BACKGROUNDBoth non-alcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) are closely associated with many metabolic disorders. Invasive coronary angiography (CAG) is a common approach as an intervention for CAD. However, the association between angiographic severity of coronary artery and NAFLD remains controversial. This study aimed to evaluate the relationship between NAFLD and CAD.

METHODSTotally 542 consecutive patients who planned to undergo CAG due to a suspected CAD were enrolled. Abdominal computed tomography (CT) was performed before angiography to detect NAFLD. CAD was defined as stenosis of at least 50% in at least one major coronary artery. The severity of CAD was assessed by the number of vessels affected and the vessel score multiplied by the severity score (Gensini score). Significant stenosis was defined as 70% or greater reduction in lumen diameter. A probability value of P < 0.05 was considered statistically significant.

RESULTSOf 542 patients studied, 248 (45.8%) were found to have NAFLD by abdominal CT, and 382 patients (88%) were found to have significant CAD by CAG. Age, diabetes mellitus, waist circumference, body mass index, and obesity were associated with NAFLD. According to the results of Logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG (odds ratio (OR), 95% confidence interval (CI): 7.585 (4.617-12.461); P < 0.001). NAFLD was significantly more common in patients as CAD severity increased (P < 0.001).

CONCLUSIONSThe presence of NAFLD is associated with high severity of CAD, requiring that patients with abdominal obesity be also investigated for NAFLD. Patients with NAFLD should be closely followed up for the presence and severity of CAD.

Aged ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; pathology ; Fatty Liver ; diagnostic imaging ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease

BACKGROUNDPostsystolic shortening (PSS) has been proposed as a marker of myocardial dysfunction. Strain rate imaging (SRI) is a novel ultrasonic technique, allowing reliable and noninvasive measurement of myocardial deformation. The purpose of this study was to investigate the characteristics of myocardial longitudinal PSS by SRI in ischemic and infarct myocardium in patients with coronary artery disease, and to explore its clinical applicability.

METHODSEleven patients with angina pectoris, 21 patients with myocardial infarction and 20 healthy subjects were included in the study. Apical four-, three- and two-chamber views were displayed; and septal, lateral, anteroseptal, posterior, anterior and inferior walls of the left ventricle were scanned, respectively. PSS strain (epsilon(pss)), the ratio of epsilon(pss) and systolic strain (epsilon(pss)/epsilon(sys)), the ratio of epsilon(pss) and maximum strain (epsilon(pss)/epsilon(max)) and the duration of PSS (T(pss)) in ischemic, infarct and normal myocardium were analyzed.

RESULTSPSS was found more frequent in the ischemic and infarct segments compared with the normal segments (39% vs 22% and 56% vs 22%, respectively; both P < 0.01). It was even more frequent in the infarct segments than in the ischemic segments (56% vs 39%, P < 0.01). The absolute magnitude of epsilon(pss), epsilon(pss)/epsilon(sys), epsilon(pss)/epsilon(max) were significantly larger and T(pss) significantly longer in the ischemic and infarct segments compared with that in the normal myocardium (P < 0.01). epsilon(pss)/epsilon(sys), epsilon(pss)/epsilon(max) were even larger and T(pss) even longer in the infarct than in the ischemic segments (P < 0.01).

CONCLUSIONSPSS is a common and important feature of the ischemic and infarct myocardium. epsilon(pss), epsilon(pss)/epsilon(sys), epsilon(pss)/epsilon(max) and T(pss) as measured by SRI may be promising markers for the quantitative assessment of regional myocardial dysfunction in patients with coronary artery disease. epsilon(pss)/epsilon(sys), epsilon(pss)/epsilon(max) and T(pss) may be helpful in differentiating infarct from ischemic myocardium.

Aged ; Coronary Artery Disease ; diagnostic imaging ; physiopathology ; Echocardiography ; methods ; Heart ; physiopathology ; Humans ; Middle Aged ; Myocardial Ischemia ; diagnostic imaging ; physiopathology ; Myocardium ; pathology ; Systole

OBJECTIVETo observe the relationship between the parameters of artery elasticity and coronary artery stenosis in normotensive and hypertensive patients with coronary artery disease (CAD).

METHODSSystemic vascular compliance (SVC), systemic vascular resistance (SVR), brachial artery compliance (BAC) and brachial artery resistance (BAR) were measured by Dynapulse 200M (Pulse Metric, Inc., USA) in 88 hypertensive and 41 normotensive patients with chest pain before coronary artery angiography.

RESULTS(1) The prevalence rate of severe coronary disease (> or = 2 coronary branches) was higher in hypertensives than in normotensives (64.7% vs. 27.1%, P < 0.05); (2) the peripheral artery buffering function was significantly lower in hypertensives than in normotensives [SVC: (0.85 +/- 0.10) ml/mm Hg (1 mm Hg = 0.133 kPa) vs. (1.17 +/- 0.11) ml/mm Hg; BAC: (0.047 +/- 0.011) ml/mm Hg vs. (0.063 +/- 0.010) ml/mm Hg, all P < 0.05]; (3) Lower arterial elasticity was associated with severe coronary artery stenosis.

