BACKGROUND: Coronary blood flow shows phasic and diastolic dominant flow pattern in normal coronary artery, which can be changed in coronary artery stenosis. We measured and analysed coronary blood flow velocity by Doppler-tipped guidewire to clarify the change of flow pattern in the proximal and distal segments of coronary narrowings. METHODS: Coronary flow velocity were measured by 0.018 or 0.014 inch Doppler-tipped guidewire in 14 paients, 17 sites(LCS 11, RCA 6) in the proximal and distal segment of coronary narrowings, during coronary angiography or coronary angioplasty after bolus intracoronary infusion of 20microg nitroglycerine. Coronary flow reserve also measured after adenosine intracoronary infusion(LCA 12gmicrog, RCA 6microg). Perent stenosis of coronary artery was measured by digital cailper in 2 different projections and averaged. RESULTS: 1) The was no significant correlation between percent stenosis and proximal distal velocity ratio(P/D) ration(r=0.56. P>0.05). 2) Average peak velocity(APV, cm/sec) and diastolic artery, respectively(p<0.01) Distal APV was significantly lower than proximal APV(p<0.01) but DSVR showed no significant difference(P>0.01). 3) Coronary flow reserve(CFR) was significantly lower in significant coronary stenotic patients compared to insignificant stenotic patients(1.8 vs 3.6, P<0.01). CONCLUSION: Coronary flow velocity measurement by Doppler dipped guidewire gave us physiologic information. We think it could be used as an important tool to assess the significance of the intermediate coronary narrowings and the effect of conorary angioplasty.
Adenosine ; Angioplasty ; Arteries ; Blood Flow Velocity ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Coronary Vessels* ; Humans ; Nitroglycerin

OBJECTIVETo observe the difference of serum lipid levels between patients with coronary heart disease(CHD) and those without,in Zhejiang province.

METHODSAccording to coronary angiogram, 602 patients were divided into two groups as group 1 (vessel stenosis > or =50% luminal diameter narrowing of at least one major coronary artery), group 2 (no vessel stenosis or vessel stenosis <50% luminal diameter narrowing ). Their serum triglyceride (TG), total cholesterol (TC), lower density lipoprotein cholesterol (LDL-C), higher density lipoprotein cholesterol (HDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) were measured and analysed.

RESULTSSerum lipid levels of the two groups were all close to the proper scopes of Principles for the prevention of dyslipidemia recommended by dyslipemia group of the editorial board of Chinese Journal of Cardiology. Data also showed that levels of serum TC, LDL-C and non-HDL-C in group 1 were alightly higher than those in group 2 (4.70 mmol/L +/- 1.22 mmol/L vs. 4.49 mmol/L +/- 0.96 mmol/L, 2.63 mmol/L +/- 1.00 mmol/L vs. 2.44 mmol/L+/- 0.77 mmol/L, 3.45 mmol/L+/- 1.14 mmol/L vs. 3.22 mmol/L+/- 0.92 mmol/L, P < 0.05, P< 0.01, respectively).

CONCLUSIONHyperlipidemia was not a inherent characteristic for CHD patients in Zhejiang province.

Aged ; China ; Coronary Angiography ; Coronary Stenosis ; blood ; Female ; Humans ; Lipids ; blood ; Male ; Middle Aged

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: Progression of coronary atherosclerosis is a unpredictable process. It follows a nonlinear course, and information derived from sequential coronary angiograms is of little value in predicting future progression. This study was designed to evaluate the changing patterns of coronary artery disease(CAD) and to determine possible factors for progression. METHOD: We analyzed progression and regression of CAD in 22 patients(group I : patients with progression of the coronary lesion, group II : patients with regression or no significant change of the coronary lesion) who underwent coronary arteriography two times. Progression was defined either as an increase in percent stenosis of preexisting stenoses by > or =20% including occlusions or as formation of new stenoses > or =20%. The results were compared with clinical findings to determine the nature of the progression of coronary atherosclerosis. RESULTS: Progression of the coronary artery lesion was found in 14 of 22 patients, regression in 4 and no significant changes in 4. New lesions occured in 22 of 156 segments in previously normal segments of arteries. The highest progression percentage was shown by the proximal right coronary artery. Progression occured most frequently in segments with stenosis of 50% to 74% at initial arteriogram. There were no significant differences in mean values for age, blood pressure, total serum cholesterol and blood sugar between two groups. CONCLUSION: The coronary arterial lesions are more frequently progressive rather than regressive of stationary. The progression follows nonlinear course. Many new lesions occurred in segments with previously normal segments of arteries.
Angina Pectoris ; Angiography ; Arteries ; Blood Glucose ; Blood Pressure ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Humans

