Aged ; Angina Pectoris, Variant ; physiopathology ; Coronary Vasospasm ; physiopathology ; Coronary Vessels ; physiopathology ; Humans ; Male

OBJECTIVETo examine the relationship between coronary arterial remodeling and clinical presentation.

METHODSA total of 34 patients with acute (10 with recent myocardial infarction and 24 with unstable angina) and 26 with stable (8 with old myocardial infarction and 18 with stable angina) coronary syndrome underwent intravascular ultrasound (IVUS) before intervention. Target lesions were classified as soft or hard plaques. Quantitative measurements of cross-sectional area (CSA) of external elastic membrane (EEM), lumen and plaque were performed at the lesion site and at the proximal and distal reference sites. Remodeling index (RI) was expressed by the ratio of EEM CSA at the lesion site to the mean EEM CSA of both proximal and distal reference sites. Positive remodeling was defined as RI > 1.05 and negative remodeling as RI < 0.95.

RESULTSSoft plaque was observed more frequently in acute than in stable coronary syndrome (59% vs 31%), whereas hard plaque was more common in stable coronary syndrome (69% vs 41%) (P = 0.03). The EEM CSA (15.11 +/- 2.89 mm(2) vs 13.25 +/- 3.10 mm(2), P = 0.019) and plaque CSA (10.83 +/- 2.62 mm(2) vs 9.30 +/- 2.84 mm(2), P = 0.035) were significantly greater at target lesions in patients with acute rather than stable coronary syndrome, while lumen CSA and percent area stenosis were similar in both groups. RI was significantly higher (1.08 +/- 0.16 vs 0.95 +/- 0.14, P = 0.002) and positive remodeling was more frequent in acute coronary syndrome (53% vs 23%, P = 0.019), whereas negative remodeling was more common in stable coronary syndrome (58% vs 24%, P = 0.007).

CONCLUSIONSThe study indicates that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling.

Aged ; Coronary Disease ; diagnostic imaging ; pathology ; physiopathology ; Coronary Vessels ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Ultrasonography

Child, Preschool ; Coronary Vessel Anomalies ; physiopathology ; Coronary Vessels ; physiopathology ; Female ; Humans ; Pulmonary Artery ; abnormalities

Coronary Vasospasm ; diagnosis ; Coronary Vessels ; physiopathology ; Electrocardiography ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis

Adult ; Aneurysm, Dissecting ; diagnosis ; physiopathology ; Aneurysm, False ; Coronary Aneurysm ; diagnosis ; physiopathology ; Coronary Vessels ; pathology ; physiopathology ; Humans ; Male ; Myocardial Infarction ; diagnosis ; physiopathology ; Thoracic Injuries ; complications ; physiopathology ; Young Adult

BACKGROUNDFractional flow reserve (FFR) has become an increasingly important index when making decisions with respect to revascularization of coronary artery stenosis. However, the pressure guidewire used in obtaining FFR measurements is difficult to control and manipulate in certain complex coronary artery lesions, resulting in increased fluoroscopy time and contrast dye usage. This study examined a novel (NOV) technique for obtaining FFR measurements in hope of easing the difficulties associated with evaluating and treating complex coronary artery lesions.

METHODSFifty-six patients with complex coronary artery lesions were assigned to a conventional (CON) FFR technique group or a NOV FFR technique group. The NOV technique involved the use of a balloon and wire exchange within the coronary artery. The fluoroscopy time, contrast dye usage, and FFR-related complications were assessed after completing the FFR measurement procedure for each patient.

RESULTSThe median time required for fluoroscopy in the NOV technique group was significantly less than that in the CON technique group; additionally, lesser amounts of contrast dye were used in the NOV technique group (both P < 0.05). The NOV technique was successfully performed in thirty patients, without any FFR-related complications. However, the CON technique failed in three patients, including two who experienced coronary artery spasms (P > 0.05).

CONCLUSIONSCompared to the CON technique used for measuring FFR, the new technique reduced the fluoroscopy time and amount of contrast dye used when evaluating complex coronary artery lesions. The new technique did not increase the risk of operation or decrease the success rate.

Aged ; Aged, 80 and over ; Coronary Disease ; physiopathology ; Coronary Vessels ; physiopathology ; Female ; Fractional Flow Reserve, Myocardial ; physiology ; Humans ; Male

OBJECTIVETo investigate electrocardiographic (ECG) and angiographic characteristics of patients with acute solitary posterior myocardial infarction. Patients complicated by inferior wall or right ventricular infarction were excluded.

