Current ; trends ; Coronary Arteriosclerosis

Complete atrioventricular block ; Exercise ; Coronary Arteriosclerosis ; Case Report

Advanced atherosclerosis is often associated with dystrophic calcification and remodeling of extracellular matrix of vascular wall. Recently many studies have documented a general relationship between calcification and severity of coronary disease, and discussed the feasibility of electron beam computed tomography for detecting and quantifying the coronary artery calcification in the patients. The present study investigated the expression and the localization of osteopontin, one of noncollagenous bone matrix protein, within the calcified coronary arteries. Autopsy-derived coronary artery specimens were scanned and reconstructed to visualize the pattern of coronary calcification using a novel microscopic computed tomography technique. The localization of the osteopontin were evaluated by immunohistochemial stain with LF7. The present study showed that the pattern of coronary calcification is variable and the expression of osteopontin is localized mainly to calcified lesion. The smooth muscle cells in addition to macrophage expressed osteopontin protein in human coronary atherosclerotic plaques. Soluble osteopontin released near to the sites of vascular calcification may represent an adaptive mechanism aimed at regulating the process of vascular calcification.
Aged ; Calcinosis/metabolism ; Coronary Arteriosclerosis/pathology* ; Coronary Arteriosclerosis/metabolism* ; Coronary Vessels/pathology* ; Coronary Vessels/metabolism ; Coronary Vessels/chemistry* ; Female ; Human ; Immunohistochemistry ; Male ; Middle Age ; Sialoglycoproteins/biosynthesis ; Sialoglycoproteins/analysis*

The objectives of this investigation were to evaluate biomechanical factors in the atherosclerotic process using human in vivo hemodynamic parameters and computed numerical simulation qualitatively and quantitatively. The three-dimensional spatial patterns of steady and pulsatile flows in the left coronary artery were simulated, using a finite volume method. Coronary angiogram and Doppler ultrasound measurement of the proximal left coronary flow velocity were performed in humans. Inlet wave velocity distribution obtained from in vivo data of the intravascular Doppler study allowed for input of in vitro numerical simulation. Hemodynamic variables, such as flow velocity, pressure and shear stress of the left anterior descending coronary bifurcation site were calculated. We found that there were spatial fluctuation of flow-velocity and recirculation areas at the curved outer wall of the left anterior descending coronary artery, which were due to the differences of flow-velocity and shear stress, especially during the declaration phase of pulsatile flow. This study suggests that rheologic properties may be a part of the atherogenic process in the coronary bifurcated and curved areas.
Biomechanics ; Blood Flow Velocity/physiology ; Blood Pressure/physiology ; Coronary Arteriosclerosis/physiopathology* ; Coronary Arteriosclerosis/etiology* ; Coronary Vessels/physiopathology* ; Hemodynamics/physiology* ; Homeostasis/physiology ; Human ; Models, Cardiovascular* ; Pulsatile Flow ; Stress, Mechanical

If there is coronary plaque, do we need statin therapy? Many studies have been conducted to answer this question. According to global guidelines, there is a high-risk patient population who could benefit from statin therapy. According to the guidelines, patients with a history of previous cardiovascular disease are subject to statin therapy. In addition, several other studies have shown that asymptomatic coronary plaque could cause future cardiovascular events. Therefore, statin therapy could be considered in patients with coronary artery plaque. These coronary plaques can be quantified through invasive intra-coronary imaging equipment. Especially, vulnerable arteriosclerosis is the main cause of cardiovascular events. Use of statins in the presence of coronary plaques may help reduce atheroma volume and stabilize vulnerability. In conclusion, coronary artery imaging is very useful for the initiation and evaluation of statin therapy.
Arteriosclerosis ; Cardiovascular Diseases ; Coronary Vessels ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Plaque, Atherosclerotic

OBJECTIVETo investigate the depression in arteriosclerosis obliterans (ASO) patients and its risk factors.

METHODSThe self-rating depression scale (SDS) was applied in 228 ASO patients hospitalized in the vascular surgery department of Peking Union Medical College Hospital from March 2010 to October 2011. The risk factors of depression were analyzed by using univariate and multivariate Logistic regression analysis.

RESULTSOf these 228 ASO patients, 133 (58.3%) were found to be depressive. Univariate and multivariate analysis showed that female (OR=0.15,95% CI:0.05-0.45), hypertension (OR=4.63,95% CI:1.90-11.29), coronary heart disease (OR=3.62,95%CI:1.43-9.18), as well as Fontaine 2a (OR=20.76,95% CI:3.21-134.28), 2b (OR=26.34,95% CI:4.20-164.97), 3(OR=192.28,95% CI:25.97-1423.51), and 4(OR=291.41,95% CI:28.67-2962.21) were the risk factors of depression in ASO patients.

CONCLUSIONSASO patients can easily develop depression. Female, hypertension, coronary heart disease, and Fontaine 2a, 2b,3,and 4 are the risk factors of depression in ASO patients.

Arteriosclerosis Obliterans ; Coronary Artery Disease ; Depression ; Female ; Humans ; Hypertension ; Logistic Models ; Multivariate Analysis ; Risk Factors

OBJECTIVETo evaluate the long-term outcomes of successful or failed revascularization in patients with chronic total occlusions (CTO).

METHODSThe clinical data of 1332 consecutive patients underwent percutaneous coronary intervention (PCI) for CTO between June 1993 and December 2006 in our hospital were analyzed. These patients were divided into two groups according to the procedural success (n = 1202) or failure (n = 130).

