peripheral arteries, it appears to have very limited applications in the coronary arteries. Laser balloon angioplasty appears to be beneficial in the setting of threatened acute closure; the device continues to be evaluated for potential beneficial impact on restenosis. Mechanical atherectomy catheters are designed to remove atherosclerotic plaque from the arterial system and include the AtheroCath, the Transluminal Extraction Catheter (TEC), and the Pullback Atherectomy Catheter (PAC). The Rotablator is an atheroablation device which debrides the obstructing plaque material with distal embolization of the particulate debris. Successful removal/debridement of atherosclerotic plaque has been demonstrated with the AtheroCath, Rotablator, and the TEC device. Pre-clinical studies demonstrate successful removal of plaque material with the PAC device. Despite the theoretic advantage

  10. Physiologic Assessment of Coronary Artery Disease by Cardiac Computed Tomography

    PubMed Central

    Kochar, Minisha

    2013-01-01

    Coronary artery disease (CAD) remains the leading cause of death and morbidity worldwide. To date, diagnostic evaluation of patients with suspected CAD has relied upon the use of physiologic non-invasive testing by stress electrocardiography, echocardiography, myocardial perfusion imaging (MPI) and magnetic resonance imaging. Indeed, the importance of physiologic evaluation of CAD has been highlighted by large-scale randomized trials that demonstrate the propitious benefit of an integrated anatomic-physiologic evaluation method by performing lesion-specific ischemia assessment by fractional flow reserve (FFR)-widely considered the "gold" standard for ischemia assessment-at the time of invasive angiography. Coronary CT angiography (CCTA) has emerged as an attractive non-invasive test for anatomic illustration of the coronary arteries and atherosclerotic plaque. In a series of prospective multicenter trials, CCTA has been proven as having high diagnostic performance for stenosis detection as compared to invasive angiography. Nevertheless, CCTA evaluation of obstructive stenoses is prone to overestimation of severity and further, detection of stenoses by CCTA does not reliably determine the hemodynamic significance of the visualized lesions. Recently, a series of technological innovations have advanced the possibility of CCTA to enable physiologic evaluation of CAD, thereby creating the potential of this test to provide an integrated anatomic-physiologic assessment of CAD. These advances include rest-stress MPI by CCTA as well as the use of computational fluid dynamics to non-invasively calculate FFR from a typically acquired CCTA. The purpose of this review is to summarize the most recent data addressing these 2 physiologic methods of CAD evaluation by CCTA. PMID:23964289

  11. Sleep-Disordered Breathing and Coronary Artery Disease.

    PubMed

    Arzt, Michael; Hetzenecker, Andrea; Steiner, Stephan; Buchner, Stefan

    2015-07-01

    Coronary artery disease (CAD) is one of the most frequent diseases in industrial nations. Despite significant advances in diagnosis and therapy, CAD and its long-term consequences are important contributors to morbidity and mortality. Therefore, in addition to management of traditional CAD risk factors, there are continued efforts to evaluate other factors and comorbidities that might contribute to the development and progression of CAD. One such factor is sleep-disordered breathing (SDB), which is characterized by repetitive apneas, arousals from sleep, and intermittent hypoxia. There is increasing evidence that SDB is a risk factor for CAD. In the early phase after myocardial infarction (MI) the heart might be in a vulnerable state sensitive to the negative consequences of SDB, including increased cardiac workload and endothelial dysfunction, which might ultimately lead to a mismatch between oxygen demand and supply. Despite successful percutaneous coronary intervention, patients with acute MI and SDB have prolonged myocardial ischemia, less salvaged myocardium, and impaired left and right ventricular remodelling compared with those without SDB, all of which predispose to heart failure. Suppression of SDB with positive airway pressure therapy in the early phase after MI is feasible. However, whether treatment of SDB with positive airway pressure will be an effective nonpharmacological treatment approach that will prevent the development of heart failure after MI remains to be determined and is the subject of current investigations.

  12. Antioxidants and Coronary Artery Disease: From Pathophysiology to Preventive Therapy

    PubMed Central

    Leopold, Jane A.

    2014-01-01

    Oxidant stress in the cardiovascular system may occur when antioxidant capacity is insufficient to reduce reactive oxygen species and other free radicals. Oxidant stress has been linked to the pathogenesis of atherosclerosis and incident coronary artery disease. As a result of this connection, early observational studies focused on dietary antioxidants, such as β-carotene, α-tocopherol, and ascorbic acid, and demonstrated an inverse relationship between intake of these antioxidants and major adverse cardiovascular events. These findings supported a number of randomized trials of selected antioxidants as primary and secondary prevention to decrease cardiac risk; however, many of these studies reported disappointing results with little or no observed risk reduction in antioxidant treated patients. Several plausible explanations for these findings have been suggested, including incorrect antioxidant choice or dose, synthetic versus dietary antioxidant as the intervention, and patient selection, all of which will be important to consider when designing future clinical trials. This review will focus on the contemporary evidence that is the basis for our current understanding of the role of antioxidants in cardiovascular disease prevention. PMID:25369999

  13. Prognostic impact of stress testing in coronary artery disease

    SciTech Connect

    Severi, S.; Michelassi, C. )

    1991-05-01

    Observational data prospectively collected permit the examination of a complex set of decisions, including the decision not to perform any stress testing. Patients with or without previous myocardial infarction admitted for coronary evaluation and not submitted to any stress testing because of clinical reasons are at a higher risk for subsequent death. For prognostication, no test has been better validated than exercise electrocardiography: it can identify patients at low and high risk for future cardiac events among those without symptoms, with typical chest pain, and with previous myocardial infarction. In patients with triple-vessel disease, the results of exercise also allow those at low and high risk to be recognized. Both exercise radionuclide angiography and {sup 201}Tl scintigraphy (the latter in larger patient populations) have also demonstrated significant prognostic value on patients with or without previous myocardial infarction. Neither one has shown superiority to the other in prognostication. So far, they have been considered the only viable alternatives to exercise electrocardiography stress testing for diagnosis and prognostication. However, their costs limit their extensive application. Preliminary data suggest that intravenous dipyridamole echocardiography can be used for both diagnosis and prognostication of coronary artery disease; moreover, the prognostic information derived from dipyridamole echocardiography testing seems independent of and additive to that provided by exercise electrocardiography. Further prospective studies on larger patient populations are needed to better define the prognostic value of dipyridamole echocardiography testing.47 references.

  14. Antioxidants and coronary artery disease: from pathophysiology to preventive therapy.

    PubMed

    Leopold, Jane A

    2015-03-01

    Oxidant stress in the cardiovascular system may occur when antioxidant capacity is insufficient to reduce reactive oxygen species and other free radicals. Oxidant stress has been linked to the pathogenesis of atherosclerosis and incident coronary artery disease. As a result of this connection, early observational studies focused on dietary antioxidants, such as β-carotene, α-tocopherol, and ascorbic acid, and demonstrated an inverse relationship between intake of these antioxidants and major adverse cardiovascular events. These findings supported a number of randomized trials on the use of selected antioxidants as primary or secondary prevention strategies to decrease cardiac risk; however, many of these studies reported disappointing results with little or no observed risk reduction in antioxidant-treated patients. Several plausible explanations for these findings have been suggested, including incorrect antioxidant choice or dose, synthetic versus dietary antioxidants as the intervention, and patient selection, all of which will be important to consider when designing future clinical trials. This review will focus on the contemporary evidence that is the basis for our current understanding of the role of antioxidants in cardiovascular disease prevention.

  15. Placental Induced Growth Factor (PIGf) in Coronary Artery Disease

    NASA Technical Reports Server (NTRS)

    Sundaresan, Alamelu; Carabello, Blaise; Mehta, Satish; Schlegel, Todd; Pellis, Neal; Ott, Mark; Pierson, Duane

    2010-01-01

    Our previous studies on normal human lymphocytes have shown a five-fold increase (p less than 0.001) in angiogenic inducers such as Placental Induced Growth Factor (PIGf) in physiologically stressful environments such as modeled microgravity, a space analog. This suggests de-regulation of cardiovascular signalling pathways indicated by upregulation of PIGf. In the current study, we measured PIGf in the plasma of 33 patients with and without coronary artery disease (CAD) to investigate whether such disease is associated with increased levels of PIGf. A control consisting of 31 sex matched apparently healthy subjects was also included in the study. We observed that the levels of PIGf in CAD patients were significantly increased compared to those in healthy control subjects (p less than 0.001) and usually increased beyond the clinical threshold level (greater than 27ng/L). The mechanisms leading to up-regulation of angiogenic factors and the adaptation of organisms to stressful environments such as isolation, high altitude, hypoxia, ischemia, microgravity, increased radiation, etc are presently unknown and require further investigation in spaceflight and these other physiologically stressed environments.

  16. Clinical Assessment of Patients with Peripheral Arterial Disease

    PubMed Central

    Bailey, Marc A.; Griffin, Kathryn J.; Scott, D. Julian A.

    2014-01-01

    Peripheral arterial disease (PAD) describes the clinical manifestations of atherosclerosis affecting the circulation in the legs. The severity of PAD is classified according to symptom severity, time course, and anatomical distribution. The signs and symptoms of PAD reflect the degree of circulatory compromise and whether there has been a gradual reduction in the circulation or an abrupt, uncompensated decrease. Accurate clinical assessment underpins decisions on management strategy and should objectively assess the severity of the ischemia and need for revascularization. Clinical history should discriminate symptoms of PAD from other conditions presenting with leg pain, elucidate cardiovascular risk factors and the effect of symptoms on the patient's quality of life. Clinical examination includes signs of general cardiovascular disease and associated conditions before assessing the circulation and viability of the limb. Palpation of peripheral pulses must be augmented by determination of the ankle brachial pressure index using hand held Doppler. A whole patient approach to management is required and must include modification of cardiovascular risk status as well as dealing with the local circulatory manifestation of PAD. PMID:25435653

  17. Newer perspectives of coronary artery disease in young

    PubMed Central

    Aggarwal, Amitesh; Srivastava, Saurabh; Velmurugan, M

    2016-01-01

    Coronary artery disease (CAD) occurring in less than 45 years of age is termed as young CAD. Recent studies show a prevalence of 1.2% of CAD cases in this age group. Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%. Conventional risk factors such as smoking, diabetes, hypertension, obesity and family history seems to be as important as in older CAD subjects. But the prevalence of these risk factors seems to vary in younger subjects. By far the most commonly associated risk factor is smoking in young CAD. Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein (CETP) gene, hepatic lipase gene, lipoprotein lipase gene, apo A1 gene, apo E gene and apo B. Biomarkers such as lipoprotein (a), fibrinogen, D-dimer, serum Wnt, gamma glutamyl transferase, vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies. In general CAD in young has better prognosis than older subjects. In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes. Angiographic studies shows predominance of single vessel disease in young CAD patients. Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events. PMID:28070240

  18. Diagnostic Potential of Pulsed Arterial Spin Labeling in Alzheimer's Disease

    PubMed Central

    Trebeschi, Stefano; Riederer, Isabelle; Preibisch, Christine; Bohn, Karl P.; Förster, Stefan; Alexopoulos, Panagiotis; Zimmer, Claus; Kirschke, Jan S.; Valentinitsch, Alexander

    2016-01-01

    Alzheimers disease (AD) is the most common cause of dementia. Although the underlying pathology is still not completely understood, several diagnostic methods are available. Frequently, the most accurate methods are also the most invasive. The present work investigates the diagnostic potential of Pulsed Arterial Spin Labeling (PASL) for AD: a non-invasive, MRI-based technique for the quantification of regional cerebral blood flow (rCBF). In particular, we propose a pilot computer aided diagnostic (CAD) procedure able to discriminate between healthy and diseased subjects, and at the same time, providing visual informative results. This method encompasses the creation of a healthy model, the computation of a voxel-wise likelihood function as comparison between the healthy model and the subject under examination, and the correction of the likelihood function via prior distributions. The discriminant analysis is carried out to maximize the accuracy of the classification. The algorithm has been trained on a dataset of 81 subjects and achieved a sensitivity of 0.750 and a specificity of 0.875. Moreover, in accordance with the current pathological knowledge, the parietal lobe, and limbic system are shown to be the main discriminant factors. PMID:27147946

  19. Coronary Artery Disease: Why We should Consider the Y Chromosome.

    PubMed

    Molina, Elsa; Clarence, Elyse Michele; Ahmady, Farah; Chew, Guat Siew; Charchar, Fadi Joseph

    2016-08-01

    Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality globally. In the last few years our understanding of the genetic and molecular mechanisms that promote CAD in individuals has increased with the advent of the genome era. This complex inflammatory disease has well-defined environmental risk factors. However, in the last 10 years, studies including genome-wide association studies (GWAS) have clearly demonstrated a genetic influence on CAD. Recently, studies on the human Y chromosome have also demonstrated that genetic variation within the male-specific region of the Y chromosome (MSY) could play a part in determining cardiovascular risk in men, confirming the notion that the increased risk for CAD in men cannot be fully explained through common CAD risk factors. Here, we review the literature about the pathophysiology of CAD, its potential causes and environmental risk factors known so far. Furthermore, we review the genetics of CAD, especially the latest discoveries regarding the implication of the Y chromosome, the most underexplored portion of the human genome to date, highlighting methods and difficulties arising in this research field, and discussing the importance of considering the Y chromosome in CAD research.

  20. Myocardial performance and perfusion during exercise in patients with coronary artery disease caused by Kawasaki disease

    SciTech Connect

    Paridon, S.M.; Ross, R.D.; Kuhns, L.R.; Pinsky, W.W. )

    1990-01-01

    For a study of the natural history of coronary artery lesions after Kawasaki disease and their effect on myocardial blood flow reserve with exercise, five such patients underwent exercise testing on a bicycle. Oxygen consumption, carbon dioxide production, minute ventilation, and electrocardiograms were monitored continuously. Thallium-201 scintigraphy was performed for all patients. One patient stopped exercise before exhaustion of cardiovascular reserve but had no evidence of myocardial perfusion abnormalities. Four patients terminated exercise because of exhaustion of cardiovascular reserve; one had normal cardiovascular reserve and thallium scintiscans, but the remaining patients had diminished cardiovascular reserve. Thallium scintigrams showed myocardial ischemia in two and infarction in one. No patient had exercise-induced electrocardiographic changes. These results indicate that patients with residual coronary artery lesions after Kawasaki disease frequently have reduced cardiovascular reserve during exercise. The addition of thallium scintigraphy and metabolic measurements to exercise testing improved the detection of exercise-induced abnormalities of myocardial perfusion.

  1. An electrophysiological study of excitatory purinergic neuromuscular transmission in longitudinal smooth muscle of chicken anterior mesenteric artery

    PubMed Central

    Khalifa, Maisa; El-Mahmoudy, AbuBakr; Shiina, Takahiko; Shimizu, Yasutake; Nikami, Hideki; El-Sayed, Mossad; Kobayashi, Haruo; Takewaki, Tadashi

    2005-01-01

    The object of the present study was to clarify the neurotransmitters controlling membrane responses to electrical field stimulation (EFS) in the longitudinal smooth muscle cells of the chicken anterior mesenteric artery. EFS (5 pulses at 20 Hz) evoked a depolarization of amplitude 19.7±2.1 mV, total duration 29.6±3.1 s and latency 413.0±67.8 ms. This depolarization was tetrodotoxin (TTX)-sensitive and its amplitude was partially decreased by atropine (0.5 μM); however, its duration was shortened by further addition of prazosin (10 μM). Atropine/prazosin-resistant component was blocked by the nonspecific purinergic antagonist, suramin, in a dose-dependent manner, indicating that this component is mediated by the neurotransmitter adenosine 5′-triphosphate (ATP). Neither desensitization nor blocking of P2X receptor with its putative receptor agonist α,β-methylene ATP (α,β-MeATP, 1 μM) and its antagonist pyridoxalphosphate-6-azophenyl-2′,4′-disulfonic (PPADS, up to 50 μM), had significant effect on the purinergic depolarization. In contrast, either desensitization or blocking of P2Y receptor with its putative agonist 2-methylthioATP (2-MeSATP, 1 μM) and its antagonist Cibacron blue F3GA (CBF3GA, 10 μM) abolished the purinergic depolarization, indicating that this response is mediated through P2Y but not P2X receptor. The purinergic depolarization was inhibited by pertussis toxin (PTX, 600 ng ml−1). Furthermore, it was significantly inhibited by a phospholipase C (PLC) inhibitor, U-73122 (10 μM), indicating that the receptors involved in mediating the purinergic depolarization are linked to a PTX-sensitive G-protein, which is involved in a PLC-mediated signaling pathway. Data of the present study suggest that the EFS-induced excitatory membrane response occurring in the longitudinal smooth muscle of the chicken anterior mesenteric artery is mainly purinergic in nature and is mediated via P2Y purinoceptors. PMID:15685211

  2. Relation Between Family History of Premature Coronary Artery Disease and the Risk of Death in Patients With Coronary Artery Disease.

    PubMed

    Abdi-Ali, Ahmed; Shaheen, AbdelAziz; Southern, Danielle; Zhang, Mei; Knudtson, Merril; White, James; Graham, Michelle; James, Mathew T; Wilton, Stephen B

    2016-02-01

    Family history (FHx) of premature coronary artery disease (CAD) is a risk factor for development of incident cardiovascular disease. However the association between FHx and outcomes in patients with established CAD is unclear. We followed 84,373 patients with angiographic CAD enrolled in the inclusive Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease registry between April 2002 and March 2013. Overall, 25,566 (30%) self-reported an FHx of CAD, defined as a first-degree relative with premature CAD (men, age <55 years; women, age <65 years). We tested the association between FHx and all-cause mortality using multivariable Cox proportional hazards regression. After adjusting for baseline differences in clinical characteristics, indication, and extent of CAD, FHx was associated with reduced all-cause mortality over a median 5.6 years in follow-up (hazard ratio [HR] 0.77 [95% CI 0.73 to 0.80]). The magnitude of this protective association was weaker in those with versus without a previous myocardial infarction (HR 0.87 [95% CI 0.81 to 0.93] versus 0.72 [0.69 to 0.76], interaction p <0.0001) and slightly stronger in those presenting with versus without an acute coronary syndrome (HR 0.74 [0.70 to 0.79] versus 0.80 [0.75 to 0.85], interaction p = 0.08). There was attenuation of association with increasing age, but FHx remained protective even in those aged older than 80 years (HR 0.86 [0.77 to 0.95]). In conclusion, in patients with angiographic CAD, self-reported FHx of premature CAD is associated with improved long-term survival rate, independent of clinical characteristics, mode of presentation, and extent of disease. Further investigation of potential patient- and system-level mediators of this seemingly paradoxical relation is required.

  3. Stress scintigraphy using single-photon emission computed tomography in the evaluation of coronary artery disease

    SciTech Connect

    Nohara, R.; Kambara, H.; Suzuki, Y.; Tamaki, S.; Kadota, K.; Kawai, C.; Tamaki, N.; Torizuka, K.

    1984-05-01

    Twenty-seven patients with angina pectoris, 24 with postmyocardial infarction angina and 7 with normal coronary arteries were examined by exercise thallium-201 emission computed tomography (SPECT) and planar scintigraphy. Exercise SPECT was compared with the reperfusion imaging obtained approximately 2 to 3 hours after exercise. The sensitivity and specificity of demonstrating involved coronary arteries by identifying the locations of myocardial perfusion defects were 96 and 87% for right coronary artery, 88 and 89% for left anterior descending artery (LAD) and 78 and 100% for left circumflex artery (LC). These figures are higher than those for planar scintigraphy (85 and 87% for right coronary artery, 73 and 89% for LAD and 39 and 100% for LC arteries). In patients with 3-vessel disease, sensitivity of SPECT (100, 88 and 75% for right coronary artery, LAD and LC, respectively) was higher than planar imaging (88, 63 and 31%, respectively), with a significant difference for LC (p less than 0.05). In 1, 2 and 0-vessel disease the sensitivity and specificity of the 2 techniques were comparable. Multivessel disease was more easily identified as multiple coronary involvement than planar imaging with a significant difference in 3-vessel disease (p less than 0.05). In conclusion, stress SPECT provides useful information for the identification of LC lesions in coronary heart disease, including 3-vessel involvement.

  4. Recurrent cystic adventitial disease of the popliteal artery: successful treatment with percutaneous transluminal angioplasty.

    PubMed

    Maged, Ismaeel M; Kron, Irving L; Hagspiel, Klaus D

    2009-01-01

    Cystic adventitial disease (CAD) is a rare vascular condition that most commonly affects the popliteal artery. Percutaneous transluminal angioplasty (PTA) is generally not considered a valid therapeutic option due to high recurrence rate. We report a case of CAD of the popliteal artery that recurred after surgical cyst enucleation that was successfully treated with PTA. To the best of our knowledge, this is the first case of successful PTA for the treatment of recurrent CAD of the popliteal artery.

  5. Paraplegia after aortic and superior mesenteric artery stenting for occlusive disease.

    PubMed

    Hans, Sachinder S; Ngo, William; McAllister, Michael

    2014-02-01

    Paraplegia after endovascular therapy for aortic and visceral artery occlusive disease is an extremely uncommon occurrence. Two cases of paraplegia after placement of an aortic covered stent for infrarenal aortic stenosis and a superior mesenteric artery stent for chronic visceral ischemia are presented. In both patients, embolization of the arterial supply to the spinal cord was the presumed cause. One patient had a slight recovery after intense physical therapy and rehabilitation. The second patient did not have any recovery from her paraplegia.

  6. Multiple Intrahepatic Artery Aneurysms in a Patient with Behcet's Disease: Use of Transcatheter Embolization for Rupture

    SciTech Connect

    Ahmed, Irfan; Fotiadis, Nikolas I. Dilks, Phil; Kocher, Hemant M.; Fotheringham, Tim; Matson, Matthew

    2010-04-15

    Intrahepatic artery aneuryms are a rare and potentially life-threatening condition. We present the first case in the English literature of multiple intrahepatic artery aneuryms in a patient with Behcet's disease who presented acutely with rupture. The ruptured aneurysm was treated successfully with transcatheter arterial coil embolization-CT and clinical follow-up confirming a good result. We discuss the management dilemma with regard to prophylactic embolization of the numerous other small asymptomatic intrahepatic aneurysms in this same patient.

  7. Molecular Mechanisms and Treatment Strategies for Obesity-Associated Coronary Artery Disease, an Imminent Military Epidemic

    DTIC Science & Technology

    2009-12-01

    Abstract—Atherothrombotic vascular disease is the major cause of death and disability in obese and diabetic subjects with insulin resistance...Strategies for Obesity-Associated Coronary Artery Disease , an Imminent Military Epidemic PRINCIPAL INVESTIGATOR: Ira Tabas, M.D., Ph.D...Molecular Mechanisms and Treatment Strategies for Obesity-Associated Coronary Artery Disease , an Imminent Military Epidemic 5b. GRANT NUMBER W81XWH-06

  8. Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease.

    PubMed

    Numano, Fujito; Shimizu, Chisato; Tremoulet, Adriana H; Dyar, Dan; Burns, Jane C; Printz, Beth F

    2016-03-01

    Coronary artery inflammation and aneurysm formation are the most common complications of Kawasaki disease (KD). Valvulitis and myocarditis are also well described and may lead to valvar regurgitation and left ventricular dysfunction. However, functional changes in the right heart have rarely been reported. We noted several acute KD patients with dilated pulmonary arteries (PA) and thus sought to systematically characterize PA size and right-heart function in an unselected cohort of KD patients cared for at a single clinical center. Clinical, laboratory, and echocardiographic data from 143 acute KD subjects were analyzed. PA dilation was documented in 23 subjects (16.1 %); these subjects had higher median right ventricle myocardial performance index (RV MPI), higher ratio of early tricuspid inflow velocity to tricuspid annular early diastolic velocity (TV E/e'), and lower median TV e' velocity compared to the non-PA dilation group (0.50 vs 0.38 p < 0.01, 4.2 vs 3.6 p < 0.05, and 13.5 vs 15.2 cm/s p < 0.01, respectively). Almost all subjects with PA dilation had improved PA Z-score, RV MPI, and TV E/e' in the subacute phase (p < 0.01). There were no significant differences in indices of left ventricle function between PA dilation group and non-PA dilation group. In summary, PA dilation was documented in 16 % of acute KD subjects. These subjects were more likely to have echocardiographic indices consistent with isolated RV dysfunction that improved in the subacute phase. The long-term consequence of these findings will require longitudinal studies of this patient population.

  9. Mediastinal mass and brachial plexopathy caused by subclavian arterial aneurysm in Behçet's disease.

    PubMed

    Yoo, W H; Kim, H K; Park, J H; Park, T S; Baek, H S

    2000-01-01

    Vascular involvement in Behçet's disease is divided into venous and arterial thrombosis and arterial aneurysmal formation. Subclavian arterial aneurysm rarely occurs in Behçet's disease; however, when it does occur, it causes serious aneurysmal rupture and local complications such as nerve compression and arterial ischemia. We describe the case of a 39-year-old male who presented with neurologic symptoms and signs of brachial plexopathy and mediastinal mass caused by Behçet's subclavian arterial aneurysm. This case shows that the occurrence of brachial plexopathy should be considered a manifestation of Behçet's disease, and that Behçet's aneurysm should be considered in the differential diagnosis of upper mediastinal mass.

  10. Epidemiology of stroke and coronary artery disease in Asia.

    PubMed

    Hata, Jun; Kiyohara, Yutaka

    2013-01-01

    Stroke and coronary artery disease (CAD) are major causes of death throughout the world. As half of the world's population lives in Asian countries, prevention of stroke and CAD in Asia is crucial. According to the vital statistics, East Asian countries have a lower mortality rate for CAD than for stroke. In contrast, CAD is a more common cause of death than stroke in other Asian countries and Western countries. Hypertension, diabetes, hypercholesterolemia, and smoking are major risk factors for stroke and CAD in Asia as well as in Western countries. In an observational study in Japan, the stroke incidence decreased as a result of improvements in blood pressure control and reduction in the smoking rate over the past half century, whereas the CAD incidence did not show a clear secular change, probably because the benefits of blood pressure control and smoking cessation were negated by increasing prevalence of both glucose intolerance and hypercholesterolemia. Although Asian populations have lower serum cholesterol levels than Western populations, the prevalence of hypercholesterolemia has increased during the past half century in Asia. In addition, the smoking rate among Asian men is higher than for Western men. These results underscore that, in addition to blood pressure control, smoking cessation and the management of metabolic risk factors are very important for prevention of stroke and CAD in Asia.

  11. Dye-Staining Angioscopy for Coronary Artery Disease.

    PubMed

    Uchida, Yasumi; Uchida, Yasuto

    Novel imaging techniques using biomarkers have clarified the mechanisms of hitherto unanswered or misunderstood phenomena of coronary artery disease and enabled evaluation of myocardial blood and tissue fluid flows in vivo. Dye-staining coronary angioscopy using Evans blue (EB) as the biomarker can visualize fibrin and damaged endothelial cells, revealing that the so-called platelet thrombus is frequently a fibrin-rich thrombus; occlusive transparent fibrin thrombus, but not platelet thrombus, is not infrequently a cause of acute coronary syndrome; "fluffy" coronary luminal surface is caused by fibrin threads arising from damaged endothelial cells and is a residue of an occlusive thrombus after autolysis in patients with acute coronary syndrome without angiographically demonstrable coronary stenosis; and web or membrane-like fibrin thrombus is a cause of stent edge restenosis. Fluorescent angioscopy using visual or near-infrared light wavelengths is now used clinically for molecular imaging of the substances such as lipoproteins and cholesterol that constitute coronary plaques. Dye-staining cardioscopy using EB or fluorescein enables direct and real-time visualization of subendocardial microcirculation.

  12. Genetics of Lipid Traits and Relationship to Coronary Artery Disease

    PubMed Central

    Keenan, Tanya E.; Rader, Daniel J.

    2013-01-01

    Despite the critical importance of plasma lipoproteins in the development of atherosclerosis, varying degrees of evidence surround the causal associations of lipoproteins with coronary artery disease (CAD). These causal contributions can be assessed by employing genetic variants as unbiased proxies for lipid levels. A relatively large number of low-density lipoprotein cholesterol (LDL-C) variants strongly associate with CAD, confirming the causal impact of this lipoprotein on atherosclerosis. Although not as firmly established, genetic evidence supporting a causal role of triglycerides (TG) in CAD is growing. Conversely, high-density lipoprotein cholesterol (HDL-C) variants not associated with LDL-C or TG have not yet been shown to be convincingly associated with CAD, raising questions about the causality of HDL-C in atherosclerosis. Finally, genetic variants at the LPA locus associated with lipoprotein(a) [Lp(a)] are decisively linked to CAD, indicating a causal role for Lp(a). Translational investigation of CAD-associated lipid variants may identify novel regulatory pathways with therapeutic potential to alter CAD risk. PMID:23881580

  13. The Prevalence of Metabolic Syndrome in Coronary Artery Disease Patients

    PubMed Central

    Montazerifar, Farzaneh; Bolouri, Ahmad; Mahmoudi Mozaffar, Milad; Karajibani, Mansour

    2016-01-01

    Background Metabolic syndrome (MetS) is a worldwide health problem, which is growing in Iranian adults. MetS is associated with risk of type 2 diabetes and coronary artery disease (CAD). In this study, we aimed to investigate the prevalence of MetS and its individual components in CAD patients. Methods This cross-sectional study was performed on 200 CAD patients who had undergone elective coronary angiography at the cardiology department. Anthropometric indices including waist circumference (WC) and body mass index were measured. Blood samples were obtained to determine glucose and lipid profile. MetS components were defined according to the modified Adult Treatment Panel III (ATP III) criteria. Results The prevalence of MetS among patients was 49.5% (women: 55.9%; men: 40.2%; P < 0.05). The prevalence increased with age. The low high-density lipoprotein-cholesterol (low HDL-C) (84.8%), high fasting blood glucose (high FBG) (77.8%) and high WC (75.8%) were the most prevalent risk factors in CAD patients with MetS. Conclusions Recent data indicate that the dyslipidemia, hyperglycemia and abdominal obesity are crucial predictors of MetS in CAD patients. Further prospective studies are recommended for more clarification. PMID:28197293

  14. Signal and image processing for early detection of coronary artery diseases: A review

    NASA Astrophysics Data System (ADS)

    Mobssite, Youness; Samir, B. Belhaouari; Mohamad Hani, Ahmed Fadzil B.

    2012-09-01

    Today biomedical signals and image based detection are a basic step to diagnose heart diseases, in particular, coronary artery diseases. The goal of this work is to provide non-invasive early detection of Coronary Artery Diseases relying on analyzing images and ECG signals as a combined approach to extract features, further classify and quantify the severity of DCAD by using B-splines method. In an aim of creating a prototype of screening biomedical imaging for coronary arteries to help cardiologists to decide the kind of treatment needed to reduce or control the risk of heart attack.

  15. Multiple pulmonary artery aneurysms: a rare cause of massive hemoptysis as presentation of Behcet's disease.

    PubMed

    Al Amri, Salem Mohammad; Banjar, Ahmad Hassan; Cheema, Ahsan Iqbal

    2014-11-01

    We report a case of an acute episode of massive hemoptysis in a diagnosed patient of Behcet's disease, managed conservatively, using angio-guided vascular plug and coils for occluding the multiple bilateral pulmonary artery aneurysms with thoracic surgery backup. The episode of massive hemoptysis was caused by ruptured Pulmonary Artery Aneurysms (PAA).

  16. Aging syndrome genes and premature coronary artery disease

    PubMed Central

    Low, Adrian F; O'Donnell, Christopher J; Kathiresan, Sekar; Everett, Brendan; Chae, Claudia U; Shaw, Stanley Y; Ellinor, Patrick T; MacRae, Calum A

    2005-01-01

    Background Vascular disease is a feature of aging, and coronary vascular events are a major source of morbidity and mortality in rare premature aging syndromes. One such syndrome is caused by mutations in the lamin A/C (LMNA) gene, which also has been implicated in familial insulin resistance. A second gene related to premature aging in man and in murine models is the KLOTHO gene, a hypomorphic variant of which (KL-VS) is significantly more common in the first-degree relatives of patients with premature coronary artery disease (CAD). We evaluated whether common variants at the LMNA or KLOTHO genes are associated with rigorously defined premature CAD. Methods We identified 295 patients presenting with premature acute coronary syndromes confirmed by angiography. A control group of 145 patients with no evidence of CAD was recruited from outpatient referral clinics. Comprehensive haplotyping of the entire LMNA gene, including the promoter and untranslated regions, was performed using a combination of TaqMan® probes and direct sequencing of 14 haplotype-tagging single nucleotide polymorphisms (SNPs). The KL-VS variant of the KLOTHO gene was typed using restriction digest of a PCR amplicon. Results Two SNPs that were not in Hardy Weinberg equilibrium were excluded from analysis. We observed no significant differences in allele, genotype or haplotype frequencies at the LMNA or KLOTHO loci between the two groups. In addition, there was no evidence of excess homozygosity at the LMNA locus. Conclusion Our data do not support the hypothesis that premature CAD is associated with common variants in the progeroid syndrome genes LMNA and KLOTHO. PMID:16262891

  17. Genetics of coronary artery disease and myocardial infarction

    PubMed Central

    Dai, Xuming; Wiernek, Szymon; Evans, James P; Runge, Marschall S

    2016-01-01

    Atherosclerotic coronary artery disease (CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction (MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MI-associated genetic variants identified using candidate gene approaches and genome-wide association studies (GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI. PMID:26839654

  18. Cerebral Small Vessel Disease and Arterial Stiffness: Tsunami Effect in the Brain?

    PubMed Central

    Saji, Naoki; Toba, Kenji; Sakurai, Takashi

    2016-01-01

    Background Cerebral small vessel diseases, including silent lacunar infarcts, white matter hyperintensities, and microbleeds, pose a risk for cerebrovascular disease, cognitive impairment, and the geriatric syndrome via effects on arterial stiffness. However, the vascular, physiological, and metabolic roles of arterial stiffness in cerebral small vessel diseases remain unclear. Summary Arterial stiffness can be assessed using various indicators such as the ankle-brachial index, pulse wave velocity, cardio-ankle vascular index, and augmentation index. Arterial stiffness is independently associated with all components of cerebral small vessel disease including silent lacunar infarcts, white matter hyperintensities, and microbleeds, although there are some methodological differences between the various surrogate markers. Evidence of arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. Further, vascular narrowing due to atherosclerosis and vascular stiffness due to lipohyalinosis can accelerate the pulse waves. This hemodynamic stress, pulsatile pressure, or blood pressure variability can cause a ‘tsunami effect’ towards the cerebral parenchyma and lead to cerebral small vessel disease. Previous studies have shown that silent lacunar infarcts and white matter hyperintensities are strongly associated with arterial stiffness. However, the association between microbleeds and arterial stiffness remains controversial, as there are two vessel mechanisms related to microbleeds: cerebral amyloid angiopathy and hypertensive small vessel disease. Key Messages Cerebral small vessel disease with associated arterial stiffness is a risk factor for silent cerebral lesions, stroke, and cognitive impairment. Improvement of the living environment, management of risk factors, and innovation and development of novel drugs that improve arterial stiffness may suppress the progression of cerebral small vessel disease, and may reduce

  19. Limitations of regional myocardial thallium clearance for identification of disease in individual coronary arteries

    SciTech Connect

    Becker, L.C.; Rogers, W.J. Jr.; Links, J.M.; Corn, C. )

    1989-11-15

    The purpose of this study was to critically evaluate the usefulness of postexercise regional myocardial thallium-201 clearance for identifying disease in individual coronary arteries. Exercise and redistribution planar imaging studies were performed in 114 subjects, including 19 normal volunteers and 95 patients undergoing cardiac catheterization (70 with and 25 without greater than or equal to 50% narrowing in one or more coronary arteries). Thallium clearance was measured from predefined myocardial regions corresponding to the left anterior descending, left circumflex and right coronary arteries and was expressed as the percent decrease in activity at 4 h, assuming monoexponential clearance. In regions perfused by a normal or insignificantly diseased coronary artery, mean 4 h clearance was 58.9 +/- 9.4% for normal volunteers, 43.1 +/- 15.5% for catheterized patients without coronary artery disease and 36.3 +/- 24.9% for catheterized patients with coronary artery disease (p less than 0.001 patients with coronary artery disease versus normal volunteers). Clearance from normal regions was significantly associated with two measures of exercise performance: percent of predicted maximal heart rate achieved (r = 0.49) and exercise duration (r = 0.35). In regions perfused by a stenotic coronary artery, mean clearance was lower (31.1 +/- 19.8%) but was not significantly different from that in normal regions in the same patients. Clearance from diseased regions was also associated with maximal exercise heart rate (r = 0.28) and exercise duration (r = 0.41), but not with percent coronary artery stenosis (r = 0.02). After taking exercise performance into account, the number of diseased vessels or the presence or absence of disease in a given vessel had little influence on regional thallium clearance.

  20. Long-Term Comparative Outcomes of Patients With Peripheral Artery Disease With and Without Concomitant Coronary Artery Disease.

    PubMed

    Chen, Debbie C; Singh, Gagan D; Armstrong, Ehrin J; Waldo, Stephen W; Laird, John R; Amsterdam, Ezra A

    2017-04-15

    There are limited contemporary data on guideline-directed medical therapy (GDMT) utilization and long-term clinical outcomes in patients with peripheral artery disease (PAD) with and without concomitant coronary artery disease (CAD). From 2006 to 2013, 879 patients with claudication or critical limb ischemia (CLI) underwent diagnostic angiography or therapeutic endovascular intervention at our multidisciplinary vascular center. GDMT use was assessed at the time of angiography, and major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality were determined during 5 years of follow-up. Cox proportional hazard modeling was used to adjust for baseline differences between patients with and without concomitant CAD. Despite a higher adherence to GDMT (all p ≤0.002) for the use of aspirin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statins, patients with PAD and concomitant CAD had higher unadjusted 5-year rates of MACCE (hazard ratio [HR] 1.7, 95% CI 1.3 to 2.1, p = 0.0001) and all-cause mortality (HR 1.86, 95% CI 1.4 to 2.4, p = 0.0001). After adjustment for baseline co-morbidities, the presence of CAD remained an independent risk factor for mortality (adjusted HR 1.35, 95% CI 1.02 to 1.80, p = 0.04) but not for MACCE (adjusted HR 1.24, 95% CI 0.96 to 1.60, p = 0.10) in patients with PAD. A sensitivity analysis limited to patients with CLI demonstrated that concomitant CAD was associated with significantly higher adjusted rates of both MACCE (adjusted HR 1.52, 95% CI 1.14 to 2.03, p = 0.01) and mortality (adjusted HR 1.64, 95% CI 1.12 to 2.20, p = 0.006). In conclusion, despite higher rates of GDMT use, PAD patients with concomitant CAD had significantly increased risk of all-cause mortality during a 5-year postprocedural follow-up. The subgroup of CLI patients with concomitant CAD was at particularly high risk for both MACCE and all-cause mortality.