OBJECTIVE: To analyze the correlation of lipoprotein(a) [Lp(a)] with the clinical stability and severity of coronary artery stenosis in patients with coronary artery disease (CAD). METHODS: A total of 531 patients undergoing coronary angiography in Nanfang Hospital between January, 2013 and December, 2016 were enrolled in this study. At the cutoff Lp(a) concentration of 300 mg/L, the patients were divided into high Lp(a) group (=191) and low Lp(a) group (=340). In each group, the patients with an established diagnosis of CAD based on coronary angiography findings were further divided into stable angina pectoris (SAP) group and acute coronary syndrome (ACS) group. The correlation between the severity of coronary artery stenosis and Lp(a) was evaluated. RESULTS: The patients in high and low Lp(a) groups showed no significant differences in age, gender, body mass index, smoking status, hypertension, or diabetes (>0.05). Multivariate logistic regression analysis revealed that age, gender, and serum levels of low-density lipoprotein cholesterol (LDL-C) and Lp(a) were independent risk factors for CAD in these patients. A high Lp(a) level was associated with an increased risk of CAD (OR=2.443, 95%CI: 1.205-4.951, =0.013). The patients with a high Lp(a) level were at a significantly higher risk of CAD than those with a low Lp(a) level irrespective of a low or high level of LDL-C (=0.006 and 0.020). In the patients with CAD, the ACS group had a significantly higher Lp(a) level than the SAP group ( < 0.001); the proportion of the patients with high Gensini scores was significantly greater in high Lp(a) group than in low Lp(a) group (17.3% vs 5.6%, =0.026), and a linear relationship was found between Lp(a) level and Gensini score (R=0.130, =0.006). CONCLUSIONS Serum level of Lp(a) is an independent risk factor for CAD, and an increased Lp(a) is the residual risk for CAD. In patients with CAD, a high Lp(a) level is associated with the clinical instability and severity of coronary artery stenosis.
Acute Coronary Syndrome ; blood ; Angina Pectoris ; blood ; Cholesterol, LDL ; blood ; Coronary Angiography ; Coronary Artery Disease ; blood ; classification ; Coronary Stenosis ; blood ; pathology ; Humans ; Lipoprotein(a) ; blood ; Regression Analysis ; Risk Factors ; Severity of Illness Index

OBJECTIVES: Severity of coronary artery stenosis has been defined in terms of geometric dimensions, pressure gradient-flow relations, resistance to flow and coronary flow reserve(CFR) after maximum arteriolar vasodilation. Myocardial fractional flow reserve(FFR) is a new index of the functional severity of coronary stenosis that is calculated from pressure measurements during coronary angiography. We compared the relationship between FFR and CFR after PTCA and the residual stenosis with FFR and CFR in the patients with acute myocardial infarction (AMI) and angina. METHODS: The study population consisted of 25 patients with AMI and 18 patients with angina. All AMI patients had successful restoration of infarc-related artery by thrombolysis or direct PTCA. Doppler index was measured using 0.014 inch Doppler wire 15 minutes after successful restoration of infarc- related artery. Hyperemic index was measured after intracoronary injection of adenosine(16-18ug). Baseline and hyperemic distal coronary artery pressure was measured using 0.014 inch pressure wire with advancing the wire distal to the lesion and simultaneous proximal aortic pressure was measured using guiding catheter. RESULTS: 1) Post-interventional FFR and CFR were 0.91+/-0.09 and 1.87+/-0.45 in AMI and 0.93+/-0.06 and 2.73+/-0.67 in angina. There was no significant correlation between FFR and CFR in AMI and angina(p=NS). CFR showed the weak correlation with hyperemic distal pressure(hPd) in AMI(p=0.04) and FFR with hDSVR in angina(p=0.04). FFR and CFR were not correlated with mean blood pressure and heart rate(p=NS). 2) FFR and hyperemic pressure gradient had the close correlation with residual stenosis after successful PTCA in AMI and angina(p<0.001). Baseline pressure gradient also showed weak correlation with FFR(p<0.05). 3) CFR was 1.87+/-0.45 in AMI and 2.73+/-0.67 in angina with significant difference between two groups (p<0.001) and FFR was 0.91+/-0.09 in AMI and 0.93+/-0.06 in angina without difference(p=NS). hPa and hPd showed the significant difference between the two groups(p<0.05). CONCLUSION: FFR seems to be a new index of the functional severity of coronary stenosis that is calculated from pressure measurements during coronary angiography.
Arterial Pressure ; Arteries ; Blood Pressure ; Catheters ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Heart ; Humans ; Myocardial Infarction ; Vasodilation

BACKGROUNDImpaired coronary flow reserve (CFR) in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction. Antihypertensive treatment has been shown to improve coronary microvascular dysfunction. The aim of this study was to evaluate the impact of uncontrolled blood pressure (BP) on diagnostic accuracy of CFR for detecting significant coronary stenosis.