METHODECG and angiographic changes in 11 patients with acute solitary posterior myocardial infarction admitted to our emergency room from 2001 to 2006 were analyzed.

RESULTSBesides typical ST segment elevation in V(7)-V(9) leads, other ECG manifestations in these patients included V(1)-V(2) R/S > or = 1 (9/11, 81.8%), 1 - 2 mm ST depression in V(1)-V(4) (5/11, 45.5%), 0.5 - 1.5 mm ST elevation in I, aVL leads (4/11, 36.4%) and 0.5 - 1.5 mm ST elevation in V(5)-V(6) leads (5/11, 45.5%). Coronary angiography showed that left circumflex artery (LCX) was the infarction related artery in all cases. The infarction area located before OM1 origination in 1 patient with a 95% pipe-like stenosis (1/11), after OM1 origination in 6 patients (6/11, 4 with total occlusion, 1 with sub-total occlusion and 1 with 90% long length stenosis), in OM1 in 4 patients (4/11, 2 with total occlusion, 1 with sub-total occlusion and 1 with 95% local stenosis). There were 3 patients (27.3%) with single vessel lesion, 4 patients (36.4%) combined with left anterior descending artery (LAD) lesion, 2 patients (18.2%) combined with right coronary artery (RCA) lesion and 2 patients (18.2%) combined with LAD and RCA lesions.

CONCLUSIONSAcute posterior myocardial infarction should be suspected with V(1)-V(2) R/S > or = 1 and V(1)-V(4) ST depression in standard 12 leads ECG. Besides symptoms and cardiac enzyme measurements, recording posterior leads electrocardiogram and performing coronary angiography will help to make the correct diagnosis.

Aged ; Coronary Angiography ; Coronary Vessels ; physiopathology ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnostic imaging ; physiopathology ; Myocardium ; enzymology

OBJECTIVEDuring progression of atherosclerosis, the vessel may develop either positive or negative remodeling. The pathophysiology of vascular remodeling is not fully understood. This study investigated the relationship between plaque characteristics and arterial remodeling using intravascular ultrasound imaging (IVUS).

METHODSA total of 77 patients (male 53, mean age 58 +/- 10 years) who underwent IVUS imaging (ClearView or Galaxy2, Boston Scientific, USA) of culprit vessel were enrolled in this study. Among the 77 patients, 31 presented with stable angina pectoris and 46 presented with acute coronary syndrome. Qualitative assessment of the lesion and quantitative measurement were performed in both stenotic and reference segments. The lesions were classified into soft plaque and hard plaque (including fibrous plaque, calcified plaque and mixed plaque) according to different ultrasound patterns of tissue reflection. The remodeling index (RI) was defined as the ratio of vessel cross sectional area (EEMcsa) of lesion segment to the mean reference EEMcsa. Positive remodeling was defined as RI > 1.0 and negative remodeling as RI < 1.0.

RESULTSOf 77 lesions, 45 (58%) had undergone positive remodeling, and 32 (42%) had negative remodeling. In comparison to the patients with negative remodeling, patients with positive remodeling presented with more acute coronary syndrome (74% vs. 43%, P = 0.006). Both the plaque area and the vessel area were significantly larger in the lesion with positive remodeling than in lesion with negative remodeling. The lesions with positive remodeling were predominantly soft (71% vs. 34%, P = 0.001) and had less calcification [21% vs. 54%, P = 0.003 and (18 +/- 37) degrees vs. (40 +/- 50) degrees, P = 0.027] compared with lesions with negative remodeling. The difference of clinical presentation and plaque characteristics between the patients with different patterns of remodeling is still significant with binary logistic analysis.

CONCLUSIONSCoronary arterial remodeling pattern is related to the clinical manifestation and the composition of plaque. Lesions presented with positive remodeling have a higher prevalence of soft plaque and less calcification.