  1. Angiotensin-Converting-Enzyme Inhibition in Stable Coronary Artery Disease

    PubMed Central

    2008-01-01

    BACKGROUND Angiotensin-converting-enzyme (ACE) inhibitors are effective in reducing the risk of heart failure, myocardial infarction, and death from cardiovascular causes in patients with left ventricular systolic dysfunction or heart failure. ACE inhibitors have also been shown to reduce atherosclerotic complications in patients who have vascular disease without heart failure. METHODS In the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial, we tested the hypothesis that patients with stable coronary artery disease and normal or slightly reduced left ventricular function derive therapeutic benefit from the addition of ACE inhibitors to modern conventional therapy. The trial was a double-blind, placebo-controlled study in which 8290 patients were randomly assigned to receive either trandolapril at a target dose of 4 mg per day (4158 patients) or matching placebo (4132 patients). RESULTS The mean (±SD) age of the patients was 64±8 years, the mean blood pressure 133±17/78±10 mm Hg, and the mean left ventricular ejection fraction 58±9 percent. The patients received intensive treatment, with 72 percent having previously undergone coronary revascularization and 70 percent receiving lipid-lowering drugs. The incidence of the primary end point — death from cardiovascular causes, myocardial infarction, or coronary revascularization — was 21.9 percent in the trandolapril group, as compared with 22.5 percent in the placebo group (hazard ratio in the trandolapril group, 0.96; 95 percent confidence interval, 0.88 to 1.06; P=0.43) over a median follow-up period of 4.8 years. CONCLUSIONS In patients with stable coronary heart disease and preserved left ventricular function who are receiving “current standard” therapy and in whom the rate of cardiovascular events is lower than in previous trials of ACE inhibitors in patients with vascular disease, there is no evidence that the addition of an ACE inhibitor provides further benefit in

  2. Clinical findings of intracranial vertebral artery disease using magnetic resonance angiography.

    PubMed

    Liu, Lu-Han; Chen, Clayton Chi-Chang; Chang, Ming-Hong

    2004-09-01

    The vertebral artery lesion has a variety of clinical characteristics. We sought to clarify the clinical patterns and the location of the intracranial vertebral artery (ICVA) diseases according to analyses of images obtained using magnetic resonance angiography (MRA). We studied vascular lesions, risk factors, symptoms, signs, and outcomes in 35 patients with ICVA disease (3 had bilateral occlusion; 9, unilateral occlusion; 6, bilateral stenosis; and 17, unilateral stenosis). The most common site of unilateral and bilateral lesions was the distal ICVA after the origin of posterior inferior cerebellar artery (PICA). We found accompanying basilar artery disease in 28.6% of patients with unilateral and bilateral ICVA disease. The majority of the ICVA lesions were associated with internal carotid arteries disease (48.8%). The common vascular risk factors were hypertension (71%), diabetes mellitus (34%), hyperlipidemia (31%), smoking (29%), and coronary artery disease (23%). Eighteen patients (51.4%) had transient ischemic attacks (TIAs) only, 10 patients (28.6%) had TIAs before stroke, and 5 patients (14.3%) had strokes without TIAs. Most patients (80%) with TIAs, with or without stroke, had multiple episodes. Vertigo or dizziness, ataxia, limbs weakness and abnormal gait were the common symptoms and signs. At 6 months follow-up, 66.7% patients had no symptoms or only slight symptoms that caused no disability. Our data showed (1) the usual location of ICVA disease (occlusion or severe stenosis) was distal to PICA, especially near the vertebrobasilar junction; (2) the risk factors were hypertension, diabetes mellitus, hyperlipidemia, smoking, and coronary artery disease; (3) patients with ICVA disease had a high frequency of accompanying internal carotid, middle cerebral, or basilar artery disease; (4) vertigo or dizziness, and ataxia were the common symptoms and signs; (5) TIA was the most common clinical pattern; (6) the outcome was favorable, except in cases with

  3. Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients.

    PubMed

    Seyahi, Emire; Melikoglu, Melike; Akman, Canan; Hamuryudan, Vedat; Ozer, Harun; Hatemi, Gulen; Yurdakul, Sebahattin; Tuzun, Hasan; Oz, Buge; Yazici, Hasan

    2012-01-01

    Pulmonary artery aneurysms (PAAs) are well known causes of mortality and morbidity in Behçet disease (BD). However, pulmonary artery involvement in BD is not limited to PAA; the other main type of pulmonary artery involvement is pulmonary artery thrombus (PAT), with or without associated PAA. In addition, other types of lung disease like nodules and cavities in the lung parenchyma are frequently associated with pulmonary artery involvement, and can be misinterpreted as being due to infection. We surveyed the clinical, radiologic, and laboratory characteristics and outcome of 47 BD patients with pulmonary artery involvement and the associated findings, all seen and followed at a single dedicated tertiary care center.We identified 47 (41 male, 6 female) patients in whom pulmonary artery involvement was diagnosed, who were registered in the multidisciplinary clinic at Cerrahpasa Medical Faculty between January 2000 and December 2007. Mean age at diagnosis was 29 ± 8 years, and mean disease duration to the onset of pulmonary artery involvement was 3.6 ± 4.8 years. Hemoptysis was the most common presenting symptom (79%) followed by cough, fever, dyspnea, and pleuritic chest pain. Thirty-four of 47 patients (72%) presented with PAA, including 8 with associated PAT. The remaining 13 patients (28%) had isolated PAT. Patients with isolated PAT in general have clinical features similar to patients with PAA. However, hemoptysis was less frequent and voluminous in patients with isolated PAT. Most (91%) of the patients had active disease outside the lungs when they presented with pulmonary artery involvement.Forty (85%) patients had nodules and 6 (13%) had cavities when first seen. Peripheral venous thrombosis was present in 36 of 47 (77%) patients, and intracardiac thrombi in 12 of the 36 (33%) patients. Nodules, cavities, and intracardiac thrombi were mainly present in the acute stages of pulmonary artery involvement.Pulmonary artery involvement is usually multiple, and

  4. [Pulmonary artery aneurysms in Behçet's disease: contribution of imaging in 5 cases].

    PubMed

    Hassine, Elyès; Bousnina, Sophia; Marniche, Kamel; Fennira, Hammouda; Ben Khelil, Jalila; Ben Mustapha, Mohamed Ali; Megdiche, Mohamed Lamine; Chabbou, Abdellatif

    2002-05-01

    Pulmonary involvement in Behçet's disease is an uncommon condition (12%). Thromboembolism of the superior vena cava and/or other mediastinal veins, aneurysms of the aorta and pulmonary arteries are the main vascular manifestations in addition to pulmonary infarct and intrathoracic hemorrhage. Despite their scarcity, respiratory symptoms may be life-threatening. The aim of this study was to assess the contribution of thoracic imaging for one of the most serious aspects of the disease: pulmonary artery aneurysm. We report five patients with pulmonary artery aneurysms (mean age: 39.5 years). Hemoptysia revealed Behçet's disease in three. Initially explored by conventional radiography, computed tomography and angiography, pulmonary artery aneurysms are currently investigated well with helicoidal computed tomography, digital angiography, magnetic resonance imaging (MRI) and angio-MRI. These imaging techniques provide helpful information for the diagnosis of Behçet's disease.

  5. Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease

    PubMed Central

    Patel, Manesh R.; Conte, Michael S.; Cutlip, Donald E.; Dib, Nabil; Geraghty, Patrick; Gray, William; Hiatt, William R.; Ho, Mami; Ikeda, Koji; Ikeno, Fumiaki; Jaff, Michael R.; Jones, W. Schuyler; Kawahara, Masayuki; Lookstein, Robert A.; Mehran, Roxana; Misra, Sanjay; Norgren, Lars; Olin, Jeffrey W.; Povsic, Thomas J.; Rosenfield, Kenneth; Rundback, John; Shamoun, Fadi; Tcheng, James; Tsai, Thomas T.; Suzuki, Yuka; Vranckx, Pascal; Wiechmann, Bret N.; White, Christopher J.; Yokoi, Hiroyoshi; Krucoff, Mitchell W.

    2016-01-01

    The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease. PMID:25744011

  6. What You Need to Know If You Have Coronary Artery Disease

    MedlinePlus

    ... that you are at increased risk for developing atherosclerosis (commonly called hardening of the arteries), then this Patient Page is for you. Why does atherosclerosis develop in the first place? This disease is ...

  7. Diagnosis & Treatment | Coronary Artery Disease | NIH MedlinePlus the Magazine

    MedlinePlus

    ... Diagnosis Your healthcare provider diagnoses coronary artery disease (atherosclerosis) based on your medical and family histories, a ... may recommend one or more tests to diagnose atherosclerosis. These tests can help define the extent of ...

  8. Inflammation and Immunity in Diseases of the Arterial Tree: Players and Layers

    PubMed Central

    Libby, Peter; Hansson, Göran K.

    2014-01-01

    The hypothesis that immunity and inflammation participate in the pathogenesis of vascular diseases has now gained widespread recognition and stimulated work around the globe. Broadening knowledge has extended the recognition of the role of immune and inflammatory mechanisms to all of the layers of the artery, to all levels of the arterial tree, and implicated virtually all arms, cellular “players,” and effector molecules and pathways involved in these crucial host defenses, that turn against us in disease. We provide here a guide to a compendium series of papers that aimed to look forward, and broaden the traditional focus of immunopathogenesis of arterial disease, with the goal of integrating the “players” and the “layers” involved. While the field has advanced remarkably, much remains to be done, and this commentary also aims to highlight some of the gaps that future research should strive to close regarding the participation of inflammation and immunity in arterial diseases. PMID:25593275

  9. Peripheral Arterial Disease Study (PERART): Prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality

    PubMed Central

    Alzamora, María Teresa; Baena-Díez, José Miguel; Sorribes, Marta; Forés, Rosa; Toran, Pere; Vicheto, Marisa; Pera, Guillem; Reina, María Dolores; Albaladejo, Carlos; Llussà, Judith; Bundó, Magda; Sancho, Amparo; Heras, Antonio; Rubiés, Joan; Arenillas, Juan Francisco

    2007-01-01

    Background The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index (AAI) is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the PERART study (PERipheral ARTerial disease) is to determine the prevalence of peripheral arterial disease (both silent and symptomatic) in a general population of both sexes and determine its predictive value related to morbimortality (cohort study). Methods/Design This cross-over, cohort study consists of 2 phases: firstly a descriptive, transversal cross-over study to determine the prevalence of peripheral arterial disease, and secondly, a cohort study to evaluate the predictive value of AAI in relation to cardiovascular morbimortality. From September 2006 to June 2007, a total of 3,010 patients over the age of 50 years will be randomly selected from a population adscribed to 24 healthcare centres in the province of Barcelona (Spain). The diagnostic criteria of peripheral arterial disease will be considered as an AAI < 0.90, determined by portable Doppler (8 Mhz probe) measured twice by trained personnel. Cardiovascular risk will be calculated with the Framingham-Wilson tables, with Framingham calibrated by the REGICOR and SCORE groups. The subjects included will be evaluted every 6 months by telephone interview and the clnical history and death registries will be reviewed. The appearance of the following cardiovascular events will be considered as variables of response: transitory ischaemic accident, ictus, angina, myocardial infartction, symptomatic abdominal aneurysm and vascular mortality. Discussion In this study we hope to determine the prevalence of peripheral arterial disease, especially the silent forms, in the general population and establish its relationship with cardiovascular morbimortality. A low

  10. Increased arterial diameters in the posterior cerebral circulation in men with Fabry disease.

    PubMed

    Uçeyler, Nurcan; Homola, György A; Guerrero González, Hans; Kramer, Daniela; Wanner, Christoph; Weidemann, Frank; Solymosi, László; Sommer, Claudia

    2014-01-01

    A high load of white matter lesions and enlarged basilar arteries have been shown in selected patients with Fabry disease, a disorder associated with an increased stroke risk. We studied a large cohort of patients with Fabry disease to differentially investigate white matter lesion load and cerebral artery diameters. We retrospectively analyzed cranial magnetic resonance imaging scans of 87 consecutive Fabry patients, 20 patients with ischemic stroke, and 36 controls. We determined the white matter lesion load applying the Fazekas score on fluid-attenuated inversion recovery sequences and measured the diameters of cerebral arteries on 3D-reconstructions of the time-of-flight-MR-angiography scans. Data of different Fabry patient subgroups (males-females; normal-impaired renal function) were compared with data of patients with stroke and controls. A history of stroke or transient ischemic attacks was present in 4/30 males (13%) and 5/57 (9%) females with Fabry disease, all in the anterior circulation. Only one man with Fabry disease showed confluent cerebral white matter lesions in the Fazekas score assessment (1%). Male Fabry patients had a larger basilar artery (p<0.01) and posterior cerebral artery diameter (p<0.05) compared to male controls. This was independent of disease severity as measured by renal function and did not lead to changes in arterial blood flow properties. A basilar artery diameter of >3.2 mm distinguished between men with Fabry disease and controls (sensitivity: 87%, specificity: 86%, p<0.001), but not from stroke patients. Enlarged arterial diameters of the posterior circulation are present only in men with Fabry disease independent of disease severity.

  11. Role of surgical revascularization in diabetic patients with coronary artery disease.

    PubMed

    Góngora, Enrique; Sundt, Thoralf M

    2005-03-01

    Diabetes is a well-known risk factor for morbidity and mortality associated with coronary artery disease. Currently, diabetics represent approximately a quarter of patients requiring coronary revascularization in the USA. The purpose of this article is to review and analyze the available data in surgical revascularization of diabetic patients with coronary artery disease. The review will also examine new developments in myocardial revascularization and assess their probable impact on the long-term outcome of diabetic patients.

  12. Oxidative stress in coronary artery disease: epigenetic perspective.

    PubMed

    Lakshmi, Sana Venkata Vijaya; Naushad, Shaik Mohammad; Reddy, Cheruku Apoorva; Saumya, Kankanala; Rao, Damera Seshagiri; Kotamraju, Srigiridhar; Kutala, Vijay Kumar

    2013-02-01

    The association between oxidative stress and coronary artery disease (CAD) is well documented. However, the role of epigenetic factors contributing to oxidative stress is relatively unexplored. In this study, we aimed to explore the impact of DNA methylation profile in BCL2/E1B adenovirus interacting protein 3 (BNIP3), extracellular superoxide dismutase (EC-SOD) and glutathione-S-transferase P1 (GSTP1) on the oxidative stress in CAD. Further, the contribution of folate pathway genetic polymorphisms in regulating epigenome was elucidated. The expression of BNIP3, EC-SOD, and GSTP1 were studied by using Maxima@SYBR-green based real-time qPCR approach in peripheral blood samples. Combined bisulfite restriction analysis and methylation-specific PCR were used to study promoter CpG island methylation. Further, the effect of homocysteine on BNIP3 gene expression was studied in human aortic endothelial cells in vitro. CAD cases exhibited upregulation of BNIP3, downregulation of EC-SOD and GSTP1. Hypomethylation of BNIP3 and hypermethylation of EC-SOD were observed in CAD cases. The expression of BNIP3 was positively correlated with homocysteine, MDA, protein carbonyls, and methylene tetrahydrofolate reductase C677T, while showing inverse association with cytosolic serine hydroxymethyl transferase C1420T. The expressions of EC-SOD and GSTP1 showed positive association with thymidylate synthase (TYMS) 2R3R, while inverse association with MDA, protein carbonyls, and methionine synthase reductase (MTRR) A66G. In vitro analysis showed homocysteine-dependent upregulation of BNIP3. The results of this study suggest that the aberrations in one-carbon metabolism appear to induce altered gene expression of EC-SOD, GSTP1, and BNIP3, and thus contribute to the increased oxidative stress and increased susceptibility to CAD.

  13. Coronary artery disease and the contours of pharmaceuticalization.

    PubMed

    Pollock, Anne; Jones, David S

    2015-04-01

    Coronary artery disease (CAD) has dominated mortality for most of the past century, not just in Europe and North America but worldwide. Treatments for CAD, both pharmaceutical and surgical, have become leading sectors of the healthcare economy. This paper focuses on the therapeutic landscape for CAD in the United States. We hope to add texture to the broader conversation of pharmaceuticalization explored in this issue by situating pharmaceutical therapies as just one element in the broader therapeutic terrain, alongside cardiac surgery and interventional cardiology. Patients with CAD must navigate a therapeutic landscape with three intersecting paths: lifestyle change, pharmaceuticals, and surgery. While pharmaceuticals are often seen as a quick fix, a way of avoiding more difficult lifestyle changes, it is surgery and angioplasty that promise patients the quickest fix of all. There also is another option, often overlooked by analysts but popular among physicians and patients: inaction. The U.S. context is often critiqued as a site of excessive treatment with respect to both drugs and procedures, and yet there is deep stratification within it--over-treatment in many populations and under-treatment in others. People who experience the serious risks of CAD do so in a racialized terrain of durable preoccupations with difference and unequal access to care. While the pharmaceuticalization literature disproportionately attends to lifestyle drugs, which some observers consider to be medically inappropriate or unnecessary, CAD does remain the leading cause of death. Thus, the stakes are high. Examination of the pharmaceuticalization of CAD in light of surgical treatments and racial disparities offers a window into the pervasiveness and persuasiveness of pharmaceuticals in an increasingly consumer-driven medicine, as well as the limits of their appeal and their reach.

  14. Community walking programs for treatment of peripheral artery disease

    PubMed Central

    Mays, Ryan J.; Rogers, R. Kevin; Hiatt, William R.; Regensteiner, Judith G.

    2013-01-01

    Background Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), while effective, are often not utilized due to barriers including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option, as they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methodologies and outcomes of community walking programs for PAD. Methods A literature review using appropriate search terms was conducted within PubMed/Medline and the Cochrane databases to identify studies in the English language employing community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. Results Randomized controlled trials (n=10) examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes with no differences in peak walking time compared to supervised walking exercise groups. Conclusions Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs. PMID:24103409

  15. Variability in Fundamental Frequency during Speech in Prodromal and Incipient Parkinson's Disease: A Longitudinal Case Study

    ERIC Educational Resources Information Center

    Harel, Brian; Cannizzaro, Michael; Snyder, Peter J.

    2004-01-01

    Nearly two centuries ago, Parkinson (1817) first observed that a particular pattern of speech changes occur in patients with idiopathic Parkinson's disease (PD). Numerous studies have documented these changes using a wide variety of acoustic measures, and yet few studies have attempted to quantify any such changes longitudinally, through the early…

  16. A longitudinal study for the impact of Johne's Disease status on milk production in individual cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Longitudinal data from three commercial dairy herds in the Northeast United States were collected from 2004 to 2007. Johne’s Disease status, as indicated by Mycobacterium avium subsp. paratuberculosis infection levels, was determined through quarterly ELISA serum testing, biannual fecal culture, and...

  17. Renovascular heart failure: heart failure in patients with atherosclerotic renal artery disease.

    PubMed

    Kawarada, Osami; Yasuda, Satoshi; Noguchi, Teruo; Anzai, Toshihisa; Ogawa, Hisao

    2016-07-01

    Atherosclerotic renal artery disease presents with a broad spectrum of clinical features, including heart failure as well as hypertension, and renal failure. Although recent randomized controlled trials failed to demonstrate renal artery stenting can reduce blood pressure or the number of cardiovascular or renal events more so than medical therapy, increasing attention has been paid to flash pulmonary edema and congestive heart failure associated with atherosclerotic renal artery disease. This clinical entity "renovascular heart failure" is diagnosed retrospectively. Given the increasing global burden of heart failure, this review highlights the background and catheter-based therapeutic aspects for renovascular heart failure.

  18. Impaired Global Right Ventricular Longitudinal Strain Predicts Long-Term Adverse Outcomes in Patients with Pulmonary Arterial Hypertension

    PubMed Central

    Park, Jae-Hyeong; Park, Margaret M.; Farha, Samar; Sharp, Jacqueline; Lundgrin, Erika; Comhair, Suzy; Tang, Wai Hong; Erzurum, Serpil C.

    2015-01-01

    Background New 2-dimensional strain echocardiography enables quantification of right ventricular (RV) mechanics by assessing global longitudinal strain of RV (GLSRV) in patients with pulmonary arterial hypertension (PAH). However, the prognostic significance of impaired GLSRV is unclear in these patients. Methods Comprehensive echocardiography was performed in 51 consecutive PAH patients without atrial fibrillation (40 females, 48 ± 14 years old) with long-term follow-up. GLSRV was measured with off-line with velocity vector imaging (VVI, Siemens Medical System, Mountain View, CA, USA). Results GLSRV showed significant correlation with RV fractional area change (r = -0.606, p < 0.001), tricuspid annular plane systolic excursion (r = -0.579, p < 0.001), and RV Tei index (r = 0.590, p < 0.001). It showed significant correlations with pulmonary vascular resistance (r = 0.469, p = 0.001) and B-natriuretic peptide concentration (r = 0.351, p = 0.012). During a clinical followup time (45 ± 15 months), 20 patients experienced one or more adverse events (12 death, 2 lung transplantation, and 15 heart failure hospitalization). After multivariate analysis, age [hazard ratio (HR) = 2.343, p = 0.040] and GLSRV (HR = 2.122, p = 0.040) were associated with adverse clinical events. Age (HR = 3.200, p = 0.016) and GLSRV (HR = 2.090, p = 0.042) were also significant predictors of death. Impaired GLSRV (≥ -15.5%) was associated with lower event-free survival (HR = 4.906, p = 0.001) and increased mortality (HR = 8.842, p = 0.005). Conclusion GLSRV by VVI showed significant correlations with conventional echocardiographic parameters indicating RV systolic function. Lower GLSRV (≥ -15.5%) was significantly associated with presence of adverse clinical events and deaths in PAH patients. PMID:26140151

  19. The effect of regular physical activity on the left ventricle systolic function in patients with chronic coronary artery disease.

    PubMed

    Panovský, R; Kukla, P; Jančár, R; Meluzín, J; Jančík, J; Kincl, V; Poloková, K; Mífková, L; Havelková, A; Látalová, R; Dobšák, P; Pešl, M

    2011-01-01

    The purpose of this study was to assess the influence of aerobic training on the left ventricular (LV) systolic function. Thirty patients with stable coronary artery disease, who had participated in the conducted 3-month physical training, were retrospectively divided into 2 cohorts. While patients in the cohort I (n=14) had continued training individually for 12 months, patients in the cohort II (n=16) had stopped training after finishing the conducted program. Rest and stress dobutamine/atropine echocardiography was performed in all patients before the training program and 1 year later. The peak systolic velocities of mitral annulus (Sa) were assessed by tissue Doppler imaging for individual LV walls. In addition, to determine global LV systolic longitudinal function, the four-site mean systolic velocity was calculated (Sa glob). According to the blood supply, left ventricular walls were divided into 5 groups: A- walls supplied by nonstenotic artery; B- walls supplied by coronary artery with stenosis ≤50 %; C- walls supplied by coronary artery with stenosis 51-70 %; D- walls with stenosis of supplying artery 71-99 %; and E- walls with totally occluded supplying artery. In global systolic function, the follow-up values of Sa glob in cohort I were improved by 0.23±0.36 as compared with baseline values at rest, and by 1.26±0.65 cm/s at the maximal load, while the values of Sa glob in cohort II were diminished by 0.53±0.22 (p=NS), and by 1.25±0.45 cm/s (p<0.05), respectively. Concerning the resting regional function, the only significant difference between cohorts in follow-up changes was found in walls E: 0.37±0.60 versus -1.76±0.40 cm/s (p<0.05). At the maximal load, the significant difference was found only in walls A (0.16±0.84 versus -2.67±0.87 cm/s; p<0.05). Patients with regular 12-month physical activity improved their global left ventricle systolic function mainly due to improvement of contractility in walls supplied by a totally occluded coronary

  20. Cystic adventitial disease of the popliteal artery: elongation into the media of the popliteal artery and communication with the knee joint capsule: report of a case.

    PubMed

    Unno, N; Kaneko, H; Uchiyama, T; Yamamoto, N; Nakamura, S

    2000-01-01

    Cystic disease of the popliteal artery is a rare disorder in which most cases involve the formation of an adventitial cyst that disturbs the popliteal artery blood flow. We present herein the case of a patient presenting with popliteal artery occlusion due to compression by a cyst which formed at the media of the popliteal artery. The onset occurred during a baseball game in which he played catcher. Preoperative magnetic resonance imaging demonstrated a communication of the cyst with the adjacent knee joint. This unusual case could provide important clues to help identify the pathogenesis of this disease.

  1. IREB2 and GALC Are Associated with Pulmonary Artery Enlargement in Chronic Obstructive Pulmonary Disease

    PubMed Central

    Lee, Jin Hwa; Cho, Michael H.; Hersh, Craig P.; McDonald, Merry-Lynn N.; Wells, J. Michael; Dransfield, Mark T.; Bowler, Russell P.; Lynch, David A.; Lomas, David A.; Crapo, James D.

    2015-01-01

    Pulmonary hypertension is associated with advanced chronic obstructive pulmonary disease (COPD), although pulmonary vascular changes occur early in the course of the disease. Pulmonary artery (PA) enlargement (PAE) measured by computed tomography correlates with pulmonary hypertension and COPD exacerbation frequency. Genome-wide association studies of PAE in subjects with COPD have not been reported. To investigate whether genetic variants are associated with PAE within subjects with COPD, we investigated data from current and former smokers from the COPDGene Study and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study. The ratio of the diameter of the PA to the diameter of the aorta (A) was measured using computed tomography. PAE was defined as PA/A greater than 1. A genome-wide association study for COPD with PAE was performed using subjects with COPD without PAE (PA/A ≤ 1) as a control group. A secondary analysis used smokers with normal spirometry as a control group. Genotyping was performed on Illumina platforms. The results were summarized using fixed-effect meta-analysis. Both meta-analyses revealed a genome-wide significant locus on chromosome 15q25.1 in IREB2 (COPD with versus without PAE, rs7181486; odds ratio [OR] = 1.32; P = 2.10 × 10−8; versus smoking control subjects, rs2009746; OR = 1.42; P = 1.32 × 10−9). PAE was also associated with a region on 14q31.3 near the GALC gene (rs7140285; OR = 1.55; P = 3.75 × 10−8). Genetic variants near IREB2 and GALC likely contribute to genetic susceptibility to PAE associated with COPD. This study provides evidence for genetic heterogeneity associated with a clinically important COPD vascular subtype. PMID:25101718

  2. IREB2 and GALC are associated with pulmonary artery enlargement in chronic obstructive pulmonary disease.

    PubMed

    Lee, Jin Hwa; Cho, Michael H; Hersh, Craig P; McDonald, Merry-Lynn N; Wells, J Michael; Dransfield, Mark T; Bowler, Russell P; Lynch, David A; Lomas, David A; Crapo, James D; Silverman, Edwin K

    2015-03-01

    Pulmonary hypertension is associated with advanced chronic obstructive pulmonary disease (COPD), although pulmonary vascular changes occur early in the course of the disease. Pulmonary artery (PA) enlargement (PAE) measured by computed tomography correlates with pulmonary hypertension and COPD exacerbation frequency. Genome-wide association studies of PAE in subjects with COPD have not been reported. To investigate whether genetic variants are associated with PAE within subjects with COPD, we investigated data from current and former smokers from the COPDGene Study and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study. The ratio of the diameter of the PA to the diameter of the aorta (A) was measured using computed tomography. PAE was defined as PA/A greater than 1. A genome-wide association study for COPD with PAE was performed using subjects with COPD without PAE (PA/A ≤ 1) as a control group. A secondary analysis used smokers with normal spirometry as a control group. Genotyping was performed on Illumina platforms. The results were summarized using fixed-effect meta-analysis. Both meta-analyses revealed a genome-wide significant locus on chromosome 15q25.1 in IREB2 (COPD with versus without PAE, rs7181486; odds ratio [OR] = 1.32; P = 2.10 × 10(-8); versus smoking control subjects, rs2009746; OR = 1.42; P = 1.32 × 10(-9)). PAE was also associated with a region on 14q31.3 near the GALC gene (rs7140285; OR = 1.55; P = 3.75 × 10(-8)). Genetic variants near IREB2 and GALC likely contribute to genetic susceptibility to PAE associated with COPD. This study provides evidence for genetic heterogeneity associated with a clinically important COPD vascular subtype.

  3. Relation between high density lipoprotein cholesterol and coronary artery disease in asymptomatic men

    SciTech Connect

    Uhl, G.S.; Troxler, R.G.; Hickman, J.R. Jr.; Clark, D.

    1981-11-01

    The well established inverse relation of high density lipoprotein cholesterol (HDL) and the risk of coronary artery disease was tested in a cross-sectional group of 572 asymptomatic aircrew members who were being screened for risk of coronary artery disease. A battery of tests was performed, including determinations of fasting serum cholesterol, HDL cholesterol and triglycerides and performance of a maximal symptom-limited exercise tolerance test. Of the 572 patients, 132 also had an abnormal S-T segment response to exercise testing or were otherwise believed to have an increased risk of organic heart disease and subsequently underwent coronary angiography. Significant coronary artery disease was found in 16 men and minimal or subcritical coronary disease in 14; coronary angiograms were normal in the remaining 102 men. The remaining 440 men, who were believed to have a 1 percent chance of having coronary artery disease by sequential testing of risk factors and treadmill testing, had a mean cholesterol level of 213 mg/100 ml, a mean HDL cholesterol of 51 mg/100 ml and a mean cholesterol/HDL ratio of 4.4. The mean values of cholesterol, HDL cholesterol and cholesterol/HDL cholesterol did not differ significantly in men with normal angiographic finding and those with subcritical coronary disease. However, 14 of 16 men with coronary artery disease had a cholesterol/HDL ratio of 6.0 or more whereas only 4 men with normal coronary arteries had a ratio of 6.0 or more. Of the classical coronary risk factors evaluated, the cholesterol/HDL ratio of 6.0 or more had the highest odds ratio (172:1). It appears that determination of HDL cholesterol level helps to identify asymptomatic persons with a greater risk of having coronary artery disease.

  4. [Behcet's disease with multiple intracranial arterial aneurysms. Report of a case].

    PubMed

    el Abbadi, N; el Mostarchid, B; Ababou, A; Mosadik, A; Semlali, A; Bellakhdar, F

    1999-06-01

    Behçet disease is a rare condition in central Europe but more common in Morocco. A case of multiple intracranial arterial aneurysms occurring in a 44 year-old Moroccan patient with 2-years history of Behçet's disease is reported. CT-scan showed an infarction in the right middle cerebral artery territory. Panangiography showed sacciform aneurysms of the bifurcation of the right and left middle cerebral arteries. The draining veins and sinuses were normal. The two aneurysms were successfully clipped by two microsurgical frontotemporal approach in one surgical time. There have been only eight reports of intracranial arterial aneurysms associated to Behçet disease in the literature.

  5. Development of Pulmonary Artery Aneurysms Due to Behçet's Disease and Resolution after Treatment

    PubMed Central

    Kage, Hidenori; Goto, Yasushi; Amano, Yosuke; Makita, Kosuke; Isago, Hideaki; Kobayashi, Kouichi; Narumoto, Osamu; Okudaira, Reiko; Tanaka, Goh; Takami, Kazutaka; Ohishi, Nobuya; Nagase, Takahide

    2016-01-01

    We herein describe a patient with Behçet's disease in whom we followed the development and resolution of pulmonary artery aneurysms. He presented with intermittent hemoptysis, pulmonary thromboembolism was initially diagnosed, and anticoagulant therapy was started. Over the next several months, the expansion of pulmonary arteries was noted. Five months after his initial admission, he was readmitted for massive hemoptysis, and further examinations revealed that he had Behçet's disease. Corticosteroids and intravenous cyclophosphamide were started. Over the next five months, the pulmonary artery aneurysms and thrombosis resolved. The development of pulmonary artery aneurysms led to the diagnosis of Behçet's disease, and they resolved after immunosuppressive therapy. PMID:27853079

  6. Celiac artery aneurysm repair in Behcet disease complicated by recurrent thoracoabdominal aortic aneurysms.

    PubMed

    Ullery, Brant W; Pochettino, Alberto; Wang, Grace J; Jackson, Benjamin M; Fairman, Ronald M; Woo, Edward Y

    2010-02-01

    Behçet's disease is a chronic, relapsing multisystemic inflammatory disorder characterized by recurrent orogenital aphthous ulcers, uveitis, and skin lesions. Vascular involvement occurs in up to 38% of these patients. Herein, we report a 19-year-old male who initially presented with an isolated celiac artery aneurysm that was treated with open surgical repair. The patient was subsequently diagnosed with Behçet's disease after the development of oral aphthous ulcers and multiple recurrent postoperative deep venous thromboses and thoracoabdominal arterial aneurysms. Ultimately, a hybrid approach was undertaken. This is the fifth celiac artery aneurysm ever reported in this patient group and the first to present with an isolated celiac artery aneurysm as the initial manifestation of Behçet's disease.

  7. Disgust in pre-clinical Huntington's disease: a longitudinal study.

    PubMed

    Sprengelmeyer, R; Schroeder, U; Young, A W; Epplen, J T

    2006-01-01

    Emotion recognition from both face and voice and experience of emotions were investigated in a group of non-symptomatic people at risk of carrying the Huntington's disease gene who presented for genetic testing. Based on the results of the DNA test, a group of people carrying the Huntington's disease gene (HD+), and a group of non-carriers (HD-) were formed. Since we were especially interested in the time course of possible deficits in emotion recognition, all people at risk were reassessed 6 and 12 months after the initial assessment. Recognising facial expressions of disgust was significantly impaired on all three assessments in the HD+ group, while recognition of vocal emotions and the experience of emotions were largely unaffected, confirming that deficits in recognition of facial expressions of disgust are an early correlate of carrying the gene for Huntington's disease. The inclusion of a healthy control group (n = 37) further allowed an estimate of the genetic and environmental contribution to deficits in facial emotion recognition.

  8. Relationship between R-R interval and left ventricular systolic synchrony in subjects with coronary artery disease determined using angiography.

    PubMed

    Ma, Li; Li, Yanhong; Wu, Zhisheng; Mu, Yuming

    2016-01-01

    The aim of this study was to assess the relationship between R-R interval and left ventricular systolic synchrony in subjects with coronary artery disease determined using angiography. A total of 277 subjects who underwent coronary angiography for suspected CAD were recruited in this study. For all subjects, the R-R interval was quantified using simultaneous ECG, and the times to peak systolic longitudinal strain (Tssl) on 17 LV segments were quantified using four-dimensional (4D) speckle tracking echocardiography (STE) and manually measured. The independent predictors of R-R interval using multiple linear regression analyses were the time to peak systolic longitudinal strain in the apical-septal segment (Tssl-Apical-S) (β=0.325, P=0.000), smoking status (β=0.141, P=0.013), and the time to peak systolic longitudinal strain in the basal-anterolateral segment (Tssl-Basal-AL) (β=0.151, P=0.014), which were significantly independently associated with the R-R interval. In multiple regression analyses, smoking status (OR, 1.943; 95% CI, 1.119-3.375, P=0.018), Tssl-Basal-AL (OR, 1.002; 95% CI, 1.000-1.004, P=0.043), the time to peak systolic longitudinal strain in the mid-inferoseptal segment (Tssl-Mid-IS) (OR, 1.008; 95% CI, 1.003-1.013, P=0.004), and Tssl-Apical-S (OR, 1.010; 95% CI, 1.004-1.016, P=0.002) remained independently associated with the risk of a longer R-R interval (the median 849.49 ms was set as the cutoff value) in the population. Our findings may provide the basis for future investigations of LV systolic synchrony and cardiac resynchronization therapy.

  9. Relationship between R-R interval and left ventricular systolic synchrony in subjects with coronary artery disease determined using angiography

    PubMed Central

    Ma, Li; Li, Yanhong; Wu, Zhisheng; Mu, Yuming

    2016-01-01

    The aim of this study was to assess the relationship between R-R interval and left ventricular systolic synchrony in subjects with coronary artery disease determined using angiography. A total of 277 subjects who underwent coronary angiography for suspected CAD were recruited in this study. For all subjects, the R-R interval was quantified using simultaneous ECG, and the times to peak systolic longitudinal strain (Tssl) on 17 LV segments were quantified using four-dimensional (4D) speckle tracking echocardiography (STE) and manually measured. The independent predictors of R-R interval using multiple linear regression analyses were the time to peak systolic longitudinal strain in the apical-septal segment (Tssl-Apical-S) (β=0.325, P=0.000), smoking status (β=0.141, P=0.013), and the time to peak systolic longitudinal strain in the basal-anterolateral segment (Tssl-Basal-AL) (β=0.151, P=0.014), which were significantly independently associated with the R-R interval. In multiple regression analyses, smoking status (OR, 1.943; 95% CI, 1.119-3.375, P=0.018), Tssl-Basal-AL (OR, 1.002; 95% CI, 1.000-1.004, P=0.043), the time to peak systolic longitudinal strain in the mid-inferoseptal segment (Tssl-Mid-IS) (OR, 1.008; 95% CI, 1.003-1.013, P=0.004), and Tssl-Apical-S (OR, 1.010; 95% CI, 1.004-1.016, P=0.002) remained independently associated with the risk of a longer R-R interval (the median 849.49 ms was set as the cutoff value) in the population. Our findings may provide the basis for future investigations of LV systolic synchrony and cardiac resynchronization therapy. PMID:28078178

  10. National survey of pediatric hospitalizations due to Kawasaki disease and coronary artery aneurysms in the USA.

    PubMed

    Okubo, Yusuke; Nochioka, Kotaro; Sakakibara, Hiroshi; Testa, Marcia; Sundel, Robert P

    2017-02-01

    Several studies revealed the epidemiology of Kawasaki disease-related hospitalizations among children in the USA and other countries. However, disparities of developing coronary artery aneurysms by race/ethnicity, patient socioeconomic status, and geographic locations remain unknown in the USA. Hospital discharge record data of patients with Kawasaki disease aged 19 years or younger were obtained from the 2003, 2006, 2009, and 2012 Kid's Inpatient Database. The data were weighted to estimate the annual hospitalization rates with respect to age, gender, and race/ethnicity in the USA. Multivariable logistic regression was conducted to ascertain the factors associated with the development of coronary artery aneurysms. Total annual hospitalization rates of Kawasaki disease showed a decreasing trend, ranging from 6.54 per 100,000 children in 2003 to 6.11 per 100,000 children in 2012 (p < 0.001). The proportions of coronary artery aneurysms among patients with Kawasaki disease ranged from 2.25 to 3.20%. Factor associated with the development of coronary artery aneurysms was hospitals in West (OR 2.15, 95% CI 1.42-3.26). Race/ethnicity, health insurance status, and household income were not associated with the development of coronary artery aneurysms. Total hospitalization rates of Kawasaki disease showed a decreasing trend. Children admitted to hospitals in West region were more likely to develop coronary artery aneurysms.

  11. Traditional risk factors are predictive on segmental localization of coronary artery disease.

    PubMed

    Tacoy, Gulten; Balcioglu, Akif Serhat; Akinci, Sinan; Erdem, Güliz; Kocaman, Sinan Altan; Timurkaynak, Timur; Cengel, Atiye

    2008-01-01

    The aim of this study was to investigate the relationship between established risk factors and segmental localization of coronary artery disease. A total of 2760 patients who underwent coronary angiography were enrolled into the study. Coronary angiographic segmental evaluation was performed according to the scheme of American Heart Association. Patients were classified into 2 groups (group 1: normal coronary artery segments, group 2: coronary artery segments with coronary artery disease). Smoking was highly related with left main coronary artery disease (odds ratio = 7.5; P = .005). Diabetes mellitus and male sex increased the risk of atherosclerosis in all coronary vasculature (odds ratio = 2.7-2.2; P < .001-P < .001). Hypertension was correlated with distal coronary artery (odds ratio = 1.4; P < .001) and family history with distal circumflex lesions (odds ratio = 4.5; P = .005) High triglyceride levels were associated with right coronary artery lesions (odds ratio = 1.00; P =.03). The effect of advanced age was small (odds ratio = 1.08; P < .001). Risk factors may be predictive for segmental localization.

  12. Epigenetics of Cardiovascular Disease – A New “Beat” in Coronary Artery Disease

    PubMed Central

    Turgeon, Paul J.; Sukumar, Aravin N.; Marsden, Philip A.

