OBJECTIVETo study the association of red blood cell distribution width (RDW) and lipoprotein-associated phospholipase A2 (LP-PLA2) with the degree of coronary artery stenosis in patients with coronary artery disease (CAD) and the value of RDW combined with LP-PLA2 detection in accurate evaluation of coronary artery stenosis.

METHODSA total of 224 patients including 119 non-CAD cases and 105 CAD cases admitted in our hospital between June, 2013 and June, 2014 were enrolled in this study. The patients' baseline clinical data were collected and venous blood samples were obtained for detecting WBC, RDW-CV and LP-PLA2. The Gensini score of the CAD patients was calculated based on coronary angiographic findings.

RESULTSCompared with the non-CAD patients, CAD patients had significantly higher RDW-CV (P=0.009) and LP-PLA2 (P=0.004) levels. The CAD patients with high Gensini scores had also significantly higher RDW-CV (P=0.001) and LP-PLA2 (P<0.001) levels than those with low scores; RDW-CV and LP-PLA2 were significantly correlated with the Gensini score, and the area under curve of their combined detection was 0.931.

CONCLUSIONCombination of RDW and LP-PLA2 can improve the diagnostic accuracy of the degree of coronary artery stenosis in patients with CAD.

1-Alkyl-2-acetylglycerophosphocholine Esterase ; blood ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Coronary Stenosis ; diagnosis ; Erythrocyte Count ; Erythrocytes ; cytology ; Humans

BACKGROUND: The non-invasive differentiation of ischemic and nonischemic acute heart failure (AHF) not resulting from acute myocardial infarction is difficult and has therapeutic and prognostic implications. The aim of this study was to assess whether resting myocardial contrast echocardiography (MCE) can detect coronary artery disease (CAD) in patients with decreased left ventricular (LV) systolic function and global hypokinesis presenting with AHF. METHODS: Twenty-one consecutive patients underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during contrast IV infusion of Definity(R). Following transient microbubbles destruction, the contrast replenishment rate (beta), reflecting myocardial blood flow velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function: y (t) = A (1 - e(-beta(t-t0))) + C. RESULTS: Of the 21 (mean age 56.6 +/- 13.6 years) patients, 5 (23.8%) demonstrated flow-limiting CAD (> 70% of luminal diameter narrowing). The mean +/- standard deviation of LV ejection fraction was 29.6 +/- 8.6%. Quantitative MCE analysis was feasible in 258 of 378 segments (68.3%). There were no significant difference in "beta" and "Abeta" in patients without and with CAD (0.48 +/- 0.27 vs. 0.45 +/- 0.25, p = 0.453 for beta and 2.99 +/- 2.23 vs. 3.68 +/- 3.13, p = 0.059 for Abeta, respectively). No contrast-related side effects were reported. CONCLUSION: Resting quantitative MCE analysis in patients with AHF was feasible, however, the parameters did not aid in detecting of CAD.
Blood Flow Velocity ; Coronary Artery Disease* ; Coronary Disease ; Diagnosis ; Echocardiography* ; Heart Failure* ; Humans ; Microbubbles ; Myocardial Infarction ; Phenobarbital ; Pilot Projects*

BACKGROUND: Hypertension is a common, chronic disease that poses as a main risk factor of coronary artery disease. Therefore, it requires accurate diagnosis. This study attempted to examine the problem of misclassification and accurate diagnosis of hypertension in primary care settings and to consider the relationship between variability of blood pressure and number of measurements. METHODS: Among the 168 patients with initially high blood pressure who visited health screening center of one university hospital from May to November, 1999, 97 persons who corresponded to the following conditions were chosen for this study. We classified hypertension as stage 1 and 2. The subjects were not previously diagnosed as hypertensive and had no past history of use of antihypertensive medication. Blood pressure was measured according to 1999 WH0/1SH Hypertension Guideline, and two or more measures were performed at each visit on five separate occasions at one week intervals RESULTS: The mean of initial blood pressure was 169.6 mmHg in systole, 96.3 mmHg in diastole. The mean of subsequent blood pressure was 165.0 mmHg, 146.1 mmHg, 143.4 mmHg, 138.7 mmHg in systole and 92.5 mmHg, 88.4 mmHg, 87 mmHg, 85.1 mmHg in diastole, which showed the tendency to be lower. In both systole and diastole, the mean differences between first and second measurements, second and third measurements were significant, but insignificant between third and forth measurements, and forth and fifth measurements. We divided systolic and diastolic pressures into two subgroups according to stage 1,2 classification of hypertension. In stage 1 subgroup, the means of blood pressures were lower from 151.3mmHg to 135.4 mmHg in systole, from 95.1 mmHg to 85.3 mmHg in diastole, but there were not significant. In stage 2 subgroup, the mean blood pressure was lower from 169.7 mmHg to 142.5mmHg in systole, from 105.4 mmHg to 87.8 mmHg in diastole, and the mean differences between first and second measurements, second and third measurements were significant, but not significant between third and forth measurements, and forth and fifth measurements. CONCLUSION: Blood pressure tends to be checked significantly lower until subsequent third measurements, but not thereafter. We think that more studies to find out how many blood pressure measurements are needed for diagnosing hypertension in consideration of patient's blood pressure level and risk factors.
Blood Pressure* ; Chronic Disease ; Classification ; Coronary Artery Disease ; Diagnosis* ; Diastole ; Humans ; Hypertension* ; Mass Screening ; Primary Health Care ; Risk Factors ; Systole

OBJECTIVETo study the relationship among peripheral leucocytes, coronary artery stenosis and Chinese medicine syndromes in patients with coronary heart disease (CHD).

