scholarly journals Clinical Outcomes of Mitral Annuloplasty with Flexible Bands in Ischemic Mitral Regurgitation

2018 ◽  
Vol 21 (5) ◽  
pp. E345-E351 ◽  
Author(s):  
Mehmet Adnan Celkan ◽  
Ismail Kork ◽  
Abdullah Ulucay
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Odds Ratio ◽  
Ischemic Mitral Regurgitation ◽  
Redo Surgery ◽  
Cox Regression Analysis ◽  
Artery Disease

Background: In this study, we present the outcomes of 53 patients with concomitant coronary artery disease and ischemic mitral regurgitation (IMR)who underwent coronary bypass grafting (CABG) plus mitral repair (flexible posterior band annuloplasty). Materials and Methods: A total of 53 patients with concomitant ischemic mitral regurgitation  and coronary artery disease underwent CABG plus posterior mitral band annuloplasty between June 2008 and June 2015. Flexible Duran AnCore® annuloplasty band (Medtronic) was used in all patients. Transesophageal echocardiography (TEE) was intraoperatively performed in all patients. A transthoracic (TTE) follow-up examination was performed at postoperative months 1, 3, 6, and 12. Results: The average cross-clamp and cardiopulmonary bypass times were 85.11 ± 5.79 and 105.98 ± 6.14 minutes, respectively. Postoperatively, there was an improvement in the grade of mitral regurgitation from 3.8 to 0.7 and in the NYHA class from 3.1 ± 0.5 to 0.5 ± 0.6 (both P < .001). In addition, statistically significant reductions in LVEDD, LVESD, and PAP were observed (P < .001). Ejection fraction rose from 39 ± 10% to 45 ± 8% (P < .01). Early mortality rate was 7.5% (n = 4). Mean follow-up was at 16 months. Late mortality occurred in one patient. During the follow-up period, reoperation was required in 2 patients. Only 2 parameters, redo surgery (P = .030) and IABP use (P = .021), were found related to mortality (P < .001). Cox regression analysis showed that redo surgery and postoperative bleeding increased mortality by 14.731 times (odds ratio: 14.731; 95% confidence interval [CI]: 1.530-141.852) and 23.839 times (odds ratio: 23.839; 95% CI: 1.478-348.641). Discussion: In patients with IMR, mitral band annuloplasty performed in conjunction with CABG was associated with an increase in functional capacity and ejection fraction as well as a reduction in LVEDD and LVESD. This approach represents a feasible alternative with low mortality and  prevents future development of mitral regurgitation and the need for redo surgery.

Circulating t-PA antigen predicts major adverse coronary events in patients with stable coronary artery disease – a 13-year follow-up

2003 ◽  
Vol 90 (08) ◽  
pp. 344-350 ◽  
Author(s):  
Alexander Niessner ◽  
Senta Graf ◽  
Mariam Nikfardjam ◽  
Walter Speidl ◽  
Renate Huber-Beckmann ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Predictive Value ◽  
Odds Ratio ◽  
Coronary Events ◽  
Artery Disease ◽  
Prognostic Power