    2014-01-01

    Genome-wide association studies (GWAS) have become a powerful tool in the identification of disease-associated variants. Unfortunately, many of these studies have found that the estimated variability in cardiovascular disease risk cannot be fully explained by traditional paradigms of genetic variation in protein coding genes. Moreover, traditional views do not sufficiently explain the well-known link between cardiovascular disease and environmental influence. We posit that epigenetics, defined as chromatin-based mechanisms important in the regulation of gene expression that do not involve changes in the DNA sequence per se, represents the missing link. The nuclear-based mechanisms that contribute to epigenetic gene regulation can be broadly separated into three unique but highly interrelated processes: DNA methylation and hydroxymethylation; histone density and post-translational modifications; and RNA-based mechanisms. Together they complement the cis/trans perspective on transcriptional control paradigms in blood vessels. Moreover, it provides a molecular basis for understanding how the environment impacts the genome to modify cardiovascular disease risk over the lifetime of a cell and its offspring. This review provides an introduction to epigenetic function and cardiovascular disease, with a focus on endothelial cell biology. Additionally, we highlight emerging concepts on epigenetic gene regulation that are highly relevant to atherosclerosis and coronary artery disease. PMID:25408699

  13. A longitudinal assessment of periodontal disease in 52 miniature schnauzers

    PubMed Central

    2014-01-01

    Background Periodontal disease (PD) is the most widespread oral disease in dogs and has been associated with serious systemic diseases. The disease is more prevalent in small breeds compared to large breeds and incidence increases with advancing age. In prevalence studies 84% of beagles over the age of 3 and 100% of poodles over the age of 4 were diagnosed with PD. Current knowledge of the rate of progression of PD is limited. The objective of this study was to determine the rate of PD progression in miniature schnauzers, an at risk small breed of dog. Dogs (n = 52, age 1.3-6.9 years) who had received a regular oral care regime prior to this study were assessed for levels of gingivitis and periodontitis around the whole gingival margin in every tooth under general anaesthetic. Assessments were conducted approximately every six weeks for up to 60 weeks following the cessation of the oral care regime. Results All of the 2155 teeth assessed entered the study with some level of gingivitis. 23 teeth entered the study with periodontitis, observed across 12 dogs aged between 1.3 and 6.9 years. 35 dogs had at least 12 teeth progress to periodontitis within 60 weeks. Of the teeth that progressed to periodontitis, 54% were incisors. The lingual aspect of the incisors was significantly more likely to be affected (p < 0.001). The severity of gingivitis in periodontitis-affected teeth was variable with 24% of the aspects affected having very mild gingivitis, 36% mild gingivitis and 40% moderate gingivitis. Periodontitis progression rate was significantly faster in older dogs. Only one dog (age 3.5) did not have any teeth progress to periodontitis after 60 weeks. Conclusions This is the first study to have assessed the progression rate of periodontitis in miniature schnauzers and highlights that with no oral care regime, the early stages of periodontitis develop rapidly in this breed. An oral care regime and twice yearly veterinary dental health checks should be

  14. Identification of longitudinally dynamic biomarkers in Alzheimer’s disease cerebrospinal fluid by targeted proteomics

    PubMed Central

    2014-01-01

    Background Alzheimer’s disease (AD) is the leading cause of dementia affecting greater than 26 million people worldwide. Although cerebrospinal fluid (CSF) levels of Aβ42, tau, and p-tau181 are well established as diagnostic biomarkers of AD, there is a need for additional CSF biomarkers of neuronal function that continue to change during disease progression and could be used as pharmacodynamic measures in clinical trials. Multiple proteomic discovery experiments have reported a range of CSF biomarkers that differ between AD and control subjects. These potential biomarkers represent multiple aspects of the disease pathology. The performance of these markers has not been compared with each other, and their performance has not been evaluated longitudinally. Results We developed a targeted-proteomic, multiple reaction monitoring (MRM) assay for the absolute quantitation of 39 peptides corresponding to 30 proteins. We evaluated the candidate biomarkers in longitudinal CSF samples collected from aged, cognitively-normal control (n = 10), MCI (n = 5), and AD (n = 45) individuals (age > 60 years). We evaluated each biomarker for diagnostic sensitivity, longitudinal consistency, and compared with CSF Aβ42, tau, and p-tau181. Four of 28 quantifiable CSF proteins were significantly different between aged, cognitively-normal controls and AD subjects including chitinase-3-like protein 1, reproducing published results. Four CSF markers demonstrated significant longitudinal change in AD: Amyloid precursor protein, Neuronal pentraxin receptor, NrCAM and Chromogranin A. Robust correlations were observed within some subgroups of proteins including the potential disease progression markers. Conclusion Using a targeted proteomics approach, we confirmed previous findings for a subset of markers, defined longitudinal performance of our panel of markers, and established a flexible proteomics method for robust multiplexed analyses. PMID:24902845

  15. Peripheral arterial obliterative disease. Cost of illness in France.

    PubMed

    Montron, A; Guignard, E; Pelc, A; Comte, S

    1998-01-01

    The main purpose of this study, carried out in 1995, was to determine, using available sources, the cost of peripheral arterial obliterative disease (PAOD) in France over a 1-year period. This cost-of-illness study was based on a retrospective analysis of the available literature and databases. It involved a description of epidemiological data and a cost estimate of the different medical resources consumed over 1 year. For this latter purpose, a payer perspective was chosen. Data were extracted from national representative surveys and databases with respect to morbidity and mortality [from the National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale; INSERM) and the National Sickness Insurance Fund for Salaried People (Caisse Nationale d'Assurance Maladie des Travailleurs Salariés; CNAMTS)], consultations, examination tests and drug prescriptions [from the French Medical Audit conducted by Intercontinental Medical Statistics (IMS)], hospitalisations [from the Statistical Unit of the Department of Health-Service des Statistiques, des Etudes et des Systemes d'Information (SESI) and the National Public Research Centre in Health Economics (Centre de Recherche d'Etude et de Documentation en Economie de la Santé; CREDES)] and related health expenditure from CNAMTS. In France, the prevalence of stage II PAOD (Leriche and Fontaine classification) in 1992 was estimated to be 675,000; 53% of these patients had undergone vascular or bypass surgery. The total annual cost of healthcare (including consultations, drugs, laboratory tests, hospitalisation and hydrotherapy) for the management of patients with PAOD ranged from 3.9 billion French francs (F) to F4.6 billion (1995 values), depending on the type of hospital considered. 50% of this cost was related to hospitalisations and 75% was covered by the CNAMTS. Although this study was only a partial evaluation and did not take into account indirect costs or nonmedical direct

  16. Electrocardiographic chest wall mapping in the diagnosis of coronary artery disease.

    PubMed Central

    Salmasi, A M; Nicolaides, A N; Vecht, R J; Hendry, W G; Salmasi, S N; Nicolaides, E P; Kidner, P H; Besterman, E M

    1983-01-01

    Chest wall mapping of ST segment changes, inverted U waves, and Q waves using 16 electrocardiographic electrodes was performed at rest and during and after bicycle ergometry in 150 patients presenting with chest pain suggestive of angina. All patients underwent coronary angiography. The presence or absence of appreciable coronary artery disease (greater than or equal to 50% stenosis) was detected with a sensitivity of 98% and a specificity of 88%. The identification of lesions in individual coronary arteries was also possible with a sensitivity and specificity of 87% and 85% respectively for the territory of the left anterior descending and diagonal artery, 71% and 85% respectively for the right coronary artery, and 85% and 80% respectively for the circumflex artery. This test appears to be a reliable non-invasive screening method for selecting patients for angiography. PMID:6407696

  17. Association of abdominal aortic calcium with coronary artery calcium and obstructive coronary artery disease: a pilot study.

    PubMed

    Zweig, Bryan M; Sheth, Meetkumar; Simpson, Steve; Al-Mallah, Mouaz H

    2012-02-01

    This study sought to determine the association of abdominal aortic calcium (AAC) with coronary artery calcium (CAC) and obstructive coronary artery disease (CAD). We included 58 patients (mean age 54.4 years, 40% males) without known CAD who underwent a non-contrast abdominal computed tomography (CT) scan and 64-slice coronary computed tomography angiography (CCTA) within 2 years. A total AAC score using Agatston method was calculated in the abdominal aorta from the takeoff of the celiac artery to the aortic bifurcation. A total of 43/58 patients had AAC. Patients with AAC were older with no differences in other baseline characteristics. None of the patients with a zero AAC score had obstructive CAD. Thus, an AAC score of zero had a 100% negative predictive value (NPV) and 23% positive predictive value (PPV) for the detection of obstructive CAD and an 80% NPV and 79% PPV for detection of any coronary plaque. Using multivariate linear regression, AAC score was an independent predictor of CAC score after adjusting for age (P < 0.001). In our analysis, AAC score correlates with CAC score and has a high NPV to rule out CAD. The absence of AAC may help exclude obstructive coronary disease and improve the selection of patients that may benefit from further risk stratification.

  18. Peripheral Artery Disease and Chronic Kidney Disease: Clinical Synergy to Improve Outcomes

    PubMed Central

    Garimella, Pranav S.; Hirsch, Alan T.

    2014-01-01

    Persons with chronic kidney disease (CKD) are at a higher risk of developing peripheral artery disease (PAD) and its adverse health outcomes than individuals in the general population who have normal renal function. Classic atherosclerosis risk factors care (e.g., age, smoking, diabetes, hypertension and hyperlipidemia) are common in CKD patients, but CKD also imposes additional unique risk factors that promote arterial disease (e.g., chronic inflammation, hypoalbuminemia and a pro-calcific state). Current nephrology clinical practice is adversely impacted by PAD diagnostic challenges, the complexities of managing two serious comorbid diseases, delayed vascular specialist referral, and slow PAD treatment initiation in CKD patients. Persons with CKD are less likely to be provided recommended ‘optimal’ PAD care. The knowledge that both limb and mortality outcomes are significantly worse in CKD patients, especially those on dialysis, is not a biologic fact, but can serve as a care delivery call to action. Nephrologists can facilitate positive change. This manuscript proposes that patients with PAD and CKD be strategically co-managed by care teams that encompass the skills to create and use evidence-based care pathways. This proposed collaborative multidisciplinary approach will include vascular medicine specialists, nephrologists, wound specialists and mid-level providers. Just as clinical care quality metrics have served as the base for ESRD and acute MI quality improvement, it is time that such quality outcomes metrics be initiated for the large PAD-CKD population. This new system will identify and resolve key gaps in the current care model so that clinical outcomes improve within a cost-effective care frame for this vulnerable population. PMID:25443571

  19. A two years longitudinal study of a transgenic Huntington disease monkey

    PubMed Central

    2014-01-01

    Background A two-year longitudinal study composed of morphometric MRI measures and cognitive behavioral evaluation was performed on a transgenic Huntington’s disease (HD) monkey. rHD1, a transgenic HD monkey expressing exon 1 of the human gene encoding huntingtin (HTT) with 29 CAG repeats regulated by a human polyubiquitin C promoter was used together with four age-matched wild-type control monkeys. This is the first study on a primate model of human HD based on longitudinal clinical measurements. Results Changes in striatal and hippocampal volumes in rHD1 were observed with progressive impairment in motor functions and cognitive decline, including deficits in learning stimulus-reward associations, recognition memory and spatial memory. The results demonstrate a progressive cognitive decline and morphometric changes in the striatum and hippocampus in a transgenic HD monkey. Conclusions This is the first study on a primate model of human HD based on longitudinal clinical measurements. While this study is based a single HD monkey, an ongoing longitudinal study with additional HD monkeys will be important for the confirmation of our findings. A nonhuman primate model of HD could complement other animal models of HD to better understand the pathogenesis of HD and future development of diagnostics and therapeutics through longitudinal assessment. PMID:24581271

  20. Longitudinal study of viruses associated with canine infectious respiratory disease.

    PubMed

    Erles, Kerstin; Dubovi, Edward J; Brooks, Harriet W; Brownlie, Joe

    2004-10-01

    In this investigation a population of dogs at a rehoming center was monitored over a period of 2 years. Despite regular vaccination of incoming dogs against distemper, canine adenovirus type 2 (CAV-2), and canine parainfluenza virus (CPIV), respiratory disease was endemic. Tissue samples from the respiratory tract as well as paired serum samples were collected for analysis. The development of PCR assays for the detection of CPIV, canine adenovirus types 1 and 2, and canine herpesvirus (CHV) is described. Surprisingly, canine adenovirus was not detected in samples from this population, whereas 19.4% of tracheal and 10.4% of lung samples were positive for CPIV and 12.8% of tracheal and 9.6% of lung samples were positive for CHV. As reported previously, a novel canine respiratory coronavirus (CRCoV) was detected in this population (K. Erles, C. Toomey, H. W. Brooks, and J. Brownlie, Virology 310:216-223, 2003). Infections with CRCoV occurred mostly during the first week of a dog's stay at the kennel, whereas CPIV and CHV were detected at later time points. Furthermore, the evaluation of an enzyme-linked immunosorbent assay for detection of antibodies to CPIV and an immunofluorescence assay for detection of antibodies to CHV is described. This study shows that CPIV is present at kennels despite vaccination. In addition, other agents such as CHV and CRCoV may play a role in the pathogenesis of canine respiratory disease, whereas CAV-2 and canine distemper virus were not present in this population, indicating that their prevalence in the United Kingdom is low due to widespread vaccination of dogs.

  1. Longitudinal study of normal cognition in Parkinson disease

    PubMed Central

    Pigott, Kara; Rick, Jacqueline; Xie, Sharon X.; Hurtig, Howard; Chen-Plotkin, Alice; Duda, John E.; Morley, James F.; Chahine, Lama M.; Dahodwala, Nabila; Akhtar, Rizwan S.; Siderowf, Andrew; Trojanowski, John Q.

    2015-01-01

    Objective: To report the rates and predictors of progression from normal cognition to either mild cognitive impairment (MCI) or dementia using standardized neuropsychological methods. Methods: A prospective cohort of patients diagnosed with Parkinson disease (PD) and baseline normal cognition was assessed for cognitive decline, performance, and function for a minimum of 2 years, and up to 6. A panel of movement disorders experts classified patients as having normal cognition, MCI, or dementia, with 55/68 (80.9%) of eligible patients seen at year 6. Kaplan-Meier curves and Cox proportional hazard models were used to examine cognitive decline and its predictors. Results: We enrolled 141 patients, who averaged 68.8 years of age, 63% men, who had PD on average for 5 years. The cumulative incidence of cognitive impairment was 8.5% at year 1, increasing to 47.4% by year 6. All incident MCI cases had progressed to dementia by year 5. In a multivariate analysis, predictors of future decline were male sex (p = 0.02), higher Unified Parkinson's Disease Rating Scale motor score (p ≤ 0.001), and worse global cognitive score (p < 0.001). Conclusions: Approximately half of patients with PD with normal cognition at baseline develop cognitive impairment within 6 years and all new MCI cases progress to dementia within 5 years. Our results show that the transition from normal cognition to cognitive impairment, including dementia, occurs frequently and quickly. Certain clinical and cognitive variables may be useful in predicting progression to cognitive impairment in PD. PMID:26362285

  2. Longitudinal Study of Viruses Associated with Canine Infectious Respiratory Disease

    PubMed Central

    Erles, Kerstin; Dubovi, Edward J.; Brooks, Harriet W.; Brownlie, Joe

    2004-01-01

    In this investigation a population of dogs at a rehoming center was monitored over a period of 2 years. Despite regular vaccination of incoming dogs against distemper, canine adenovirus type 2 (CAV-2), and canine parainfluenza virus (CPIV), respiratory disease was endemic. Tissue samples from the respiratory tract as well as paired serum samples were collected for analysis. The development of PCR assays for the detection of CPIV, canine adenovirus types 1 and 2, and canine herpesvirus (CHV) is described. Surprisingly, canine adenovirus was not detected in samples from this population, whereas 19.4% of tracheal and 10.4% of lung samples were positive for CPIV and 12.8% of tracheal and 9.6% of lung samples were positive for CHV. As reported previously, a novel canine respiratory coronavirus (CRCoV) was detected in this population (K. Erles, C. Toomey, H. W. Brooks, and J. Brownlie, Virology 310:216-223, 2003). Infections with CRCoV occurred mostly during the first week of a dog's stay at the kennel, whereas CPIV and CHV were detected at later time points. Furthermore, the evaluation of an enzyme-linked immunosorbent assay for detection of antibodies to CPIV and an immunofluorescence assay for detection of antibodies to CHV is described. This study shows that CPIV is present at kennels despite vaccination. In addition, other agents such as CHV and CRCoV may play a role in the pathogenesis of canine respiratory disease, whereas CAV-2 and canine distemper virus were not present in this population, indicating that their prevalence in the United Kingdom is low due to widespread vaccination of dogs. PMID:15472304

  3. [Peripheral artery disease as supplemental diagnosis in coronary heart disease--influence on diagnostics, treatment and prognosis].

    PubMed

    Espinola-Klein, C; Savvidis, S; Kopp, H

    2014-01-01

    Peripheral arterial disease (PAD) increases cardiovascular event rate in patients with coronary artery disease (CAD). Therefore PAD should be considered in patients with CAD with regard to diagnostic and therapeutic strategies. PAD may difficult diagnostic tests in CAD patients. Patients with PAD and CAD may be limited in stress testing by decreased leg perfusion. In addition, arterial puncture can be more difficult in sclerotic femoral arteries. Cardiovascular risk factors should be treated carefully in all manifestations of atherosclerosis. Target values from current guidelines are similar for PAD and CAD. Inhibitors of platelet aggregation are indication in both CAD and PAD. Exercise not only improves walking distance in patients with intermittent claudication but also improves cardiovascular prognosis in patients with atherosclerosis.

  4. Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

    PubMed Central

    2010-01-01

    Purpose Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study. Patients and Methods In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months. Results Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%). Conclusion We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis. PMID:20958964

  5. Evaluation of diseased coronary arterial branches by polar representations of thallium-201 rotational myocardial imaging

    SciTech Connect

    Iino, T.; Toyosaki, N.; Katsuki, T.; Noda, T.; Natsume, T.; Yaginuma, T.; Hosoda, S.; Furuse, M.

    1987-09-01

    The perfusion territories in polar representations of stress Tl-201 rotational myocardial imaging in patients with angina pectoris who had one diseased coronary segment were analyzed. The lesions proximal or distal to the first major septal perforator in left anterior descending arteries were detected by the presence or absence of defects at the base of the anterior septum. Right coronary artery lesions were detected by the presence of defects at the basal posterior septum, in contrast to the preservation of myocardial uptake at this portion in lesions of the left circumflex artery. The specific defect patterns were detected in cases with lesions at the first diagonal, obtuse marginal, and posterolateral branches. Recognition of these defects in the polar maps allows detailed detection of diseased coronary arterial branches.

  6. Vertebral artery dissection in patients with autosomal dominant polycystic kidney disease.

    PubMed

    Kuroki, Takuma; Yamashiro, Kazuo; Tanaka, Ryota; Hirano, Kazuoki; Shimada, Yoshiaki; Hattori, Nobutaka

    2014-01-01

    Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal cystic disease, and it is associated with various extrarenal manifestations, including vascular complications, such as intracranial aneurysms, and aortic root dilatation and aneurysms. However, intracranial arterial dissection has rarely been reported. We herein report the cases of 2 patients with ADPKD who developed a vertebral artery (VA) dissection. Dissection was also observed on the other side of the VA and in the internal carotid artery in the first and second patient, respectively. Both patients also had a history of hypertension, which is frequently accompanied by ADPKD, and their serum creatinine levels were normal. Our report supports the importance of considering ADPKD as one of the possible pathogenic factors in arterial dissection.

  7. Drug-eluting stents in the management of peripheral arterial disease.

    PubMed

    Bosiers, Marc; Cagiannos, Catherine; Deloose, Koen; Verbist, Jürgen; Peeters, Patrick

    2008-01-01

    Since major meta-analyses of randomized controlled trials in interventional cardiology showed the potential of drug-eluting stents in decreasing restenosis and reintervention rates after coronary artery stenting, one of the next steps in the treatment of arterial occlusive disease is the transfer of the active coating technology towards peripheral arterial interventions. In this manuscript, we aim to provide a literature overview on available peripheral (lower limb, renal, and supra-aortic) drug-eluting stent applications, debate the cost implications, and give recommendations for future treatment strategies.

  8. Drug-eluting stents in the management of peripheral arterial disease

    PubMed Central

    Bosiers, Marc; Cagiannos, Catherine; Deloose, Koen; Verbist, Jürgen; Peeters, Patrick

    2008-01-01

    Since major meta-analyses of randomized controlled trials in interventional cardiology showed the potential of drug-eluting stents in decreasing restenosis and reintervention rates after coronary artery stenting, one of the next steps in the treatment of arterial occlusive disease is the transfer of the active coating technology towards peripheral arterial interventions. In this manuscript, we aim to provide a literature overview on available peripheral (lower limb, renal, and supra-aortic) drug-eluting stent applications, debate the cost implications, and give recommendations for future treatment strategies. PMID:18827906

  9. Pseudoaneurysm of the Superficial Femoral Artery in Behcet's Disease with Spontaneous Thrombosis Followed by CT Angiography

    SciTech Connect

    Yoshida, Satoru; Akiba, Hidenari; Tamakawa, Mituharu; Takeda, Miki; Yama, Naoya; Hareyama, Masato; Morita, Kazuo; Masuda, Atsushi; Shimamoto, Kazuaki

    1998-07-15

    A 25-year-old man developed sudden pain and a pulsating mass in the left thigh. A diagnosis of Behcet's disease was made because of four major symptoms. Laboratory data indicated active inflammation. Emergency spiral computed tomographic angiography (CTA) showed an aneurysm of the left superficial femoral artery (SFA). Under steroid therapy, follow-up spiral CTA showed spontaneous occlusion of the aneurysm. In the active phase of arteritis, spiral CTA is useful for the diagnosis of arterial lesions to avoid the arterial puncture of conventional arteriography.

  10. Rapidly progressive coronary artery disease as the first manifestation of antiphospholipid syndrome.

    PubMed

    Abdullah, Abdullah Sayied; Yagoub, Hatim; Kiernan, Thomas J; Daly, Caroline

    2014-04-08

    Antiphospholipid syndrome (APS) is an autoimmune multisystem disorder characterised by high incidence of arterial and venous thrombosis. Cardiovascular manifestations also include valvular heart disease, ventricular thrombi and higher risk for coronary artery disease (CAD). In this case report, we describe a 61-year-old woman who had no significant risk factors for CAD, and presented with aggressive disease in native and graft vessels that required multiple coronary interventions. The extent of her aggressive CAD could not be explained by her risk factors profile. Therefore autoantibodies screening was carried out and showed a strongly positive anticardiolipin and β2 glycoprotein-I antibody, and hence a diagnosis of antiphospholipid syndrome was made.

  11. The impact of peripheral arterial disease on patients with congestive heart failure.

    PubMed

    Keswani, Amit N; White, Christopher J

    2014-04-01

    Congestive heart failure (CHF) is a prevalent disease with many comorbidities and is associated with high health care expenditures. Peripheral arterial disease (PAD) is a known comorbidity of CHF and is associated with worse morbidity and mortality. CHF and PAD share risk factors, pathophysiology, treatment strategies, and prognostic features. We review the impact of PAD on patients with CHF using several studies to support PAD's influence on outcomes in CHF. Based on the evidence and current guidelines, patients with heart failure who are smokers, and those who have known coronary artery disease and/or diabetes should be screened for PAD.

  12. Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study

    PubMed Central

    Escobedo, Jorge; Rana, Jamal S.; Lombardero, Manuel S.; Albert, Stewart G.; Davis, Andrew M.; Kennedy, Frank P.; Mooradian, Arshag D.; Robertson, David G.; Srinivas, V. S.; Gebhart, Suzanne S. P.

    2010-01-01

    OBJECTIVE: To evaluate the effect of prior duration of diabetes, glycated hemoglobin level at study entry, and microalbuminuria or macroalbuminuria on the extent and severity of coronary artery disease (CAD) and peripheral arterial disease. PATIENTS AND METHODS: We studied baseline characteristics of the 2368 participants of the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) study, a randomized clinical trial that evaluates treatment efficacy for patients with type 2 diabetes and angiographically documented stable CAD. Patients were enrolled from January 1, 2001, through March 31, 2005. Peripheral arterial disease was ascertained by an ankle-brachial index (ABI) of 0.9 or less, and extent of CAD was measured by presence of multivessel disease, a left ventricular ejection fraction (LVEF) of less than 50%, and myocardial jeopardy index. RESULTS: Duration of diabetes of 20 or more years was associated with increased risk of ABI of 0.9 or less (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.04-2.26), intermittent claudication (OR, 1.61; 95% CI, 1.10-2.35), and LVEF of less than 50% (OR, 2.03; 95% CI, 1.37-3.02). Microalbuminuria was associated with intermittent claudication (OR, 1.53; 95% CI, 1.16-2.02) and ABI of 0.9 or less (OR, 1.31; 95% CI, 0.98-1.75), whereas macroalbuminuria was associated with abnormal ABI, claudication, and LVEF of less than 50%. There was a significant association between diabetes duration and extent of CAD as manifested by number of coronary lesions, but no other significant associations were observed between duration of disease, glycated hemoglobin levels, or albumin-to-creatinine ratio and other manifestations of CAD. CONCLUSION: Duration of diabetes and microalbuminuria or macroalbuminuria are important predictors of severity of peripheral arterial disease and left ventricular dysfunction in a cohort of patients selected for the presence of CAD. PMID:20042560

  13. Bone mineral density and cardiovascular risk factors in postmenopausal women with coronary artery disease

    PubMed Central

    Alissa, Eman M; Alnahdi, Wafa A; Alama, Nabil; Ferns, Gordon A

    2015-01-01

    It has been suggested that osteoporosis and coronary artery disease (CAD) have overlapping pathophysiological mechanisms and related risk factors. The aim of this study was to investigate the association between several traditional cardiovascular risk factors and measures of bone mineral density (BMD) in postmenopausal women with and without clinically significant CAD defined angiographically. A case–control study was undertaken of 180 postmenopausal women (aged between 48 and 88 years) who were recruited from King Abdulaziz University Hospital, Saudi Arabia. Study subjects underwent dual-energy x-ray absorptiometry and coronary angiography. The presence of hypertension, diabetes, dyslipidemia, obesity, smoking and physical activity was identified from clinical examination and history. Demographic, anthropometric and biochemical characteristics were measured. Univariate and multivariate analyses were employed to explore the relationships between cardiovascular risk factors, including BMD, and the presence of CAD. CAD patients were more likely to have a lower BMD and T-score at the femoral neck than those without CAD (P<0.05). Significant differences were found between the groups for fasting lipid profile, fasting blood glucose and anthropometric measures (P<0.05). Conditional logistic regression showed that 3 risk factors were significantly related with the presence of CAD: high-density lipoprotein-cholesterol (odds ratio, OR: 0.226, 95% confidence interval, CI: 0.062–0.826), fasting plasma glucose (OR: 1.154, 95% CI: 1.042–1.278) and femoral neck T-score (OR: 0.545, 95% CI: 0.374–0.794). This study suggests an association of low BMD and elevated CAD risk. Nevertheless, additional longitudinal studies are needed to determine the temporal sequence of this association. PMID:26587227

  14. Serum low-density lipoprotein levels, statin use, and cognition in patients with coronary artery disease

    PubMed Central

    Rej, Soham; Saleem, Mahwesh; Herrmann, Nathan; Stefatos, Anthi; Rau, Allison; Lanctôt, Krista L

    2016-01-01

    Aim Statins have been associated with decreased cognition due to the effects of low concentrations of low-density lipoprotein (LDL) on brain function. This has remained controversial and is particularly relevant to patients with coronary artery disease (CAD), who have an increased risk of cognitive decline and are frequently prescribed statins. This study hypothesized that low concentration of LDL is associated with poor cognition in CAD patients using statins. It also explored the association between high-dose versus low-dose statins on cognition in this population. Patients and methods Baseline cross-sectional data from a longitudinal study of 120 statin-using CAD patients were examined (mean statin duration 25±43 months). The main outcomes were measures of global cognition and cognitive domains, with poor cognition defined as cognitive performance ≤1 standard deviation below the population age and education adjusted means. A battery of cognitive tests was used to assess verbal memory, executive function, speed of processing, visuospatial memory, and global cognition. Adjusting for age, sex, education, and other covariates, multivariable logistic regression analyses assessed associations between low LDL levels (<1.5 mmol/L), statin use, and poor cognition. Results LDL levels were not associated with global cognition or individual cognitive domains. High-dose statin use was associated with higher visuospatial memory (odds ratio, OR [95% confidence interval, CI] =0.12 [0.02–0.66], P=0.01) and executive functioning (OR =0.25 [0.06–0.99], P=0.05). This effect was independent of covariates such as LDL levels. Conclusion Low LDL levels do not appear to be associated with poor cognition in CAD patients using statins. Whether high-dose statin use may have positive effects on cognition in CAD patients could be investigated in future studies. PMID:27877045

  15. Bone mineral density and cardiovascular risk factors in postmenopausal women with coronary artery disease.

    PubMed

    Alissa, Eman M; Alnahdi, Wafa A; Alama, Nabil; Ferns, Gordon A

    2015-01-01

    It has been suggested that osteoporosis and coronary artery disease (CAD) have overlapping pathophysiological mechanisms and related risk factors. The aim of this study was to investigate the association between several traditional cardiovascular risk factors and measures of bone mineral density (BMD) in postmenopausal women with and without clinically significant CAD defined angiographically. A case-control study was undertaken of 180 postmenopausal women (aged between 48 and 88 years) who were recruited from King Abdulaziz University Hospital, Saudi Arabia. Study subjects underwent dual-energy x-ray absorptiometry and coronary angiography. The presence of hypertension, diabetes, dyslipidemia, obesity, smoking and physical activity was identified from clinical examination and history. Demographic, anthropometric and biochemical characteristics were measured. Univariate and multivariate analyses were employed to explore the relationships between cardiovascular risk factors, including BMD, and the presence of CAD. CAD patients were more likely to have a lower BMD and T-score at the femoral neck than those without CAD (P<0.05). Significant differences were found between the groups for fasting lipid profile, fasting blood glucose and anthropometric measures (P<0.05). Conditional logistic regression showed that 3 risk factors were significantly related with the presence of CAD: high-density lipoprotein-cholesterol (odds ratio, OR: 0.226, 95% confidence interval, CI: 0.062-0.826), fasting plasma glucose (OR: 1.154, 95% CI: 1.042-1.278) and femoral neck T-score (OR: 0.545, 95% CI: 0.374-0.794). This study suggests an association of low BMD and elevated CAD risk. Nevertheless, additional longitudinal studies are needed to determine the temporal sequence of this association.

  16. Marital Discord and Coronary Artery Disease: A Comparison of Behaviorally Defined Discrete Groups

    ERIC Educational Resources Information Center

    Smith, Timothy W.; Uchino, Bert N.; Berg, Cynthia A.; Florsheim, Paul

    2012-01-01

    Objective: Marital difficulties can confer risk of coronary heart disease, as in a study of outwardly healthy couples (T. W. Smith et al., 2011) where behavioral ratings of low affiliation and high control during marital disagreements were associated with asymptomatic coronary artery disease (CAD). However, taxometric studies suggest that marital…

  17. Spontaneous Right Coronary Artery Rupture and Acute Cardiac Tamponade in Behçet's Disease.

    PubMed

    Keskin, Muhammed; Bozbay, Mehmet; Kayacıoğlu, İlyas; Koçoğulları, Cevdet; Bozbay, Ayfer Yıldız; Hayıroğlu, Mert İlker; Gürkan, Ufuk; Eren, Mehmet

    2016-11-01

    Coronary involvement in Behçet's disease is extremely rare and it can bring devastating consequences when it occurs. In this report, we present a 29-year-old male patient with Behçet's disease who developed rapidly changing and progressive coronary artery involvements under medical treatment.

  18. Effects of cranberry juice consumption on vascular function in patients with coronary artery disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cranberry juice contains polyphenolic compounds that could improve endothelial function and reduce cardiovascular disease risk. The objective was to examine the effects of cranberry juice on vascular function in subjects with coronary artery disease. We completed an acute pilot study with no placebo...

  19. Cortical cathepsin D activity and immunolocalization in Alzheimer disease, critical coronary artery disease, and aging.

    PubMed

    Haas, U; Sparks, D L

    1996-09-01

    The activity and immunocytochemical localization of cathepsin D in the frontal cortex were investigated in patients with Alzheimer disease (AD) and two groups of nondemented subjects; individuals with critical coronary artery disease (cCAD; > 75% stenosis) and non-heart disease controls (non-HD). The cathepsin D activity significantly increased with age in the non-HD population. No such age-related increase was observed in either AD or cCAD. Enzymatic activity was significantly increased in only the midaged, but not the older AD and cCAD subjects compared to controls. Immunocytochemical reactivity paralleled cathepsin D enzymatic activity. Frontal cortex neurons displayed an increased accumulation of cathepsin D immunoreactivity in aging (non-HD controls) with a further increase in cCAD, especially in the midaged group. Such immunoreactivity was markedly increased in AD. There was also an apparent age-related increase in the number of cathepsin D immunoreactive neurons in the non-HD population and a disease-related increase in only the mid-aged AD and cCAD subjects compared to controls. Senile plaques (SP) occurred in all AD patients, many cCAD, and a few of the oldest non-HD subjects, and they were immunoreactive to cathepsin D in each group. The data suggest a possible relationship between activation of cathepsin D and SP formation in AD, cCAD, and aging.

  20. Effect of ultrasonic nebulization on arterial oxygen saturation in chronic obstructive pulmonary disease.

    PubMed

    Flick, M R; Moody, L E; Block, A J

    1977-03-01

    Twenty patients with mild to severe chronic obstructive pulmonary disease received ultrasonic nebulization to assess the danger of short-term changes in blood gas levels during this therapy. The status of arterial oxygenation was monitored during 20 minutes of therapy and for 20 minutes following therapy. In nine patients with periodic studies of arterial blood, the mean change in arterial oxygen pressure from base line was a decrease of 0.8 mm Hg at ten minutes into therapy, 2.8 mm Hg at the conclusion of therapy, and 2.9 mm Hg 20 minutes after therapy. In all 20 patients, ear oximetric studies showed only a small mean change at ten minutes into therapy, at the end of therapy, and at 20 minutes after therapy. Changes in the status of arterial oxygenation during and after therapy with ultrasonic nebulization in a group of patients with chronic obstructive pulmonary disease are generally small and of no statistical and limited clinical significance; however, alarming falls in arterial oxygenation can occur and cannot be predicted by base-line testing of pulmonary function or studies of arterial blood. It would be prudent to monitor patients with chronic obstructive pulmonary disease during therapy with ultrasonic nebulization or to withhold therapy altogether.

  1. Comparison of thallium-201 scanning in idiopathic dilated cardiomyopathy and severe coronary artery disease

    SciTech Connect

    Dunn, R.F.; Uren, R.F.; Sadick, N.; Bautovich, G.; McLaughlin, A.; Hiroe, M.; Kelly, D.T.

    1982-10-01

    To determine whether cardiomyopathy could be distinguished from coronary artery disease, we used thallium scanning to study 25 patients with severe left ventricular dysfunction and chronic heart failure. Ten patients had normal coronary arteries and idiopathic cardiomyopathy (ejection fraction 20 +/- 5%), and 15 patients had multivessel coronary disease and left ventricular dysfunction (ejection fraction 25 +/- 6%). The exercise time and maximal heart rate were similar in the two groups. Two patients with cardiomyopathy and 11 with coronary artery disease had a positive exercise ECG (p less than 0.05). Thallium scans showed perfusion defects in all 25 patients. The perfusion defects were complete in nine coronary artery disease patients (60%) and in one patient (10%) with cardiomyopathy (p less than 0.05). Extensive defects involving more than 40% of the left ventricular circumference, the number of segments involved, redistribution on the 4-hour scan, lung uptake and ventricular size were similar in the two groups. Perfusion defects on thallium scanning can occur in patients with idiopathic dilated cardiomyopathy and chronic heart failure. Thallium scanning cannot be reliably used in patients with chronic heart failure to distinguish coronary artery disease from cardiomyopathy unless complete defects are present.

  2. Comparison of thallium-201 scanning in idiopathic dilated cardiomyopathy and severe coronary artery disease

    SciTech Connect

    Dunn, R.F.; Uren, R.F.; Sadick, N.; Bautovich, G.; McLaughlin, A.; Hiroe, M.; Kelly, D.T.

    1982-10-01

    To determine whether cardiomyopathy could be distinguished from coronary artery disease, we used thallium scanning to study 25 patients with severe left ventricular dysfunction and chronic heart failure. Ten patients had normal coronary arteries and idiopathic cardiomyopathy (ejection fraction 20 +/- 5%), and 15 patients had multivessel coronary disease and left ventricular dysfunction (ejection fraction 25 +/- 6%). The exercise time and maximal heart rate were similar in the two groups. Two patients with cardiomyopathy and 11 with coronary artery disease had a positive exercise ECG (p<0.05). Thallium scans showed perfusion defects in all 25 patients. The perfusion defects were complete in nine coronary artery disease patients (60%) and in one patient (10%) with cardiomyopathy (p<0.05). Extensive defects involving more than 40% of the left ventricular circumference, the number of segments involved, redistribution on the 4-hour scan, lung uptake and ventricular size were similar in the two groups. Perfusion defects on thallium scanning can occur in patients with idiopathic dilated cardiomyopathy and chronic heart failure. Thallium scanning cannot be reliably used in patients with chronic heart failure to distinguish coronary artery disease from cardiomyopathy unless complete defects are present.

  3. Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management

    PubMed Central

    Olin, Jeffrey W.; Sealove, Brett A.

    2010-01-01

    Peripheral artery disease (PAD), which comprises atherosclerosis of the abdominal aorta, iliac, and lower-extremity arteries, is underdiagnosed, undertreated, and poorly understood by the medical community. Patients with PAD may experience a multitude of problems, such as claudication, ischemic rest pain, ischemic ulcerations, repeated hospitalizations, revascularizations, and limb loss. This may lead to a poor quality of life and a high rate of depression. From the standpoint of the limb, the prognosis of patients with PAD is favorable in that the claudication remains stable in 70% to 80% of patients over a 10-year period. However, the rate of myocardial infarction, stroke, and cardiovascular death in patients with both symptomatic and asymptomatic PAD is markedly increased. The ankle brachial index is an excellent screening test for the presence of PAD. Imaging studies (duplex ultrasonography, computed tomographic angiography, magnetic resonance angiography, catheter-based angiography) may provide additional anatomic information if revascularization is planned. The goals of therapy are to improve symptoms and thus quality of life and to decrease the cardiovascular event rate (myocardial infarction, stroke, cardiovascular death). The former is accomplished by establishing a supervised exercise program and administering cilostazol or performing a revascularization procedure if medical therapy is ineffective. A comprehensive program of cardiovascular risk modification (discontinuation of tobacco use and control of lipids, blood pressure, and diabetes) will help to prevent the latter. PMID:20592174

  4. Optimal ECG Electrode Sites and Criteria for Detection of Asymptomatic Coronary Artery Disease at Rest and with Exercise.

    DTIC Science & Technology

    1985-12-01

    47 In OPTIMAL ECG ELECTRODE SITES AND CRITERIA to FOR DETECTION OF ASYMPTOMATIC CORONARY to ARTERY DISEASE AT REST AND WITH EXERCISE Ronald H...of Asymptomatic Coronary Artery Disease at Rest and with Exercise 12. PERSONAL AUTHOR(S) Selvester, Ronald H.; and Solomon, Joseph C.13a. TYPE OF...15-30, of all new coronary events in persons with previously unsuspected coronary disease . The prevalence of unrecognized but severe coronary artery

  5. Bilateral pulmonary artery aneurysms with protein C and protein S deficiency in a patient with Behçet's disease.

    PubMed

    Ozge, C; Calikoğlu, M; Yildiz, A; Türsen, U; Tamer, L

    2004-01-01

    Behçet's disease is a chronic inflammatory disorder of unknown aetiology, characterized by recurrent attacks. Pulmonary artery aneurysm is a rare but serious complication of Behçet's disease. We describe a patient with Behçet's disease and protein C and S deficiency who developed bilateral pulmonary artery aneurysms.

  6. Quantitative analysis of regional myocardial performance in coronary artery disease

    NASA Technical Reports Server (NTRS)

    Stewart, D. K.; Dodge, H. T.; Frimer, M.

    1975-01-01

    Findings from a group of subjects with significant coronary artery stenosis are given. A group of controls determined by use of a quantitative method for the study of regional myocardial performance based on the frame-by-frame analysis of biplane left ventricular angiograms are presented. Particular emphasis was placed upon the analysis of wall motion in terms of normalized segment dimensions, timing and velocity of contraction. The results were compared with the method of subjective assessment used clinically.

  7. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease.

