OBJECTIVETo evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease.

METHODFifteen patients (11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed.

RESULTSThere were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39.3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32.4 ± 8.1) years vs. (47.0 ± 10.2) years], had less risk factors for atherosclerosis (1.2 ± 1.5 to 2.8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 - 7 years (average 1.6 years) to 3 - 30 years (average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by echocardiography was less than 50% in 8 patients.

CONCLUSIONPatients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.

Adult ; Coronary Angiography ; Coronary Artery Disease ; complications ; pathology ; Coronary Vessels ; pathology ; Female ; Humans ; Male ; Middle Aged ; Vasculitis ; complications ; pathology

Animals ; Arteritis ; complications ; immunology ; Coronary Artery Disease ; etiology ; pathology ; Coronary Vessels ; pathology ; Models, Animal ; Rabbits

To investigate the association of pancreatic steatosis with coronary atherosclerosis in patients with type 2 diabetes mellitus (T2DM). Patients with T2DM who underwent coronary computed tomography angiography(CCTA)in our center due to chest pain were enrolled from January 2016 to February 2019. According to the CCTA findings,patients were divided into normal group,mild-to-moderate coronary atherosclerosis group and severe coronary atherosclerosis group. CT attenuation of pancreas and spleen was measured on abdominal non-enhanced CT,and the CT attenuation indexes including the difference between pancreatic and splenic attenuation (P-S) and the ratio of pancreas-to-spleen attenuation (P/S) were calculated. Analysis of variance or Kruskal-Wallis rank test were used to assess differences among each group. Logistic regression analysis was used to analyze the risk factors of severe coronary stenosis. The accuracy of P/S in predicting severe coronary artery stenosis was assessed by receiver operator characteristic (ROC) curve analysis. A total of 173 consecutive T2DM patients were enrolled. These patients included 27 patients with normal coronary artery (15.6%),124 patients with mild to moderate stenosis (71.7%),and 22 patients with severe stenosis (12.7%). There were significant differences in CT attenuation of pancreas (=11.543,=0.003),P-S (=11.152,=0.004) and P/S (=11.327,=0.004) among normal coronary artery group,mild and moderate stenosis group,and severe stenosis group. The CT attenuation of pancreatic head,body,and tail significantly differed in patients with coronary artery stenosis (=14.737,=0.001). After adjusting for confounding factors,multiple Logistic regression showed that P/S (=0.062,95%=0.008-0.487,=0.008) was still significantly associated with the severe coronary artery stenosis. The area under the ROC curve of P/S for the diagnosis of severe coronary artery stenosis was 0.701,and the optimal cutoff point was 0.660. CT attenuation of pancreas and CT attenuation indexes are associated with the severity of coronary stenosis in T2DM patients,suggesting that pancreatic steatosis may be used as one of the indicators for predicting severe coronary artery stenosis.
Coronary Angiography ; Coronary Artery Disease ; complications ; Coronary Stenosis ; Diabetes Mellitus, Type 2 ; complications ; Humans ; Pancreas ; pathology ; Predictive Value of Tests

Rupture of unstable atherosclerotic plaque is an essential pathogenetic mechanism of acute coronary syndrome (ACS), thereby, to stabilize the vulnerable plaque is of great importance for prevention and treatment of ACS. Recent study has shown the multi-target effects of traditional Chiese medicine intervention in stabilizing unstable atherosclerotic plaque is promising. The literatures involving this topic in recent years were reviewed in this paper.
Acute Coronary Syndrome ; complications ; drug therapy ; pathology ; Animals ; Coronary Artery Disease ; complications ; drug therapy ; pathology ; Coronary Vessels ; pathology ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Phytotherapy

OBJECTIVETo explore the impact of age and diabetes mellitus (DM) on the ultrastructure of radial artery (RA).

METHODSFrom June 2009 to December 2010, 64 patients underwent coronary artery bypass grafting (CABG) with autologous RA: 14 patients aged beyond 65 years without DM [9 male patients and 5 female patients, age (70 ± 4) years] and 18 patients aged beyond 65 years with DM [11 male patients and 7 female patients, age (68 ± 5) years], 20 patients aged under 60 years without DM [13 male patients and 7 female patients, age (53 ± 5) years] and 12 patients aged under 60 years with DM [7 male patients and 5 female patients, age (51 ± 6) years]. Four groups were subjected to routine electron microscopic examination and transmission electron microscopic examination.