METHODSA total of 98 hypertensive patients scheduled for coronary angiography (CAG) due to chest pain were studied. Of them, 45 patients had uncontrolled BP (defined as the office BP ≥ 140/90 mmHg (1 mmHg = 0.133 kPa) in general hypertensive patients, or ≥ 130/80 mmHg in hypertensive individuals with diabetes mellitus), and the remaining 53 patients had well-controlled BP. CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography (TTDE) within 48 hours prior to CAG. Significant LAD stenosis was defined as > 70% luminal narrowing. Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis.

RESULTSCFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP (2.1 ± 0.6 vs. 2.6 ± 0.9, P < 0.01). Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis (β = -0.445, P < 0.0001) and the presence of uncontrolled BP (β = -0.272, P = 0.014). With a receiver operating characteristic analysis, CFR < 2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients (AUC 0.83, 95%CI 0.75 - 0.91) with a sensitivity of 75%, a specificity of 78%, and an accuracy of 77%. A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP (67% vs. 93%, P = 0.031).

CONCLUSIONSCFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients. However, the diagnostic specificity is reduced in patients with uncontrolled BP.

Aged ; Blood Pressure ; physiology ; Coronary Circulation ; physiology ; Coronary Stenosis ; diagnosis ; Female ; Humans ; Hypertension ; physiopathology ; Male ; Middle Aged

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

OBJECTIVE: To investigate the relationship between serum level of homocysteine and the development of collaterals in patients with severe coronary artery stenosis (SCAS). METHODS: Eighty patients with at least one vessel stenosis over 90% among the 3 main vessels of coronary artery were consecutively enrolled into the study according to angiographic estimation. The development of collaterals was classified by Rentrop's method. RESULTS: The serum levels of homocysteine among the single-vessel, bi-vessel and tri-vessel coronary artery disease groups had no significant difference; there was no linear correlation between the serum level of homocysteine and Gensini's score. The level of homocysteine in the poorly developed collaterals was significantly higher than that in the well-developed collaterals in the SCAS patients (P<0.001). Multiple stepwise logistic analysis revealed that homocysteine negatively correlated with the development of collaterals (P<0.001, odds ratio=0.353; 95% confidence interval=0.201 - 0.620), whereas it positively correlated with the number of stenosis vessels. CONCLUSION The serum level of homocysteine is independently and negatively associated with the development of collateral circulation in severe SCAs patients.
Adult ; Aged ; Aged, 80 and over ; Collateral Circulation ; Coronary Angiography ; Coronary Circulation ; Coronary Stenosis ; blood ; physiopathology ; Female ; Homocystine ; blood ; Humans ; Logistic Models ; Male ; Middle Aged

BACKGROUND: Coronary atherosclerosis with inflammation gives rise to coronary vasospasm in the patients with coronary vasospastic angina. We have postulated that the peripheral leukocyte count and the differential count are associated with vasospastic angina. METHODS: 144 patients who underwent intracoronary ergonovine provocation testing between January 2002 and December 2004 were divided into two groups: Group I (72 patients with provoked spasm, mean age: 54.8+/-10.7 years, males: 75%) and Group II (72 without spasm, mean age: 55.3+/-10.2 years, males: 35%). Blood sampling was done to measure the lipid profiles and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) levels and the monocyte counts. We compared the angiographic findings and laboratory data between the two groups. RESULTS: There were no significant differences in the levels of serum lipid and hsCRP between the two groups. The white blood cell count and the monocyte count were higher in Group I than with Group II (7496.4+/-2622.28 vs. 6703.2+/-1768.37/mm3, respectively, p=0.035; 627.5+/-270.70 vs. 426.9+/-205.76/mm3, respectively, p<0.001). Gensini's score was higher in Group I than in Group II (2.2+/-2.88 vs. 0.5+/-1.03, respectively, p<0.001). Multivariate analysis showed that the monocyte count and Gensini's score were independent factors affecting coronary spasm (p=0.047 and p=0.018, respectively). According to a receiver operating characteristics curve analysis, the area under the curve of the monocyte count was 0.738, that of the neutrophil count was 0.577 and that of the WBC count was 0.572. The cut-off value of the monocyte count was 530/mm3; the sensitivity and specificity of this cut-off value were 64% and 76%, respectively. CONCLUSIONS: The peripheral monocyte count is an independent marker for predicting vasospastic angina in the patients with resting chest pain and insignificant coronary artery stenosis.
Multivariate Analysis ; *Monocytes ; Middle Aged ; Male ; *Leukocyte Count ; Humans ; Female ; Coronary Vasospasm/*blood/diagnosis ; Coronary Stenosis/*blood ; Chest Pain/*blood ; C-Reactive Protein/analysis ; Biological Markers ; Aged ; Adult