    PubMed

    Shirai, Kazuyuki; Lansky, Alexandra J; Mehran, Roxana; Dangas, George D; Costantini, Costantino O; Fahy, Martin; Slack, Steven; Mintz, Gary S; Stone, Gregg W; Leon, Martin B

    2004-04-15

    The purpose of this study was to compare the clinical outcomes of stenting and minimally invasive coronary artery bypass grafting (MIDCAB) in patients with proximal left anterior descending (LAD) coronary artery disease. The Patency, Outcome, Economics of Minimally invasive direct coronary bypass (POEM) study demonstrated that MIDCAB had similar safety and long-term efficacy for LAD revascularization compared with conventional coronary artery bypass grafting. Although LAD stenting is superior to conventional balloon angioplasty, whether it is comparable to MIDCAB is not known. We identified a matched population of 429 consecutive patients with 1-vessel disease who underwent elective proximal LAD stenting and compared their clinical outcomes with those of the 152 patients in the MIDCAB group of the POEM study. The in-hospital event rate was similar in both groups, except for a shorter length of hospital stay with LAD stenting compared with MIDCAB (2.68 vs 4.07 days, p <0.0001). At 6-month follow-up, the incidence of death and Q-wave myocardial infarction or that of cerebrovascular accident was not significantly different between these 2 groups. However, target vessel revascularization was significantly higher with LAD stenting than MIDCAB (13.3% vs 6.6%, p = 0.045). In the subgroup of patients without diabetes, all clinical events were similar in both groups, and the benefit of a shorter hospital stay associated with stenting was maintained. Compared with MIDCAB, LAD stenting is associated with higher repeat revascularization rates but offers the advantage of shorter hospitalization. For nondiabetics with proximal LAD disease, stenting may be the revascularization strategy of choice.

  8. Current Status of Interventional Radiology Treatment of Infrapopliteal Arterial Disease

    SciTech Connect

    Rand, T.; Uberoi, R.

    2013-06-15

    Treatment of infrapopliteal arteries has developed to a standard technique during the past two decades. With the introduction of innovative devices, a variety of techniques has been created and is still under investigation. Treatment options range from plain balloon angioplasty (POBA), all sorts of stent applications, such as bare metal, balloon expanding, self-expanding, coated and drug-eluting stents, and bio-absorbable stents, to latest developments, such as drug-eluting balloons. Regarding the scientific background, several prospective, randomized studies with relevant numbers of patients have been (or will be) published that are Level I evidence. In contrast to older studies, which primarily were based mostly on numeric parameters, such as diameters or residual stenoses, more recent study concepts focus increasingly on clinical features, such as amputation rate improvement or changes of clinical stages and quality of life standards. Although it is still not decided, which of the individual techniques might be the best one, we can definitely conclude that whatever treatment of infrapopliteal arteries will be used it is of substantial benefit for the patient. Therefore, the goal of this review is to give an overview about the current developments and techniques for the treatment of infrapopliteal arteries, to present clinical and technical results, to weigh individual techniques, and to discuss the recent developments.

  9. Selection of treatment for patients with carotid artery disease: medication, carotid endarterectomy, or carotid artery stenting.

    PubMed

    Bosiers, Marc; Peeters, Patrick; Deloose, Koen; Verbist, Jürgen; Sprouse, Richard L

    2005-01-01

    Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case. This algorithm was then employed to determine therapy in 308 consecutive patients presenting to a single institution during one calendar year. Ninety-five (30.8%) patients presented with an asymptomatic carotid stenosis of more than 80% and 213 (69.2%) with a symptomatic stenosis of more than 50%. According to our algorithm, 59 (62.1%) of the 95 asymptomatic patients received CAS, 20 (21.1%) received CEA, and 16 (16.8%) received medical therapy. All symptomatic patients underwent intervention; 153 (71.8%) were treated with CAS and 60 (28.2%) with CEA. Combined 30-day stroke and death rates after CAS were 1.7% in asymptomatic patients and 2.6% in symptomatic patients. After CEA, these rates were 0% and 3.3%, respectively. Careful selection of treatment modality according to predetermined criteria can result in improved outcomes.

  10. A longitudinal study of arterial blood pressure in chronic haemodialysis patients with different levels of plasma renin concentration.

    PubMed

    Kornerup, H J; Fredsted, B; Pedersen, R S

    1978-01-01

    The purpose of the study was to examine the value of regular measurements of plasma renin concentration (PRC) in selecting those chronic haemodialysis patients suitable for bilateral nephrectomy to prevent development of uncontrollable hypertension. Regular measurements of arterial blood pressure (BP) and PRC were performed during one year in 31 patients undergoing regular haemodialysis because of end-stage renal disease. Among 18 patients with PRC greater than or equal to 100 micro Goldblatt units per ml plasma (microGU/ml) systolic and/or diastolic hypertension persisted or developed in 12. In contrast, among 13 patients with PRC greater than 100microGU/ml, BP became normal in all but one, who had a slightly increased systolic BP. However, hypertension was mild and easily controlled by conventional therapy in all except one, who probably had an overlying volume-dependent hypertension. Therefore, bilateral nephrectomy was not necessary in any case. The results indicate that hypertension in the majority of chronic haemodialysis patients with high PRC can be adequately controlled without surgical intervention and that regular measurements of PRC have no practical value in forecasting the development of uncontrollable hypertension in chronic haemodialysis patients.

  11. Presentation of Coronary Artery Disease in a Chiropractic Clinic: A Report of 2 Cases

    PubMed Central

    Larson, Ryan S.

    2016-01-01

    Objective The purpose of this report is to describe 2 patients with coronary artery disease presenting with musculoskeletal symptoms to a chiropractic clinic. Clinical Features A 48-year-old male new patient had thoracic spine pain aggravated by physical exertion. A 61-year-old man under routine care for low back pain experienced a secondary complaint of acute chest pain during a reevaluation. Intervention and Outcome In both cases, the patients were strongly encouraged to consult their medical physician and were subsequently diagnosed with coronary artery disease. Following their diagnoses, each patient underwent surgical angioplasty procedures with stenting. Conclusion Patients may present for chiropractic care with what appears to be musculoskeletal chest pain when the pain may be generating from coronary artery disease necessitating medical and possibly emergency care. PMID:27069435

  12. Off-pump coronary artery bypass grafting in a patient with Behçet's disease.

    PubMed

    Kobayashi, Akira; Sakata, Ryuzo; Kinjo, Tamahiro; Yotsumoto, Goichi; Matsumoto, Kazuhisa; Iguro, Yoshifumi

    2004-11-01

    We report the case of a 58-year-old man with Behçet's disease who developed chest pain. Coronary angiography showed severe triple-vessel disease, and the patient was transferred to our department for urgent coronary artery bypass grafting. Because of the risk of anastomotic leakage or pseudoaneurysm formation, we performed off-pump coronary artery bypass grafting with the aortic no-touch technique. Postoperative coronary angiography showed that all the grafts were patent and no anastomotic pseudoaneurysms were observed. Pathological examination of the right internal thoracic artery specimen revealed mild intimal thickening and disruption of elastic fibers in the medial layer, both of which are characteristics of Behçet's disease. These findings indicated that the patient must be monitored carefully for postoperative pseudoaneurysm formation.

  13. Inhibition of the renin-angiotensin system for lowering coronary artery disease risk.

    PubMed

    Sheppard, Richard J; Schiffrin, Ernesto L

    2013-04-01

    The renin-angiotensin system when activated exerts proliferative and pro-inflammatory actions and thereby contributes to progression of atherosclerosis, including that occurring in the coronary arteries. It thus contributes as well to coronary artery disease (CAD). Several clinical trials have examined effects of renin-angiotensin system inhibition for primary and secondary prevention of coronary heart disease. These include important trials such as HOPE, EUROPA and PEACE using angiotensin converting enzyme inhibitors, VALIANT, OPTIMAAL and TRANSCEND using angiotensin receptor blockers, and the ongoing TOPCAT study in patients with preserved ejection fraction heart failure, many of who also have coronary artery disease. Data are unavailable as yet of effects of either direct renin inhibitors or the new angiotensin receptor/neprilysin inhibitor agents. Today, inhibition of the renin-angiotensin system is standard-of-care therapy for lowering cardiovascular risk in secondary prevention in high cardiovascular risk subjects.

  14. The role of microRNAs in coronary artery disease: From pathophysiology to diagnosis and treatment.

    PubMed

    Economou, Evangelos K; Oikonomou, Evangelos; Siasos, Gerasimos; Papageorgiou, Nikolaos; Tsalamandris, Sotiris; Mourouzis, Konsantinos; Papaioanou, Spyridon; Tousoulis, Dimitris

    2015-08-01

    MicroRNAs (miRNAs) are tiny non-coding RNA molecules that regulate gene expression predominantly at the post-transcriptional level. Far from being simple intracellular regulators, miRNAs have recently been involved in intercellular communication and have been shown to circulate in the bloodstream in stable forms. In the past years specific miRNA expression patterns have been linked to the development of atherosclerosis and coronary artery disease, two closely related conditions. The study of miRNAs has promoted our understanding of the processes involved in the pathogenesis of atherosclerosis and innovative diagnostic and therapeutic approaches have emerged. In this review, we present the role of miRNAs in the development of atherosclerosis, on coronary artery disease progression and we assess their role as diagnostic biomarkers. Finally we evaluate the therapeutic and preventive opportunities that arise from the study of miRNAs in coronary artery disease and especially in myocardial infarction.

  15. Coronary artery disease in women: a review on prevention, pathophysiology, diagnosis, and treatment

    PubMed Central

    Araujo, Leila Fernandes; de Matos Soeiro, Alexandre; Fernandes, Juliano Lara; Pesaro, Antônio Eduardo; Serrano, Carlos V

    2006-01-01

    Despite numerous studies on women's cardiac health throughout the past decade, the number of female deaths caused by cardiovascular disease still rises and remains the leading cause of death in women in most areas of the world. Novel studies have demonstrated that cardiovascular disease, and more specifically coronary artery disease presentations in women, are different than those in men. In addition, pathology and pathophysiology of the disease present significant gender differences, which leads to difficulties concerning diagnosis, treatment and outcome of the female population. The reason for this disparity is all steps for female cardiovascular disease evaluation, treatment and prevention are not well elucidated; and an area for future research. This review brings together the most recent studies published in the field of coronary artery disease in women and points out new directions for future investigation on some of the important issues. PMID:17323601

  16. Effect of programmed ventricular stimulation on myocardial lactate extraction in patients with and without coronary artery disease

    SciTech Connect

    Morady, F.; DiCarlo, L.A. Jr.; Krol, R.B.; de Buitleir, M.; Nicklas, J.M.; Annesley, T.M.

    1986-02-01

    The arterial-coronary sinus lactate difference was measured in 17 patients after each step of a programmed ventricular stimulation protocol consisting of single, double, and triple extrastimuli, first at a basic drive cycle length of 600 msec, then at 400 msec, with an inter-train interval of 4 seconds. Four patients had no structural heart disease, four had an idiopathic dilated cardiomyopathy, and nine had coronary artery disease with a significant stenosis in at least one branch of the left coronary artery. Net myocardial lactate production during programmed ventricular stimulation was observed in three patients with coronary artery disease, but not in any patient without coronary artery disease. Among the patients who had coronary artery disease, net myocardial lactate production generally occurred in the patients who had more severe coronary artery disease. Exercise-induced ischemia, as demonstrated by a stress thallium-201 test, did not correlate with myocardial lactate production during programmed ventricular stimulation. Programmed ventricular stimulation, with a stimulation protocol typically used in many electrophysiology laboratories, is capable of inducing myocardial ischemia in at least some patients who have coronary artery disease. This finding suggests that myocardial ischemia may potentially influence the results of programmed ventricular stimulation in some patients with coronary artery disease.

  17. Biological and clinical effects of sulodexide in arterial disorders and diseases.

    PubMed

    Coccheri, S

    2014-06-01

    Arteries, veins and capillaries share the feature of hosting the "endothelial organ", an ubiquitous structure lining the surface of the entire circulatory tree. Endothelial cells and their supporting elements as the basement membrane, the intracellular matrix, and the surface covering glycocalyx, although displaying significant regional differences, maintain a common response to injury and to pharmacological stimuli. Sulodexide (SDX), a highly purified extractive glycosaminoglycan (GAG), shows many biological actions indicating effectiveness in arterial disorders and diseases. In fact, SDX besides inhibiting experimental arterial thrombogenesis displays, especially by the oral route, a number of vascular protective actions that are largely independent of those affecting blood coagulation. Among the activities relevant to arterial disorders, the agent provides restoration of damaged glycocalyx and of degraded intracellular matrix, as well as antiproliferative, antinflammatory, antioxidant, anti-proteolytic and anti-ischemic activities. Among the latter properties, the inhibiting effect on the enzyme family of matrix metalloproteinases (MMPs), and especially on the expression of MMP9 and its precursor, seems of crucial importance given the role of these matrix degrading enzymes in the pathogenesis and progression of atherothrombosis in coronary, carotid and peripheral arteries. These important biological data, many of them very recent, supply clues for the interpretation of a number of previous clinical trials in arterial diseases. Studies published in the years 1990-2005, showing significant reduction of cardiovascular events after a myocardial infarction, as well as a marked improvement in the walking ability in patients with peripheral arterial disease, deserve today an active re-appraisal likely conducive to new clinical research protocols in the field of primary and secondary prevention of cardiovascular disease of atherothrombotic nature.

  18. Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms

    PubMed Central

    Rabahi, Marcelo Fouad; Pereira, Sheila Alves; Silva Júnior, José Laerte Rodrigues; de Rezende, Aline Pacheco; Castro da Costa, Adeliane; de Sousa Corrêa, Krislainy; Conde, Marcus Barreto

    2015-01-01

    Background The diagnosis of chronic obstructive pulmonary disease (COPD) is often delayed until later stages of the disease. The purpose of the present study was to determine the prevalence of COPD among adults on treatment for systemic arterial hypertension independently of the presence of respiratory symptoms. Methods This cross-sectional study included adults aged ≥40 years with tobacco/occupational exposure and systemic arterial hypertension diagnosed at three Primary Health Care facilities in Goiania, Brazil. Patients were evaluated using a standardized respiratory questionnaire and spirometry. COPD prevalence was measured considering the value of forced vital capacity and/or forced expiratory volume in 1 second <0.70. Results Of a total of 570 subjects, 316 (55%) met inclusion criteria and were invited to participate. Two hundred and thirty-three (73.7%) patients with arterial hypertension reported at least one respiratory symptom, while 83 (26.3%) reported no respiratory symptoms; 41 (17.6%) patients with arterial hypertension and at least one respiratory symptom, and 10 (12%) patients with arterial hypertension but no respiratory symptoms were diagnosed with COPD (P=0.24). The prevalence of COPD in people with no previous COPD diagnosis was greater among those with no respiratory symptoms (100%) than among those with respiratory symptoms (56.1%) (P=0.01). Conclusion Our findings suggest that regardless of the presence of respiratory symptoms, individuals aged ≥40 years with tobacco/occupational exposure and arterial hypertension may benefit from spirometric evaluation. PMID:26257517

  19. Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter

    SciTech Connect

    Massmann, Alexander Katoh, Marcus; Shayesteh-Kheslat, Roushanak; Buecker, Arno

    2012-10-15

    Purpose: To retrospectively examine the technical feasibility and safety of directional atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Methods: Five patients (one woman, four men, age range 51-81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease-related symptoms during the last 2-6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery (n = 4) and in-stent occlusion of the superficial femoral artery (n = 1). Subsequently, all patients were treated by atherectomy with the SilverHawk (ev3 Endovascular, USA) device. Results: The mean diameter of treated vessels was 5.1 {+-} 1.0 mm. The length of the occlusion ranged 2-14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. Conclusion: The recanalization of infrainguinal arterial vessel occlusions by atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.

  20. Dynamics of the connectome in Huntington's disease: A longitudinal diffusion MRI study

    PubMed Central

    Odish, Omar F.F.; Caeyenberghs, Karen; Hosseini, Hadi; van den Bogaard, Simon J.A.; Roos, Raymund A.C.; Leemans, Alexander

    2015-01-01

    Objectives To longitudinally investigate the connectome in different stages of Huntington's disease (HD) by applying graph theoretical analysis to diffusion MRI data. Experimental design We constructed weighted structural networks and calculated their topological properties. Twenty-two premanifest (preHD), 10 early manifest HD and 24 healthy controls completed baseline and 2 year follow-up scans. We stratified the preHD group based on their predicted years to disease onset into a far (preHD-A) and near (preHD-B) to disease onset group. We collected clinical and behavioural measures per assessment time point. Principle observations We found a significant reduction over time in nodal betweenness centrality both in the early manifest HD and preHD-B groups as compared to the preHD-A and control groups, suggesting a decrease of importance of specific nodes to overall network organization in these groups (FDR adjusted ps < 0.05). Additionally, we found a significant longitudinal decrease of the clustering coefficient in preHD when compared to healthy controls (FDR adjusted p < 0.05), which can be interpreted as a reduced capacity for internodal information processing at the local level. Furthermore, we demonstrated dynamic changes to hub-status loss and gain both in preHD and early manifest HD. Finally, we found significant cross-sectional as well as longitudinal relationships between graph metrics and clinical and neurocognitive measures. Conclusions This study demonstrates divergent longitudinal changes to the connectome in (pre) HD compared to healthy controls. This provides novel insights into structural correlates associated with clinical and cognitive functions in HD and possible compensatory mechanisms at play in preHD. PMID:26288754

  1. Pharmacology in Peripheral Arterial Disease: What the Interventional Radiologist Needs to Know

    PubMed Central

    Atturu, Gnaneswar; Homer-Vanniasinkam, Shervanthi; Russell, David A.

    2014-01-01

    Peripheral arterial disease (PAD) is a progressive disease with significant morbidity and mortality. Risk factor control, using diet and lifestyle modification, exercise, and pharmacological methods, improves symptoms and reduces associated cardiovascular events in these patients. Antiplatelet agents and anticoagulants may be used to reduce the incidence of acute events related to thrombosis. The armamentarium available for symptom relief and disease modification is discussed. Novel treatments such as therapeutic angiogenesis are in their evolutionary phase with promising preclinical data. PMID:25435658

  2. Cystic adventitial disease of the popliteal artery: an infrequent cause of intermittent claudication

    PubMed Central

    Kauffman, Paulo; Kuzniec, Sergio; Sacilotto, Roberto; Teivelis, Marcelo Passos; Wolosker, Nelson; Tachibana, Adriano

    2014-01-01

    Intermittent claudication is frequently associated with atherosclerotic disease, but differential diagnosis must be sought in patients with no traditional risk factors. Cystic adventitial disease, of unknown etiology, most frequently affects the popliteal artery, and occasionally presents as intermittent claudication. We report a case of this disease and the surgical treatment, and discuss some aspects related to etiopathogenesis, diagnosis and treatment of this condition. PMID:25167336

  3. [Adjuvant and individual application of lumbar sympathectomy at patient with arterial disease in lower limb].

    PubMed

    Govedarski, V; Petrov, I; Zahariev, T; Nachev, G

    2010-01-01

    The first lumbar sympathectomy for treatment of arterial occlusive disease of the lower extremity was performed in 1924 by Julio Diez of Buenos Aires. The standart anatomy textbooks indicate, as a rule that the lumbar sympathetic trunk contains four or five ganglia. The overall anatomic denervation is important for achievement of an adequate sympathectomy of a given segment of an extremity. Criteria and indications for complete sympathetic block are still not clear. Exceptionally important for the improvement of the reology of the lower limbs is the option for a direct increase of the collaterals' debit which could be achieved by extensive profundoplasty. As an addition to the arterial reconstructions, the sympathectomy increases the passability of small vessel anastomosis and the recovery of traumatized arteries. Unilateral or bilateral lumbar sympathectomy is performed by retroperitonal access. From 01.01.2008 till 01.11.2008 in our clinic were performed 117 isolated and after arterial reconstruction lumbar sympathectomies.

  4. Summary of cases of adventitial cystic disease of the popliteal artery.

    PubMed Central

    Flanigan, D P; Burnham, S J; Goodreau, J J; Bergan, J J

    1979-01-01

    Adventitial cystic disease of the popliteal artery is explored. The results of correspondence with authors reporting this condition are elaborated upon. This has provided an opportunity to discuss the history of the condition, the findings in 115 cases which have come to the attention of the Correspondence Office dealing with this entity, and the results of treatment. A discussion of the suspected etiology of the condition is presented. The condition remains one of unknown etiology which can be treated by cyst evacuation or aspiration when the popliteal artery is patent and which is best treated by arterial reconstruction when the artery is occluded. The results of such treatment are good but are dependent upon technical excellence of the operative procedure. PMID:426549

  5. The treadmill test in the assessment of peripheral arterial occlusive disease.

    PubMed

    Ucchino, S; Nardi, M; Santarelli, M; Legnini, M; Costantini, A; Ucchino, G; Napolitano, A M

    1992-01-01

    Results of a study using the treadmill test on 32 patients with peripheral Fontaine's stage II arterial disease are described. The aim of the study was to evaluate the utility of the test in assessing useful information concerning the site of the lesion. Patients were divided in three classes depending on the arterial segment involved (iliac-femoral, femoro-popliteal, associated lesions) as resulted from the velocimetric and angiographic evaluation. Ankle pressure and WI, at rest and after stress test, PFWD and RT were evaluated. The authors conclude that data achieved with the dynamic test are related to the arterial involvement, allowing to differentiate obstructive and stenotic lesions, but do not give information concerning the site of the lesion. Nevertheless it is a valuable means of highlighting arterial lesions well compensated at rest and with normal pressure values.

  6. Current Role of Ivabradine in Stable Coronary Artery Disease Without Heart Failure.

    PubMed

    Porres-Aguilar, Mateo; Muñoz, Oscar C; Abbas, Aamer

    2016-02-01

    Increase in heart rate represents a significant contribution in the pathophysiology of coronary artery disease and heart failure, by promoting atherosclerotic process and endothelial dysfunction. Thus, it negatively influences cardiovascular risk in the general population. The aim of this review is to analyze the current, controversial, and future role of ivabradine as an anti-anginal agent in the setting of coronary artery disease without heart failure. Ivabradine represents a selective heart rate-lowering agent that increased diastolic perfusion time and improving energetics in the ischemic myocardium.

  7. Current Approach to the Diagnosis and Treatment of Femoral-Popliteal Arterial Disease. A Systematic Review

    PubMed Central

    Kasapis, Christos; Gurm, Hitinder S

    2009-01-01

    Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and surgical management of SFPA disease. PMID:21037847

  8. Physiological assessment of sensitivity of noninvasive testing for coronary artery disease

    SciTech Connect

    Simonetti, I.; Rezai, K.; Rossen, J.D.; Winniford, M.D.; Talman, C.L.; Hollenberg, M.; Kirchner, P.T.; Marcus, M.L. )

    1991-05-01

    The sensitivity of three noninvasive tests for coronary artery disease was assessed by means of quantitative indexes of disease severity in three different groups of patients. The overall population consisted of 110 subjects with limited coronary artery disease and no myocardial infarction. Planar dipyridamole-{sup 201}Tl scintigraphy was evaluated in 31 patients, computer-assisted exercise treadmill in 28, and high-dose dipyridamole echocardiography testing in 51. Sensitivity was assessed by rigorous gold standards to define disease severity, such as measurement of minimum cross-sectional area and percent area of stenosis, by quantitative computerized coronary angiography (Brown/Dodge method). On the basis of the results of previous studies, the presence of physiologically significant coronary artery disease was indicated by a stenotic minimum cross-sectional area (MCSA) of less than 2.0 mm{sup 2} or a greater than 75% area of stenosis. With MCSA as the gold standard, dipyridamole-{sup 201}Tl scintigraphy, computerized exercise treadmill, and dipyridamole echocardiography testing showed sensitivities of 52%, 54%, and 61%, respectively, in the three different patient cohorts enrolled. With percent area of stenosis as the gold standard, the sensitivity figures obtained for dipyridamole-{sup 201}Tl, computerized exercise treadmill, and dipyridamole echocardiography testing were 64%, 54%, and 69%, respectively. For each of the three tests, sensitivity increased with increasing lesion severity. Sensitivity was also better in patients with left anterior descending coronary (LAD) disease when compared with patients with left circumflex or right coronary artery disease. Results of these studies demonstrate that in patients with limited coronary artery disease none of the tests evaluated is definitely superior in sensitivity.

  9. Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients with Diabetic Nephropathy and Left Main Coronary Artery Disease

    PubMed Central

    Li, Hsin-Ru; Hsu, Chiao-Po; Sung, Shih-Hsien; Shih, Chun-Che; Lin, Shing-Jong; Chan, Wan-Leong; Wu, Cheng-Hsueh; Lu, Tse-Min

    2017-01-01

    Background Patients with diabetic nephropathy and unprotected left main (LM) coronary artery disease suffer from high cardiovascular morbidity and mortality. Although surgical revascularization is currently recommended in this special patient population, the optimal revascularization method for this distinct patient group has remained unclear. Methods We collected 99 consecutive patients with unprotected LM disease and diabetic nephropathy, including 46 patients who had undergone percutaneous coronary intervention (PCI), and 53 who had coronary artery bypass grafting (CABG), with a mean age of 72 ± 10; with 80.8% male. Diabetic nephropathy was defined as overt proteinuria (proteinuria > 500 mg/day) and estimated glomerular filtration rate (eGFR) by the modified Modification of Diet in Renal Disease (MDRD) equation of less than 60 mL/min/1.73 m2. The baseline characteristics, angiographic results and long-term clinical outcomes were retrospectively analyzed. Results The baseline characteristic of all patients were similar except for smokers, low density lipoprotein (LDL) level and extension of coronary artery disease involvement. The median follow-up period was 3.8 years. There were 73 patients (74%) considered as high risk with additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≥ 6. During follow-up period, the long term rate of all-cause death (PCI vs. CABG: 45.7% vs. 58.5%, p = 0.20) and all-cause death/myocardial infarction (MI)/stroke (PCI vs. CABG: 52.2% vs. 60.4%, p = 0.41) were comparable between the PCI and CABG group, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI vs. CABG: 32.6% vs. 9.4%, p < 0.01). eGFR remained an independent predictor for all-cause death [hazard ratio: 0.97, 95% confidence interval: 0.96 to 0.99; p = 0.002] in multivariate logistic regression. Conclusions In the real-world practice of high-risk patients with unprotected LM disease and diabetic nephropathy, we found

  10. Longitudinal Analysis for Disease Progression via Simultaneous Multi-Relational Temporal-Fused Learning

    PubMed Central

    Lei, Baiying; Jiang, Feng; Chen, Siping; Ni, Dong; Wang, Tianfu

    2017-01-01

    It is highly desirable to predict the progression of Alzheimer's disease (AD) of patients [e.g., to predict conversion of mild cognitive impairment (MCI) to AD], especially longitudinal prediction of AD is important for its early diagnosis. Currently, most existing methods predict different clinical scores using different models, or separately predict multiple scores at different future time points. Such approaches prevent coordinated learning of multiple predictions that can be used to jointly predict clinical scores at multiple future time points. In this paper, we propose a joint learning method for predicting clinical scores of patients using multiple longitudinal prediction models for various future time points. Three important relationships among training samples, features, and clinical scores are explored. The relationship among different longitudinal prediction models is captured using a common feature set among the multiple prediction models at different time points. Our experimental results based on the Alzheimer's disease neuroimaging initiative (ADNI) database shows that our method achieves considerable improvement over competing methods in predicting multiple clinical scores. PMID:28316569

  11. Predicting missing biomarker data in a longitudinal study of Alzheimer disease

    PubMed Central

    Jagust, William J.; Aisen, Paul; Jack, Clifford R.; Toga, Arthur W.; Beckett, Laurel; Gamst, Anthony; Soares, Holly; C. Green, Robert; Montine, Tom; Thomas, Ronald G.; Donohue, Michael; Walter, Sarah; Dale, Anders; Bernstein, Matthew; Felmlee, Joel; Fox, Nick; Thompson, Paul; Schuff, Norbert; Alexander, Gene; DeCarli, Charles; Bandy, Dan; Chen, Kewei; Morris, John; Lee, Virginia M.-Y.; Korecka, Magdalena; Crawford, Karen; Neu, Scott; Harvey, Danielle; Kornak, John; Saykin, Andrew J.; Foroud, Tatiana M.; Potkin, Steven; Shen, Li; Buckholtz, Neil; Kaye, Jeffrey; Dolen, Sara; Quinn, Joseph; Schneider, Lon; Pawluczyk, Sonia; Spann, Bryan M.; Brewer, James; Vanderswag, Helen; Heidebrink, Judith L.; Lord, Joanne L.; Petersen, Ronald; Johnson, Kris; Doody, Rachelle S.; Villanueva-Meyer, Javier; Chowdhury, Munir; Stern, Yaakov; Honig, Lawrence S.; Bell, Karen L.; Morris, John C.; Mintun, Mark A.; Schneider, Stacy; Marson, Daniel; Griffith, Randall; Clark, David; Grossman, Hillel; Tang, Cheuk; Marzloff, George; Toledo-Morrell, Leylade; Shah, Raj C.; Duara, Ranjan; Varon, Daniel; Roberts, Peggy; Albert, Marilyn S.; Pedroso, Julia; Toroney, Jaimie; Rusinek, Henry; de Leon, Mony J; De Santi, Susan M; Doraiswamy, P. Murali; Petrella, Jeffrey R.; Aiello, Marilyn; Clark, Christopher M.; Pham, Cassie; Nunez, Jessica; Smith, Charles D.; Given, Curtis A.; Hardy, Peter; Lopez, Oscar L.; Oakley, MaryAnn; Simpson, Donna M.; Ismail, M. Saleem; Brand, Connie; Richard, Jennifer; Mulnard, Ruth A.; Thai, Gaby; Mc-Adams-Ortiz, Catherine; Diaz-Arrastia, Ramon; Martin-Cook, Kristen; DeVous, Michael; Levey, Allan I.; Lah, James J.; Cellar, Janet S.; Burns, Jeffrey M.; Anderson, Heather S.; Laubinger, Mary M.; Bartzokis, George; Silverman, Daniel H.S.; Lu, Po H.; Graff-Radford MBBCH, Neill R; Parfitt, Francine; Johnson, Heather; Farlow, Martin; Herring, Scott; Hake, Ann M.; van Dyck, Christopher H.; MacAvoy, Martha G.; Benincasa, Amanda L.; Chertkow, Howard; Bergman, Howard; Hosein, Chris; Black, Sandra; Graham, Simon; Caldwell, Curtis; Hsiung, Ging-Yuek Robin; Feldman, Howard; Assaly, Michele; Kertesz, Andrew; Rogers, John; Trost, Dick; Bernick, Charles; Munic, Donna; Wu, Chuang-Kuo; Johnson, Nancy; Mesulam, Marsel; Sadowsky, Carl; Martinez, Walter; Villena, Teresa; Turner, Scott; Johnson, Kathleen B.; Behan, Kelly E.; Sperling, Reisa A.; Rentz, Dorene M.; Johnson, Keith A.; Rosen, Allyson; Tinklenberg, Jared; Ashford, Wes; Sabbagh, Marwan; Connor, Donald; Jacobson, Sandra; Killiany, Ronald; Norbash, Alexander; Nair, Anil; Obisesan, Thomas O.; Jayam-Trouth, Annapurni; Wang, Paul; Lerner, Alan; Hudson, Leon; Ogrocki, Paula; DeCarli, Charles; Fletcher, Evan; Carmichael, Owen; Kittur, Smita; Mirje, Seema; Borrie, Michael; Lee, T-Y; Bartha, Dr Rob; Johnson, Sterling; Asthana, Sanjay; Carlsson, Cynthia M.; Potkin, Steven G.; Preda, Adrian; Nguyen, Dana; Tariot, Pierre; Fleisher, Adam; Reeder, Stephanie; Bates, Vernice; Capote, Horacio; Rainka, Michelle; Hendin, Barry A.; Scharre, Douglas W.; Kataki, Maria; Zimmerman, Earl A.; Celmins, Dzintra; Brown, Alice D.; Gandy, Sam; Marenberg, Marjorie E.; Rovner, Barry W.; Pearlson, Godfrey; Anderson, Karen; Saykin, Andrew J.; Santulli, Robert B.; Englert, Jessica; Williamson, Jeff D.; Sink, Kaycee M.; Watkins, Franklin; Ott, Brian R.; Wu, Chuang-Kuo; Cohen, Ronald; Salloway, Stephen; Malloy, Paul; Correia, Stephen; Rosen, Howard J.; Miller, Bruce L.; Mintzer, Jacobo

    2012-01-01

    Objective: To investigate predictors of missing data in a longitudinal study of Alzheimer disease (AD). Methods: The Alzheimer's Disease Neuroimaging Initiative (ADNI) is a clinic-based, multicenter, longitudinal study with blood, CSF, PET, and MRI scans repeatedly measured in 229 participants with normal cognition (NC), 397 with mild cognitive impairment (MCI), and 193 with mild AD during 2005–2007. We used univariate and multivariable logistic regression models to examine the associations between baseline demographic/clinical features and loss of biomarker follow-ups in ADNI. Results: CSF studies tended to recruit and retain patients with MCI with more AD-like features, including lower levels of baseline CSF Aβ42. Depression was the major predictor for MCI dropouts, while family history of AD kept more patients with AD enrolled in PET and MRI studies. Poor cognitive performance was associated with loss of follow-up in most biomarker studies, even among NC participants. The presence of vascular risk factors seemed more critical than cognitive function for predicting dropouts in AD. Conclusion: The missing data are not missing completely at random in ADNI and likely conditional on certain features in addition to cognitive function. Missing data predictors vary across biomarkers and even MCI and AD groups do not share the same missing data pattern. Understanding the missing data structure may help in the design of future longitudinal studies and clinical trials in AD. PMID:22491869

  12. Numerical Modeling of Nitinol Stent Oversizing in Arteries with Clinically Relevant Levels of Peripheral Arterial Disease: The Influence of Plaque Type on the Outcomes of Endovascular Therapy.

    PubMed

    Gökgöl, Can; Diehm, Nicolas; Büchler, Philippe

    2017-02-01

    Oversizing of the Nitinol stents in the femoro-popliteal arterial tract is commonly performed by clinicians and further encouraged by stent manufacturers. However, in spite of the procedure's supposed benefits of strong wall apposition and increased luminal gain, its effects on the mechanical behavior of arteries with peripheral arterial disease are not fully clear. In this study, finite element (FE) analyses of endovascular revascularization of an idealized artery with 70% stenosis and three different plaque types have been performed to examine the influence of Nitinol stent oversizing on the arterial stresses and acute lumen gain. The analyses included the simulation of balloon angioplasty to model plaque failure, followed by stent implantation, in which four different oversizing ratios were investigated. Results showed that balloon angioplasty was crucial in determining the stress levels of the artery prior to stent implantation and heavily affected the outcome of endovascular therapy. For all plaque types, Nitinol stent oversizing was found to produce a marginal lumen gain in contrast to a significant increase in arterial stresses. For the arteries with lightly and moderately calcified plaques, oversizing was found to be non-critical; whereas for the arteries with heavily calcified plaques, the procedure should be avoided due to a risk of tissue failure.

  13. Effect of age on left ventricular function during exercise in patients with coronary artery disease

    SciTech Connect

    Hakki, A.H.; DePace, N.L.; Iskandrian, A.S.

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p . not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p . 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p . not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  14. Effect of age on left ventricular function during exercise in patients with coronary artery disease.

    PubMed

    Hakki, A H; DePace, N L; Iskandrian, A S

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p = not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p = 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p = not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  15. Classification of coronary artery tissues using optical coherence tomography imaging in Kawasaki disease

    NASA Astrophysics Data System (ADS)

    Abdolmanafi, Atefeh; Prasad, Arpan Suravi; Duong, Luc; Dahdah, Nagib

    2016-03-01

    Intravascular imaging modalities, such as Optical Coherence Tomography (OCT) allow nowadays improving diagnosis, treatment, follow-up, and even prevention of coronary artery disease in the adult. OCT has been recently used in children following Kawasaki disease (KD), the most prevalent acquired coronary artery disease during childhood with devastating complications. The assessment of coronary artery layers with OCT and early detection of coronary sequelae secondary to KD is a promising tool for preventing myocardial infarction in this population. More importantly, OCT is promising for tissue quantification of the inner vessel wall, including neo intima luminal myofibroblast proliferation, calcification, and fibrous scar deposits. The goal of this study is to classify the coronary artery layers of OCT imaging obtained from a series of KD patients. Our approach is focused on developing a robust Random Forest classifier built on the idea of randomly selecting a subset of features at each node and based on second- and higher-order statistical texture analysis which estimates the gray-level spatial distribution of images by specifying the local features of each pixel and extracting the statistics from their distribution. The average classification accuracy for intima and media are 76.36% and 73.72% respectively. Random forest classifier with texture analysis promises for classification of coronary artery tissue.

  16. Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

    PubMed Central

    Valdivielso, Pedro; Ramírez-Bollero, José; Pérez-López, Carmen

    2014-01-01

    Peripheral arterial disease, manifested as intermittent claudication or critical ischaemia, or identified by an ankle/brachial index < 0.9, is present in at least one in every four patients with type 2 diabetes mellitus. Several reasons exist for peripheral arterial disease in diabetes. In addition to hyperglycaemia, smoking and hypertension, the dyslipidaemia that accompanies type 2 diabetes and is characterised by increased triglyceride levels and reduced high-density lipoprotein cholesterol concentrations also seems to contribute to this association. Recent years have witnessed an increased interest in postprandial lipidaemia, as a result of various prospective studies showing that non-fasting triglycerides predict the onset of arteriosclerotic cardiovascular disease better than fasting measurements do. Additionally, the use of certain specific postprandial particle markers, such as apolipoprotein B-48, makes it easier and more simple to approach the postprandial phenomenon. Despite this, only a few studies have evaluated the role of postprandial triglycerides in the development of peripheral arterial disease and type 2 diabetes. The purpose of this review is to examine the epidemiology and risk factors of peripheral arterial disease in type 2 diabetes, focusing on the role of postprandial triglycerides and particles. PMID:25317236

  17. Clinical and angiographic features of coronary artery disease after chest irradiation

    SciTech Connect

    McEniery, P.T.; Dorosti, K.; Schiavone, W.A.; Pedrick, T.J.; Sheldon, W.C.

    1987-11-01

    Coronary artery disease (CAD) developed in 15 patients at a mean of 16 years (range 3 to 29) after chest irradiation. The mean dose of radiation was 42 +/- 7 grays; irradiation was performed for Hodgkin's disease in 9 patients, lymphoma in 2, breast carcinoma in 3 and cystic hygroma in 1 patient. Mean age was 48 years (range 26 to 63) at diagnosis of CAD; 4 patients were younger than 35 years. Nine were women. Ten presented with angina, 3 with acute myocardial infarction, 1 patient with syncope and 1 with dyspnea. Twelve had no more than 2 risk factors of atherosclerosis. At coronary angiography, 8 had at least 50% diameter narrowing of the left main coronary artery and 4 had severe ostial stenosis of the right coronary artery. Eight patients also had valvular heart disease, 4 pericardial disease and 4 complete heart block. Mean left ventricular ejection fraction was 67 +/- 11% (range 53 to 80%). Nine had undergone coronary artery bypass grafting, but surgery was difficult or impossible in 3 because of severe mediastinal and pericardial fibrosis. Radiation-associated CAD is characterized by a high incidence of left main and right ostial coronary disease and often occurs in women with relatively few conventional risk factors for CAD.

  18. Imaging of Small Animal Peripheral Artery Disease Models: Recent Advancements and Translational Potential

    PubMed Central

    Lin, Jenny B.; Phillips, Evan H.; Riggins, Ti’Air E.; Sangha, Gurneet S.; Chakraborty, Sreyashi; Lee, Janice Y.; Lycke, Roy J.; Hernandez, Clarissa L.; Soepriatna, Arvin H.; Thorne, Bradford R. H.; Yrineo, Alexa A.; Goergen, Craig J.