Aged ; Coronary Disease ; diagnostic imaging ; physiopathology ; Coronary Vessels ; diagnostic imaging ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Ultrasonography, Interventional

No abstract available.
Coronary Artery Disease/*therapy ; *Coronary Circulation ; Coronary Vessels/*physiopathology ; *Endothelial Progenitor Cells ; Female ; Humans ; Male ; Microvessels/*physiopathology ; Percutaneous Coronary Intervention/*instrumentation ; *Re-Epithelialization ; *Stents

OBJECTIVEKawasaki disease (KD) is a kind of febrile disorder without definite etiology. The pathologic change of KD is characterized by nonspecific vasculitis, which mainly involves the coronary artery. Some patients may have coronary angioma formation, and some of them will result in the coronary narrowing or embolism. Notwithstanding that KD has been one of the most common causes for acquired heart diseases in childhood in addition to the rheumatic fever, the pathogenesis of the vascular damage remains unknown. This study was conducted to explore the pathophysiological role of cell adhesion molecules (P-selectin and E-selectin) on the endothelial lesions in KD, and to look for the evidence of direct relationship between the plasma levels of soluble cell adhesion molecules (P- and E-selectin) and the incidence of the coronary artery lesion (CAL).

METHODSSoluble P-selectin (PS), E-selectin (ES), thromboxane-B(2)(TXB(2)), 6-keto-PGF(1)alpha (6-KPGF(1)alpha) were measured in 36 patients with KD, 20 patients with febrile disease and 30 healthy children by using double antibody sandwich enzyme linked immunosorbent assay (ELISA) and radioimmunoassay. Patients with KD were separated into acute phase group, subacute phase group, recovery phase group, coronary artery lesion group (CAL), non-coronary artery lesion group (NCAL), intravenous immunoglobulin (IVIG) effective group (body temperature back to normal after 48 hours of using IVIG), and IVIG ineffective group.

RESULTSPlasma PS and ES levels in the acute phase group [(211 +/- 28 and 186 +/- 14) ng/ml], subacute phase group [(238 +/- 27 and 151 +/- 13) ng/ml] and recovery phase group [(198 +/- 21 and 1008 +/- 9) ng/ml] were significantly higher than those in the healthy group [(102 +/- 36 and 72 +/- 10) ng/ml, P < 0.01]. The plasma PS levels remained higher after the treatment, but in IVIG effective group, the PS and ES levels declined significantly (P < 0.01) compared with those in acute phase group. Plasma PS and ES levels of CAL group [(281 +/- 78 and 210 +/- 52) ng/ml] were significantly higher than those of NCAL group [(217 +/- 15 and 108 +/- 10) ng/ml, P < 0.01]. In contrast to 1 week after the treatment, the PS and ES in IVIG effective group at the time point of 2 weeks after the treatment decreased more significantly (P < 0.01). While the PS and ES in IVIG ineffective group remained higher at the time point of 2 weeks after the treatment, which showed no significant difference compared with those 1 week after the treatment (P > 0.05). One week after the treatment, the PS levels of IVIG effective and ineffective groups did not descend, and there was no significant difference in PS between these two groups at this time point. Two weeks after the treatment, the PS and ES in IVIG ineffective group remained higher than those in IVIG effective group, and there was a significant difference between them. The peak level of PS appeared in the subacute phase. TXB(2) levels of KD in acute phase group increased markedly, which were significantly higher than those of healthy group [(345 +/- 127 and 190 +/- 69) ng/L, P < 0.01]. There was no significant difference between subacute phase group and healthy group. No significant difference was found between CAL group and NCAL group (P > 0.05). The levels of TXB(2) declined quickly after the treatment. The 6-KPGF(1)alpha level in KD of acute phase group, subacute phase group and recovery phase group [(7.1 +/- 2.8, 10.8 +/- 3.7 and 11.3 +/- 4.0) ng/L, respectively] was significantly lower than that of healthy group [(17.7 +/- 5.8) ng/L, P < 0.01], and the levels did not recover to normal even 2 weeks after the treatment. There was no significant difference 6-KPGF(1)alpha levels between CAL group and NCAL group (P > 0.05). In the febrile group, PS and ES levels showed no significant differences compared with healthy children (P > 0.05). ES level of KD patients was significantly correlated with CRP levels (r = 0.79 P < 0.01). In febrile group, there was no significant correlation between ES and CRP. There was a significant correlation between PS and PLT levels in KD patients (r = 0.75 P < 0.01), and no significant correlation between PS and PLT levels in febrile patients.

CONCLUSIONThe increase of plasma PS and ES levels in KD acute phase and subacute phase might play an important role in the pathophysiology of the endothelial damage. E- and P-selectin may potentially be a predictor of CAL in patients with KD.

Child ; Coronary Artery Disease ; physiopathology ; Coronary Vessels ; physiopathology ; E-Selectin ; blood ; Endothelium, Vascular ; physiopathology ; Humans ; Mucocutaneous Lymph Node Syndrome ; blood ; physiopathology ; P-Selectin ; blood