CONCLUSIONThe non-invasive obtained artery elasticity is associated with the degree of coronary artery stenosis in hypertensive patients with CAD.

Aged ; Blood Pressure ; Coronary Angiography ; Coronary Artery Disease ; complications ; diagnostic imaging ; physiopathology ; Coronary Stenosis ; complications ; diagnostic imaging ; physiopathology ; Female ; Humans ; Hypertension ; complications ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Prevalence ; Pulse

Aged ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; diagnostic imaging ; pathology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Tomography, Emission-Computed, Single-Photon

Adult ; Atherosclerosis ; diagnosis ; Chest Pain ; Coronary Aneurysm ; diagnosis ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; Coronary Vessel Anomalies ; diagnosis ; Coronary Vessels ; diagnostic imaging ; physiopathology ; Electrocardiography ; Humans ; Male ; Risk Factors ; Troponin I ; metabolism ; Vascular Diseases ; congenital ; diagnosis

AIMTo investigate the relationship between androgen level and the indexes indicating endothelial function in male patients with coronary heart disease (CHD).

METHODSWe registered the following data for 106 50-70-year-old men: age, weight, blood lipid, including total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglyceride, whether a smoker, sugar levels, blood pressure, free testosterone (FT), vascular cell adhesion molecule-1 (VCAM-1) and the intima-media thickness (IMT) of common carotid artery, common carotid diameter, maximum velocity in systolic phase, minimum velocity in diastolic phase and resistant index. Among the 106 men, 51 were patients with CHD. The relationships between FT level, VCAM-1 concentration and IMT were examined, respectively, using a stepwise linear regression technique among all the 106 men.

RESULTSThere was no statistical difference in terms of age, blood pressure, whether a smoker, sugar levels, HDL-C, minimum velocity in diastolic phase, resistant index between male CHD patients and controls; whereas results for weight, total cholesterol, low density lipoprotein cholesterol, triglyceride, VCAM-1 and IMT of male CHD patients were higher than those of controls; FT level and maximum velocity in systolic phase were lower. It was found that among all the objects, FT level was inversely correlated with IMT and VCAM-1 concentration.

CONCLUSIONFT level was inversely correlated with VCAM-1 concentration and IMT which are indicators of endothelial function.

Aged ; Carotid Artery, Common ; diagnostic imaging ; Coronary Disease ; blood ; physiopathology ; Endothelium, Vascular ; physiopathology ; Humans ; Male ; Middle Aged ; Testosterone ; blood ; Tunica Intima ; diagnostic imaging ; Tunica Media ; diagnostic imaging ; Ultrasonography ; Vascular Cell Adhesion Molecule-1 ; blood

BACKGROUNDDual-axis rotational coronary angiography (DARCA) was developed as an innovative adaptation of rotational angiography (RA), but it requires a longer coronary injection compared to standard coronary angiography (SA). As the body of the average Chinese patient is smaller than that of most western patients, with the same contrast injection time, the risk of complications from the contrast agent is increased in this population. The purpose of this study was to assess the clinical safety and efficacy of DARCA in the diagnosis of coronary artery disease (CAD) in the Chinese population by directly comparing it to SA.

METHODSTwo hundred Chinese patients were randomized to either the SA group (n = 100) or DARCA group (n = 100). Contrast utilization, radiation exposure and procedure time were recorded for each modalities. Blood pressure (BP), heart rate (HR) pre and post injection symptoms and any arrhythmias were recorded.

RESULTSCompared to the SA group, there was a 42% reduction in contrast utilization, 55% reduction in radiation exposure and a 31% shorter procedure time in the DARCA group. In both groups, there were slight declines in the systolic BP values in the left coronary artery (LCA) post injection (P < 0.01). Moreover, post injection HRs for the LCA were also reduced in the DARCA group (P < 0.01). But all of these changes were small, transient and without clinical importance. Only one patient (1%) in the DARCA group had an attack of ventricular tachycardia immediately post injection and it resolved by itself during LCA angiography. No arrhythmias occurred in the SA group.

CONCLUSIONDARCA is a safe, efficient, and clinically comparable alternative to SA in the diagnosis of coronary artery disease in the Chinese population with less contrast utilized, which is less radiation exposure and a shorter procedure time than SA.

Aged ; Blood Pressure ; Coronary Angiography ; adverse effects ; methods ; Coronary Artery Disease ; diagnostic imaging ; physiopathology ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Rotation

OBJECTIVETo understand the prevalence of sleep disordered breathing (SDB) in elderly patients with coronary artery disease (CAD) and explore the relations between SDB and CAD.

METHODSSixty-two elderly patients with and 18 without CAD identified by coronary angiography underwent examinations by polysomnography (PSG). Left ventricular ejection fraction (LVEF) was measured by 99Tc equilibrium radionuclide angiography.