    2015-01-01

    Peripheral artery disease (PAD) is a broad disorder encompassing multiple forms of arterial disease outside of the heart. As such, PAD development is a multifactorial process with a variety of manifestations. For example, aneurysms are pathological expansions of an artery that can lead to rupture, while ischemic atherosclerosis reduces blood flow, increasing the risk of claudication, poor wound healing, limb amputation, and stroke. Current PAD treatment is often ineffective or associated with serious risks, largely because these disorders are commonly undiagnosed or misdiagnosed. Active areas of research are focused on detecting and characterizing deleterious arterial changes at early stages using non-invasive imaging strategies, such as ultrasound, as well as emerging technologies like photoacoustic imaging. Earlier disease detection and characterization could improve interventional strategies, leading to better prognosis in PAD patients. While rodents are being used to investigate PAD pathophysiology, imaging of these animal models has been underutilized. This review focuses on structural and molecular information and disease progression revealed by recent imaging efforts of aortic, cerebral, and peripheral vascular disease models in mice, rats, and rabbits. Effective translation to humans involves better understanding of underlying PAD pathophysiology to develop novel therapeutics and apply non-invasive imaging techniques in the clinic. PMID:25993289

  19. Effects of Beraprost Sodium on Subjective Symptoms in Diabetic Patients with Peripheral Arterial Disease

    PubMed Central

    Yoon, Hang Seob; Choi, Woo Jin; Sung, Il Hoon; Lee, Ho Seong; Chung, Hyung Jin

    2013-01-01

    Background This study evaluated the effects of Beraprost sodium (Berasil) on subjective leg symptoms in patients with peripheral arterial disease caused by diabetes mellitus. Methods Ninety-four diabetic patients with peripheral arterial disease were treated with Beraprost in a fixed-dose, prospective, multicenter, cohort study. Beraprost (40 µg) was administered orally 3 times daily (120 µg/day) for 12 weeks. We developed a new disease-specific symptom questionnaire, which evaluated the effect of peripheral arterial disease on leg discomfort in daily life and assessed therapeutic responses to treatment. Patients were asked for their subjective assessment of symptoms on a written questionnaire before treatment and after 12 weeks of therapy. Results There was significant improvement in all estimated subjective symptoms (burning, coldness, edema, exertional pain, stabbing, and paresthesias) in the lower extremities at 12 weeks (p < 0.001). There were 18 patients with neuropathy in whom significant improvement was noted for 6 subjective symptoms at 12 weeks (p < 0.05). Adverse events considered to be drug-related were observed in 4 patients (4.3%), all of which were mild and resolved with discontinuation of the medication. Conclusions Beraprost is effective as a treatment for improving various subjective symptoms in the lower extremities, such as burning, coldness, edema, exertional pain, stabbing, and paresthesias, in diabetic patients with peripheral arterial disease. PMID:23730480

  20. Bacteriological quality of water and water borne diseases in Bangalore: a longitudinal study.

    PubMed

    Jadhav, Jyothi

    2011-03-01

    In developing countries diarrhea diseases take a big toll which can be prevented by adequate supply of safe drinking water. Thus a longitudinal study was taken up to determine the morbidity due to water borne diseases and bacteriological quality of water. 150 houses in two different areas, one supplied by bore well and other by tap water was selected by modified cluster sampling. Weekly morbidity details collected. Monthly water samples were assessed for bacteriological quality from main supply, household storage and morbidity reported houses. The difference in proportion of potable and non potable water at storage points was statistically significant. The overall incidence rate of target diseases was 3.58%,majority were diaarrhoel diseases with increased incidence in children less than five years.

  1. Longitudinal epitope mapping in MuSK myasthenia gravis: implications for disease severity.

    PubMed

    Huijbers, Maartje G; Vink, Anna-Fleur D; Niks, Erik H; Westhuis, Ruben H; van Zwet, Erik W; de Meel, Robert H; Rojas-García, Ricardo; Díaz-Manera, Jordi; Kuks, Jan B; Klooster, Rinse; Straasheijm, Kirsten; Evoli, Amelia; Illa, Isabel; van der Maarel, Silvère M; Verschuuren, Jan J

    2016-02-15

    Muscle weakness in MuSK myasthenia gravis (MG) is caused predominantly by IgG4 antibodies which block MuSK signalling and destabilize neuromuscular junctions. We determined whether the binding pattern of MuSK IgG4 antibodies change throughout the disease course ("epitope spreading"), and affect disease severity or treatment responsiveness. We mapped the MuSK epitopes of 255 longitudinal serum samples of 53 unique MuSK MG patients from three independent cohorts with ELISA. Antibodies against the MuSK Iglike-1 domain determine disease severity. Epitope spreading outside this domain did not contribute to disease severity nor to pyridostigmine responsiveness. This provides a rationale for epitope specific treatment strategies.

  2. Assessment of Arterial Wall Enhancement for Differentiation of Parent Artery Disease from Small Artery Disease: Comparison between Histogram Analysis and Visual Analysis on 3-Dimensional Contrast-Enhanced T1-Weighted Turbo Spin Echo MR Images at 3T

    PubMed Central

    Jang, Jinhee; Kim, Tae-Won; Hwang, Eo-Jin; Koo, Jaseong; Shin, Yong Sam; Jung, So-Lyung; Ahn, Kook-Jin; Kim, Bum-soo

    2017-01-01

    Objective The purpose of this study was to compare the histogram analysis and visual scores in 3T MRI assessment of middle cerebral arterial wall enhancement in patients with acute stroke, for the differentiation of parent artery disease (PAD) from small artery disease (SAD). Materials and Methods Among the 82 consecutive patients in a tertiary hospital for one year, 25 patients with acute infarcts in middle cerebral artery (MCA) territory were included in this study including 15 patients with PAD and 10 patients with SAD. Three-dimensional contrast-enhanced T1-weighted turbo spin echo MR images with black-blood preparation at 3T were analyzed both qualitatively and quantitatively. The degree of MCA stenosis, and visual and histogram assessments on MCA wall enhancement were evaluated. A statistical analysis was performed to compare diagnostic accuracy between qualitative and quantitative metrics. Results The degree of stenosis, visual enhancement score, geometric mean (GM), and the 90th percentile (90P) value from the histogram analysis were significantly higher in PAD than in SAD (p = 0.006 for stenosis, < 0.001 for others). The receiver operating characteristic curve area of GM and 90P were 1 (95% confidence interval [CI], 0.86–1.00). Conclusion A histogram analysis of a relevant arterial wall enhancement allows differentiation between PAD and SAD in patients with acute stroke within the MCA territory. PMID:28246519

  3. Longitudinal influence of microglial activation and amyloid on neuronal function in Alzheimer's disease.

    PubMed

    Fan, Zhen; Okello, Aren A; Brooks, David J; Edison, Paul

    2015-12-01

    Amyloid deposition, tangle formation, neuroinflammation and neuronal dysfunction are pathological processes involved in Alzheimer's disease. However, the relative role of these processes in driving disease progression is still unclear. The aim of this positron emission tomography study was to: (i) investigate longitudinal changes of microglial activation, amyloid and glucose metabolism; and (ii) assess the temporospatial relationship between these three processes in Alzheimer's disease. A group of eight patients with a diagnosis of Alzheimer's disease (66 ± 4.8 years) and 14 healthy controls (65 ± 5.5 years) underwent T1 and T2 magnetic resonance imaging, along with (11)C-(R)-PK11195, (11)C-Pittsburgh compound B and (18)F-fluorodeoxyglucose positron emission tomography scans for microglial activation, amyloid deposition and glucose metabolism. All patients were followed-up with repeated magnetic resonance imaging and three positron emission tomography scans after 16 months. Parametric maps were interrogated using region of interest analysis, Statistical Parametric Mapping, and between-group correlation analysis at voxel-level using Biological Parametric Mapping. At baseline, patients with Alzheimer's disease showed significantly increased microglial activation compared to the control subjects. During follow-up, for the first time, we found that while there is a progressive reduction of glucose metabolism, there was a longitudinal increase of microglial activation in the majority of the patients with Alzheimer's disease. Voxel-wise correlation analysis revealed that microglial activation in patients with Alzheimer's disease was positively correlated with amyloid deposition and inversely correlated with regional cerebral metabolic rate at voxel level over time. Even though one of the limitations of this study is the lack of longitudinal follow-up of healthy control subjects, this study demonstrates that there is persistent neuroinflammation throughout the Alzheimer

  4. Beta-1-Selective Beta-Blockers and Cognitive Functions in Patients With Coronary Artery Disease: A Cross-Sectional Study.

    PubMed

    Burkauskas, Julius; Noreikaite, Aurelija; Bunevicius, Adomas; Brozaitiene, Julija; Neverauskas, Julius; Mickuviene, Narseta; Bunevicius, Robertas

    2016-01-01

    The association between current beta-1-selective beta-blocker use and cognitive function was evaluated in 722 patients with coronary artery disease without dementia. Beta-1-selective beta-blocker use was associated with worse incidental learning independently of sociodemographic characteristics, clinical coronary artery disease severity, and depression/anxiety.

  5. Behçet's disease with right ventricle thrombus and bilateral pulmonary artery aneurysms--a case report.

    PubMed

    Kaya, Akin; Ertan, Cağatay; Gürkan, Ozlem Ural; Fitöz, Suat; Atasoy, Cetin; Kiliçkap, Mustafa; Numanoğlu, Numan

    2004-01-01

    Behçet's disease is currently recognized as a multisystemic disease that may present with vascular, cutaneous, pulmonary, neurologic, rheumatologic, gastrointestinal, and genitourinary manifestations. Despite this multiplicity, cardiac involvement and also the coexistence of bilateral pulmonary arterial aneurysms are rare. An interesting case is presented here with intracardiac thrombi and bilateral pulmonary arterial aneurysms that showed clinical regression with immunosuppressive therapy.

  6. Spontaneous Intra-Abdominal Hemorrhage Due to Rupture of Jejunal Artery Aneurysm in Behcet Disease

    PubMed Central

    Wu, Xiao-yan; Wei, Jiang-peng; Zhao, Xiu-yuan; Wang, Yue; Wu, Huan-huan; Shi, Tao; Liu, Tong; Liu, Gang

    2015-01-01

    Abstract Rupture of jejunal artery aneurysm is a very rare event resulting in life-threatening hemorrhage in Behcet disease (BD). We report a case of ruptured jejunal artery aneurysm in a 35-year-old patient with BD. The patient had a 1-year history of intermittent abdominal pain caused by superior mesenteric artery aneurysm with thrombosis. Anticoagulation treatment showed a good response. Past surgical history included stenting for aortic pseudoaneurysm. On admission, the patient underwent an urgent operation due to sudden hemorrhagic shock. Resection was performed for jejunal artery aneurysm and partial ischemia of intestine. The patient was diagnosed with BD, based on a history of recurrent oral and skin lesions over the past 6 years. Treatment with anti-inflammatory medications showed a good response during the 8-month follow-up. An increased awareness of BD and its vascular complications is essential. Aneurysms in BD involving jejunal artery are rare, neglected and require proper management to prevent rupture and death. To our knowledge, this is the first reported case of jejunal artery aneurysm caused by BD. PMID:26559278

  7. Peripheral Arterial Disease - Multiple Languages: MedlinePlus

    MedlinePlus

    ... krvnih žila - Bosanski (Bosnian) Bilingual PDF Health Information Translations Chinese - Simplified (简体中文) Blood Vessel Disease 血管疾病 - 简体中文 (Chinese - Simplified) Bilingual PDF Health Information Translations Chinese - Traditional (繁體中文) Blood Vessel Disease 血管疾病 - 繁體中文 ( ...

  8. Selective uterine artery embolization: a new therapeutic approach in a patient with low-risk gestational trophoblastic disease.

    PubMed

    Carlini, Laura; Villa, Antonella; Busci, Luisa; Trezzi, Gaetano; Agazzi, Roberto; Frigerio, Luigi

    2006-07-01

    We report a case of persistent gestational trophoblastic disease (GTD) in which a selective uterine artery embolization instead of invasive surgery achieved both the control of pelvic hemorrhage and of disease.

  9. Neointimal hyperplasia and calcification in medium sized arteries in adult patients with chronic kidney disease.

    PubMed

    Chitalia, Nihil; Ross, Louise; Krishnamoorthy, Mahesh; Kapustin, Alexander; Shanahan, Catherine M; Kaski, Juan Carlos; Roy-Chaudhury, Prabir; Chemla, Eric; Banerjee, Debasish

    2015-01-01

    The nature of arterial changes resulting in cardiovascular events and dialysis vascular access failures in adult predialysis patients is not well known. This study examined intimal changes, calcium deposition, and consequent stiffness in brachial and radial arteries of adult CKD patients. Ten brachial-artery and seven radial-artery specimens were obtained during fistula creation from nine predialysis and eight dialysis-dependent, nondiabetic patients; and age-gender matched controls undergoing coronary bypass grafts (6 radial) or kidney donation (6 renal). Arterial stiffness was measured at baseline. Vessel histology, morphometric analysis of intima-media, and direct quantification of calcium load was performed using standard techniques. Both predialysis and dialysis patients demonstrated significant arterial intimal hyperplasia with intima:media ratio higher than controls (0.13 ± 0.12 vs. 0.02 ± 0.05, p = 0.01). Calcium deposition was demonstrated on histology and the calcium content in patients was higher than controls (34.68 ± 26.86 vs. 10.95 ± 9.18 μg/μg, p = 0.003). The blood vessel calcium content correlated with arterial stiffness (r = 0.64, p = 0.018). This study for the first time describes, and suggests mechanistic linkage between, intimal hyperplasia, pathological calcium deposition, and increased functional arterial stiffness in dialysis and predialysis patients. Our research could serve as a unique window into the in vivo status of the uremic vasculature impacting fistula maturation and cardiovascular disease.

  10. Cardioscopic observation of subendocardial microvessels in patients with coronary artery disease.

    PubMed

    Uchida, Yasuto; Kanai, Masahito; Maezawa, Yuko; Maezawa, Yoshiro; Shirai, Seiichiro; Nakagawa, Osamu; Uchida, Yasumi

    2011-01-01

    Coronary microvessels play a direct and critical role in determining the extent and severity of myocardial ischemia and cardiac function. However, because direct observation has never been performed in vivo, the functional properties of the individual microvesssels in patients with coronary artery disease remain unknown. Subendocardial coronary microvessels were observed by cardioscopy in 149 successive patients with coronary artery disease (81 with stable angina and 68 with old myocardial infarction). Twenty-four arterial microvessels (AMs) and 27 venous microvessels (VMs) were observed in the left ventricular subendocardium. All 12 AMs and 13 of 14 VMs that were located in normokinetic-to-hypokinetic left ventricular wall segments were filled with blood during diastole and were collapsed during systole. In contrast, 8 of 12 AMs and 9 of 13 VMs that were located in akinetic-to-dyskinetic wall segments were filled with blood during systole and were collapsed during diastole. There were no significant correlations between the timing of blood filling and the severity of coronary stenosis and collateral development. In patients with coronary artery disease, the timing of blood filling of AMs and VMs was dependent on the regional left ventricular contractile state; during diastole when contraction was preserved and during systole when it was not. It remains to be elucidated whether and how blood filling is disturbed in other categories of heart disease.

  11. Validity of a Questionnaire to Assess the Physical Activity Level in Coronary Artery Disease Patients

    ERIC Educational Resources Information Center

    Guiraud, Thibaut; Granger, Richard; Bousquet, Marc; Gremeaux, Vincent

    2012-01-01

    The aim of the study is to compare, in coronary artery disease patients, physical activity (PA) assessed with the Dijon Physical Activity Questionnaire (DPAQ) and the true PA objectively measured using an accelerometer. Seventy patients wore an accelerometer (MyWellness Key actimeter) throughout 1 week after a cardiac rehabilitation program that…

  12. Cardiac vagal control and dynamic responses to psychological stress among patients with coronary artery disease.

    PubMed

    Grossman, P; Watkins, L L; Wilhelm, F H; Manolakis, D; Lown, B

    1996-12-15

    Two groups of patients with coronary artery disease who differed in level of cardiac vagal control were compared in their cardiovascular responses to psychological stress. Patients with lower vagal control manifested increased reactions in diastolic blood pressure and rate-pressure product to mental stress and tended to have greater systemic vasoconstriction.

  13. Physiological Adaptations to Chronic Endurance Exercise Training in Patients with Coronary Artery Disease.

    ERIC Educational Resources Information Center

    Physician and Sportsmedicine, 1987

    1987-01-01

    In a roundtable format, five doctors explore the reasons why regular physical activity should continue to play a significant role in the rehabilitation of patients with coronary artery disease. Endurance exercise training improves aerobic capacity, reduces blood pressure, and decreases risk. (Author/MT)

  14. Renal Artery Embolization Controls Intractable Pain in a Patient with Polycystic Kidney Disease

    SciTech Connect

    Hahn, Seong Tai; Park, Seog Hee; Lee, Jae Mun; Kim, Choon-Yul; Chang, Yoon Sik

    1999-09-15

    A 65-year-old man with adult polycystic kidney disease (APKD) and chronic renal failure suffered from intractable abdominal pain and distension for 2 weeks. Meperidine infusion did not alleviate his pain. However, pain and abdominal distension were successfully controlled by embolization of both renal arteries.

  15. Etiology of End-Stage Renal Disease and Arterial Stiffness among Hemodialysis Patients

    PubMed Central

    El Ghoul, Balsam; Korjian, Serge; El Alam, Andrew; Samad, Salam; Dahdah, Georges; Blacher, Jacques; Safar, Michel E.

    2017-01-01

    Background. Prior studies have demonstrated that conventional and emerging CV risk factors are associated with worsening arterial stiffness among end-stage renal disease (ESRD) patients on hemodialysis. The present cross-sectional study evaluates the association between the etiology of ESRD and arterial stiffness among a cohort of hemodialysis patients. Methods. Etiology of ESRD was identified from patients' medical records and classified as either vascular renal disease, diabetic nephropathy, nondiabetic glomerulopathy, tubular interstitial nephropathy, hereditary nephropathy, or ESRD of unconfirmed etiology. Results. A total of 82 subjects were enrolled. cfPWV was independently associated with the composite of either diabetic nephropathy or vascular renal disease (p = 0.022), pulse pressure (p = 0.001), and a history of CV events (p = 0.025), but not history of hypertension or diabetes mellitus alone. The median cfPWVs in diabetic nephropathy and vascular renal disease were comparable and significantly higher than median cfPWVs in other etiologies of ESRD. Conclusion. The study suggests that the etiology of ESRD is independently associated with arterial stiffness among hemodialysis patients. Furthermore, arterial stiffness was higher among patients who developed renal sequelae of either diabetes mellitus or hypertension as compared with those who have a history of either diabetes mellitus or hypertension alone. PMID:28299320

  16. A case of atypical Kawasaki disease with giant coronary artery aneurysm containing thrombus

    PubMed Central

    Attard, Montalto S; Grech, V

    2016-01-01

    Introduction Kawasaki disease (KD) is an acute febrile, systemic vasculitic syndrome of unknown etiology, occurring primarily in children younger than 5 years of age. Administration of IVIG within the first 10 days after onset of fever in combination with high dose aspirin reduces the risk of coronary artery damage in KD. Though rare, giant aneurysms of the coronary arteries may develop in untreated cases and prove extremely challenging to manage. Case Presentation A 9-month-old Caucasian boy presented to our paediatric emergency department with a 4-week history of intermittent pyrexia and irritability. Typical mucocutaneous signs of Kawasaki Disease were absent upon presentation. A trans-thoracic echocardiogram identified a giant aneurysm of the left anterior descending artery with thrombus formation in-situ and the child was managed with intravenous immunoglobulin, steroids, high dose aspirin therapy and later warfarinisation. Discussion Cardiovascular sequelae of Kawasaki disease include giant coronary artery aneurysms with thrombosis. Enlargement of a coronary aneurysm after the acute phase of Kawasaki disease is uncommon and the outcome of interventional approaches poorly studied.

  17. Cardiointegram: detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram

    SciTech Connect

    Teichholz, L.E.; Steinmetz, M.Y.; Escher, D.; Herman, M.V.; Naimi, S.; Mahony, D.V.; Ellestad, M.H.

    1986-07-01

    The cardiointegram is a non-invasive technique for the analysis of the electrical signals of the heart obtained by a transformation of the voltage vs. time format by a series of integrations. This multicenter study compares the results of the cardiointegram with coronary arteriography in 140 male patients with chest pain and a normal resting electrocardiogram. The cardiointegram was determined on two resting complexes of Leads I, II, V4, V5 and V6 and called abnormal if greater than or equal to four of ten complexes were abnormal, i.e., fell outside of a previously determined template of normality. The sensitivity was 73% and specificity was 78% for the diagnosis of occlusive coronary artery disease. When greater than or equal to five of ten abnormal complexes were used as the cut-off for an abnormal test and ''equivocal'' results (four of ten abnormal, n = 18) were excluded from analysis there was a sensitivity of 69% and specificity of 88%. Thirty-seven of 38 patients (97%) with an abnormal cardiointegram and a positive exercise stress test had coronary artery disease. Thus, the cardiointegram appears to be a useful non-invasive test for the detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram in whom the diagnosis of coronary artery disease is being considered.

  18. Common variants associated with plasma triglycerides and risk for coronary artery disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Triglycerides are transported in plasma by specific triglyceride-rich lipoproteins; in epidemiological studies, increased triglyceride levels correlate with higher risk for coronary artery disease (CAD). However, it is unclear whether this association reflects causal processes. We used 185 common va...

  19. Red blood cell MUFAs and risk of coronary artery disease in the Physicians’ Health Study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Previous studies have reported beneficial effects of a Mediterranean diet rich in monounsaturated fatty acids (MUFAs) on coronary artery disease (CAD) risk. However, these findings remain inconsistent because some experimental studies have suggested atherogenic and lipotoxicity effects of long-chain...

  20. Common genetic loci influencing plasma homocysteine concentrations and their effect on risk of coronary artery disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The strong observational association between total homocysteine (tHcy) concentrations and risk of coronary artery disease (CAD) and the null associations in the homocysteine-lowering trials have prompted the need to identify genetic variants associated with homocysteine concentrations and risk of CA...

  1. Are there ways to attenuate arterial calcification and improve cardiovascular outcomes in chronic kidney disease?

    PubMed Central

    Vo, Thanh-Mai; Disthabanchong, Sinee

    2014-01-01

    The risk of cardiovascular mortality among patients with end-stage renal disease is several times higher than general population. Arterial calcification, a marker of atherosclerosis and a predictor of cardiovascular mortality, is common in chronic kidney disease (CKD). The presence of traditional cardiovascular risk factors such as diabetes, hypertension, hyperlipidemia, and advanced age cannot fully explain the high prevalence of atherosclerosis and arterial calcification. Other factors specific to CKD such as hyperphosphatemia, excess of calcium, high dose active vitamin D and prolonged dialysis vintage play important roles in the development of arterial calcification. Due to the significant health risk, it is prudent to attempt to lower arterial calcification burden in CKD. Treatment of hyperlipidemia with statin has failed to lower atherosclerotic and arterial calcification burden. Data on diabetes and blood pressure controls as well as smoking cessation on cardiovascular outcomes in CKD population are limited. Currently available treatment options include non-calcium containing phosphate binders, low dose active vitamin D, calcimimetic agent and perhaps bisphosphonates, vitamin K and sodium thiosulfate. Preliminary data on bisphosphonates, vitamin K and sodium thiosulfate are encouraging but larger studies on efficacy and outcomes are needed. PMID:24944752

  2. Relationship between carotid intima‐media thickness and arterial stiffness in children after Kawasaki disease

    PubMed Central

    Cheung, Y‐f; Wong, S J; Ho, M H K

    2007-01-01

    Background Evidence of premature atherosclerosis and systemic arterial stiffening in patients after Kawasaki disease is accumulating. Aim To test the hypothesis that carotid intima‐media thickness (IMT), a surrogate marker of atherosclerosis, is associated with systemic arterial stiffness in children after Kawasaki disease. Methods A cohort of 72 patients was studied, comprising 26 patients with Kawasaki disease and coronary aneurysms (group I), 24 patients with Kawasaki disease and normal coronary arteries (group II) and 22 healthy age‐matched children (group III). The carotid IMT, carotid artery stiffness index, brachioradial pulse wave velocity (PWV), fasting total cholesterol, high‐density lipoprotein (HDL) cholesterol and low‐density lipoprotein (LDL) cholesterol were determined and compared among the three groups. Results The carotid IMT was related to indices of arterial stiffness, and significant determinants of carotid IMT were identified by multivariate analysis. The mean (standard deviation (SD)) carotid IMT of both group I (0.41 (0.04) mm) and group II (0.39 (0.04) mm) was significantly greater than that of group III (0.36 (0.04) mm; p<0.001 and p = 0.008, respectively). For the entire cohort, carotid IMT correlated positively with LDL cholesterol (r = 0.31, p = 0.009), carotid artery stiffness index (r = 0.40, p = 0.001) and brachioradial PWV (r = 0.28, p = 0.016), but not with age, body mass index, systemic blood pressure, and HDL and total cholesterol. Multiple linear regression analysis identified carotid artery stiffness index (β = 0.25, p = 0.028) and subject grouping (β = −0.39, p = 0.001; model R2 = 0.29) as significant correlates of carotid IMT. Conclusion The increased carotid IMT in children after Kawasaki disease is associated with systemic arterial stiffening. PMID:16820386

  3. Continuous coronary sinus and arterial pH monitoring during pacing-induced ischaemia in coronary artery disease.

    PubMed Central

    Cobbe, S M; Poole-Wilson, P A

    1982-01-01

    Catheter tip pH electrodes were used for continuous recording of coronary sinus and arterial pH during atrial pacing in 20 patients undergoing coronary arteriography for chest pain. An ischaemic response to atrial pacing was identified by the onset of angina and/or electrocardiographic abnormalities. Technically satisfactory coronary sinus recordings were obtained in 18 patients. Mean coronary sinus pH at the peak pacing rate fell by 0.021 +/- 0.006 units (n = 9) in the ischaemic group, while there was no significant change in the non-ischaemic group. A larger fall in coronary sinus pH (-0.052 +/- 0.009) was found in the ischaemic group in the 30 seconds after the end of atrial pacing, the maximum change occurring after 16.1 +/- 1.5 seconds. A maximum fall of coronary sinus pH greater then 0.02 units identified patients with an ischaemic response. Changes in arterial pH did not account for these results. The sensitivity of coronary sinus pH recording for the detection of ischaemic heart disease is enhanced by sampling during the "washout" phase after the end of pacing. Images PMID:7066122

  4. Factors Influencing the Prescription of Cardiovascular Preventive Therapies in Patients with Peripheral Arterial Disease

    PubMed Central

    Gauvin, Valerie; Turcotte, Stephane; Milot, Alain; Douville, Yvan

    2016-01-01

    Background Guidelines recommend that patients with peripheral arterial disease should be medically treated to reduce the occurrence of serious cardiovascular events. Despite these recommendations, studies conducted in the early 2000s reported that medical therapies for secondary cardiovascular prevention are not given systematically to patients with peripheral arterial disease (PAD). We identified factors associated with the prescription of preventive therapies in patients with symptomatic PAD. Methods and Findings Consecutive patients with symptomatic peripheral arterial disease (n = 362) treated between 2008 and 2010 in one tertiary care center (CHU de Quebec, Canada) were considered. Data were collected from the medical charts. The main outcome was the combined prescription of three therapies: 1) statins, 2) antiplatelets, 3) angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers. The mean age was 70 years and 43% had a pre-existing coronary artery disease. Antiplatelet therapy was the most prescribed drug (83%). A total of 52% of the patients received the three combined therapies. Less than 10% of patients had a known contraindication to one class of medication. Having at least three cardiovascular risk factors (Odds Ratio (OR) = 4.51; 95% CI: 2.76–7.37) was the factor most strongly associated with the prescription of the combined therapies. Pre-existing coronary artery disease (OR = 2.28; 95% CI: 1.43–3.65) and history of peripheral vascular surgery (OR = 2.30; 95% CI: 1.37–3.86) were two factors independently associated with the prescription of the combined therapies. However, peripheral arterial disease patients with chronic critical limb ischemia were less likely to receive the combined therapies (OR = 0.53; 95% CI: 0.32–0.87) than those with claudication. The retrospective nature of this study, not allowing for an exhaustive report of the contraindication to medication prescription, is the main limitation. Conclusion About half

  5. Longitudinal measurement and hierarchical classification framework for the prediction of Alzheimer’s disease

    PubMed Central

    Huang, Meiyan; Yang, Wei; Feng, Qianjin; Chen, Wufan; Weiner, Michael W.; Aisen, Paul; Petersen, Ronald; Jack, Clifford R.; Jagust, William; Trojanowki, John Q.; Toga, Arthur W.; Beckett, Laurel; Green, Robert C.; Saykin, Andrew J.; Morris, John; Shaw, Leslie M.; Kaye, Jeffrey; Quinn, Joseph; Silbert, Lisa; Lind, Betty; Carter, Raina; Dolen, Sara; Schneider, Lon S.; Pawluczyk, Sonia; Beccera, Mauricio; Teodoro, Liberty; Spann, Bryan M.; Brewer, James; Vanderswag, Helen; Fleisher, Adam; Heidebrink, Judith L.; Lord, Joanne L.; Mason, Sara S.; Albers, Colleen S.; Knopman, David; Johnson, Kris; Doody, Rachelle S.; Villanueva-Meyer, Javier; Chowdhury, Munir; Rountree, Susan; Dang, Mimi; Stern, Yaakov; Honig, Lawrence S.; Bell, Karen L.; Ances, Beau; Morris, John C.; Carroll, Maria; Creech, Mary L.; Franklin, Erin; Mintun, Mark A.; Schneider, Stacy; Oliver, Angela; Marson, Daniel; Griffith, Randall; Clark, David; Geldmacher, David; Brockington, John; Roberson, Erik; Love, Marissa Natelson; Grossman, Hillel; Mitsis, Effie; Shah, Raj C.; deToledo-Morrell, Leyla; Duara, Ranjan; Varon, Daniel; Greig, Maria T.; Roberts, Peggy; Albert, Marilyn; Onyike, Chiadi; D’Agostino, Daniel; Kielb, Stephanie; Galvin, James E.; Cerbone, Brittany; Michel, Christina A.; Pogorelec, Dana M.; Rusinek, Henry; de Leon, Mony J.; Glodzik, Lidia; De Santi, Susan; Doraiswamy, P. Murali; Petrella, Jeffrey R.; Borges-Neto, Salvador; Wong, Terence Z.; Coleman, Edward; Smith, Charles D.; Jicha, Greg; Hardy, Peter; Sinha, Partha; Oates, Elizabeth; Conrad, Gary; Porsteinsson, Anton P.; Goldstein, Bonnie S.; Martin, Kim; Makino, Kelly M.; Ismail, M. Saleem; Brand, Connie; Mulnard, Ruth A.; Thai, Gaby; Mc-Adams-Ortiz, Catherine; Womack, Kyle; Mathews, Dana; Quiceno, Mary; Levey, Allan I.; Lah, James J.; Cellar, Janet S.; Burns, Jeffrey M.; Swerdlow, Russell H.; Brooks, William M.; Apostolova, Liana; Tingus, Kathleen; Woo, Ellen; Silverman, Daniel H. S.; Lu, Po H.; Bartzokis, George; Graff-Radford, Neill R.; Parfitt, Francine; Kendall, Tracy; Johnson, Heather; Farlow, Martin R.; Hake, Ann Marie; Matthews, Brandy R.; Brosch, Jared R.; Herring, Scott; Hunt, Cynthia; van Dyck, Christopher H.; Carson, Richard E.; MacAvoy, Martha G.; Varma, Pradeep; Chertkow, Howard; Bergman, Howard; Hosein, Chris; Black, Sandra; Stefanovic, Bojana; Caldwell, Curtis; Hsiung, Ging-Yuek Robin; Feldman, Howard; Mudge, Benita; Assaly, Michele; Finger, Elizabeth; Pasternack, Stephen; Rachisky, Irina; Trost, Dick; Kertesz, Andrew; Bernick, Charles; Munic, Donna; Mesulam, Marek Marsel; Lipowski, Kristine; Weintraub, Sandra; Bonakdarpour, Borna; Kerwin, Diana; Wu, Chuang-Kuo; Johnson, Nancy; Sadowsky, Carl; Villena, Teresa; Turner, Raymond Scott; Johnson, Kathleen; Reynolds, Brigid; Sperling, Reisa A.; Johnson, Keith A.; Marshall, Gad; Yesavage, Jerome; Taylor, Joy L.; Lane, Barton; Rosen, Allyson; Tinklenberg, Jared; Sabbagh, Marwan N.; Belden, Christine M.; Jacobson, Sandra A.; Sirrel, Sherye A.; Kowall, Neil; Killiany, Ronald; Budson, Andrew E.; Norbash, Alexander; Johnson, Patricia Lynn; Obisesan, Thomas O.; Wolday, Saba; Allard, Joanne; Lerner, Alan; Ogrocki, Paula; Tatsuoka, Curtis; Fatica, Parianne; Fletcher, Evan; Maillard, Pauline; Olichney, John; DeCarli, Charles; Carmichael, Owen; Kittur, Smita; Borrie, Michael; Lee, T-Y; Bartha, Rob; Johnson, Sterling; Asthana, Sanjay; Carlsson, Cynthia M.; Potkin, Steven G.; Preda, Adrian; Nguyen, Dana; Tariot, Pierre; Burke, Anna; Trncic, Nadira; Fleisher, Adam; Reeder, Stephanie; Bates, Vernice; Capote, Horacio; Rainka, Michelle; Scharre, Douglas W.; Kataki, Maria; Adeli, Anahita; Zimmerman, Earl A.; Celmins, Dzintra; Brown, Alice D.; Pearlson, Godfrey D.; Blank, Karen; Anderson, Karen; Flashman, Laura A.; Seltzer, Marc; Hynes, Mary L.; Santulli, Robert B.; Sink, Kaycee M.; Gordineer, Leslie; Williamson, Jeff D.; Garg, Pradeep; Watkins, Franklin; Ott, Brian R.; Querfurth, Henry; Tremont, Geoffrey; Salloway, Stephen; Malloy, Paul; Correia, Stephen; Rosen, Howard J.; Miller, Bruce L.; Perry, David; Mintzer, Jacobo; Spicer, Kenneth; Bachman, David; Pomara, Nunzio; Hernando, Raymundo; Sarrael, Antero; Relkin, Norman; Chaing, Gloria; Lin, Michael; Ravdin, Lisa; Smith, Amanda; Raj, Balebail Ashok; Fargher, Kristin

    2017-01-01

    Accurate prediction of Alzheimer’s disease (AD) is important for the early diagnosis and treatment of this condition. Mild cognitive impairment (MCI) is an early stage of AD. Therefore, patients with MCI who are at high risk of fully developing AD should be identified to accurately predict AD. However, the relationship between brain images and AD is difficult to construct because of the complex characteristics of neuroimaging data. To address this problem, we present a longitudinal measurement of MCI brain images and a hierarchical classification method for AD prediction. Longitudinal images obtained from individuals with MCI were investigated to acquire important information on the longitudinal changes, which can be used to classify MCI subjects as either MCI conversion (MCIc) or MCI non-conversion (MCInc) individuals. Moreover, a hierarchical framework was introduced to the classifier to manage high feature dimensionality issues and incorporate spatial information for improving the prediction accuracy. The proposed method was evaluated using 131 patients with MCI (70 MCIc and 61 MCInc) based on MRI scans taken at different time points. Results showed that the proposed method achieved 79.4% accuracy for the classification of MCIc versus MCInc, thereby demonstrating very promising performance for AD prediction. PMID:28079104

  6. Combined dementia-risk biomarkers in Parkinson's disease: a prospective longitudinal study.

    PubMed

    Compta, Yaroslau; Pereira, Joana B; Ríos, Jose; Ibarretxe-Bilbao, Naroa; Junqué, Carme; Bargalló, Núria; Cámara, Ana; Buongiorno, Mariateresa; Fernández, Manel; Pont-Sunyer, Claustre; Martí, Maria J

    2013-08-01

    Neuropsychological (mostly posterior-cortical) deficits, quantitative magnetic resonance imaging (MRI) atrophy patterns, and low cerebrospinal fluid (CSF) levels of amyloid-β have been separately related to worsening cognition in Parkinson's disease (PD). However, these biomarkers have not been longitudinally assessed in combination as PD-dementia predictors. In this prospective longitudinal study, 27 non-demented PD patients underwent CSF, neuropsychological and 3-T brain-MRI studies at baseline and were re-assessed 18 months later in terms of progression to dementia (primary outcome) and longitudinal neuropsychological and cortical thickness changes (secondary outcomes). At follow-up 11 patients (41%) had progressed to dementia. Lower CSF amyloid-β, worse verbal learning, semantic fluency and visuoperceptual scores, and thinner superior-frontal/anterior cingulate and precentral regions were significant baseline dementia predictors in binary logistic regressions as quantitative and/or dichotomised traits. All participants without baseline biomarker abnormalities remained non-demented whereas all with abnormalities in each biomarker type progressed to dementia, with intermediate risk for those showing abnormalities in a single to two biomarker types (p = 0.006). Both the dementia-outcome and low baseline CSF amyloid-β were prospectively associated with limbic and posterior-cortical neuropsychological decline and frontal, limbic and posterior-cortical thinning from baseline to follow-up. These findings suggest that the combination of CSF amyloid-β, neuropsychological and cortical thickness biomarkers might provide a basis for dementia-risk stratification and progression monitoring in PD.

  7. Longitudinal measurement and hierarchical classification framework for the prediction of Alzheimer's disease.

    PubMed

    Huang, Meiyan; Yang, Wei; Feng, Qianjin; Chen, Wufan

    2017-01-12

    Accurate prediction of Alzheimer's disease (AD) is important for the early diagnosis and treatment of this condition. Mild cognitive impairment (MCI) is an early stage of AD. Therefore, patients with MCI who are at high risk of fully developing AD should be identified to accurately predict AD. However, the relationship between brain images and AD is difficult to construct because of the complex characteristics of neuroimaging data. To address this problem, we present a longitudinal measurement of MCI brain images and a hierarchical classification method for AD prediction. Longitudinal images obtained from individuals with MCI were investigated to acquire important information on the longitudinal changes, which can be used to classify MCI subjects as either MCI conversion (MCIc) or MCI non-conversion (MCInc) individuals. Moreover, a hierarchical framework was introduced to the classifier to manage high feature dimensionality issues and incorporate spatial information for improving the prediction accuracy. The proposed method was evaluated using 131 patients with MCI (70 MCIc and 61 MCInc) based on MRI scans taken at different time points. Results showed that the proposed method achieved 79.4% accuracy for the classification of MCIc versus MCInc, thereby demonstrating very promising performance for AD prediction.

  8. Association of increased lipid peroxide levels in the aorta in comparison to the pulmonary artery with the presence of coronary artery disease

    PubMed Central

    MALIK, ABDUL RAUOOF

    2016-01-01

    Atherosclerosis predominantly affects systemic arteries as compared to pulmonary arteries; however, the reasons for this differential predilection are not clear. Oxidative damage caused by free radicals is a key initiating event in atherogenesis and the lungs are able to produce large quantities of free radicals even under physiological conditions. The present study investigated whether pulmonary venous blood reaching the aorta contained greater quantities of lipid peroxides, a marker of oxidative stress, compared to the pulmonary artery. Aortic and pulmonary artery blood samples were collected at the time of cardiac catheterization from 45 consecutive patients (38% female) without acute coronary event and free of other medical disorders, who were scheduled to undergo coronary angiography for anginal chest pain. Lipid peroxides were measured in terms of malondialdehyde (MDA). MDA levels were significantly higher in the aorta compared to the pulmonary artery (4.93±1.97 vs. 3.36±1.14 nmol/ml; P<0.001); the difference was significant in patients with angiographic coronary artery disease (CAD) (P<0.001) compared to the patients without CAD (P=0.071). Higher aortic MDA levels were associated with the presence of CAD even following adjustment for major risk factors. The results of the present study demonstrate that aortic blood contains significantly greater levels of lipid peroxides compared to pulmonary artery. This differential oxidative stress between systemic and pulmonary arteries could provide a mechanistic explanation for their difference in the propensity to develop atherosclerosis. PMID:27073637

  9. Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease

    PubMed Central

    KAMPITS, Cassio; MONTENEGRO, Marlon M.; RIBEIRO, Ingrid W. J.; FURTADO, Mariana V.; POLANCZYK, Carisi A.; RÖSING, Cassiano K.; HAAS, Alex. N

    2016-01-01

    ABSTRACT Periodontal disease has been associated with elevations of blood cytokines involved in atherosclerosis in systemically healthy individuals, but little is known about this association in stable cardiovascular patients. The aim of this study was to assess the association between periodontal disease (exposure) and blood cytokine levels (outcomes) in a target population of patients with stable coronary artery disease (CAD). Material and Methods This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1β, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. Results CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). Conclusion Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients. PMID:27556206

  10. Baseline and longitudinal grey matter changes in newly diagnosed Parkinson's disease: ICICLE-PD study.

    PubMed

    Mak, Elijah; Su, Li; Williams, Guy B; Firbank, Michael J; Lawson, Rachael A; Yarnall, Alison J; Duncan, Gordon W; Owen, Adrian M; Khoo, Tien K; Brooks, David J; Rowe, James B; Barker, Roger A; Burn, David J; O'Brien, John T

    2015-10-01

    converters showed bilateral temporal cortex thinning relative to the Parkinson's disease with no cognitive impairment stable subjects. Although loss of both cortical and subcortical volume occurs in non-demented Parkinson's disease, our longitudinal analyses revealed that Parkinson's disease with mild cognitive impairment shows more extensive atrophy and greater percentage of cortical thinning compared to Parkinson's disease with no cognitive impairment. In particular, an extension of cortical thinning in the temporo-parietal regions in addition to frontal atrophy could be a biomarker in therapeutic studies of mild cognitive impairment in Parkinson's disease for progression towards dementia.