SummaryThrombus formation after rupture of an atherosclerotic plaque plays a crucial role in coronary artery disease (CAD). A decreased endogenous fibrinolytic system and prothrombotic factors are supposed to influence coronary thrombosis. It was our aim to investigate the predictive value of tissue plasmino-gen activator (t-PA) antigen, von Willebrand Factor, Lipoprotein (a) and anti-cardiolipin antibodies for major adverse coronary events in patients with stable CAD in a prospective cohort study of more than 10 years.We observed 141 patients with angiographically proven CAD for a median follow-up period of 13 years. t-PA antigen was the only marker predicting coronary events (logistic regression, p = 0.044) with a poor prognosis for patients in the 5th quintile with an odds ratio of 7.3 (compared to the 1st quintile). The odds ratio even increased to 10.0 for coronary events associated with the “natural course” of CAD excluding events due to restenosis. t-PA antigen had a slightly higher prognostic power (ROC curve; AUC = 0.69) than fasting glucose (AUC = 0.68) and cholesterol (AUC = 0.67). Triglycerides influenced plasma levels of t-PA antigen (regression, p < 0.001). The predictive value of t-PA antigen remained significant after adjustment for inflammation (logistic regression, p = 0.013) and extent of CAD (p = 0.045) but disappeared adjusting for insulin resistance (p = 0.12).In conclusion t-PA antigen predicted coronary events during a very long-term follow-up with a comparable prognostic power to established cardiovascular risk factors. Markers of insulin resistance influenced t-PA antigen and its predictive value.Part of this paper was originally presented at the joint meetings of the 16th International Congress of the International Society of Fibrinolysis and Proteolysis (ISFP) and the 17th International Fibrinogen Workshop of the International Fibrinogen Research Society (IFRS) held in Munich, Germany, September 2002.

scholarly journals The Chromosome 9p21 Variant Not Predicting Long-Term Cardiovascular Mortality in Chinese with Established Coronary Artery Disease: An Eleven-Year Follow-Up Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
I-Te Lee ◽  
Mark O. Goodarzi ◽  
Wen-Jane Lee ◽  
Jerome I. Rotter ◽  
Yii-der Ida Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Mortality ◽  
Odds Ratio ◽  
Recessive Model ◽  
Dominant Model ◽  
Chromosome 9P21 ◽  
Artery Disease

Introduction. We examined whether the variant at chromosome 9p21, rs4977574, was associated with long-term cardiovascular mortality in Han Chinese patients with coronary artery disease (CAD).Methodology. Subjects who underwent coronary angiography for chest pain were consecutively enrolled. Fasting blood samples were collected for laboratory and genotype assessments. The information was correlated with data collected from the national death database.Results. There were 925 cases with CAD and 634 without CAD enrolled in the present study. The G allele conferred a significant increase in risk of CAD (odds ratio = 1.47,P=0.003in the dominant model; odds ratio = 1.36,P=0.018in the recessive model). During a median of 11 years (inter-quartile range between 5.2 and 12.5 years) of follow-up, neither the total nor the cardiovascular mortality was different among CAD subjects with different genotypes. Using Cox regression analysis, genotypes of rs4977574 still failed to predict cardiovascular mortality (hazard ratio = 1.25,P=0.138in the dominant model; hazard ratio = 1.05,P=0.729in the recessive model).Conclusions. The rs4977574 at chromosome 9p21 is associated with presence of CAD in Han Chinese. However, rs4977574 could not predict cardiovascular mortality in these CAD subjects during the eleven-year period of the study.

P4581Outcome of surgical revascularization for coronary artery disease after 30 years

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E M Delmo-Walter ◽  
R Hetzer
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Surgical Revascularization ◽  
Term Survival ◽  
Vein Grafts ◽  
Significant Difference ◽  
Artery Disease