METHODSThe Chinese medicine syndromes of 189 CHD patients were differentiated into six types: the turbidity-phlegm blood-stasis type (A), the qi-deficiency blood-stasis type (B), the cold-congealing blood-stasis type (C), the qi-stagnancy blood-stasis type (D), the qi-deficiency phlegm-stasis type (E) and the turbidity-phlegm blocking laterals type (F). Coronary angiography and peripheral leucocyte counting were performed simultaneously for determining the degree of blood-stasis by scoring (BSS), and the outcome of coronary angiography was evaluated depending Gensini scoring system. All data obtained were analyzed statistically.

RESULTSThe highest BSS, that means the highest degree of coronary artery stenosis, was shown in patients of Chinese medicine type C, following with type A, B and D in order, the lowest level was found in the non-blood-stasis groups, namely, patients of Chinese medicine type E and F. Peripheral count of leucocytes were correlated with the BSS and Gensini score, count of mononuclear cell was individually correlated with BSS, and that of neutrophil was individually correlated with Gensini score.

CONCLUSIONSBSS and distribution of peripheral leucocytes were different in CHD patients of various Chinese medicine types, count of peripheral mononuclear cell is individually correlated with BSS, and that of neutrophil is individually correlated with Gensini score.

Adult ; Aged ; Coronary Artery Disease ; blood ; diagnosis ; pathology ; Coronary Stenosis ; blood ; diagnosis ; pathology ; Female ; Humans ; Leukocyte Count ; Leukocytes ; Male ; Medicine, Chinese Traditional ; Middle Aged

BACKGROUNDWe investigated whether and to what extent the ratio between circulating fibrinogen (Fg) and its degradation products (FDP) reflects the severity of coronary artery disease (CAD) in type 2 diabetic patients.

METHODSPlasma levels of Fg and FDP were determined, and Fg/FDP ratio was calculated in 344 consecutive patients with type 2 diabetes and chest pain on exertion undergoing coronary angiography. The severity of CAD was evaluated by the number of significant CAD (>50% luminal diameter narrowing) and Gensini score.

RESULTSPlasma Fg was higher, but Fg/FDP ratio was lower in patients with significant CAD (n = 255) compared with those without (n = 89), due to a disproportionate increase in FDP. Fg and FDP correlated positively, while Fg/FDP ratio negatively, with the number of diseased coronary arteries and the tertile of Gensini score (all P values for trend < 0.01). After adjusting for age, sex, risk factors for CAD, lipid profiles, glycosylated hemoglobin A1c, creatinine, leukocyte count, and high-sensitivity C-reactive protein, Fg/FDP ratio remained an independent determinant for multivessel coronary disease (MVD) (odds ratio [OR], 0.869; 95% confidence interval [CI], 0.788-0.958, P = 0.005) and high tertile of Gensini score (OR, 0.797, 95% CI, 0.682-0.930, P = 0.004). The area under the curve of Fg/FDP ratio was larger than that of Fg for predicting the presence of MVD (0.647 vs. 0.563, P = 0.048) and Gensini score ≥ 30 (0.656 vs. 0.538, P = 0.026).

CONCLUSIONSElevated plasma Fg and FDP level and reduced Fg/FDP ratio are associated with presence of CAD, and Fg/FDP ratio is superior to Fg in reflecting severe coronary atherosclerosis for patients with type 2 diabetes.

Aged ; Coronary Angiography ; Coronary Artery Disease ; blood ; diagnosis ; metabolism ; Diabetes Mellitus, Type 2 ; blood ; metabolism ; Female ; Fibrin ; metabolism ; Fibrinogen ; metabolism ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the correlation of the occurrence and prognosis of coronary slow flow phenomenon (CSF) with blood homocysteine (Hcy) levels in patients receiving emergency percutaneous coronary intervention therapy (PCI).

METHODSFrom January, 2010 to December, 2011, 138 patients with ST-elevation myocardial infarction received emergency angioplasty, among whom 46 patients developed CSF and 92 did not (control group). Blood Hcy levels were determined in these patients. The patients with CSF were classified into two groups with mild and moderate Hcy elevations (32 and 14 cases, respectively), and the left ventricular ejection fraction (LVEF) during hospitalization and at 3 months of follow-up as well as major adverse cardiac events (MACE) were compared between the two groups and analyzed for their association with Hcy level.