  11. The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population

    PubMed Central

    2010-01-01

    Background The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the study is to know the prevalence and associated risk factors of peripheral arterial disease in the general population. Methods We performed a cross-sectional, multicentre, population-based study in 3786 individuals >49 years, randomly selected in 28 primary care centres in Barcelona (Spain). Peripheral arterial disease was evaluated using the ankle-arm index. Values < 0.9 were considered as peripheral arterial disease. Results The prevalence (95% confidence interval) of peripheral arterial disease was 7.6% (6.7-8.4), (males 10.2% (9.2-11.2), females 5.3% (4.6-6.0); p < 0.001). Multivariate analysis showed the following risk factors: male sex [odds ratio (OR) 1.62; 95% confidence interval 1.01-2.59]; age OR 2.00 per 10 years (1.64-2.44); inability to perform physical activity [OR 1.77 (1.17-2.68) for mild limitation to OR 7.08 (2.61-19.16) for breathless performing any activity]; smoking [OR 2.19 (1.34-3.58) for former smokers and OR 3.83 (2.23-6.58) for current smokers]; hypertension OR 1.85 (1.29-2.65); diabetes OR 2.01 (1.42-2.83); previous cardiovascular disease OR 2.19 (1.52-3.15); hypercholesterolemia OR 1.55 (1.11-2.18); hypertriglyceridemia OR 1.55 (1.10-2.19). Body mass index ≥25 Kg/m2 OR 0.57 (0.38-0.87) and walking >7 hours/week OR 0.67 (0.49-0.94) were found as protector factors. Conclusions The prevalence of peripheral arterial disease is low, higher in males and increases with age in both sexes. In addition to previously described risk factors we found a protector effect in physical exercise and overweight. PMID:20529387

  12. Monotherapy with HMG-CoA reductase inhibitors and secondary prevention in coronary artery disease.

    PubMed

    Rackley, C E

    1996-09-01

    Although thrombolytic drugs, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting have provided major advances in the treatment of coronary artery disease, the use of lipid-lowering drugs for secondary prevention has significantly reduced cardiovascular events in the population with coronary artery disease. Secondary prevention trials using HMG-CoA reductase inhibitors include the Familial Atherosclerosis Treatment Study (FATS), the Monitored Atherosclerosis Regression Study (MARS), the Canadian Coronary Atherosclerosis Intervention Trial (CCAIT), the Asymptomatic Carotid Artery Progression Study (ACAPS), the Multi Anti-Atheroma Study (MAAS), the Scandinavian Simvastatin Survival Study (4S), the Pravastatin Limitation of Atherosclerosis in Coronary Arteries (PLAC I), the Regression Growth Evaluation Statin Study (REGRESS), the Pravastatin Multinational Study, and the Pravastatin, Lipids, and Atherosclerosis in Carotids (PLAC II). Mean changes from baseline of lipid fractions in these trials included: total cholesterol 18 to 35% reduction; low-density lipoprotein (LDL) cholesterol 26 to 46% reduction; high-density lipoprotein (HDL) cholesterol 5 to 15% increase; and triglyceride 7 to 22% reduction. Angiographic regression or lack of progression was statistically demonstrated in the FATS, MARS, CCAIT, MAAS, PLAC I, and REGRESS trials. Cardiovascular events decreased 25 to 92% in all trials, and there was a significant reduction in both cardiovascular and total mortality in the 4S. The greater reduction in cardiovascular events than in anatomic changes suggests that the HMG-CoA reductase inhibitors stabilized the surface of plaques. Monotherapy with HMG-CoA reductase inhibitors provides the clinical opportunity to modify the natural history of coronary artery disease.

  13. Cardiovascular toxicity due to metoprolol poisoning in a patient with coronary artery disease

    PubMed Central

    Unverir, Pinar; Topacoglu, Hakan; Bozkurt, Selim; Kaynak, Firat

    2007-01-01

    What is already known about this subject Poisoning with β-blockers can result in cardiovascular and central nervous system effects. Although much has been reported about metoprolol poisoning's cardiovascular complications, little attention has been paid to acute myocardial infarction (AMI) accompanied by elevated cardiac markers. What this study adds This case report demonstrates for the first time an association of metoprolol poisoning with acute myocardial infarction in a patient with a previous history of coronary artery disease. Metoprolol poisoning can induce acute myocardial reinfarction in patients with prior AMI or known coronary artery disease. In other words, metoprolol overdose can trigger myocardial ischaemia and dysrhythmia in patients with coronary artery disease. Aim To demonstrate that β-blocker poisoning results in cardiovascular and central nervous system findings. Methods A 56-year-old woman was brought to the emergency department, having been admitted to hospital with 1500 mg of metoprolol ingestion 2 h previously. She had undergone percutanerous transluminal coronary angioplasty and stenting because of acute myocardial infarction (AMI). Her ECG revealed ST segment elevation in inferior leads and junctional dysrhythmia. Her clinical symptoms relieved after pacing and hospitalization and she was discharged. Results Our patient demonstrated findings of AMI with hypotension and bradycardia that appeared to result from metoprolol poisoning. Although one patient has been reported to have AMI associated with metoprolol poisoning, our patient is unique with her ECG changes and elevated cardiac markers: this is the first time that AMI characterized by elevated cardiac markers associated with metoprolol toxicity has been reported. Conclusions Emergency physicians should bear in mind that AMI can accompany the presentation of metoprolol overdose in those with coronary artery disease. In other words, metoprolol poisoning can trigger myocardial ischaemia

  14. Short-Term Longitudinal Study of Central Auditory Function in Alzheimer's Disease and Mild Cognitive Impairment

    PubMed Central

    Idrizbegovic, Esma; Hederstierna, Christina; Dahlquist, Martin; Rosenhall, Ulf

    2013-01-01

    Background/Aims Central auditory function can be studied to monitor the progression of mild cognitive impairment to dementia. Our aim was to address this issue in a prospective longitudinal setting. Methods Tests of central hearing function were performed on 70 subjects with either Alzheimer's disease (AD) or mild cognitive impairment, and in controls with subjective memory complaints but normal cognition. The time span until follow-up was 1.5 years. Results The dichotic digit free recall test showed a significant decline in the AD group compared with the controls (left ear). Conclusion The short time span was long enough to disclose a central auditory processing decline in AD. PMID:24516414

  15. Disparities in utilization of coronary artery disease treatment by gender, race, and ethnicity: opportunities for prevention.

    PubMed

    Bhalotra, Sarita; Ruwe, Mathilda B M; Strickler, Gail K; Ryan, Andrew M; Hurley, Clare L

    2007-07-01

    Racial, ethnic, (R/E) and gender disparities in access to health services in the United States and their relationship to adverse health outcomes are well established. Despite an increase in evidence-based cardiovascular treatment, gender, racial, and ethnic disparities in coronary artery disease (CAD) treatment persist. There is neither currently a comprehensive framework for understanding why disparities occur in cardiovascular disease care, nor viable solutions for intervention. This article synthesizes the literature on disparities in coronary artery disease with a conceptual model for understanding chronic disease disparities. This article follows the natural history of disease to observe where differences arise, beginning with health risk management, screening, diagnosis, treatment, and rehabilitation. Racial, ethnic, and gender differences were found at every step of this continuum, including a higher burden of risk factors and a less likelihood of receiving needed lifesaving cardiac procedures. Unfortunately, there is a dearth of intervention strategies to reduce racial, ethnic, and gender disparities in coronary artery disease. Comprehensive solutions will require addressing the barriers at the system, the provider, and the patient level. An early intervention approach that addresses multiple risk factors should be a high priority.

  16. Emergency Endovascular Management of Pulmonary Artery Aneurysms In Behcet's Disease: Report of Two Cases and a Review of the Literature

    SciTech Connect

    Cantasdemir, Murat; Kantarci, Fatih; Mihmanli, Ismail; Akman, Canan; Numan, Furuzan; Islak, Civan; Bozkurt, A. Kursat

    2002-12-15

    his report describes two patients with a known history of Behcet's disease in whom massive hemoptysis developed from rupture of pulmonary artery aneurysms. The high recurrence rate of complications related to pulmonary artery aneurysms and even the aneurysms themselves due to inadequacy of medical therapy and the disadvantages of surgical treatment make these aneurysms candidates for endovascular management.The pulmonary artery aneurysms reported here were successfully treated with endovascular embolization using n-butylcyanoacrylate. Pulmonary artery aneurysm embolization in Behcet's disease has been reviewed in the light of relevant literature.

  17. Detection of coronary artery disease using MR imaging with dipyridamole infusion

    SciTech Connect

    Pennell, D.J.; Underwood, S.R.; Longmore, D.B. )

    1990-03-01

    Exercise testing in the magnetic resonance (MR) scanner is difficult because of space restriction and movement artefact, which limit its use in the investigation of patients with suspected coronary artery disease. Pharmacological stress, however, can be used as a substitute for exercise. Therefore, a patient with angina underwent MR ventricular wall motion studies before and after intravenous dipyridamole. Reversible abnormal regional contraction of the myocardium was demonstrated and correlated with a reversible perfusion defect on subsequent thallium myocardial perfusion imaging and a blocked artery at coronary angiography. A clinically useful investigative procedure may be developed.

  18. Evaluation of the Effects of Mesoglycan on Some Markers of Endothelial Damage and Walking Distance in Diabetic Patients with Peripheral Arterial Disease.

    PubMed

    Derosa, Giuseppe; D'Angelo, Angela; Romano, Davide; Maffioli, Pamela

    2017-03-06

    The aim of this study was to evaluate the variation of some parameters involved in peripheral artery disease progression in diabetic patients with peripheral artery disease after six months of mesoglycan [...].

  19. [Treatment of hypertension in patients with coronary arterial disease].

    PubMed

    Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    Reports of randomized controlled trials and prospective observational studies provide the most reliable data on the association between blood pressure and coronary heart disease (CHD). The totality of the evidence indicate a strong association between blood pressure and coronary heart disease, which is continuous at levels of less than 115 mm Hg of systolic. In general, 60 to 69 years of age, 10 lower mm Hg systolic blood pressure is associated with lower risk of one-fifth of a coronary heart disease event. The size and shape of this Association are consistent in all regions, for men and women and life-threatening events such as stroke and myocardial infarction. Trials that compared active treatment with placebo or no treatment have shown that the benefits of reducing blood pressure with different classes of drugs (e.g., diuretics, beta-blockers, ACE inhibitors, calcium antagonists) are quite similar, with about a fifth of reduction in coronary heart disease. The important points in this review are: First, that the relative benefit to the decline in blood pressure for the prevention of coronary heart disease appears to be constant in a range of different populations. Second, it is likely that considerable benefit with blood pressure low below thresholds of "traditional" blood pressure (140/90 mm Hg), especially in those with high absolute risk. Third, start, reduce with caution -especially in adult- and keep the maximum tolerance of blood pressure reduction is an issue more important than the choice of the initial agent.

  20. Successful Intra-Arterial Chemotherapy for Extramammary Paget's Disease of the Axilla in a Patient with Parkinson's Disease

    SciTech Connect

    Damascelli, Bruno; Ticha, Vladimira

    2011-02-15

    Extramammary Paget's disease (EMPD) is a rare intraepithelial neoplasm occurring less frequently in men and even more rarely in the axilla. A 59-year-old man with severe Parkinson's disease presented with axillary EMPD. The neurological comorbidity made treatment of the EMPD problematical and prompted us to propose locoregional intra-arterial chemotherapy in single short sessions. Two innovative chemotherapeutic macrocomplexes were used: doxorubicin incorporated in large liposomes and the taxane paclitaxel incorporated in albumin nanoparticles. A therapeutic response was seen right from the first treatment and was macroscopically close to complete after four cycles. Five months after the end of treatment the patient had minimal visible disease and had enjoyed a distinct improvement in quality of life, with no noteworthy complications related to the intra-arterial chemotherapy with percutaneous transfemoral catheterization.

  1. Bronchial Artery Embolization for Hemoptysis Due to Benign Diseases: Immediate and Long-Term Results

    SciTech Connect

    Kato, Akira; Kudo, Sho; Matsumoto, Koichi; Fukahori, Tetsuhiro; Shimizu, Toshihisa; Uchino, Akira; Hayashi, Shinichiro

    2000-09-15

    Purpose: To clarify the immediate effect and long-term results of bronchial artery embolization (BAE) for hemoptysis due to benign diseases and the factors influencing the outcomes.Methods: One hundred and one patients (aged 34-89 years) received bronchial artery embolization with polyvinyl alcohol particles and gelatin sponge for massive or continuing moderate hemoptysis caused by benign pulmonary diseases and resistant to medical treatment.Results: After BAE, bleeding stopped in 94 patients (94%). The immediate effect was unfavorable in cases where feeder vessels were overlooked or the embolization of the intercostal arteries was insufficient. Long-term cumulative hemoptysis non recurrence rates after the initial embolization were 77.7% for 1 year and 62.5% for 5 years. In bronchitis (n 9) and active tuberculosis (n = 4) groups, an excellent (100%) 5-year cumulative non recurrence rate was obtained. The rate was lower in groups with pneumonia/abscess/pyothorax (n = 8) or with pulmonary aspergillosis (n = 9) (53.3%, 1-year cumulative non recurrence). There were higher incidences of early recurrence among patients with massive hemorrhage or more marked vascularity and systemic artery-pulmonary artery shunt in angiography: however, these trends were not statistically significant. Conclusions: BAE can yield long-term benefit in patients with hemoptysis due to benign diseases. Technical problems in the procedure had an impact on the short-term effect. The degree of hemorrhage or the severity of angiographical findings were not significant factors affecting the outcome. The most significant factor affecting long-term results was whether the inflammation caused by the underlying disease was medically well controlled.

  2. [DIAGNOSIS OF ISCHEMIC HEART DISEASE CAUSED BY TORTUOSITY OF CORONARY ARTERIES].

    PubMed

    Lebedeva, E O; Lazoryshynets, V V; Beshliaga, V M; Grusha, M M

    2015-01-01

    This article is devoted to the problems of diagnostics of coronary artery tortuosity phenomenon. Given the lack of literature about the role of phenomenon tortuosity of coronary arteries in the genesis of ischemic myocardial damage, the purpose of study was to determine the clinical relevance as well as necessity for prevention and treatment of this vascular anomaly. Therefore were analyzed medical history, laboratory and clinical database as well as data functional studies of the heart and cardiovascular system in 1404 patients which were divided into four groups on the results of coronary angiography. The results of the study indicate tortuosity of coronary arteries may be independent and additional burdening factor in the development of ischemic heart disease.

  3. Acute effect of hydralazine administration on pulmonary artery hemodynamics in dogs with chronic heartworm disease.

    PubMed

    Atkins, C E; Keene, B W; McGuirk, S M; Sato, T

    1994-02-01

    In an effort to better understand the role of vasodilators in the management of pulmonary hypertension associated with chronic heartworm disease (HWD), pulmonary hemodynamic measurements were obtained from 7 experimentally infected, anesthetized dogs before and after hydralazine administration (mean dose, 1.96 mg/kg of body weight). Five dogs were maintained on room air, while 2 were maintained on 100% oxygen during the hydralazine study. The hemodynamic effect of hydralazine in dogs with HWD was evaluated, using heart rate, cardiac index, mean pulmonary artery pressure, mean arterial pressure, total pulmonary resistance, total systemic resistance, total systemic resistance/total pulmonary resistance, left ventricular dP/dtmax, left ventricular end diastolic pressure, and left and right ventricular double products ([mean arterial pressure x heart rate] and [mean pulmonary artery pressure x heart rate], respectively). Responders were defined as those in which total pulmonary resistance decreased > or = 20% without an increase in mean pulmonary arterial pressure and in which heart rate increase was < or = 10%. Comparison was also made between maximal hemodynamic effect of hydralazine with that after 100% oxygen administration for 15 minutes to previously normoxemic dogs (n = 5). Significance was determined if P < 0.05, using the paired t-test. Hydralazine induced significant reductions in mean pulmonary and systemic arterial pressures and total pulmonary resistance, with no significant change in heart rate, cardiac index, total systemic resistance, left ventricular dP/dtmax, left ventricular end diastolic pressure, or right and left ventricular double products. Four (57%) of the 7 dogs studied were considered responders. Pretreatment cardiac index, mean pulmonary artery pressure, and total pulmonary resistance did not allow differentiation of responders from nonresponders.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Transluminal angioplasty for arteriosclerotic disease of the distal vertebral and basilar arteries.

    PubMed Central

    Terada, T; Higashida, R T; Halbach, V V; Dowd, C F; Nakai, E; Yokote, H; Itakura, T; Hieshima, G B

    1996-01-01

    effective procedure to treat vertebrobasilar ischaemia secondary to high grade arteriosclerotic disease affecting either the distal vertebral or basilar artery regions that do not respond to medical treatment. Images PMID:8774399

  5. Detecting lower extremity vascular dynamics in patients with peripheral artery disease using diffuse optical tomography

    NASA Astrophysics Data System (ADS)

    Khalil, Michael A.; Kim, Hyun-Keol K.; Kim, In-Kyong; Dayal, Rajeev; Hielscher, Andreas H.

    2011-02-01

    Peripheral Artery Disease (PAD) affects over 10 million Americans and is associated with significant morbidity and mortality. While in many cases the ankle-brachial index (ABI) can be used for diagnosing the disease, this parameter is not dependable in the diabetic and elderly population. These populations tend to have calcified arteries, which leads to elevated ABI values. Dynamic optical tomography (DDOT) promises to overcome the limitations of the current diagnostic techniques and has the potential to initiate a paradigm shift in the diagnosis of vascular disease. We have performed initial pilot studies involving 5 PAD patients and 3 healthy volunteers. The time traces and tomographic reconstruction obtained from measurements on the feet show significant differences between healthy and affected vasculatures. In addition, we found that DOT is capable of identifying PAD in diabetic patients, who are misdiagnosed by the traditional ABI screening.

  6. Ruptured posterior ethmoidal artery aneurysm and Moyamoya disease in an adult patient. Case report.

    PubMed

    Mélot, A; Chazot, J-V; Troude, L; De la Rosa, S; Brunel, H; Roche, P-H

    2016-06-01

    The association between Moyamoya disease and intracranial aneurysms is well described. In our case, we describe a unique aneurismal location and its management. We report the case of a 74-year-old woman affected by a Moyamoya disease who displayed a frontal lobe hematoma. The origin of the bleeding came from the rupture of a posterior ethmoidal artery aneurysm that was treated surgically with favourable outcome. This case of a ruptured posterior ethmoidal artery aneurysm in a Moyamoya patient illustrates the polymorphism of the vascular complications encountered in this disease. It stresses the need to obtain information from an angiographic investigation in order to select the best therapeutic option and to reduce procedural complications.

  7. Detection of Conversion from Mild Cognitive Impairment to Alzheimer's Disease Using Longitudinal Brain MRI

    PubMed Central

    Sun, Zhuo; van de Giessen, Martijn; Lelieveldt, Boudewijn P. F.; Staring, Marius

    2017-01-01

    Mild Cognitive Impairment (MCI) is an intermediate stage between healthy and Alzheimer's disease (AD). To enable early intervention it is important to identify the MCI subjects that will convert to AD in an early stage. In this paper, we provide a new method to distinguish between MCI patients that either convert to Alzheimer's Disease (MCIc) or remain stable (MCIs), using only longitudinal T1-weighted MRI. Currently, most longitudinal studies focus on volumetric comparison of a few anatomical structures, thereby ignoring more detailed development inside and outside those structures. In this study we propose to exploit the anatomical development within the entire brain, as found by a non-rigid registration approach. Specifically, this anatomical development is represented by the Stationary Velocity Field (SVF) from registration between the baseline and follow-up images. To make the SVFs comparable among subjects, we use the parallel transport method to align them in a common space. The normalized SVF together with derived features are then used to distinguish between MCIc and MCIs subjects. This novel feature space is reduced using a Kernel Principal Component Analysis method, and a linear support vector machine is used as a classifier. Extensive comparative experiments are performed to inspect the influence of several aspects of our method on classification performance, specifically the feature choice, the smoothing parameter in the registration and the use of dimensionality reduction. The optimal result from a 10-fold cross-validation using 36 month follow-up data shows competitive results: accuracy 92%, sensitivity 95%, specificity 90%, and AUC 94%. Based on the same dataset, the proposed approach outperforms two alternative ones that either depends on the baseline image only, or uses longitudinal information from larger brain areas. Good results were also obtained when scans at 6, 12, or 24 months were used for training the classifier. Besides the

  8. Colchicine in Coronary Artery Disease: An Old Acquaintance in New Attire?

    PubMed

    Giannopoulos, Georgios; Angelidis, Christos; Papoutsidakis, Nikolaos; Panagopoulou, Vasiliki; Cleman, Michael W; Lekakis, John; Deftereos, Spyridon

    2015-01-01

    Colchicine has recently gained considerable attention in the field of cardiovascular research, after a number of studies showed that it may be of use in several settings of cardiovascular disease, including chronic coronary artery disease and following stent implantation. Its unique anti-inflammatory mechanism of action makes it safe to use in patients with cardiovascular disease, unlike most--if not all--currently available antiinflammatory agents. While its prophylactic and therapeutic value is well-established in certain conditions involving an acute inflammatory response, e.g. pericarditis, in other conditions, including coronary artery disease and heart failure, which are associated with a chronic low-grade inflammatory state, the evidence regarding its potential use remains sparse. In this concise review, we present key features of this drug and the rationale for colchicine therapy, in the context of acute and chronic coronary artery disease, as well as in ischemic heart failure and critically examine the evidence concerning a possible future role of colchicine treatment in these conditions.

  9. Arm exercise-thallium imaging testing for the detection of coronary artery disease

    SciTech Connect

    Balady, G.J.; Weiner, D.A.; Rothendler, J.A.; Ryan, T.J.

    1987-01-01

    Patients with lower limb impairment are often unable to undergo a standard bicycle or treadmill test for the evaluation of coronary artery disease. To establish an alternative method of testing, 50 subjects (aged 56 +/- 10 years) performed arm ergometry testing in conjunction with myocardial thallium scintigraphy. All underwent coronary angiography; significant coronary artery disease (greater than or equal to 70% stenosis) in at least one vessel was present in 41 (82%) of the 50 patients. Thallium scintigraphy was found to have an 83% sensitivity and 78% specificity for detecting coronary disease, compared with a sensitivity and specificity of 54% (p less than 0.01) and 67% (p = NS), respectively, for exercise electrocardiography. In the subgroup of 23 patients who had no prior myocardial infarction or left bundle branch block and were not taking digitalis, thallium scintigraphy had a sensitivity of 80% versus 50% for exercise electrocardiography. Scintigraphy yielded a sensitivity of 84, 74 and 90% for one, two and three vessel disease, respectively. Noninvasive arm ergometry exercise-thallium imaging testing appears to be reliable and useful and should be considered in the evaluation of coronary artery disease in patients with lower limb impairment.

  10. Exercise thallium-201 scintigraphy in the diagnosis and prognosis of coronary artery disease

    SciTech Connect

    Kotler, T.S.; Diamond, G.A. )

    1990-11-01

    The objective of this study is to determine the discriminant accuracy of exercise thallium-201 myocardial perfusion scintigraphy for the diagnosis and prognosis of patients with known or suspected coronary artery disease. This is a survey of the National Library of Medicine MEDLINE database. The key medical subject headings used were coronary disease, myocardial infarction, radionuclide imaging, and thallium. A total of 122 retrieved studies were considered relevant and were reviewed in depth. Only studies reporting both the sensitivity and specificity of thallium scintigraphy were analyzed. Discriminant accuracy for diagnosis and prognosis was summarized in terms of pooled sensitivity and specificity. Exercise thallium scintigraphy is useful in the noninvasive diagnosis of coronary artery disease, especially in patients with abnormal resting electrocardiograms, restricted exercise tolerance, and intermediate probability of having disease at the time of testing as well as of defining the prognosis of patients with known or suspected coronary artery disease, especially in those with previous myocardial infarction. Because of various shortcomings in the published record, however, the marginal discriminant accuracy and cost effectiveness of thallium scintigraphy compared with conventional clinical assessment and exercise electrocardiography remain controversial. 193 references.

  11. Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors.

    PubMed

    Kupeli, Serhan

    2014-07-26

    Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World. In cancer patients, cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease. An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades. Determining and handling the long-term effects of cancer treatment have become more important nowadays, parallel to the good results reached in survival rates. Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications. Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart. Approximately ten years after the completion of all therapies, the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma. The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review, in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment. Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography.

  12. Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors

    PubMed Central

    Kupeli, Serhan

    2014-01-01

    Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World. In cancer patients, cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease. An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades. Determining and handling the long-term effects of cancer treatment have become more important nowadays, parallel to the good results reached in survival rates. Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications. Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart. Approximately ten years after the completion of all therapies, the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma. The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review, in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment. Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography. PMID:25068016

  13. Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience

    SciTech Connect

    Brountzos, E. N. Petersen, B.; Binkert, C.; Panagiotou, I.; Kaufman, J. A.

    2004-11-15

    Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery-to-coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients. Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively. Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients' symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions.

  14. Identical mitochondrial somatic mutations unique to chronic periodontitis and coronary artery disease

    PubMed Central

    Pallavi, Tokala; Chandra, Rampalli Viswa; Reddy, Aileni Amarender; Reddy, Bavigadda Harish; Naveen, Anumala

    2016-01-01

    Context: The inflammatory processes involved in chronic periodontitis and coronary artery diseases (CADs) are similar and produce reactive oxygen species that may result in similar somatic mutations in mitochondrial deoxyribonucleic acid (mtDNA). Aims: The aims of the present study were to identify somatic mtDNA mutations in periodontal and cardiac tissues from subjects undergoing coronary artery bypass surgery and determine what fraction was identical and unique to these tissues. Settings and Design: The study population consisted of 30 chronic periodontitis subjects who underwent coronary artery surgery after an angiogram had indicated CAD. Materials and Methods: Gingival tissue samples were taken from the site with deepest probing depth; coronary artery tissue samples were taken during the coronary artery bypass grafting procedures, and blood samples were drawn during this surgical procedure. These samples were stored under aseptic conditions and later transported for mtDNA analysis. Statistical Analysis Used: Complete mtDNA sequences were obtained and aligned with the revised Cambridge reference sequence (NC_012920) using sequence analysis and auto assembler tools. Results: Among the complete mtDNA sequences, a total of 162 variations were spread across the whole mitochondrial genome and present only in the coronary artery and the gingival tissue samples but not in the blood samples. Among the 162 variations, 12 were novel and four of the 12 novel variations were found in mitochondrial NADH dehydrogenase subunit 5 complex I gene (33.3%). Conclusions: Analysis of mtDNA mutations indicated 162 variants unique to periodontitis and CAD. Of these, 12 were novel and may have resulted from destructive oxidative forces common to these two diseases. PMID:27041832

  15. Detection of infragenual arterial disease using noncontrast-enhanced MR angiography in patients with diabetes

    PubMed Central

    Liu, Xin; Zhang, Na; Fan, Zhaoyang; Feng, Fei; Yang, Qi; Zheng, Hairong; Liu, Pengcheng; Li, Debiao

    2013-01-01

    Purpose To evaluate the diagnostic performance of a newly developed noncontrast-enhanced MR angiography (NCE-MRA) technique using flow-sensitive dephasing (FSD) prepared steady-state free precession (SSFP) for detecting calf arterial disease in patients with diabetes. Materials and Methods Forty-five patients with diabetes who underwent routine CE-MRA of lower extremities were recruited for NCE-MRA at the calf on a 1.5T MR system. Image quality evaluated on a four-point scale and diagnostic performance for detecting more than 50% arterial stenosis were statistically analyzed, using CE-MRA as the standard of reference. Results A total of 264 calf arterial segments were obtained in the 45 patients with 88 legs. The percentage of diagnostic arterial segments was all 98% for NCE- and CE-MRA. The image quality, SNR, CNR was 3.3, 177, 138 and 3.5, 103, 99 for NCE-MRA and CE-MRA respectively. The average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of NCE-MRA were 97%, 96%, 90%, 99%, and 96%, respectively on a per-segment basis and 90%, 84%, 82%, 91%, and 87%, respectively on a per-patients basis. Conclusion The NCE-MRA technique demonstrates adequate image quality in the delineation of calf arteries and consistent diagnostic performance for detecting significant stenosis with CE-MRA in patients with diabetes. PMID:24925770

  16. No Evidence for Retinal Damage Evolving from Reduced Retinal Blood Flow in Carotid Artery Disease

    PubMed Central

    Heßler, Henning; Zimmermann, Hanna; Oberwahrenbrock, Timm; Kadas, Ella Maria; Mikolajczak, Janine; Brandt, Alexander U.; Kauert, Andreas; Paul, Friedemann; Schreiber, Stephan J.

    2015-01-01

    Introduction. Carotid artery disease (CAD) comprising high-grade internal carotid artery stenosis (CAS) or carotid artery occlusion (CAO) may lead to ipsilateral impaired cerebral blood flow and reduced retinal blood supply. Objective. To examine the influence of chronic CAD on retinal blood flow, retinal morphology, and visual function. Methods. Patients with unilateral CAS ≥ 50% (ECST criteria) or CAO were grouped according to the grade of the stenosis and to the flow direction of the ophthalmic artery (OA). Retinal perfusion was measured by transorbital duplex ultrasound, assessing central retinal artery (CRA) blood flow velocities. In addition, optic nerve and optic nerve sheath diameter were measured. Optical coherence tomography (OCT) was performed to study retinal morphology. Visual function was assessed using high- and low-contrast visual paradigms. Results. Twenty-seven patients were enrolled. Eyes with CAS ≥ 80%/CAO and retrograde OA blood flow showed a significant reduction in CRA peak systolic velocity (no-CAD side: 0.130 ± 0.035 m/s, CAS/CAO side: 0.098 ± 0.028; p = 0.005; n = 12). OCT, optic nerve thicknesses, and visual functional parameters did not show a significant difference. Conclusion. Despite assessable hemodynamic effects, chronic high-grade CAD does not lead to gaugeable morphological or functional changes of the retina. PMID:26558275

  17. Aspirin Resistance Predicts Adverse Cardiovascular Events in Patients with Symptomatic Peripheral Artery Disease

    PubMed Central

    Pasala, Tilak; Hoo, Jennifer Soo; Lockhart, Mary Kate; Waheed, Rehan; Sengodan, Prasanna; Alexander, Jeffrey

    2016-01-01

    Antiplatelet therapy reduces the risk of myocardial infarction, stroke, and vascular death in patients who have symptomatic peripheral artery disease. However, a subset of patients who take aspirin continues to have recurrent cardiovascular events. There are few data on cardiovascular outcomes in patients with peripheral artery disease who manifest aspirin resistance. Patients with peripheral artery disease on long-term aspirin therapy (≥4 wk) were tested for aspirin responsiveness by means of the VerifyNow Aspirin Assay. The mean follow-up duration was 22.6 ± 8.3 months. The primary endpoint was a composite of death, myocardial infarction, or ischemic stroke. Secondary endpoints were the incidence of vascular interventions (surgical or percutaneous), or of amputation or gangrene caused by vascular disease. Of the 120 patients enrolled in the study, 31 (25.8%) were aspirin-resistant and 89 (74.2%) were aspirin-responsive. The primary endpoint occurred in 10 (32.3%) patients in the aspirin-resistant group and in 13 (14.6%) patients in the aspirin-responsive group (hazard ratio=2.48; 95% confidence interval, 1.08–5.66; P=0.03). There was no significant difference in the secondary outcome of revascularization or tissue loss. By multivariate analysis, aspirin resistance and history of chronic kidney disease were the only independent predictors of long-term adverse cardiovascular events. Aspirin resistance is highly prevalent in patients with symptomatic peripheral artery disease and is an independent predictor of adverse cardiovascular risk. Whether intervening in these patients with additional antiplatelet therapies would improve outcomes needs to be explored. PMID:28100965

  18. Longitudinal behavioral changes in the APP/PS1 transgenic Alzheimer's disease model.

    PubMed

    Ferguson, Sherry A; Sarkar, Sumit; Schmued, Larry C

    2013-04-01

    The APP/PS1 double transgenic mouse is an Alzheimer's Disease-like model. However, cognitive deficits measured at one age do not necessarily indicate age-related progressions. Further, results of the most widely used behavioral assessment, water maze performance, are generally limited to 1-2 endpoints. Here, male APP/PS1 and noncarrier wildtypes (n=11/group) were assessed at 7-15 months of age for water maze, open field, and motor coordination performance. Body weights and motor coordination were comparable for both groups throughout. Beginning at approximately 9 months of age, the transgenic group exhibited hypoactivity in the open field which continued throughout. Latency to locate the platform and swim path length were longer in the transgenic group; however, these appeared to be more related to increased floating and thigmotactic behavior and only partially related to a cognitive impairment. Age-related decrements in performance were not substantial; however, substantial plaque numbers were measured in six representative 16-month-old transgenic mice. The stability of water maze performance may be related to the longitudinal testing and repetitive experience, which previous research has demonstrated can confer beneficial effects on behavior and plaque deposition in transgenic Alzheimer's Disease models [1]. These results emphasize the importance of measuring multiple water maze endpoints and demonstrate the feasibility of longitudinal assessments in this model.

  19. Balloon angioplasty in acute and chronic coronary artery disease

    SciTech Connect

    Holmes, D.R. Jr.; Vlietstra, R.E. )

    1989-04-14

    Percutaneous transluminal coronary angioplasty has grown exponentially since its introduction. Currently, selection criteria include single-vessel and multivessel disease, stable and unstable angina, and acute infarction. The outcome depends on specific patient and antiographic characteristics. In ideal lesions, success rates should be greater than 90%, with low morbidity and mortality. With more severe and diffuse multivessel disease, success rates are lower and complication rates are higher. In these cases, percutaneous transluminal coronary angioplasty still offers a reasonable option, provided complete revascularization can be achieved or the angina-producing lesion dilated. Numerous issues remain unresolved, including (1) the role of percutaneous transluminal coronary angioplasty vs coronary surgery (currently being tested), (2) restenosis, which occurs in approximately 30% of treated lesions, and (3) organizational adjustments such as training and certification to maintain high standards of care.

  20. [Combined surgical treatment for coronary heart disease as well as heart valve diseases and carotid artery stenosis].

    PubMed

    Reichart, B; Kemkes, B M; Klinner, W; Kreuzer, E; Becker, H M; Harrington, O B; Crosby, V G; Wolf, R Y

    1979-04-26

    This is an account on combined procedures in 124 patients suffering from arteriosclerotic vessel disease. In order to judge the proceedings and the results the patients were divided up into two groups. in 15 patients (group I) a carotid endarterectomy combined with an aorto-coronary bypass operation was performed; once a subclavian artery stenosis was resected at the same time. One patient of that group died after 31 days (7%). In group II 108 heart valve operations were performed together with a coronary artery revascularisation. Early and late mortality divided up as follows: aortic stenosis 6/44 (14%) respectively 2/44 (5%); aortic insufficiency 1/14 (7%) resp. 0; combined aortic disease 1/8 )13%) resp. 0; mitral stenosis 1/11 (9%) resp. 0; mitral insufficiency 6/26 (23%) resp. 2/26 (8%); combined mitral valve disease 1/2 (50%) resp. 0; three times both valves (aorta, mitral) were replaced without mortality. In our opinion combined procedures, resection of supraaortic artery stenosis respectively cardiac valve operations and aorto-coronary bypass are indicated especially since the functional long-term results are excellent. Though one should consider the high operative risk in patients with mitral insufficiency and combined mitral valve disease.

  1. Longitudinal assessment of tau and amyloid beta in cerebrospinal fluid of Parkinson disease.

    PubMed

    Zhang, Jing; Mattison, Hayley A; Liu, Changqin; Ginghina, Carmen; Auinger, Peggy; McDermott, Michael P; Stewart, Tessandra; Kang, Un Jung; Cain, Kevin C; Shi, Min

    2013-11-01

    Tau gene has been consistently associated with the risk of Parkinson disease in recent genome wide association studies. In addition, alterations of the levels of total tau, phosphorylated tau [181P], and amyloid beta 1-42 in cerebrospinal fluid have been reported in patients with sporadic Parkinson disease and asymptomatic carriers of leucine-rich repeat kinase 2 mutations, in patterns that clearly differ from those typically described for patients with Alzheimer disease. To further determine the potential roles of these molecules in Parkinson disease pathogenesis and/or in tracking the disease progression, especially at early stages, the current study assessed all three proteins in 403 Parkinson disease patients enrolled in the DATATOP (Deprenyl and tocopherol antioxidative therapy of parkinsonism) placebo-controlled clinical trial, the largest cohort to date with cerebrospinal fluid samples collected longitudinally. These initially drug-naive patients at early disease stages were clinically evaluated, and cerebrospinal fluid was collected at baseline and then at endpoint, defined as the time at which symptomatic anti-Parkinson disease medications were determined to be required. General linear models were used to test for associations between baseline cerebrospinal fluid biomarker levels or their rates of change and changes in the Unified Parkinson Disease Rating Scale (total or part III motor score) over time. Robust associations among candidate markers are readily noted. Baseline levels of amyloid beta were weakly but negatively correlated with baseline Unified Parkinson Disease Rating Scale total scores. Baseline phosphorylated tau/total tau and phosphorylated tau/amyloid beta were significantly and negatively correlated with the rates of the Unified Parkinson Disease Rating Scale change. While medications (deprenyl and/or tocopherol) did not appear to alter biomarkers appreciably, a weak but significant positive correlation between the rate of change in total

  2. Meta-Analysis of Abdominal Aortic Aneurysm in Patients With Coronary Artery Disease.

    PubMed

    Elkalioubie, Ahmed; Haulon, Stephan; Duhamel, Alain; Rosa, Mickael; Rauch, Antoine; Staels, Bart; Susen, Sophie; Van Belle, Eric; Dupont, Annabelle

    2015-11-01

    The high coronary artery disease (CAD) prevalence in patients with abdominal aortic aneurysm (AAA) is well known. However, the inverse relation has been little explored. We present, based on a systematic review and meta-analysis of the published evidence, a critical appraisal of the issue of AAA prevalence and also AAA predictive risk factors in patients with CAD, comparing it with AAA prevalence in subjects without CAD. A total of 22 studies involving 13,388 patients with CAD met the inclusion criteria. Overall, AAA prevalence in patients with CAD was 8.4% (95% confidence interval [CI] 6.9 to 10.3), significantly higher than in subjects without CAD (odds ratio [OR] 2.42, 95% CI 2.08 to 2.81). Pooled analysis revealed that smoking, arterial hypertension, and concomitant carotid artery stenosis were significantly associated with AAA in patients with CAD (OR 1.72, 95% CI 1.14 to 2.61; OR 1.57, 95% CI 1.06 to 2.35; OR 2.14, 95% CI 1.20 to 3.79, respectively). In patients with CAD, AAA prevalence tended to be higher with concomitant peripheral artery disease (OR 2.66, 95% CI 0.82 to 8.61, p = 0.08). In conclusion, AAA prevalence was significantly higher in patients with CAD versus subjects without CAD.