Abstract Objective We report the long-term outcome of surgical revascularization in patients with coronary artery disease. Methods The institutional trial on Coronary Artery Disease and Surgical Therapy: Long-term Follow-up, is a 30-year follow-up study of 2728 patients with coronary artery disease who underwent surgical revascularization from April 1986 to December 1988. One-vessel coronary artery disease was found in 234 patients while 2 and 3-vessel diseases were found in 1021 and 1463 patients, respectively. Survival was analyzed according to age, gender, ejection fraction, and number of arterial and vein grafts (2165 males, mean age at coronary revascularization 59.4±8.8 years). Results Mean duration of follow-up was 30.6±1.2 years. Overall survival at this time point was 24.1%. Age–stratified survival was observed higher (40%) in those patients <50 years of age at that time of surgery compared to the other age groups, i.e. 50–59: 20%, 60–69: 10% and >70: 5% (p<0.001). Women had increased early mortality, hence have poorer survival (12%) than men (18%). However, when age (women=median 64.7, men=58.4, years) was considered between gender, no significant difference (p=0.13) in survival was observed. Interestingly, survival rate of patients with ejection fraction of <30% (n=826) was 6% which obviously fared well compared with 18% of those with ejection fraction of >30% (n=1902) at the time of coronary surgery. There was no significant difference between the use of a single internal mammary artery (IMA) [left or right] graft and use of 2 arterial grafts (combined left and right IMA or IMA and radial artery) on long-term survival (p=0.014). However, the use of an arterial graft combined with vein grafts are favorable (p<0.001). Conclusion The findings in this study showed that after a relatively long-term follow-up, age-based survival was similar compared to the general population. Female gender demonstrated poorer survival than men. However, when this is adjusted for age, no significant difference was shown. Interestingly, several patients with severely reduced ejection fraction, considered inoperable by many cardiac surgeons and cardiologists at the time of revascularization have survived for >30 years. Use of one internal mammary artery graft demonstrated better survival than use of only vein grafts. Noteworthy is that the sole use of vein grafts may also lead to an acceptable long-term survival.

scholarly journals High-Serum Angiopoietin-Like Protein 3 Levels Associated with Cardiovascular Outcome in Patients with Coronary Artery Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ming-Chun Chen ◽  
Bang-Gee Hsu ◽  
Chung-Jen Lee ◽  
Ji-Hung Wang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cox Regression ◽  
High Serum ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
Artery Disease

Background. Angiopoietin-like protein 3 (ANGPTL3) plays a pivotal role in lipid metabolism and angiogenesis, and there is growing interest regarding the association between ANGPTL3 and coronary artery disease (CAD). This study aims to investigate whether ANGPTL3 levels can be used to predict the future occurrence of major adverse cardiovascular events (MACEs) in patients with CAD. Methods. Overall, 90 patients with CAD were enrolled between January and December 2012. The study’s primary endpoint was incidence of MACEs. Patient follow-up was completed on June 30, 2017. Results. Following a median follow-up period of 54 months, 33 MACEs had occurred. Patients reporting MACEs had lower statin use (P=0.022) and higher serum C-reactive protein (P<0.001) and serum ANGPTL3 (P<0.001) levels than those without MACEs. Kaplan–Meier analysis revealed higher cumulative incidence of CV events in the high ANGPTL3 group (median ANGPTL3 level ≥ 222.37 ng/mL) than in the low ANGPTL3 group (log-rank P=0.046). Multivariable Cox regression analysis demonstrated that ANGPTL3 levels were independently associated with MACEs in patients with CAD (hazard ratio: 1.003; 95% confidence interval: 1.000–1.005; P=0.026) after adjusted for age, gender, and body mass index, classical risk factors, and potential confounders. Conclusions. Serum ANGPTL3 levels could serve as a biomarker for future occurrence of MACEs in patients with CAD.

scholarly journals P813 Association of clinical and echocardiographic signs with atrial fibrillation in coronary artery disease patients: a propensity score matching analysis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E I Yaroslavskaya ◽  
V Kuznetsov ◽  
E A Gorbatenko
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Coronary Artery Lesions ◽  
Myocardial Mass ◽  
Lv Ejection Fraction ◽  
Artery Disease