RESULTSOverall success rate of procedure was 90.2% (1202/1332). The patients in CTO success group experienced a superior 10-year survival rate (76.9% vs. 64.6%, log rank P = 0.012) and a significantly higher no major adverse cardiovascular event (MACE) survival rate (41.8% vs. 27.6%, log rank P < 0.001) compared to the patients in CTO failure group. During the long-term follow-up, the proportion of patients who accepted coronary artery bypass grafting (CABG) was significantly lower in CTO success group than that in the CTO failure group (4.3% vs. 14.6%, P < 0.001).

CONCLUSIONSuccessful PCI procedure leads to increased long-term survival and MACE-free survival and the reduced need for CABG for patients with CTO lesions.

Aged ; Angioplasty, Balloon, Coronary ; Arteriosclerosis Obliterans ; therapy ; Coronary Occlusion ; therapy ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Insulin resistance has been suggested to be an important risk factor in the development of arteriosclerosis. The correlation between insulin sensitivity and the degree of coronary atherosclerosis in patients with angina pectoris was investigated. SUBJECTS AND METHODS: The study population consisted of 74 subjects with angina (54 men, 20 women), aged from 31 to 73 years. Coronary angiograms were evaluated by 3 semiquantitative scoring systems (vessel score, stenosis score and extent score) to estimate the extent of focal and diffuse coronary artery disease (CAD). Insulin sensitivity (K ITT) was determined by an insulin tolerance test. RESULTS: There were significant correlations between K ITT and all 3 coronary scores. Multivariate analysis revealed significant and independent correlations between all 3 coronary scores and K ITT , even in patients without diabetes mellitus. Both HDL cholesterol level and K ITT were significantly lower in patients with CAD than in those without. CONCLUSION: Decreased insulin sensitivity was significantly associated with the presence and extent of CAD. These results suggest the potential benefits of insulin-sensitizing treatment strategies for patients with decreased insulin sensitivity.
Angina Pectoris ; Arteriosclerosis ; Cholesterol, HDL ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Insulin Resistance* ; Insulin* ; Male ; Multivariate Analysis ; Risk Factors

We performed both peripheral and coronary angiographies in 52 patients with an arteriosclerosis in lower extremities. The severity of arteriosclerotic narrowing of the coronany and peripheral anteries were compared on angiographies. An angiographic vascular score(AVS, 0-5) reflecting the number and the degree of stenosis in 12 lower extremity arteries and three major coronary arteries was assigned to each angiogram and the sum of scores in the lower extremity arteries was compared with the incidence of significant coronary artery disease(more than grade 3) and coronary score. Relation of incidence and severity of vascular stenosis and four risk factors(diabetes mellitus, hypertension, smoking, and hypercholesterolemia) was also analyzed. Thirty-four of 52 patients(65%) had an angiographically significant coronary artery disease. Thirteen of these 34 patients (38%) had no clinical symptom and sign of the ischemic heart disease. There was no statistically significant difference in the incidence and severity of coronary artery disease between high (more than 30) and low AVS group in lower extremity(P>0.14). All patients had at least one risk factor and 49 of 52 patients(94%) had multiple risk factors. Coronary angiography was normal in three patients with only one risk factors, and angiographically significant coronary artery disease existed in nine of 16 cases(56.3%) with two risk factors. 13 of 17 cases(76.5%) with three risk factors, and 12 of 16 cases(75.0%) with all four risk factors. There were no significant correlations between individual risk factors and incidence, severity of arteriosclerosis in coronary and lower extremity arteries. In conclusion, angiographic evaluation of the coronary artery disease in patients with lower extremity arteriosclerosis is necessary because of the high chance of coronary artery disease and difficulty in the prediction of coronary artery disease with a severity of the peripheral arteriosclerosis, presence of various risk factors, and clinical symptoms.
Angiography ; Arteries ; Arteriosclerosis* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Hypertension ; Incidence ; Lower Extremity* ; Myocardial Ischemia ; Risk Factors ; Smoke ; Smoking

Insulin resistance is an important risk factor for coronary artery disease. However, there has been no data regarding its clinical effect on the outcomes of percutaneous coronary intervention (PCI) in non-diabetic patients. We analyzed 98 non-diabetic consecutive patients (59+/-11.5 yr, male:female=63:35) who underwent elective coronary angiography. The patients were divided into two groups: Group I (n=71; the value of HOMA-IR [homeostasis model assessment of insulin resistance] <2.6) and Group II (n=27; the value of HOMA-IR > or = 2.6). In-hospital and 30-day major adverse cardiac events (MACE) were compared between the two groups. The concentrations of fasting insulin and triglyceride were significantly higher in Group II than in Group I. Significant correlations were observed between the value of HOMA-IR and body mass index (r=0.489, p<0.001), levels of total cholesterol (r=0.204, p=0.045), triglyceride (r=0.334, p=0.001) and apolipoprotein B (r=0.212, p=0.038). PCI was performed in 59 patients (60.2%). In-hospital and 30-day MACE were higher in Group II than Group I (2.4% vs. 27.8%, p=0.008; 2.4% vs. 27.8%, p=0.008). Multivariate analysis revealed that the value of HOMA-IR > or = 2.6 was an independent predictor of MACE. Increased HOMA-IR level is an important prognostic indicator in non-diabetic patients underwent PCI.
Prognosis ; Models, Biological ; Middle Aged ; Male ; *Insulin Resistance ; Humans ; Homeostasis ; Female ; Coronary Stenosis/blood/physiopathology/therapy ; Coronary Arteriosclerosis/blood/physiopathology/therapy ; *Angioplasty, Transluminal, Percutaneous Coronary/adverse effects ; Aged