  3. Coronary Artery Manifestation of Ormond Disease: The "Mistletoe Sign".

    PubMed

    Maurovich-Horvat, Pál; Suhai, Ferenc Imre; Czimbalmos, Csilla; Tóth, Attila; Becker, David; Kiss, Emese; Ferencik, Maros; Hoffmann, Udo; Vagó, Hajnalka; Merkely, Béla

    2017-02-01

    A 69-year-old woman presented with symptoms of presumed cardiac involvement of idiopathic retroperitoneal fibrosis, otherwise known as Ormond disease. Distinct pericoronary tissue proliferations were depicted at cardiac magnetic resonance (MR) imaging and coronary computed tomographic (CT) angiography. On images, the coronary manifestation was termed the "mistletoe sign." The presence of the mistletoe sign on cardiac MR and coronary CT angiographic images is probably rare, but it might be a characteristic manifestation of retroperitoneal fibrosis. With the increasing number of noninvasive cardiac imaging tests performed worldwide, the recognition of the mistletoe sign could be helpful in diagnosing retroperitoneal fibrosis. (©) RSNA, 2016 Online supplemental material is available for this article.

  4. Detection of longitudinal ulcer using roughness value for computer aided diagnosis of Crohn's disease

    NASA Astrophysics Data System (ADS)

    Oda, Masahiro; Kitasaka, Takayuki; Furukawa, Kazuhiro; Watanabe, Osamu; Ando, Takafumi; Goto, Hidemi; Mori, Kensaku

    2011-03-01

    The purpose of this paper is to present a new method to detect ulcers, which is one of the symptoms of Crohn's disease, from CT images. Crohn's disease is an inflammatory disease of the digestive tract. Crohn's disease commonly affects the small intestine. An optical or a capsule endoscope is used for small intestine examinations. However, these endoscopes cannot pass through intestinal stenosis parts in some cases. A CT image based diagnosis allows a physician to observe whole intestine even if intestinal stenosis exists. However, because of the complicated shape of the small and large intestines, understanding of shapes of the intestines and lesion positions are difficult in the CT image based diagnosis. Computer-aided diagnosis system for Crohn's disease having automated lesion detection is required for efficient diagnosis. We propose an automated method to detect ulcers from CT images. Longitudinal ulcers make rough surface of the small and large intestinal wall. The rough surface consists of combination of convex and concave parts on the intestinal wall. We detect convex and concave parts on the intestinal wall by a blob and an inverse-blob structure enhancement filters. A lot of convex and concave parts concentrate on roughed parts. We introduce a roughness value to differentiate convex and concave parts concentrated on the roughed parts from the other on the intestinal wall. The roughness value effectively reduces false positives of ulcer detection. Experimental results showed that the proposed method can detect convex and concave parts on the ulcers.

  5. Coronary artery disease detection using a fuzzy-boosting PSO approach.

    PubMed

    Ghadiri Hedeshi, N; Saniee Abadeh, M

    2014-01-01

    In the past decades, medical data mining has become a popular data mining subject. Researchers have proposed several tools and various methodologies for developing effective medical expert systems. Diagnosing heart diseases is one of the important topics and many researchers have tried to develop intelligent medical expert systems to help the physicians. In this paper, we propose the use of PSO algorithm with a boosting approach to extract rules for recognizing the presence or absence of coronary artery disease in a patient. The weight of training examples that are classified properly by the new rules is reduced by a boosting mechanism. Therefore, in the next rule generation cycle, the focus is on those fuzzy rules that account for the currently misclassified or uncovered instances. We have used coronary artery disease data sets taken from University of California Irvine, (UCI), to evaluate our new classification approach. Results show that the proposed method can detect the coronary artery disease with an acceptable accuracy. Also, the discovered rules have significant interpretability as well.

  6. Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease

    PubMed Central

    Nery, Rosane Maria; Zanini, Maurice; Ferrari, Juliana Nery; Silva, César Augusto; Farias, Leonardo Fontanive; Comel, João Carlos; Belli, Karlyse Claudino; da Silveira, Anderson Donelli; Santos, Antonio Cardoso; Stein, Ricardo

    2014-01-01

    Background Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease. Objective To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease. Methods We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts. Results The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months. Conclusion Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard. PMID:24759952

  7. The Role of Ankle-Brachial Index for Predicting Peripheral Arterial Disease

    PubMed Central

    RAC-ALBU, Marius; ILIUTA, Luminita; GUBERNA, Suzana Maria; SINESCU, Crina

    2014-01-01

    The presence of peripheral arterial disease (PAD) is associated with higher cardiovascular morbidity and mortality, regardless of gender or its clinical form of presentation (symptomatic or asymptomatic). PAD is considered an independent predictor for cardiovascular mortality, more important for survival than clinical history of coronary artery disease. The ankle brachial index (ABI) is a sensitive and cost-effective screening tool for PAD. ABI is valuable for screening of peripheral artery disease in patients at risk and for diagnosing the disease in patients who present with lower-extremity symptoms. Compared to other diagnostic methods, ABI is superior because it is s a simple, noninvasive test, which could be routinely determined in all patients. Normal cut-off values for ABI are between 0.9 and 1.4. An abnormal ankle-brachial index- below 0.9-is a powerful independent marker of cardiovascular risk. There is an inverse correlation between ABI values, non-fatal cardiac events (myocardial infarction, stroke and heart failure exacerbation) and mortality (cardiovascular and global), the relation being nonlinear, patients with very low ABI (<0.3) having a significantly higher additional risk. Also, ABI values over 1.3-1.4 correlate with major adverse cardiovascular events. Therefore, ABI can be considered a generalized atherosclerotic predictor, identifying patients at high risk for developing cardio- or cerebrovascular events and should be incorporated into routine clinical practice. PMID:25705296

  8. Diagnosing coronary artery disease with a backpropagation neural network: Lessons learned

    SciTech Connect

    Turner, D.D.; Holmes, E.R.

    1995-12-31

    The SPECT (single photon emitted computed tomography) procedure, while widely used for diagnosing coronary artery disease, is not a perfect technology. We have investigated using a backpropagation neural network to diagnose patients suffering from coronary artery disease that is independent from the SPECT procedure. The raw thallium-201 scintigrams produced before the SPECT tomographic reconstruction were used as input patterns for the backpropagation neural network, and the diagnoses resulting mainly from cardiac catheterization as the desired outputs for each pattern. Several preprocessing techniques were applied to the scintigrams, in an attempt to improve the information to noise ratio. After using the a procedure that extracted a subimage containing the heart from each scintigram, we used a data reduction technique, thereby encoding the scintigram in 12 values, which were the inputs to the backpropagation neural network. The network was then trained. This network per-formed superbly for patients suffering from inferolateral disease (classifying 10 out of 10 correctly), but performance was less than optimal for cases involving other coronary zones. While the scope of this project was limited to diagnosing coronary artery disease, this initial work can be extended to other medical imaging procedures, such as diagnosing breast cancer from a mammogram and evaluating lung perfusion studies.

  9. Blood fluidity, fibrinogen, and cardiovascular risk factors of occlusive arterial disease: results of the Aachen study.

    PubMed

    Koscielny, J; Jung, E M; Mrowietz, C; Kiesewetter, H; Latza, R

    2004-01-01

    In the Aachen study the prevalence of arterial disease was established in 346 out of a cohort of 2821 subjects between 45 and 65 years of age. Rheological variables and risk factor profile for patients with peripheral occlusive arterial disease (POAD), coronary heart disease (CHD) and cerebrovascular insufficiency (CI) in comparison to a control group are given. Significantly elevated are hematocrit in males, plasma viscosity, erythrocyte aggregation and fibrinogen. It is evident that plasma viscosity is the rheological parameter most often elevated in patients with arterial disease (70.8%). In patients with CI (80.6%) plasma viscosity is elevated about four times more often than in healthy subjects. While 85.8% of healthy volunteers show no or only one elevated rheological parameter only 44.5% of the patients have this constellation. Risk factors are bundled in patients compared to healthy volunteers. 84.2% of the healthy volunteers have no or only one risk factor whereas patients with OAD show this constellation in only 30.9% (32.4% in POAD, 16.1% in CI and 32.4% in CHD).

  10. Coronary artery disease risk assessment from unstructured electronic health records using text mining.

    PubMed

    Jonnagaddala, Jitendra; Liaw, Siaw-Teng; Ray, Pradeep; Kumar, Manish; Chang, Nai-Wen; Dai, Hong-Jie

    2015-12-01

    Coronary artery disease (CAD) often leads to myocardial infarction, which may be fatal. Risk factors can be used to predict CAD, which may subsequently lead to prevention or early intervention. Patient data such as co-morbidities, medication history, social history and family history are required to determine the risk factors for a disease. However, risk factor data are usually embedded in unstructured clinical narratives if the data is not collected specifically for risk assessment purposes. Clinical text mining can be used to extract data related to risk factors from unstructured clinical notes. This study presents methods to extract Framingham risk factors from unstructured electronic health records using clinical text mining and to calculate 10-year coronary artery disease risk scores in a cohort of diabetic patients. We developed a rule-based system to extract risk factors: age, gender, total cholesterol, HDL-C, blood pressure, diabetes history and smoking history. The results showed that the output from the text mining system was reliable, but there was a significant amount of missing data to calculate the Framingham risk score. A systematic approach for understanding missing data was followed by implementation of imputation strategies. An analysis of the 10-year Framingham risk scores for coronary artery disease in this cohort has shown that the majority of the diabetic patients are at moderate risk of CAD.

  11. Correlates of lung/heart ratio of thallium-201 in coronary artery disease

    SciTech Connect

    Homma, S.; Kaul, S.; Boucher, C.A.

    1987-10-01

    We studied 306 patients with chest pain (262 with coronary artery disease and 44 with no coronary artery disease) to determine which of 23 clinical, exercise, thallium, and angiographic variables best discriminate between patients with increased lung/heart ratios of thallium versus those with normal ratios. Normal lung/heart ratio values were defined using an additional 45 subjects with less than 1% probability of coronary artery disease. The number of diseased vessels was the best discriminator between patients with increased ratios versus those with normal ratios. Double product at peak exercise, number of segments with abnormal wall motion, patient gender, and duration of exercise were also significant discriminators. Using discriminant function analysis these variables could correctly identify 81% of cases with increased lung/heart ratios and 72% of cases with normal ratios. These results indicate that an increased lung/heart ratio of thallium reflects exercise-induced left ventricular dysfunction and affords a better understanding of why this thallium parameter is a powerful prognostic indicator in patients with chest pain.

  12. Severe multivessel coronary artery disease and high-sensitive troponin T

    PubMed Central

    Huziuk, Inga Magdalena

    2015-01-01

    Introduction A key problem in stable coronary artery disease (CAD) is non-invasive identification of patients with severe multivessel CAD. Determination of biomarkers that have pro-inflammatory properties (C-reactive protein – hsCRP) and indicate heart muscle ischemia (high-sensitive troponin T – hsTnT) can contribute to the improvement of stratification in this regard. The aim of the study The aim of the study was to identify factors associated with the presence of multivessel CAD in clinically stable men. Material and methods The study included 92 symptomatic men (mean age 64.05 ± 9.42 years) with preserved left ventricular function, scheduled for elective coronary angiography. Patients were divided and analyzed in two groups: with multivessel coronary artery disease (2-3-vessel disease, n = 46) vs. without multivessel coronary artery disease (n = 46). Results Patients with multivessel CAD had significantly higher levels of hsTnT (0.01 vs. 0.007, p = 0.0021) and fasting glucose (6.0 vs. 5.45, p = 0.0112). Based on the drawn ROC curves, the cut-off points were determined for hsTnT ≥ 0.0085 ng/ml and fasting plasma glucose ≥ 5.85 mmol/l. From multivariate analysis only hsTnT in concentration higher than the cut-off point enhanced the risk of multivessel CAD (OR 4.286, 95% CI: 1.79-10.263, p = 0.001). Conclusions In men with stable CAD, preserved systolic left ventricular function and non-high cardiovascular risk determined from the initial concentration of hsCRP, elevated level of hsTnT was independently associated with the risk of multivessel coronary artery disease. PMID:26336496

  13. Arterial Stiffness Is Significantly Associated With Left Ventricular Diastolic Dysfunction in Patients With Cardiovascular Disease.

    PubMed

    Namba, Takayuki; Masaki, Nobuyuki; Matsuo, Yuki; Sato, Atsushi; Kimura, Toyokazu; Horii, Shunpei; Yasuda, Risako; Yada, Hirotaka; Kawamura, Akio; Takase, Bonpei; Adachi, Takeshi

    2016-12-02

    Left ventricular (LV) diastolic dysfunction is considered the main cause of heart failure with preserved ejection fraction (HFpEF). There have been few reports on the correlation between LV diastolic dysfunction and arterial stiffness in patients with clinical cardiovascular disease.This cross-sectional study enrolled 100 patients (67 men, 33 women; mean age, 70 years). All participants were diagnosed with cardiovascular disease. A total of 89 (89%) patients had coronary artery disease or HF. Patients with reduced EF and valvular disease were excluded. Arterial stiffness was assessed by the cardio-ankle vascular index (CAVI), and LV diastolic dysfunction was estimated using echocardiography. The patients were divided into two groups based on the median value of CAVI. In all patients the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e') was significantly higher in the high CAVI group than in the low CAVI group (15.5 ± 6.4 versus 12.5 ± 2.9, P = 0.003). In the HF subgroup, E/e' was also significantly higher in the high CAVI group than in the low CAVI group (17.2 ± 5.9 versus 13.0 ± 3.1, P = 0.026). In univariate regression analysis, CAVI was significantly associated with E/e' in all patients (β = 0.28, P = 0.004) and in HF patients (β = 0.4, P = 0.028). Also in multivariate analysis, CAVI remained as an independent predictive factor of E/e' (β = 0.252, P = 0.037).A high CAVI was independently associated with LV diastolic dysfunction in patients with clinical cardiovascular disease. These results suggested that arterial stiffness contributed to the development of LV diastolic dysfunction.

  14. Optimal ECG (Electrocardiogram) Electrode Sites and Criteria for Detection of Asymptomatic Coronary Artery Disease at Rest and with Exercise.

    DTIC Science & Technology

    1985-12-01

    ASYMPTOMATIC CORONARY < ARTERY DISEASE AT REST AND WITH EXERCISE *Ronald H. Selvester, M.D. D T IC Joseph C. Solomon, M.S. ELECTE S JUL03 98 - University of...imalI ECG L Iec trode 1ites and Lri te ria Tor uJetect1iln of Asymptomatic Coronary Artery Disease at Rest and with Exercise 12. PERSONAL AUTHOR(SI...Coronary Artery 16 Disease , Myocardial Infarction,- iyocardial Ischemia, 19 ABSTRACT eCon inue on reterse if necesam and id’n tifN bv bloch nunberI

  15. Sex-based Prognostic Implications of Nonobstructive Coronary Artery Disease: Results from the International Multicenter CONFIRM Study

    PubMed Central

    Taylor, Carolyn M.; Gransar, Heidi; Shaw, Leslee J.; Ahmadi, Amir; Thompson, Angus; Humphries, Karin; Berman, Daniel S.; Hausleiter, Jörg; Achenbach, Stephan; Al-Mallah, Mouaz; Budoff, Matthew J.; Cademartiri, Fillippo; Callister, Tracy Q.; Chang, Hyuk-Jae; Chow, Benjamin J. W.; Cury, Ricardo C.; Delago, Augustin J.; Dunning, Allison L.; Feuchtner, Gudrun M.; Hadamitzky, Martin; Kaufmann, Philipp A.; Lin, Fay Y.; Chinnaiyan, Kavitha M.; Maffei, Erica; Raff, Gilbert L.; Villines, Todd C.; Gomez, Millie J.; Min, James K.

    2014-01-01

    Purpose To determine the clinical outcomes of women and men with nonobstructive coronary artery disease (CADcoronary artery disease) with coronary computed tomographic (CT) angiography data in patients who were similar in terms of CADcoronary artery disease risk factors, angina typicality, and CADcoronary artery disease extent and distribution. Materials and Methods Institutional review board approval was obtained for all participating sites, with either informed consent or waiver of informed consent. In a prospective international multicenter cohort study of 27 125 patients undergoing coronary CT angiography at 12 centers, 18 158 patients with no CADcoronary artery disease or nonobstructive (<50% stenosis) CADcoronary artery disease were examined. Men and women were propensity matched for age, CADcoronary artery disease risk factors, angina typicality, and CADcoronary artery disease extent and distribution, which resulted in a final cohort of 11 462 subjects. Nonobstructive CADcoronary artery disease presence and extent were related to incident major adverse cardiovascular events (MACEmajor adverse cardiovascular events), which were inclusive of death and myocardial infarction and were estimated by using multivariable Cox proportional hazards models. Results At a mean follow-up ± standard deviation of 2.3 years ± 1.1, MACEmajor adverse cardiovascular events occurred in 164 patients (0.6% annual event rate). After matching, women and men experienced identical annualized rates of myocardial infarction (0.2% vs 0.2%, P = .72), death (0.5% vs 0.5%, P = .98), and MACEmajor adverse cardiovascular events (0.6% vs 0.6%, P = .94). In multivariable analysis, nonobstructive CADcoronary artery disease was associated with similarly increased MACEmajor adverse cardiovascular events for both women (hazard ratio: 1.96 [95% confidence interval {CIconfidence interval}: 1.17, 3.28], P = .01) and men (hazard ratio: 1.77 [95% CIconfidence interval: 1.07, 2.93], P = .03). Conclusion

  16. Multivariate mixed linear model analysis of longitudinal data: an information-rich statistical technique for analyzing plant disease resistance.

    PubMed

    Veturi, Yogasudha; Kump, Kristen; Walsh, Ellie; Ott, Oliver; Poland, Jesse; Kolkman, Judith M; Balint-Kurti, Peter J; Holland, James B; Wisser, Randall J

    2012-11-01

    ABSTRACT The mixed linear model (MLM) is an advanced statistical technique applicable to many fields of science. The multivariate MLM can be used to model longitudinal data, such as repeated ratings of disease resistance taken across time. In this study, using an example data set from a multi-environment trial of northern leaf blight disease on 290 maize lines with diverse levels of resistance, multivariate MLM analysis was performed and its utility was examined. In the population and environments tested, genotypic effects were highly correlated across disease ratings and followed an autoregressive pattern of correlation decay. Because longitudinal data are often converted to the univariate measure of area under the disease progress curve (AUDPC), comparisons between univariate MLM analysis of AUDPC and multivariate MLM analysis of longitudinal data were made. Univariate analysis had the advantage of simplicity and reduced computational demand, whereas multivariate analysis enabled a comprehensive perspective on disease development, providing the opportunity for unique insights into disease resistance. To aid in the application of multivariate MLM analysis of longitudinal data on disease resistance, annotated program syntax for model fitting is provided for the software ASReml.

  17. Longitudinal changes in free-water within the substantia nigra of Parkinson's disease.

    PubMed

    Ofori, Edward; Pasternak, Ofer; Planetta, Peggy J; Li, Hong; Burciu, Roxana G; Snyder, Amy F; Lai, Song; Okun, Michael S; Vaillancourt, David E

    2015-08-01

    There is a clear need to develop non-invasive markers of substantia nigra progression in Parkinson's disease. We previously found elevated free-water levels in the substantia nigra for patients with Parkinson's disease compared with controls in single-site and multi-site cohorts. Here, we test the hypotheses that free-water levels in the substantia nigra of Parkinson's disease increase following 1 year of progression, and that baseline free-water levels in the substantia nigra predict the change in bradykinesia following 1 year. We conducted a longitudinal study in controls (n = 19) and patients with Parkinson's disease (n = 25). Diffusion imaging and clinical data were collected at baseline and after 1 year. Free-water analyses were performed on diffusion imaging data using blinded, hand-drawn regions of interest in the posterior substantia nigra. A group effect indicated free-water values were increased in the posterior substantia nigra of patients with Parkinson's disease compared with controls (P = 0.003) and we observed a significant group × time interaction (P < 0.05). Free-water values increased for the Parkinson's disease group after 1 year (P = 0.006), whereas control free-water values did not change. Baseline free-water values predicted the 1 year change in bradykinesia scores (r = 0.74, P < 0.001) and 1 year change in Montreal Cognitive Assessment scores (r = -0.44, P = 0.03). Free-water in the posterior substantia nigra is elevated in Parkinson's disease, increases with progression of Parkinson's disease, and predicts subsequent changes in bradykinesia and cognitive status over 1 year. These findings demonstrate that free-water provides a potential non-invasive progression marker of the substantia nigra.

  18. Well-Being and Chronic Disease Incidence: The English Longitudinal Study of Ageing

    PubMed Central

    Okely, Judith A.; Gale, Catharine R.

    2016-01-01

    ABSTRACT Background Previous research suggests that greater well-being may protect against onset of chronic disease. However, it is unclear whether this association is similar across different types of disease. Method We used Cox proportional hazards regression to examine the prospective relationship between well-being (measured using the CASP-19 quality of life questionnaire) and incidence of arthritis, cancer, stroke, diabetes, myocardial infarction, and chronic lung disease over 8 years. The sample consisted of 8182 participants 50 years or older from the English Longitudinal Study of Ageing. Results After adjustments for established risk factors, a standard deviation increase in CASP-19 score was associated with a decrease in arthritis risk (hazard ratio [HR] = 0.89, 95% confidence interval [CI] = 0.83–0.96) and, in those younger than 65 years, a decrease in diabetes risk (HR = 0.82, 95% CI = 0.70–0.95) and chronic lung disease risk (HR = 0.80, 95% CI = 0.66–0.97). Higher CASP-19 scores were associated with reduced risk for stroke and myocardial infarction; however, these associations were no longer significant after adjustments for established risk factors. No association was observed for cancer incidence. An age interaction was observed for diabetes, myocardial infarction, and chronic lung disease, with a stronger association between CASP-19 score and disease incidence at younger ages. Conclusions The extent of association between well-being and incident disease risk is not consistent across different chronic diseases. Future studies should examine the cause of this variation. PMID:26569542

  19. Inheritance of coronary artery disease in men: an analysis of the role of the Y chromosome

    PubMed Central

    Charchar, Fadi J; Bloomer, Lisa DS; Barnes, Timothy A; Cowley, Mark J; Nelson, Christopher P; Wang, Yanzhong; Denniff, Matthew; Debiec, Radoslaw; Christofidou, Paraskevi; Nankervis, Scott; Dominiczak, Anna F; Bani-Mustafa, Ahmed; Balmforth, Anthony J; Hall, Alistair S; Erdmann, Jeanette; Cambien, Francois; Deloukas, Panos; Hengstenberg, Christian; Packard, Chris; Schunkert, Heribert; Ouwehand, Willem H; Ford, Ian; Goodall, Alison H; Jobling, Mark A; Samani, Nilesh J; Tomaszewski, Maciej

    2012-01-01

    Summary Background A sexual dimorphism exists in the incidence and prevalence of coronary artery disease—men are more commonly affected than are age-matched women. We explored the role of the Y chromosome in coronary artery disease in the context of this sexual inequity. Methods We genotyped 11 markers of the male-specific region of the Y chromosome in 3233 biologically unrelated British men from three cohorts: the British Heart Foundation Family Heart Study (BHF-FHS), West of Scotland Coronary Prevention Study (WOSCOPS), and Cardiogenics Study. On the basis of this information, each Y chromosome was tracked back into one of 13 ancient lineages defined as haplogroups. We then examined associations between common Y chromosome haplogroups and the risk of coronary artery disease in cross-sectional BHF-FHS and prospective WOSCOPS. Finally, we undertook functional analysis of Y chromosome effects on monocyte and macrophage transcriptome in British men from the Cardiogenics Study. Findings Of nine haplogroups identified, two (R1b1b2 and I) accounted for roughly 90% of the Y chromosome variants among British men. Carriers of haplogroup I had about a 50% higher age-adjusted risk of coronary artery disease than did men with other Y chromosome lineages in BHF-FHS (odds ratio 1·75, 95% CI 1·20–2·54, p=0·004), WOSCOPS (1·45, 1·08–1·95, p=0·012), and joint analysis of both populations (1·56, 1·24–1·97, p=0·0002). The association between haplogroup I and increased risk of coronary artery disease was independent of traditional cardiovascular and socioeconomic risk factors. Analysis of macrophage transcriptome in the Cardiogenics Study revealed that 19 molecular pathways showing strong differential expression between men with haplogroup I and other lineages of the Y chromosome were interconnected by common genes related to inflammation and immunity, and that some of them have a strong relevance to atherosclerosis. Interpretation The human Y chromosome is

  20. Clearance of chylomicron remnants in normolipidaemic patients with coronary artery disease: case control study over three years.

    PubMed Central

    Weintraub, M. S.; Grosskopf, I.; Rassin, T.; Miller, H.; Charach, G.; Rotmensch, H. H.; Liron, M.; Rubinstein, A.; Iaina, A.

    1996-01-01

    OBJECTIVE--To test the hypothesis that subjects who clear chylomicron remnants slowly from plasma may be at higher risk of coronary artery disease than indicated by their fasting plasma lipid concentrations. DESIGN--Case control study over three years. SETTING--An 800 bed general municipal hospital. SUBJECTS--85 normolipidaemic patients with coronary artery disease selected prospectively and matched with 85 normolipidaemic subjects with normal coronary arteries on angiography. INTERVENTIONS--All subjects were given a vitamin A fat loading test which specifically labels intestinal lipoproteins with retinyl palmitate. MAIN OUTCOME MEASURE--Postprandial lipoprotein metabolism. RESULTS--The area below the chylomicron remnant retinyl palmitate curve was significantly increased in the coronary artery disease group as compared with the controls (mean 23.4 (SD 15.0) v 15.3 (8.9) mumol/l.h; 95% confidence interval of difference 4.37 to 11.82). CONCLUSION--Normolipidaemic patients with coronary artery disease had significantly higher concentrations of chylomicron remnants in plasma than normolipidaemic subjects with normal coronary vessels. This may explain the mechanism underlying the susceptibility to atherosclerosis of coronary artery disease patients with normal fasting lipid values. As diet and drugs can ameliorate the accumulation of postprandial lipoproteins in plasma, the concentration of chylomicron remnants should be measured in patients at high risk of coronary artery disease. PMID:8616304

  1. Development of pulmonary arterial hypertension in women: interplay of sex hormones and pulmonary vascular disease

    PubMed Central

    Pugh, Meredith E; Hemnes, Anna R

    2010-01-01

    Pulmonary arterial hypertension (PAH) is a progressive disease of the pulmonary vasculature, ultimately resulting in right heart failure and death. This disease is strongly predominant in females, although little is known regarding how sex influences disease development. Recent developments highlighting the importance of estrogen metabolites in both animal models and human disease have substantially increased our understanding of PAH in women. This review will focus on general knowledge of PAH, translational and basic science data regarding sex hormones in the pulmonary vasculature and on clinical issues that are particular to women with PAH. Future directions for study include the influence of sex hormones on right ventricular responses, improving the understanding of the influence of estrogen exposure in human disease and the study of dehydroepiandrosterone in basic science and human disease. PMID:20187732

  2. Drug-eluting stents in unprotected left main coronary artery disease.

    PubMed

    Bernelli, Chiara

    2014-11-01

    Though coronary bypass graft surgery (CABG) has traditionally been the cornerstone of therapy in patients with unprotected left main coronary artery (ULMCA) disease, recent evidence supports the use of percutaneous coronary intervention in appropriate patients. Indeed in patients with ULMCA disease, drug-eluting stents (DES) have shown similar incidence of hard end points, fewer periprocedural complications and lower stroke rates compared with CABG, though at the cost of increased revascularization with time. Furthermore, the availability of newer efficacious and safer DES as well as improvements in diagnostic tools, percutaneous techniques and, importantly, a better patient selection, allowed percutaneous coronary intervention a viable alternative to CABG of left main-patients with low disease complexity; however, even in this interventional era characterized by efficacious DES, patients with ULMCA disease remain a challenging high-risk population where outcomes strongly depend on clinical characteristics, anatomical disease complexity and extension and operator's experience. This review summarizes the role of DES in ULMCA disease patients.

  3. Impact of lifetime opioid exposure on arterial stiffness and vascular age: cross-sectional and longitudinal studies in men and women

    PubMed Central

    Reece, Albert Stuart; Hulse, Gary Kenneth

    2014-01-01

    Objective To characterise and compare the potentiation of arterial stiffness and vascular ageing by opioids in men and women. Design Cross-sectional and longitudinal studies of 576 clinical controls and 687 opioid-dependent patients (ODP) on 710 and 1305 occasions, respectively, over a total of 2382 days (6.52 years), 2006–2011. Methodology Radial pulse wave analysis with Atcor SphygmoCor system (Sydney). Setting Primary care. Participants Controls: General practice patients with non-cardiovascular disorders, and university student controls. ODP: Patients undergoing clinical management of their opioid dependence. Controls had lower chronological ages (CAs) than ODP (30.0±0.5 vs 34.5±0.3, mean±SEM, p<0.0001). 69.6% and 67.7% participants were men, and 16% and 92.3% were smokers (p<0.0001) for controls and ODP, respectively. 86.3%, 10.3% and 3.4% of ODP were treated with buprenorphine (6.98±0.21 mg), methadone (63.04±4.01 mg) or implant naltrexone, respectively. Body mass index (BMI) was depressed in ODP. Interventions Nil. Primary outcome measures Vascular Reference Age (RA) and the ratio of vascular age to chronological age (RA/CA). Secondary outcome measures Arterial stiffness including Augmentation Index. Results After BMI adjustment, RA in ODP was higher as a function of CA and of time (both p<0.05). Modelled mean RA in control and ODP was 35.6 and 36.3 years (+1.97%) in men, and 34.5 and 39.2 years (+13.43%) in women, respectively. Changes in RA and major arterial stiffness indices were worse in women both as a factor (p = 0.0036) and in interaction with CA (p = 0.0040). Quadratic, cubic and quartic functions of opioid exposure duration outperformed linear models with RA/CA over CA and over time. The opioid dose–response relationship persisted longitudinally after multiple adjustments from p=0.0013 in men and p=0.0073 in women. Conclusions Data show that lifetime opioid exposure, an interactive cardiovascular risk factor

  4. Perspectives on the management of coronary artery disease in India

    PubMed Central

    Karthikeyan, Ganesan; Xavier, Denis; Prabhakaran, Doriaraj; Pais, Prem

    2007-01-01

    The most striking feature of the management of patients with cardiovascular disease (CVD) in India, is its heterogeneity: from patients treated at tertiary and teaching hospitals, who receive the best possible evidence‐based care, to patients who have poor or, even no, access to specialist care and whose condition, therefore, is poorly treated. The challenge for Indian healthcare lies in righting this imbalance. One step in this direction would be to document practice patterns in representative treating hospitals in different regions of the country, to identify the strengths and weaknesses of the system. Resource‐sensitive guidelines incorporating evidence‐based, cost‐effective treatments should be widely disseminated. Large‐scale efforts to improve general awareness about CVD and its risk factors, and to promote healthy lifestyles, should be undertaken, and the consumption of tobacco products and unhealthy foods discouraged. PMID:17933988

  5. Chronic kidney disease and albuminuria in arterial hypertension.

    PubMed

    Leoncini, Giovanna; Viazzi, Francesca; Pontremoli, Roberto

    2010-10-01

    Chronic kidney disease is a major public health problem worldwide: it is estimated that in the general population, 1 person in 10 has some degree of renal damage. Adequate blood pressure control represents the mainstay of treatment, to delay deterioration of renal function and prevent cardiovascular complications. Current evidence supports a target blood pressure value of 130/80 mm Hg or less (ie, <125/75 mm Hg) when proteinuria exceeds 1 g/L. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers represent the treatment of choice, especially in the presence of proteinuria. More complete blockade of the renin-angiotensin-aldosterone system (RAAS) has been advocated, using a combination of multiple RAAS blocker drugs or supramaximal doses to maximize renal protection. Achieving recommended blood pressure target values usually requires the use of multiple antihypertensive drugs, including diuretics and calcium channel blockers.

  6. Longitudinal patterns of leukoaraiosis and brain atrophy in symptomatic small vessel disease

    PubMed Central

    Benjamin, Philip; Zeestraten, Eva; Lawrence, Andrew J.; Barrick, Thomas R.; Markus, Hugh S.

    2016-01-01

    Cerebral small vessel disease is a common condition associated with lacunar stroke, cognitive impairment and significant functional morbidity. White matter hyperintensities and brain atrophy, seen on magnetic resonance imaging, are correlated with increasing disease severity. However, how the two are related remains an open question. To better define the relationship between white matter hyperintensity growth and brain atrophy, we applied a semi-automated magnetic resonance imaging segmentation analysis pipeline to a 3-year longitudinal cohort of 99 subjects with symptomatic small vessel disease, who were followed-up for ≥1 years. Using a novel two-stage warping pipeline with tissue repair step, voxel-by-voxel rate of change maps were calculated for each tissue class (grey matter, white matter, white matter hyperintensities and lacunes) for each individual. These maps capture both the distribution of disease and spatial information showing local rates of growth and atrophy. These were analysed to answer three primary questions: first, is there a relationship between whole brain atrophy and magnetic resonance imaging markers of small vessel disease (white matter hyperintensities or lacune volume)? Second, is there regional variation within the cerebral white matter in the rate of white matter hyperintensity progression? Finally, are there regionally specific relationships between the rates of white matter hyperintensity progression and cortical grey matter atrophy? We demonstrate that the rates of white matter hyperintensity expansion and grey matter atrophy are strongly correlated (Pearson’s R = −0.69, P < 1 × 10−7), and significant grey matter loss and whole brain atrophy occurs annually (P < 0.05). Additionally, the rate of white matter hyperintensity growth was heterogeneous, occurring more rapidly within long association fasciculi. Using voxel-based quantification (family-wise error corrected P < 0.05), we show the rate of white matter hyperintensity

  7. Longitudinal patterns of leukoaraiosis and brain atrophy in symptomatic small vessel disease.

    PubMed

    Lambert, Christian; Benjamin, Philip; Zeestraten, Eva; Lawrence, Andrew J; Barrick, Thomas R; Markus, Hugh S

    2016-04-01

    Cerebral small vessel disease is a common condition associated with lacunar stroke, cognitive impairment and significant functional morbidity. White matter hyperintensities and brain atrophy, seen on magnetic resonance imaging, are correlated with increasing disease severity. However, how the two are related remains an open question. To better define the relationship between white matter hyperintensity growth and brain atrophy, we applied a semi-automated magnetic resonance imaging segmentation analysis pipeline to a 3-year longitudinal cohort of 99 subjects with symptomatic small vessel disease, who were followed-up for ≥1 years. Using a novel two-stage warping pipeline with tissue repair step, voxel-by-voxel rate of change maps were calculated for each tissue class (grey matter, white matter, white matter hyperintensities and lacunes) for each individual. These maps capture both the distribution of disease and spatial information showing local rates of growth and atrophy. These were analysed to answer three primary questions: first, is there a relationship between whole brain atrophy and magnetic resonance imaging markers of small vessel disease (white matter hyperintensities or lacune volume)? Second, is there regional variation within the cerebral white matter in the rate of white matter hyperintensity progression? Finally, are there regionally specific relationships between the rates of white matter hyperintensity progression and cortical grey matter atrophy? We demonstrate that the rates of white matter hyperintensity expansion and grey matter atrophy are strongly correlated (Pearson's R = -0.69, P < 1 × 10(-7)), and significant grey matter loss and whole brain atrophy occurs annually (P < 0.05). Additionally, the rate of white matter hyperintensity growth was heterogeneous, occurring more rapidly within long association fasciculi. Using voxel-based quantification (family-wise error corrected P < 0.05), we show the rate of white matter hyperintensity

  8. Diffuse slow washout of myocardial thallium-201: a new scintigraphic indicator of extensive coronary artery disease

    SciTech Connect

    Bateman, T.M.; Maddahi, J.; Gray, R.J.; Murphy, F.L.; Garcia, E.V.; Conklin, C.M.; Raymond, M.J.; Stewart, M.E.; Swan, H.J.; Berman, D.S.

    1984-07-01

    When coronary artery disease is extensive and of relatively uniform severity, regional myocardial hypoperfusion may be balanced during stress, precluding development of spatially relative perfusion defects. Assessment of the washout of thallium-201 from myocardial regions may provide diagnostic assistance in these cases because washout analysis is spatially nonrelative and hypoperfused myocardial regions manifest a slow thallium-201 washout rate. In 1,265 consecutive patients having quantitatively analyzed stress-redistribution scintigraphy, 46 had a diffuse slow washout pattern with no or a maximum of one regional perfusion defect. Thirty-two underwent clinically indicated coronary angiography, and 23 (72%) of these were found to have three vessel or left main disease. Of 30 similar patients without a diffuse slow washout pattern and with no or a maximum of one perfusion defect, only 5 (17%) had extensive coronary disease. An independent relation between diffuse slow washout and extensive coronary disease was demonstrated by a Mantel- Haentzel chi-square analysis of a wide variety of other indexes of extensive disease. A diffuse washout abnormality, even in the absence of other scintigraphic, clinical or electrocardiographic indicators, carries a high predictive value for three vessel or left main coronary artery disease. The predictive value is maintained when the exercise level achieved is submaximal. Although an infrequent occurrence (3.6% of tested patients), a diffuse slow washout pattern without other scintigraphic indications of extensive coronary disease should lead to further diagnostic testing.

  9. Genetic testing for inherited heart diseases: longitudinal impact on health-related quality of life.

    PubMed

    Ingles, Jodie; Yeates, Laura; O'Brien, Lisa; McGaughran, Julie; Scuffham, Paul A; Atherton, John; Semsarian, Christopher

    2012-05-03

    Purpose:A genetic diagnosis is an extremely useful tool in the management and care of families with inherited heart diseases, particularly in allowing clarification of risk status of asymptomatic family members. The psychosocial consequences of genetic testing in this group are poorly understood. This longitudinal pilot study sought to determine changes in health-related quality of life in patients and asymptomatic family members undergoing genetic testing for inherited heart diseases.Methods:Individuals attending two specialized multidisciplinary cardiac genetic clinics in Australia were invited to participate. Patients undergoing proband or predictive genetic testing for an inherited cardiomyopathy or primary arrhythmogenic disorder were eligible. The Medical Outcomes Short Form-36 (version 2) was administered before the genetic result was given, and follow-up surveys were completed 1-3, 6, and 12 months after the result was given.Results:A total of 54 individuals with hypertrophic cardiomyopathy, familial dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and long QT syndrome completed baseline and at least one follow-up survey, including 33 probands and 21 asymptomatic relatives. Physical and mental component scores analyzed at baseline and 1-3 months were found to be unchanged in all groups. Furthermore, no significant differences were observed up to 12 months after result.Conclusion:In this longitudinal pilot study, no change in health-related quality of life was observed up to 12 months after the result was given in patients and their asymptomatic family members undergoing genetic testing for an inherited heart disease.Genet Med 2012 advance online publication 3 May 2012.

  10. A Variant in COX-2 Gene Is Associated with Left Main Coronary Artery Disease and Clinical Outcomes of Coronary Artery Bypass Grafting

    PubMed Central

    Liu, Hanning; Sun, Cheng

    2017-01-01

    As a particular severe phenotype of coronary artery disease (CAD), left main coronary artery disease (LMCAD) is heritable. Genetic variants related to prostaglandin metabolism are associated with LMCAD. Cyclooxygenase-2 (COX-2), a key synthase in prostaglandin pathways, displays high density in atherosclerotic lesions and promotes early atherosclerosis in CAD progression. We hypothesized that genetic variants in COX-2 gene contribute to LMCAD phenotype susceptibility compared to more peripheral coronary artery disease (MPCAD). In this study, we genotyped COX-2 rs5275, rs5277, and rs689466 of 1544 CAD patients undergoing coronary artery bypass grafting (CABG) and found that rs5277 C allele carriage was associated with LMCAD (adjusted OR: 1.590; 95% CI: 1.103~2.291; p = 0.013). Furtherly, long-term follow-up data suggested that rs5277 C allele carriage increased risk of major adverse cardiac and cerebrovascular events (MACCE) in the whole cohort (adjusted HR: 1.561; 95% CI: 1.025~2.377; p = 0.038) and LMCAD subgroup (adjusted HR: 2.014; 95% CI: 1.036~3.913; p = 0.039) but not in MPCAD subgroup (adjusted HR: 1.375; 95% CI: 0.791~2.392; p = 0.259). In conclusion, we demonstrate that COX-2 rs5277 C allele increases the risk of left main coronary artery lesion and is also correlated with poor prognosis of LMCAD patients with CABG therapy. PMID:28194409

  11. Relative Amplitude based Features of characteristic ECG-Peaks for Identification of Coronary Artery Disease

    NASA Astrophysics Data System (ADS)

    Gohel, Bakul; Tiwary, U. S.; Lahiri, T.