RESULTSThere were significant differences in percentage of endothelial denudation among four groups according to scanning electron microscopic evaluation (χ² = 18.082, P = 0.000). To compare with each other, there were significant differences between DM elderly patients and non-DM elderly patients, also between DM young patients and non-DM young patients according to scanning electron microscopic evaluation. There were no significant differences between DM elderly patients and DM young patients, also between non-DM elderly patients and non-DM young patients. Foam cells and the tendency of smooth muscle cells moving to intima could be visualized in DM patients according to transmission electron microscope. According to semiquantitative electron microscopic evaluation, non-DM young patients got the lower total scores than DM young patients (1.32 ± 0.20 vs. 4.38 ± 0.30) while non-DM elderly patients got the lower total scores than DM elderly patients (1.43 ± 0.20 vs. 4.67 ± 0.30). According to factorial design, there were significant differences between DM patients and non-DM patients (F = 41.22, P = 0.000). There were no differences between elderly patients and young patients (F = 1.24, P = 0.270). There is no interaction (F = 1.05, P = 0.309) between age and DM.

CONCLUSIONSAfter preoperative assessment with modified Allen's test and Doppler analysis, RA used as graft in the elderly has similar quality and function with young patients, and it may lead to a high patency in long term. However, the quality of RA in patients with DM is in bad condition, and further research on patency needs to be done.

Age Factors ; Aged ; Coronary Artery Bypass ; Coronary Artery Disease ; complications ; pathology ; surgery ; Diabetes Mellitus ; pathology ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; ultrastructure

Left ventricular remodeling index (LVRI) was assessed in patients with hypertensive heart disease (HHD) and coronary artery disease (CAD) by real-time three-dimensional echocardiography (RT3DE). RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controls (NC) were acquired. Left ventricular end-diastolic volume (EDV) and left ventricular end-diastolic epicardial volume (EDVepi ) were detected by RT3DE and two-dimensional echocardiography Simpson biplane method (2DE). LVRI (left ventricular mass /EDV) was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups (P<0.01). There was no significant difference in NC group (P>0.05), but significant difference in HHD and CAD intra-group (P<0.05). There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups (r=0.69, P<0.01; r=0.68, P<0.01), but no significant correlation in CAD group (r=0.30, P>0.05). It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.
Cardiomegaly/etiology ; Cardiomegaly/pathology ; Cardiomegaly/*ultrasonography ; Coronary Artery Disease/pathology ; Coronary Artery Disease/*ultrasonography ; Echocardiography, Three-Dimensional/*methods ; Hypertension/*complications ; Hypertension/ultrasonography ; Ventricular Remodeling/*physiology

Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.
Aged ; Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/*diagnosis/etiology/*pathology ; Humans ; Male ; Postoperative Complications/diagnosis/etiology ; Subclavian Steal Syndrome/*diagnosis/etiology/*pathology ; Tachycardia, Ventricular/*pathology

OBJECTIVESTo observe the clinical and coronary features of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD).

METHODSAmong 2877 SLE inpatients (age ≥ 18 years, male 363, female 2514) admitted in the Peking Union Medical College Hospital between January 1999 to October 2009, 33 patients [mean age (50.7 ± 12.8) years] were diagnosed with CAD and coronary angiogram was available in 20 out of these 33 patients. Clinical and coronary features of these patients were retrospectively reviewed.

RESULTSThe incidence of CAD was significantly higher in male SLE patients than in female patients [2.48% (9/363) vs. 0.95% (24/2514), P = 0.022]. Patients with secondary antiphospholipid syndrome were more likely to suffer from CAD [5.76% (8/139) vs. 0.91% (25/2738), P < 0.001]. Myocardial infarction was the major form of CAD (24/33). Coronary artery angiographic changes included coronary stenosis and occlusions, coronary aneurysms and acute thrombosis and multi-vessel lesions was found in 75.0% (15/20) patients with SLE and CAD.

CONCLUSIONSMale SLE patients and patients with secondary antiphospholipid syndrome are at higher risk for CAD. Myocardial infarction and multi-vessel lesions are common in SLE patients with CAD.