RESULTSIn the 62 elderly patients with CAD, 53.2% had SDB, a rate significantly higher that (22.2%) in the 18 non-CAD patients. The CAD patients with SDB had higher respiratory disturbance index (RDI) and body mass index (BMI) and lower arterial saturation of oxygen (SaO2) during sleep, with longer duration of low SPO2 (less that 90%). The incidence of hypertension was higher in CAD patients with SDB than in those without SDB. No significant correlation was found between the severity of coronary artery disease and RDI (r=-0.16, P>0.05).

CONCLUSIONThe elderly patients with CAD have higher incidence of SDB, and appropriate interventions should be administered in those with severe SDB.

Aged ; Aged, 80 and over ; China ; epidemiology ; Coronary Angiography ; Coronary Artery Disease ; complications ; diagnostic imaging ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Prevalence ; Sleep Apnea Syndromes ; complications ; epidemiology ; physiopathology

BACKGROUNDReportedly, patients with persistent refractory angina due to end-stage coronary artery disease (CAD) not amenable to traditional revascularization techniques have experienced symptomatic relief following laser revascularization, either surgical transmyocardial revascularization (TMR) or percutaneous myocardial revascularization (PMR). In spite of several hypotheses (i.e., channel patency, placebo effect, denervation, neoangiogenesis), the mechanism of action and the benefit remains controversial.

METHODSA prospective trial utilizing positron emission tomography (PET) was conducted as an attempt to correlate quantified myocardial blood flow (MBF) to clinical improvement following PMR. Thirteen consecutive patients with angina class > II in spite of maximal medical treatment underwent PMR with a holmium: yttrium-aluminum-garnet (Ho:YAG) laser. MBF at rest and under hyperemia was assessed by [(13)N]ammonia PET at baseline, 3 and 6 months following PMR.

RESULTSMean angina class and exercise tolerance time improved at 6 months compared with baseline (P < 0.001). The clinical results were accompanied with an improvement in hyperemic MBF (P = 0.05) and a reduction in minimal coronary resistance (MCR; P < 0.05) in PMR-treated segments. Opposite effects, reduced hyperemic MBF and increased MCR, were observed in nontreated segments. The increase in MCR in nontreated segments revealed the favorable therapeutic impact achieved in PMR-treated segments.

CONCLUSIONThe results of this trial utilizing a quantitative technique to quantify myocardial perfusion link clinical improvement post-PMR to neoangiogenesis and consistently improved microcirculation.

Aged ; Coronary Artery Disease ; diagnostic imaging ; physiopathology ; surgery ; Coronary Circulation ; Female ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; methods ; Positron-Emission Tomography ; Vascular Resistance

BACKGROUNDThe role of chronic hyperglycaemia as a coronary artery disease (CAD) risk factor is well-known, and the glycemic variability is still a matter of debate. The aim of this study was to investigate the association of admission glycemic excursion and hemoglobin A(1c) (HbA(1c)) with the presence and severity of CAD in patients with undiagnosed diabetes mellitus (DM).

METHODSWe studied 286 newly diagnosed DM patients without prior revascularization undergoing coronary angiography for suspected ischaemic chest pain. Patients were grouped into those with CAD and without CAD according to angiographic results. The severity of CAD was assessed using the Gensini score. Glycemic variability, indicated as the mean amplitude of glycemic excursions (MAGE), was determined by a continuous glucose monitoring system. Serum levels of HbA(1c) and high-sensitive C-reactive protein (hs-CRP) as well as plasma concentrations of fasting glucose, lipids and creatinine were measured in all patients. Predictors of CAD were determined using multivariate Logistic regression model and receiver-operating characteristic (ROC) curves.

RESULTSThe newly diagnosed DM patients with CAD were older, and more were male and current cigarette smokers compared with the patients without CAD. The CAD group had significantly higher levels of MAGE and HbA(1c). Individuals with high levels of HbA(1c) (≥ 7%) or MAGE (≥ 3.4 mmol/L) had also significantly higher CAD prevalence. Logistic regression analysis revealed that high MAGE level and high HbA(1c) level were independent predictors for CAD. The area under the receiver-operating characteristic curve for MAGE (0.606, P = 0.005) was superior to that for HbA(1c) (0.582, P = 0.028). Gensini score closely correlated with age, MAGE, HbA(1c), hs-CRP, creatinine and total cholesterol. Multivariate analysis indicated that age (P < 0.001), MAGE (P < 0.001), HbA(1c) (P = 0.022) and hs-CRP (P = 0.005) were independent determinants for Gensini score.

CONCLUSIONSBoth admission glycemic excursion and chronic hyperglycaemia are associated with the severity of CAD in newly diagnosed DM patients. MAGE displays a significant value in predicting CAD in patients with undiagnosed diabetes even more than HbA(1c).

Aged ; Blood Glucose ; metabolism ; Coronary Angiography ; Coronary Artery Disease ; blood ; diagnostic imaging ; etiology ; metabolism ; Diabetes Mellitus ; blood ; diagnostic imaging ; metabolism ; physiopathology ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Logistic Models ; Male ; Middle Aged ; Risk Factors