RESULTSThe patients with CSF showed significantly higher blood Hcy levels than the control patients (P=0.001). At 3 months of follow-up, the patients with CSF and moderate Hcy elevation had significantly lower LVEF (P=0.031) and higher incidence of MACE (P=0.019) than those with mild Hcy elevation. Hcy levels were negatively correlated with LVEF (r=-0.310, P=0.036) and positively with MACE (r=0.342, P=0.02).

CONCLUSIONA high blood Hcy level is closely correlated with the occurrence of CSF in emergency PCI, affects the recovery of LVEF and increases the incidence of MACE.

Adult ; Aged ; Coronary Artery Disease ; blood ; diagnosis ; therapy ; Emergency Treatment ; Female ; Homocysteine ; blood ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Prognosis ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left

Aortic Valve Stenosis ; blood ; diagnosis ; etiology ; Child ; Coronary Artery Disease ; blood ; diagnosis ; etiology ; Coronary Vessels ; diagnostic imaging ; pathology ; Echocardiography ; Female ; Humans ; Hyperlipoproteinemia Type II ; blood ; complications ; diagnosis ; genetics ; Lipoproteins, LDL ; blood ; Triglycerides ; blood

OBJECTIVEVery early-onset coronary artery disease (CAD) is a great challenge in cardiovascular medicine throughout the world, especially regarding its early diagnosis. This study explored whether circulating microRNAs (miRNAs) could be used as potential biomarkers for patients with very early-onset CAD.

METHODSWe performed an initial screening of miRNA expression using RNA isolated from 20 patients with angiographically documented very early-onset CAD and 20 age- and sex-matched normal controls. For further confirmation, we prospectively examined the miRNAs selected from 40 patients with very early-onset CAD and 40 angiography-normal controls.

RESULTSA total of 22 overexpressed miRNAs and 22 underexpressed miRNAs were detected in the initial screening. RT-qPCR analysis of the miRNAs obtained from the initial screening revealed that four miRNAs including miR-196-5p, miR-3163-3p, miR-145-3p, and miR-190a-5p exhibited significantly decreased expression in patients compared with that in controls (P<0.05). The areas under the receiver operating characteristic curve for these miRNAs were 0.824 (95% CI, 0.731-0.917; P<0.001), 0.758 (95% CI, 0.651-0.864; P<0.001), 0.753 (95% CI, 0.643-0.863; P<0.001), and 0.782 (95% CI, 0.680-0.884; P<0.001), respectively, in the validation set.

CONCLUSIONTo our knowledge, this is an advanced study to report about four serum miRNAs (miR-196-5p, miR-3163-3p, miR-145-3p, and miR-190a-5p) that could be used as novel biomarkers for the diagnosis of very early-onset CAD.

Aged ; Biomarkers ; blood ; Case-Control Studies ; Coronary Artery Disease ; blood ; diagnosis ; genetics ; Early Diagnosis ; Female ; Humans ; Male ; MicroRNAs ; blood ; genetics ; Middle Aged

Angina Pectoris ; diagnosis ; Blood Pressure ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Electrocardiography ; Exercise Test ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Singapore

OBJECTIVETo investigate the correlation of microalbuminuria (MA) and fibrinogen (Fib) to the severity of coronary artery lesions in patients with metabolic syndrome (MS).

METHODSEighty-five patients with MS undergoing coronary artery angiography were divided, according to the number of vessels involved, into multivessel disease group and non-multivessel disease group, and also according to the modified Gensini score, into severe lesion (Gensini score>20) and non-severe lesion group. The correlations of MA and Fib to the number of involved vessels and the severity of the lesions were analyzed.

RESULTSThe urinary albumin to creatinine ratio (ACR) and Fib were significantly different between the multivessel and non-multivessel disease groups (P<0.05), and were found to be positively correlated to the number of coronary artery lesion (r=0.378, P=0.000; r=0.327, P=0.002). ACR, Fib, sex, smoking history and HDL-C differed significantly between severe lesion and non-severe lesion groups (P<0.05), and ACR and Fib showed positive correlations to the Gensini score (r=0.337, P=0.002; r=0.286, P=0.008). Logistic regression analysis identified ACR as an independent predictor of multivessel disease (B=2.655, P=0.000) and Gensini score (B=1.803, P=0.009), independent of sex, age, body mass index, smoking history, diabetes mellitus, LDL-C and HDL-C.

CONCLUSIONMA and Fib are positively correlated to the severity of coronary artery lesion, and MA is an independent predictor of multivessel disease and Gensini score in patients with MS.

Aged ; Albuminuria ; Coronary Artery Disease ; diagnosis ; pathology ; Female ; Fibrinogen ; metabolism ; Humans ; Male ; Metabolic Syndrome ; blood ; urine ; Middle Aged