    Coronary artery disease or Myocardial Infarction is the leading cause of death and disability in the world. ECG is widely used as a cheap diagnostic tool for diagnosis of coronary artery disease but has low sensitivity with the present criteria based on ST-segment, T wave and Q wave changes. So to increase the sensitivity of the ECG we have introduced relative amplitude based new features of characteristic ‘R’ and ‘S’ ECG-peaks between two leads. Relative amplitude based features shows remarkable capability in discriminating Myocardial Infarction and Healthy pattern using backpropogation neural network classifier yield results with 81.82% sensitivity and 81.82% specificity. Also relative amplitude might be an efficient method in minimizing the effect of body composition on ECG amplitude based features without use of any information from other than ECG

  12. Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques

    PubMed Central

    Foley, James R J; Plein, Sven; Greenwood, John P

    2017-01-01

    Coronary artery disease (CAD) is a leading cause of death and disability worldwide. Cardiovascular magnetic resonance (CMR) is established in clinical practice guidelines with a growing evidence base supporting its use to aid the diagnosis and management of patients with suspected or established CAD. CMR is a multi-parametric imaging modality that yields high spatial resolution images that can be acquired in any plane for the assessment of global and regional cardiac function, myocardial perfusion and viability, tissue characterisation and coronary artery anatomy, all within a single study protocol and without exposure to ionising radiation. Advances in technology and acquisition techniques continue to progress the utility of CMR across a wide spectrum of cardiovascular disease, and the publication of large scale clinical trials continues to strengthen the role of CMR in daily cardiology practice. This article aims to review current practice and explore the future directions of multi-parametric CMR imaging in the investigation of stable CAD. PMID:28289524

  13. A Primary Care Approach to the Diagnosis and Management of Peripheral Arterial Disease

    NASA Technical Reports Server (NTRS)

    Dawson, David L.

    2000-01-01

    The objectives of this work are: (1) Be able to recognize characteristic symptoms of intermittent claudication (2) Diagnose PAD on the basis of history, physical exam, and simple limb blood pressure measurements (3) Recognize the significance of peripheral artery disease as a marker for coronary or cerebrovascular atherosclerosis (4) Provide appropriate medical management of atherosclerosis risk factors-- including use of antiplatelet therapy to reduce risk of myocardial infarction, stroke and death (5) Manage symptoms of intermittent claudication with program of smoking cessation, exercise, and medication The diagnosis of intermittent claudication secondary to peripheral artery disease (PAD) can often be made on the basis of history and physical examination. Additional evaluation of PAD is multi-modal and the techniques used will vary depending on the nature and severity of the patient's presenting problem. Most patients can be appropriately managed without referral for specialized diagnostic services or interventions.

  14. Exercise thallium-201 perfusion scintigraphy in the assessment of coronary artery disease

    SciTech Connect

    Mahmarian, J.J.; Verani, M.S. )

    1991-05-21

    Exercise thallium-201 perfusion scintigraphy has been used extensively over the last decade for the detection and localization of coronary artery disease. Single-photon emission computed tomography (SPECT) is a refinement of presently available techniques, offering improved identification over planar imaging of individual vessel stenosis and quantification of the extent of abnormally perfused myocardium. In this review, the planar and SPECT techniques are discussed in light of the most recently published large patient series, and with regard to the many factors that affect the sensitivity and specificity of perfusion imaging in identifying coronary artery disease. The clinical implications of exercise perfusion scintigraphy and its future applications in cardiology practice are discussed.67 references.

  15. Acute coronary syndrome in Behcet’s disease caused by a coronary artery aneurysm and thrombosis

    PubMed Central

    Tekin, Bahar; Özen, Gülsen; Tekayev, Nazar; Gerçek, Şeyma; Direskeneli, Haner

    2014-01-01

    Behcet’s disease (BD) is a multisystemic vasculitis that can involve vessels of all sizes and is characterized by recurrent oral and genital ulcers with variable manifestations affecting the skin, eyes, and central nervous and musculoskeletal systems. Vascular involvement in BD is reported to be up to 40% in different series. The abdominal and thoracic aorta and pulmonary and femoral arteries are the most commonly involved arteries. However coronary arteries are rarely affected. Herein, we present a 29-year-old man who was consulted with progressive severe chest pain of 3 days in duration to our clinic. The patient was diagnosed with BD with mucocutaneous symptoms and a positive pathergy test 1 year ago and was in clinical remission for the last 6 months. At the first evaluation in the emergency department, the patient’s vital signs were stable, whereas he had elevated troponin T levels with a normal electrocardiogram and hypokinetic areas in the apex of the heart in the echocardiography. Conventional and computed tomography coronary angiography revealed aneurysms and intramural thrombosis in the left anterior descending and right coronary arteries. Although ischemic symptoms and signs improved with anticoagulant and antiaggregant therapies, coronary aneurysms were observed to increase in size. Immunosuppressive (IS) treatment was started with pulse intravenous corticosteroids and cyclophosphamide. Because of the high re-stenosis risk, stents were not applied to the affected vessels during the acute thrombosis period. During routine investigations, an in situ pulmonary thrombosis was also detected bilaterally in the peripheral pulmonary arteries. In conclusion, coronary artery aneurysm is a rare and poor prognostic manifestation of BD. The treatment protocol for these aneurysms is not well clarified. IS therapies are definitely indicated, but the role of anticoagulants and invasive vascular interventions is controversial. PMID:27708903

  16. Excimer laser debulking for percutaneous coronary intervention in left main coronary artery disease.

    PubMed

    Topaz, On; Polkampally, Pritam R; Mohanty, Pramod K; Rizk, Maged; Bangs, Julie; Bernardo, Nelson L

    2009-11-01

    Excimer laser has been successfully applied to complex atherosclerotic plaques in acute coronary syndromes; however, its role in debulking in left main coronary artery disease has not been fully explored. Details of a series of 20 patients who underwent excimer laser revascularization of a spectrum of left main coronary artery lesions are presented. Twenty symptomatic patients who received excimer laser debulking were examined for procedural outcome and follow up results. The left main coronary artery was characterized as protected, semi-protected, poorly protected, or unprotected, depending on the presence or absence of patent bypass grafts to the left anterior descending (LAD) and circumflex (CX) arteries. A fully protected left main coronary artery (LMCA) was present in only 20% of the patients. The target lesions included 11(55%) distal LMCA stenoses, six (30%) ostial stenoses, and one (5%) mid-portion lesions. Two (10%) patients had in-stent re-stenosis of the entire length of the LMCA. Small (0.7 mm-1.4 mm) excimer laser catheters were mostly used. A relatively high number of laser energy pulses (1,334 +/- 643) were required to achieve adequate debulking. Successful LMCA intervention was performed in 19 (95%) patients, while in-hospital complications occurred in only one (5%) patient. Subacute/late stent thrombosis developed 3 months after the procedure in one patient, and two patients died from non-cardiac causes during follow-up. Lesions in LMCAs can be revascularized in selected patients by laser debulking and adjunct stenting. Inadequate protection by bypass grafts and decreased left ventricular function do not contradict utilization of excimer laser. Small laser catheters and high energy levels are required during laser debulking of stenoses of left main coronary arteries.

  17. Lymphocyte activation gene 3 and coronary artery disease

    PubMed Central

    Golden, Diana; Kolmakova, Antonina; Sura, Sunitha; Vella, Anthony T.; Manichaikul, Ani; Wang, Xin-Qun; Bielinski, Suzette J.; Taylor, Kent D.; Chen, Yii-Der Ida; Rich, Stephen S.

    2016-01-01

    BACKGROUND: The lipoprotein scavenger receptor BI (SCARB1) rs10846744 noncoding variant is significantly associated with atherosclerotic disease independently of traditional cardiovascular risk factors. We identified a potentially novel connection between rs10846744, the immune checkpoint inhibitor lymphocyte activation gene 3 (LAG3), and atherosclerosis. METHODS: In vitro approaches included flow cytometry, lipid raft isolation, phosphosignaling, cytokine measurements, and overexpressing and silencing LAG3 protein. Fasting plasma LAG3 protein was measured in hyperalphalipoproteinemic (HALP) and Multi-Ethnic Study of Atherosclerosis (MESA) participants. RESULTS: In comparison with rs10846744 reference (GG homozygous) cells, LAG3 protein levels by flow cytometry (P < 0.001), in lipid rafts stimulated and unstimulated (P = 0.03), and phosphosignaling downstream of B cell receptor engagement of CD79A (P = 0.04), CD19 (P = 0.04), and LYN (P = 0.001) were lower in rs10846744 risk (CC homozygous) cells. Overexpressing LAG3 protein in risk cells and silencing LAG3 in reference cells confirmed its importance in phosphosignaling. Secretion of TNF-α was higher (P = 0.04) and IL-10 was lower (P = 0.04) in risk cells. Plasma LAG3 levels were lower in HALP carriers of the CC allele (P < 0.0001) and by race (P = 0.004). In MESA, race (P = 0.0005), age (P = 0.003), lipid medications (P = 0.03), smoking history (P < 0.0001), and rs10846744 genotype (P = 0.002) were independent predictors of plasma LAG3. In multivariable regression models, plasma LAG3 was significantly associated with HDL-cholesterol (HDL-C) (P = 0.007), plasma IL-10 (P < 0.0001), and provided additional predictive value above the Framingham risk score (P = 0.04). In MESA, when stratified by high HDL-C, plasma LAG3 was associated with coronary heart disease (CHD) (odds ratio 1.45, P = 0.004). CONCLUSION: Plasma LAG3 is a potentially novel independent predictor of HDL-C levels and CHD risk. FUNDING: This work was

  18. Lymphocyte activation gene 3 and coronary artery disease.

    PubMed

    Golden, Diana; Kolmakova, Antonina; Sura, Sunitha; Vella, Anthony T; Manichaikul, Ani; Wang, Xin-Qun; Bielinski, Suzette J; Taylor, Kent D; Chen, Yii-Der Ida; Rich, Stephen S; Rodriguez, Annabelle

    2016-10-20

    BACKGROUND: The lipoprotein scavenger receptor BI (SCARB1) rs10846744 noncoding variant is significantly associated with atherosclerotic disease independently of traditional cardiovascular risk factors. We identified a potentially novel connection between rs10846744, the immune checkpoint inhibitor lymphocyte activation gene 3 (LAG3), and atherosclerosis. METHODS: In vitro approaches included flow cytometry, lipid raft isolation, phosphosignaling, cytokine measurements, and overexpressing and silencing LAG3 protein. Fasting plasma LAG3 protein was measured in hyperalphalipoproteinemic (HALP) and Multi-Ethnic Study of Atherosclerosis (MESA) participants. RESULTS: In comparison with rs10846744 reference (GG homozygous) cells, LAG3 protein levels by flow cytometry (P < 0.001), in lipid rafts stimulated and unstimulated (P = 0.03), and phosphosignaling downstream of B cell receptor engagement of CD79A (P = 0.04), CD19 (P = 0.04), and LYN (P = 0.001) were lower in rs10846744 risk (CC homozygous) cells. Overexpressing LAG3 protein in risk cells and silencing LAG3 in reference cells confirmed its importance in phosphosignaling. Secretion of TNF-α was higher (P = 0.04) and IL-10 was lower (P = 0.04) in risk cells. Plasma LAG3 levels were lower in HALP carriers of the CC allele (P < 0.0001) and by race (P = 0.004). In MESA, race (P = 0.0005), age (P = 0.003), lipid medications (P = 0.03), smoking history (P < 0.0001), and rs10846744 genotype (P = 0.002) were independent predictors of plasma LAG3. In multivariable regression models, plasma LAG3 was significantly associated with HDL-cholesterol (HDL-C) (P = 0.007), plasma IL-10 (P < 0.0001), and provided additional predictive value above the Framingham risk score (P = 0.04). In MESA, when stratified by high HDL-C, plasma LAG3 was associated with coronary heart disease (CHD) (odds ratio 1.45, P = 0.004). CONCLUSION: Plasma LAG3 is a potentially novel independent predictor of HDL-C levels and CHD risk. FUNDING: This work was

  19. Prevalence and predictors of coronary artery disease in patients with a calcium score of zero.

    PubMed

    de Carvalho, Maria Salomé Leal; de Araújo Gonçalves, Pedro; Garcia-Garcia, Hector M; de Sousa, Pedro Jerónimo; Dores, Helder; Ferreira, António; Cardim, Nuno; Carmo, Miguel Mota; Aleixo, Ana; Mendes, Miguel; Machado, Francisco Pereira; Roquette, José; Marques, Hugo

    2013-12-01

    The absence of coronary calcification is associated with an excellent prognosis. However, a calcium score of zero does not exclude the presence of coronary artery disease (CAD) or the possibility of future cardiovascular events. Our aim was to study the prevalence and predictors of coronary artery disease in patients with a calcium score of zero. Prospective registry consisted of 3,012 consecutive patients that underwent cardiac CT (dual source CT). Stable patients referred for evaluation of possible CAD that had a calcium score of zero (n = 864) were selected for this analysis. The variables that were statistically significant were included in a multivariable logistic regression model. From 864 patients with a calcium score of zero, 107 (12.4%) had coronary plaques on the contrast CT (10.8%, n = 93 with nonobstructive CAD and 1.6%, n = 14 with obstructive CAD). By logistic regression analysis, the independent predictors of CAD in this population were age >55 years [odds ratio (OR) 1.63 (1.05-2.52)], hypertension [OR 1.64 (1.05-2.56)] and dyslipidemia [OR 1.54 (1.00-2.36)]. In the presence of these 3 variables, the probability of having coronary plaques was 21%. The absence of coronary artery calcification does not exclude the presence of coronary artery disease, but the prevalence of obstructive disease is very low. In this population, the independent predictors of CAD in the setting of a calcium score of zero were hypertension, dyslipidemia, and age above 55 years. In the presence of these 3 predictors, the probability of having CAD was almost 2 times higher than in the general population.

  20. Evolution of insulin resistance in coronary artery disease patients on four different pharmacological therapies

    PubMed Central

    Piedrola, G.; Novo, E.; Serrano-Gotarredo..., J.; de Teresa, M. L.; Garcia-Robles, R.

    1999-01-01

    The objective of the study was to examine the evolution of insulin sensitivity in a group of patients with stable coronary artery disease receiving one of four different pharmacological therapies. Insulin sensitivity was evaluated using an insulin suppression test in 40 newly diagnosed patients with coronary artery disease and no previous history of metabolic disorders, who were not taking any medication which might affect insulin sensitivity. The insulin suppression test consisted of a constant infusion of glucose, insulin and somatostatin for 150 min; insulin resistance was estimated by determining the steady-state plasma glucose concentrations during the last 60 minutes of the test. The insulin sensitivity index was calculated by the formula: insulin sensitivity index = (glucose infusion rate/steady state plasma glucose concentrations) × 103. A second insulin suppression test was performed after 6 months' therapy with either isosorbide mononitrate, atenolol, diltiazem or captopril in 30 of the 40 patients.
  There were no differences between any of the groups before therapy was initiated. After 6 months, patients treated with captopril and, to a lesser extent, those treated with diltiazem showed statistically significantly decreased steady state plasma glucose concentrations and increased insulin sensitivity index compared to basal values. No statistically significant differences were found in the other two groups. We conclude that captopril and, to a lesser extent, diltiazem improve insulin sensitivity in patients with stable coronary artery disease.


Keywords: insulin resistance; coronary artery disease; captopril; diltiazem PMID:10396583

  1. Optimal Management of Peripheral Arterial Disease for the Non-Specialist

    PubMed Central

    O'Donnell, ME; Reid, JA; Lau, LL; Hannon, RJ; Lee, B

    2011-01-01

    Peripheral arterial disease (PAD) now affects approximately 20% of adults older than 55 years to an estimated total of 27 million people in the Western World. The aim of this paper is to describe the medical management of PAD for the non-vascular specialist, particularly general practitioners, where PAD has now been included in the Northern Ireland Department of Health's Primary Care Service Framework (Directed Enhanced Service). PMID:22347739

  2. No causal association between inflammation and Chlamydia pneumoniae in patients with chronic ischemic arterial disease.

    PubMed

    Altman, Raúl; Rouvier, Jorge; Scazziota, Alejandra; Gonzalez, Claudio

    2002-02-01

    The C-reactive protein, Chlamydia-specific IgG antibody, and fibrinogen were assayed in the serum of 159 patients with arterial disease (the arterial group) and 203 patients with heart valve prostheses (the valvular group) and no demonstrable coronary disease. In the arterial group, the Chlamydia pneumoniae antibody was > or = 1:32 for 67.3% (107/159) of the patients, the C-reactive protein was elevated in 41.5% (66/159), and the fibrinogen was elevated in 27.7% (44/159). In the valvular group, the C. pneumoniae antibody was > or = 1:32 for 59.1% (120/203) of the patients; the C-reactive protein was elevated in 34.0% (69/203), and the fibrinogen was elevated in 17.2% (35/203). Of 107 patients in the arterial group with C. pneumoniae titers > or = 1:32, only 26 (24.3%) had elevated fibrinogen (426 +/- 29 mg/dL) and 44 (41.1%) had elevated C-reactive protein (1.06 +/- 0.52 mg/dL). Similarly, of the 120 patients in the valvular group with C. pneumoniae titers > or = 1:32, 17 (14.2%) had elevated fibrinogen (409 +/- 29 mg/dL) and 34 had elevated C-reactive protein (0.99 +/- 1.1 mg/dL). Correlated poorly was C. pneumoniae with C-reactive protein and fibrinogen levels. Only the fibrinogen level could be discriminated between the arterial and the valvular group. These results suggest that no causal association exists between inflammation and C. pneumoniae. A highly significant correlation between C-reactive protein and fibrinogen levels was found.

  3. Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease.

    PubMed

    Briet, M; Bozec, E; Laurent, S; Fassot, C; London, G M; Jacquot, C; Froissart, M; Houillier, P; Boutouyrie, P

    2006-01-01

    Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular morbidity and mortality. Arterial stiffness and remodeling have been well documented in patients with end-stage renal disease, but little is known about arterial phenotype in CKD patients with moderate reduction in glomerular filtration rate (GFR). In total, 95 patients (58+/-15 years, mean+/-s.d.) with CKD and GFR measured by renal clearance of (51)Cr-ethylenediaminetetraacetate were compared to 121 hypertensive patients without CKD (59+/-11 years), and 57 normotensive subjects (56+/-6 years). Common carotid artery diameter, intima-media thickness (IMT), distensibility, and Young's elastic modulus were noninvasively determined with a high-definition echotracking system. Patients with CKD had a significantly larger carotid internal diameter than in hypertensives and normotensives (6.32+/-1.05, 5.84+/-0.74, and 5.50+/-0.64 m x 10(-3), respectively; P<0.001), resulting in 25% and 11% increases in circumferential wall stress, respectively, since no significant difference in IMT was observed. Carotid distensibility and elastic modulus did not significantly differ between CKD and hypertensives; normotensives had significantly higher distensibility and lower elastic modulus than CKD and hypertensive patients. Carotid-femoral pulse wave velocity was significantly higher in CKD patients than in hypertensives and normotensives. In multivariate analyses either involving the entire population or restricted to CKD patients, GFR was independently and strongly related to carotid diameter and elastic modulus. Arterial enlargement and increased arterial stiffness occur in parallel with the decline in renal function in patients with mild-to-moderate CKD.

  4. The use of echocardiography for the non-invasive evaluation of coronary artery disease.

    PubMed

    Sirtori, Cesare R; Labombarda, Fabien; Castelnuovo, Samuela; Perry, Rebecca

    2017-03-01

    In the Western world, there are now millions of patients who undergo clinical procedures that evaluate coronary artery status each year. Methods span from direct imaging using angiography, computerized tomography, to nuclear magnetic imaging as well as to functional studies, such as positron emission tomography. These techniques have provided significant information to physicians, but there is still need for an improved accessibility. Angiographic methods are expensive and expose the patient to significant amounts of radiation, undesirable in younger patients. Among the novel technologies for coronary diagnostics, transthoracic echocardiography (TTE) of coronary arteries has provided an important alternative, particularly in everyday practice. Diagnostic arterial TTE can allow determination of the coronary wall lumen in at least three major coronary segments (left main [LM], left arterial descending [LAD] and right coronary artery [RCA]). Coronary wall thickness using the LAD has been preliminarily shown to be related to the risk of coronary events. Since it is well ascertained that coronary lesions found in any location indicate that at least 80% of the coronary tree is affected, this is very important clinical information. Evaluation of coronary status by TTE is a novel technology providing important information in ischemic syndromes, in cases of coronary malformations and other coronary diseases. KEY MESSAGES Coronary evaluation can be carried out by a variety of both invasive and non-invasive methods, many requiring radiation exposure or patient immobility. Transthoracic echocardiography (TTE) of the coronaries can, in particular, evaluate the coronary wall thickness, and this may be directly related to the coronary disease risk. TTE is a useful method for the monitoring of coronary flow reserve and can allow the detection of coronary malformations.

  5. Evolution of autobiographical memory impairments in Alzheimer's disease and frontotemporal dementia - A longitudinal neuroimaging study.

    PubMed

    Irish, Muireann; Landin-Romero, Ramon; Mothakunnel, Annu; Ramanan, Siddharth; Hsieh, Sharpley; Hodges, John R; Piguet, Olivier

    2017-03-10

    Compromised autobiographical memory (ABM) retrieval is well established in dementia, attributable to degeneration of a core memory brain network. It remains unclear, however, how the progressive spread of atrophy with advancing disease severity impacts ABM retrieval across life epochs. To this end, we conducted a longitudinal study of recent and remote ABM in Alzheimer's disease (AD, n =11), and a frontotemporal lobar degeneration group (FTD, n =13) comprising 7 behavioral variant FTD and 6 semantic dementia patients, in comparison with 23 healthy older Controls. Patients were re-assessed approximately one year following their initial visit and underwent repeat testing and brain imaging. Linear mixed modeling neuroimaging analyses explored disease-specific cortical changes driving ABM alterations over time. AD patients showed comparable ABM profiles across assessment periods however, follow-up performance correlated strongly with lateral temporal lobe integrity. In contrast, recent ABMs were disproportionately disrupted at follow-up relative to baseline in the FTD group, attributable to cortical thinning in posterior brain regions, including the right posterior cingulate cortex. Our findings offer new insights regarding the potential time-specific role of discrete cortical regions in ABM retrieval and the differential fate of formerly evocative memories with advancing disease severity in dementia syndromes.

  6. On Colour, Category Effects, and Alzheimer's Disease: A Critical Review of Studies and Further Longitudinal Evidence.

    PubMed

    Moreno-Martínez, F Javier; Rodríguez-Rojo, Inmaculada C

    2015-01-01

    The role of colour in object recognition is controversial; in this study, a critical review of previous studies, as well as a longitudinal study, was conducted. We examined whether colour benefits the ability of Alzheimer's disease (AD) patients and normal controls (NC) when naming items differing in colour diagnosticity: living things (LT) versus nonliving things (NLT). Eleven AD patients were evaluated twice with a temporal interval of 3 years; 26 NC were tested once. The participants performed a naming task (colour and greyscale photographs); the impact of nuisance variables (NVs) and potential ceiling effects were also controlled. Our results showed that (i) colour slightly favoured processing of items with higher colour diagnosticity (i.e., LT) in both groups; (ii) AD patients used colour information similarly to NC, retaining this ability over time; (iii) NVs played a significant role as naming predictors in all the participants, relegating domain to a minor plane; and (iv) category effects (better processing of NLT) were present in both groups. Finally, although patients underwent semantic longitudinal impairment, this was independent of colour deterioration. This finding provides better support to the view that colour is effective at the visual rather than at the semantic level of object processing.

  7. On Colour, Category Effects, and Alzheimer's Disease: A Critical Review of Studies and Further Longitudinal Evidence

    PubMed Central

    Moreno-Martínez, F. Javier; Rodríguez-Rojo, Inmaculada C.

    2015-01-01

    The role of colour in object recognition is controversial; in this study, a critical review of previous studies, as well as a longitudinal study, was conducted. We examined whether colour benefits the ability of Alzheimer's disease (AD) patients and normal controls (NC) when naming items differing in colour diagnosticity: living things (LT) versus nonliving things (NLT). Eleven AD patients were evaluated twice with a temporal interval of 3 years; 26 NC were tested once. The participants performed a naming task (colour and greyscale photographs); the impact of nuisance variables (NVs) and potential ceiling effects were also controlled. Our results showed that (i) colour slightly favoured processing of items with higher colour diagnosticity (i.e., LT) in both groups; (ii) AD patients used colour information similarly to NC, retaining this ability over time; (iii) NVs played a significant role as naming predictors in all the participants, relegating domain to a minor plane; and (iv) category effects (better processing of NLT) were present in both groups. Finally, although patients underwent semantic longitudinal impairment, this was independent of colour deterioration. This finding provides better support to the view that colour is effective at the visual rather than at the semantic level of object processing. PMID:26074675

  8. Prodromal Markers in Parkinson’s Disease: Limitations in Longitudinal Studies and Lessons Learned

    PubMed Central

    Heinzel, Sebastian; Roeben, Benjamin; Ben-Shlomo, Yoav; Lerche, Stefanie; Alves, Guido; Barone, Paolo; Behnke, Stefanie; Berendse, Henk W.; Bloem, Bastiaan R.; Burn, David; Dodel, Richard; Grosset, Donald G.; Hu, Michele; Kasten, Meike; Krüger, Rejko; Moccia, Marcello; Mollenhauer, Brit; Oertel, Wolfgang; Suenkel, Ulrike; Walter, Uwe; Wirdefeldt, Karin; Liepelt-Scarfone, Inga; Maetzler, Walter; Berg, Daniela

    2016-01-01

    A growing body of evidence supports a prodromal neurodegenerative process preceding the clinical onset of Parkinson’s disease (PD). Studies have identified several different prodromal markers that may have the potential to predict the conversion from healthy to clinical PD but use considerably different approaches. We systematically reviewed 35 longitudinal studies reporting prodromal PD features and evaluated the methodological quality across 10 different predefined domains. We found limitations in the following domains: PD diagnosis (57% of studies), prodromal marker assessments (51%), temporal information on prodromal markers or PD diagnosis (34%), generalizability of results (17%), statistical methods (accounting for at least age as confounder; 17%), study design (14%), and sample size (9%). However, no limitations regarding drop-out (or bias investigation), or report of inclusion/exclusion criteria or prodromal marker associations were revealed. Lessons learned from these limitations and additional aspects of current prodromal marker studies in PD are discussed to provide a basis for the evaluation of findings and the improvement of future research in prodromal PD. The observed heterogeneity of studies, limitations and analyses might be addressed in future longitudinal studies using a, yet to be established, modular minimal set of assessments improving comparability of findings and enabling data sharing and combined analyses across studies. PMID:27445791

  9. Macular function and morphological features in juvenile Stargardt disease: Longitudinal study

    PubMed Central

    Testa, Francesco; Melillo, Paolo; Iorio, Valentina Di; Orrico, Ada; Attanasio, Marcella; Rossi, Settimio; Simonelli, Francesca

    2014-01-01

    Purpose to evaluate disease progression in a cohort of patients with clinical and genetic diagnosis of Stargardt disease. Design longitudinal cohort study. Subjects 56 selected patients with a clinical and molecular diagnosis of Stargardt disease, an early age of onset and a median follow-up length of two years. Methods patients underwent routine examination including full-field electroretinography, microperimetry and optical coherence tomography. Main Outcome Measures best corrected visual acuity, mean retinal sensitivity, fixation stability, preferred retinal locus, inner-outer segment (IS/OS) junction loss, atrophic lesion area. Results 56 patients with a mean age of disease onset of 15.3 years (range: 3 - 28 years), a mean disease length of 12.1 years and a mean age at baseline of 27.4 years were analyzed. The median best corrected visual acuity was 20/200 in both eyes. Optical coherence tomography parameters (IS/OS alteration and retinal pigment epithelium lesion area) were obtained in 49 patients because signal quality was poor in the remaining 7 patients. Optical coherence tomography revealed a mean retinal pigment epithelium lesion area of 2.6 mm2, preserved foveal IS/OS in 4.1% of patients, loss of foveal IS/OS in 59.2%, and extensive loss of macular IS/OS in 36.7%. Microperimetric findings showed a reduced macular sensitivity (mean 10 dB) and an unstable fixation in half of the patient cohort. The longitudinal analysis showed a significant progressive reduction of best corrected visual acuity and macular sensitivity (at an estimated rate of 0.04 decimals and 1.19 dB per year, respectively) associated with a significant enlargement of retinal pigment epithelium lesion area (0.282 mm2 per year). No significant changes in ophthalmoscopic findings and electroretinographic responses were detected. Conclusions this study highlights the importance of microperimetry and optical coherence tomography in monitoring Stargardt patients. In fact, quantifying the

  10. Lack of subclinical myocardial ischaemia in Mexican patients with systemic lupus erythematosus without traditional risk factors for coronary artery disease.

    PubMed

    García-Carrasco, M; Escárcega, R O; Pérez-Terrón, J; Ramírez, A; Muñoz-Guarneros, M; Beltrán, A; Pérez-Cuevas, B; López-Colombo, A; Cervera, R

    2007-01-01

    The objective of this study was to analyse whether patients with systemic lupus erythematosus (SLE) without traditional risk factors for coronary artery disease (CAD) develop subclinical myocardial ischaemia in the first years after diagnosis. A cross-sectional analysis of a cohort of 200 female SLE patients was conducted. We selected those patients who fulfilled the American College of Rheumatology (ACR) SLE criteria and had no traditional risk factors for CAD, including diabetes mellitus, hypertension, obesity, hyperlipidemia, and smoking. After an initial clinical and laboratory examination, patients were evaluated using a baseline echocardiogram and a dobutamine and atropine stress echocardiogram to search for subclinical myocardial ischaemia. Forty-one patients were included in the study. The mean age at the time of the study was 34.5 +/- 9.56 years (mean +/- SD). The mean age at diagnosis was 30.3 +/- 9.39 years. The mean time from diagnosis was 3.9 +/- 3.3 years. Baseline disease activity index (MEX-SLEDAI score) showed that 92.6% of patients had disease activity, although most patients had mild activity. A dobutamine and atropine stress echocardiogram was performed in 40 patients. All 40 patients had negative tests for subclinical myocardial ischaemia. Patients without traditional risk factors for CAD do not have an increased risk for subclinical myocardial ischaemia in the first years after diagnosis. A longitudinal follow-up study of these patients is needed to confirm our findings and assess if additional non-traditional risk factors for CAD increase the risk for myocardial ischaemia.

  11. Methods for analyzing observational longitudinal prognosis studies for rheumatic diseases: a review & worked example using a clinic-based cohort of juvenile dermatomyositis patients.

    PubMed

    Lim, Lily Siok Hoon; Pullenayegum, Eleanor; Moineddin, Rahim; Gladman, Dafna D; Silverman, Earl D; Feldman, Brian M

    2017-03-29

    Most outcome studies of rheumatic diseases report outcomes ascertained on a single occasion. While single assessments are sufficient for terminal or irreversible outcomes, they may not be sufficiently informative if outcomes change or fluctuate over time. Consequently, longitudinal studies that measure non-terminal outcomes repeatedly afford a better understanding of disease evolution.Longitudinal studies require special analytic methods. Newer longitudinal analytic methods have evolved tremendously to deal with common challenges in longitudinal observational studies. In recent years, an increasing number of studies have used longitudinal design. This review aims to help readers understand and apply the findings from longitudinal studies. Using a cohort of children with juvenile dermatomyositis (JDM), we illustrate how to study evolution of disease activity in JDM using longitudinal methods.

  12. Progression of carotid-artery disease in type 2 diabetic patients: a cohort prospective study

    PubMed Central

    Bosevski, Marijan; Stojanovska, Lily

    2015-01-01

    In order to assess the progression of carotid-artery disease in type 2 diabetic cohort (n=207 patients), the dynamic change in carotid intima-media thickness (CIMT) and the occurrence of plaques were followed for a period of 31.35±10.59 months. The mean CIMT at the beginning of the study was 0.9178±0.1447 mm, with a maximal value of 1.1210±0.2366 mm. The maximal value of CIMT changed by 0.07 mm/year. Progression of CIMT was noted in 86.8% and its regression in 7.8% of patients. The occurrence of carotid plaques was detected in 41.8% of patients. Multiple regression analysis revealed the maximal value of CIMT to be associated with diastolic blood pressure, despite mean CIMT being predicted by body mass index. The presence of peripheral arterial disease and hypo-high-density lipoproteinemia were found to be predictors for the occurrence of carotid plaques. Our data have clinical implications in predicting risk factors for the progression of carotid-artery disease in type 2 diabetic patients for their appropriate management. PMID:26527880

  13. [Diagnostics and treatment of lower extremity peripheral arterial disease; guideline and registry].

    PubMed

    Vahl, A; Elsman, B; van Enst, A

    2016-01-01

    - Revision of the 2005 guideline 'Diagnostics and treatment of lower extremity peripheral arterial disease' and the development of an audit have instigated a degree of efficiency and transparency for the treatment of patients with peripheral arterial disease (PAD). - The key recommendations are that first-line treatment of patients, who - preferably by means of a consultation in a vascular laboratory - are diagnosed with intermittent claudication, is supervised exercise therapy and secondary prevention. Referral for second-line treatment only needs to occur when invasive therapy is considered, for example when there is insufficient improvement in symptoms or in patients who have or are developing critical ischemia. - In case of endovascular treatments it is not necessary to insert stents routinely; this can be reserved for cases where the angiographic result of the angioplasty is insufficient. - All patients with PAD are registered on the DAPA register ('Dutch audit for peripheral arterial disease'), which has two unique characteristics: patient reported outcome measures (PROMs) are recorded and a case mix correction is incorporated for the PROMs and amputation-free survival through linkage with the health insurance database.

  14. Illness perception in patients with coronary artery disease: A systematic review.

    PubMed

    Al-Smadi, Ahmed Mohammad; Ashour, Ala; Hweidi, Issa; Gharaibeh, Besher; Fitzsimons, Donna

    2016-12-01

    The aim of this study was to conduct a systematic review that investigates the differences in illness perception with age and gender in patients diagnosed with coronary artery disease. Previous studies show some discrepancies regarding the influence of age and gender on the specific dimensions of coronary artery disease patients' illness perception. A systematic review using a narrative synthesis process included preliminary synthesis, exploration of relationships and assessment of the robustness of the synthesis and findings was conducted. Search terms were used to identify research studies published between 1996 and December 2014 across four key databases: CINAHL, Medline, PsycINFO and Web of Science. A total of 14 studies met the inclusion criteria of the review. The review found that men had a stronger perception that their own behaviour had caused their illness than women. In addition, older patients had lower perceptions of the consequences and chronicity of their illness. This analysis concludes that some dimensions of illness perception vary according to age and gender of patients with coronary artery disease. These differences should be taken into consideration, particularly when providing health education and cardiac rehabilitation.

  15. Diagnostic models of the pre-test probability of stable coronary artery disease: A systematic review

    PubMed Central

    He, Ting; Liu, Xing; Xu, Nana; Li, Ying; Wu, Qiaoyu; Liu, Meilin; Yuan, Hong

    2017-01-01

    A comprehensive search of PubMed and Embase was performed in January 2015 to examine the available literature on validated diagnostic models of the pre-test probability of stable coronary artery disease and to describe the characteristics of the models. Studies that were designed to develop and validate diagnostic models of pre-test probability for stable coronary artery disease were included. Data regarding baseline patient characteristics, procedural characteristics, modeling methods, metrics of model performance, risk of bias, and clinical usefulness were extracted. Ten studies involving the development of 12 models and two studies focusing on external validation were identified. Seven models were validated internally, and seven models were validated externally. Discrimination varied between studies that were validated internally (C statistic 0.66-0.81) and externally (0.49-0.87). Only one study presented reclassification indices. The majority of better performing models included sex, age, symptoms, diabetes, smoking, and hyperlipidemia as variables. Only two diagnostic models evaluated the effects on clinical decision making processes or patient outcomes. Most diagnostic models of the pre-test probability of stable coronary artery disease have had modest success, and very few present data regarding the effects of these models on clinical decision making processes or patient outcomes. PMID:28355366

  16. Diagnostic models of the pre-test probability of stable coronary artery disease: A systematic review.

    PubMed

    He, Ting; Liu, Xing; Xu, Nana; Li, Ying; Wu, Qiaoyu; Liu, Meilin; Yuan, Hong

    2017-03-01

    A comprehensive search of PubMed and Embase was performed in January 2015 to examine the available literature on validated diagnostic models of the pre-test probability of stable coronary artery disease and to describe the characteristics of the models. Studies that were designed to develop and validate diagnostic models of pre-test probability for stable coronary artery disease were included. Data regarding baseline patient characteristics, procedural characteristics, modeling methods, metrics of model performance, risk of bias, and clinical usefulness were extracted. Ten studies involving the development of 12 models and two studies focusing on external validation were identified. Seven models were validated internally, and seven models were validated externally. Discrimination varied between studies that were validated internally (C statistic 0.66-0.81) and externally (0.49-0.87). Only one study presented reclassification indices. The majority of better performing models included sex, age, symptoms, diabetes, smoking, and hyperlipidemia as variables. Only two diagnostic models evaluated the effects on clinical decision making processes or patient outcomes. Most diagnostic models of the pre-test probability of stable coronary artery disease have had modest success, and very few present data regarding the effects of these models on clinical decision making processes or patient outcomes.

  17. Longitudinal Assessment of Disease Sites by Attachment Level Changes and Bone Density Loss by Digital Image Analysis

    DTIC Science & Technology

    1989-04-01

    Am. Dent. Assoc. 62:709. Bossert WA, Marks HH. 1956. Prevalence and characteristics of periodontal disease in 12,800 persons under periodic dental ...density as a potential indicator of disease progression. Twenty-one patients with a history of periodontitis were monitored using both clinical and... periodontitis that did not progress over a 10 year period. A longitudinal study of untreated patients (Becker et al 1979) reported that disease

  18. Pathogenesis of coronary artery disease: focus on genetic risk factors and identification of genetic variants

    PubMed Central

    Sayols-Baixeras, Sergi; Lluís-Ganella, Carla; Lucas, Gavin; Elosua, Roberto

    2014-01-01

    Coronary artery disease (CAD) is the leading cause of death and disability worldwide, and its prevalence is expected to increase in the coming years. CAD events are caused by the interplay of genetic and environmental factors, the effects of which are mainly mediated through cardiovascular risk factors. The techniques used to study the genetic basis of these diseases have evolved from linkage studies to candidate gene studies and genome-wide association studies. Linkage studies have been able to identify genetic variants associated with monogenic diseases, whereas genome-wide association studies have been more successful in determining genetic variants associated with complex diseases. Currently, genome-wide association studies have identified approximately 40 loci that explain 6% of the heritability of CAD. The application of this knowledge to clinical practice is challenging, but can be achieved using various strategies, such as genetic variants to identify new therapeutic targets, personal genetic information to improve disease risk prediction, and pharmacogenomics. The main aim of this narrative review is to provide a general overview of our current understanding of the genetics of coronary artery disease and its potential clinical utility. PMID:24520200

  19. Diagnosing Coronary Artery Disease via Data Mining Algorithms by Considering Laboratory and Echocardiography Features

    PubMed Central

    Alizadehsani, Roohallah; Habibi, Jafar; Alizadeh Sani, Zahra; Mashayekhi, Hoda; Boghrati, Reihane; Ghandeharioun, Asma; Khozeimeh, Fahime; Alizadeh-Sani, Fariba

    2013-01-01

    Background: Coronary artery disease (CAD) is the result of the accumulation of a