Adolescent ; Adult ; Aged ; Antiphospholipid Syndrome ; complications ; Coronary Angiography ; Coronary Artery Disease ; complications ; pathology ; Female ; Humans ; Lupus Erythematosus, Systemic ; complications ; pathology ; Male ; Middle Aged ; Risk Factors ; Young Adult

Optical coherence tomography (OCT) has been recently applied to investigate coronary artery disease in interventional cardiology. Compared to intravascular ultrasound, OCT is able to visualize various vascular structures more clearly with higher resolution. Several validation studies have shown that OCT is more accurate in evaluating neointimal tissue after coronary stent implantation than intravascular ultrasound. Novel findings on OCT evaluation include the detection of strut coverage and the characterization of neointimal tissue in an in-vivo setting. In a previous study, neointimal healing of stent strut was pathologically the most important factor associated with stent thrombosis, a fatal complication, in patients treated with drug-eluting stent (DES). Recently, OCT-defined coverage of a stent strut was proposed to be related with clinical safety in DES-treated patients. Neoatherosclerosis is an atheromatous change of neointimal tissue within the stented segment. Clinical studies using OCT revealed neoatherosclerosis contributed to late-phase luminal narrowing after stent implantation. Like de novo native coronary lesions, the clinical presentation of OCT-derived neoatherosclerosis varied from stable angina to acute coronary syndrome including late stent thrombosis. Thus, early identification of neoatherosclerosis with OCT may predict clinical deterioration in patients treated with coronary stent. Additionally, intravascular OCT evaluation provides additive information about the performance of coronary stent. In the near future, new advances in OCT technology will help reduce complications with stent therapy and accelerating in the study of interventional cardiology.
Atherosclerosis/diagnosis/pathology/ultrasonography ; Coronary Artery Disease/*diagnosis/pathology/ultrasonography ; Humans ; Postoperative Complications/diagnosis/pathology/ultrasonography ; Stents/*adverse effects ; Tomography, Optical Coherence/*methods ; Ultrasonography, Interventional

PURPOSETo compare coronary plaque burden, composition, distribution and the degree of coronary artery stenosis in invasive coronary angiography (ICA) diagnosed coronary artery disease (CAD) patients with or without metabolic syndrome (MetS).

METHODSFrom January 2008 to June 2011, consecutive patients underwent both coronary computed tomography angiography (CCTA) and ICA within three months were enrolled. Patients with history of previous percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) were excluded. Plaque characteristics and maximal luminal diameter stenosis were analyzed on a 16-segment basis as suggested by the American Heart Association classification.

RESULTSThe study population consisted of 872 patients [age (60.2 ± 10.0) years, 72.70% males] including 377 patients with MetS and 495 patients without MetS. The median coronary artery calcium score (CACS) was higher in MetS patients than in non-MetS patients [102 (10, 410) vs. 58 (0, 274) , P < 0.01]. Percentage of patients with no coronary artery calcium was significantly lower in MetS group than in non-MetS group [19.63% (74/377) vs. 30.71% (152/495) , P < 0.01], while percentage of patients with severe coronary calcium (CACS ≥ 1000) were significantly higher in MetS than non-MetS group [8.22% (31/377) vs. 4.65% (23/495) , P = 0.03]. The proportion of patients with 1-vessel disease was lower [23.61% (89/377) vs. 36.77% (182/495), P < 0.01], 2-vessel [29.71% (112/377) vs. 22.83% (113/495), P < 0.05] and 3-vessel disease [35.54% (134/377) vs. 24.44% (121/495) , P < 0.01] were higher in MetS group than in non-MetS group. Calcified plaque of LM and the middle and distal coronary artery were significantly higher in MetS group than in non-MetS group (all P < 0.05) .

CONCLUSIONSCAD patients with MetS are associated with severer coronary artery calcium deposition and higher percentage of calcified plaque in the middle and distal coronary arteries and severer obstructive coronary vessels.

Aged ; Coronary Angiography ; Coronary Artery Disease ; complications ; diagnostic imaging ; Coronary Vessels ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Metabolic Syndrome ; complications ; diagnostic imaging ; Middle Aged ; Plaque, Atherosclerotic ; diagnostic imaging ; Severity of Illness Index