Abstract Background It is known that atrial fibrillation (AF) and coronary artery disease (CAD) may be encountered coincidently in a large portion of patients. However, there are not so much data available about AF association with some clinical and echocardiographic signs in CAD patients. Purpose To find out the relationship between clinical and echocardiographic features and AF in CAD patients. Methods From local database of coronary angiography we selected patients with significant coronary stenosis (≥50% of lumen of at least one epicardial artery): 178 patients with chronic or paroxysmal AF and 331 patients without AF (the last group was selected by Propensity Score Matching with balancing by sex, age, body mass index, severity of chronic heart failure, prevalence of myocardial infarction, arterial hypertension, thyroid disease). Results Patients with AF compared to patients without AF often had higher heart rate (105 ± 32 vs 70 ± 13 beats/min, р&lt;0.001), lower Canadian Cardiovascular Society angina classes (III-IV - 52.9% vs 66.5%, р=0.041), lower triglycerides level (1.74 ± 1.08 mmol/l vs 1.94 ± 1.17 mmol/l, р=0.019). In echocardiographic data the groups did not differ in prevalence and severity of left ventricular (LV) wall motion abnormalities. However LV dimension (26.7 ± 3.6 mm/m² vs 26.1 ± 3.3 mm/m², p = 0.028), right ventricular diameter (13.9 ± 2.0 mm/m² vs 13.3 ± 2.0 mm/m², p &lt; 0.001), left atrial linear dimension (24.1 ± 3.2 mm/m² vs 21.6 ± 2.9 mm/m², p &lt; 0.001), LV myocardial mass (171.0 ± 40.0 g/m² vs 154.8 ± 38.3 g/m², p &lt; 0.001) were higher in AF patients. This group of patients more often demonstrated significant mitral regurgitation (49.1% vs 18.4%, р&lt;0.001) and impaired LV ejection fraction (56.2% vs 39.5%, р&lt;0.001). Coronary angiographic data showed that patients with AF more often had right coronary dominance (87.5% vs 80.4%, р=0.043), right coronary artery lesions (92.1% vs 85.8%, р=0.037), less often left main coronary artery lesions (16.3% vs 24.8%, р=0.027). Conclusions AF in CAD patients is associated with higher ventricular, left atrial dimensions, LV myocardial mass, significant mitral regurgitation and impaired LV ejection fraction and some peculiarities of clinical and coronary angiographic symptoms.

scholarly journals Presence of Coronary Artery Disease in Patients on Methadone in the South Bronx: A Retrospective Analysis and Literature Review

2021 ◽  
Vol 6 (04) ◽  
pp. 254-258
Author(s):  
Rodríguez-Guerra, M MD ◽  
Urlapu, Kinnera Sahithi MD ◽  
Hewapathirana, Udanie ◽  
Vikram, Itare MD ◽  
Fortuzi Ked, MD ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Literature Review ◽  
Ejection Fraction ◽  
Newly Diagnosed ◽  
Artery Disease ◽  
Positive Effect

Introduction: Our comunity has faced a challenge with the addiction to opioid, long acting medication like Methadone could be helpful in the setting of withdrawal, rehab, detox or chronic pain management, but also represent risk of dependence. Besides most of the litereatyre expose the relation between opiod could be related to cardiac disease, there is also a report relating methadone witha posible positive impact in coronary artery disease. Method: Retrospective and descriptive review of records and literature review. Result: Total of 207 of patient (pts) on methadone had coronary artery disease (CAD), of which 128 pts were known to have CAD from before, of this group the most common group was Hispanic between 45-64 years old. Regarding the cardiovascular (CV) risks, the 89.06% (114 pts) were hypertensive, 61.7% (79 pts) were diabetic, 24.21% (31pts) had Kidney disease with CKD III or more. 7% (9 pts) were known to have prolonged QTc, while 4.68% (6 pts) were newly diagnosed with it (Table 1). When we studied ejection fraction (EF), in the known CAD patients, we observed that the 20 % (26 pts) had EF < 40%, while the 10.16 % (13 pts) had intermediate EF (40-55%). Over the study period 97 pts had follow up echocardiography of with the 17.52% (17 pts) had improved EF, 64.94% (63pts) no change, while 17.52% (17 pts) had decreased EF. Regarding the cardiac events in this group, 13 patients had myocardial infarctions, of which six patients had ejection fraction below 40% and one patient had prolonged QTc (Table 2). Only 9.38% of the patients (12) had a follow up cardiac catheterization, of which 83% (10 pts) showed a progression of CAD. In the other hand, a total 38.16% (79 pts) had newly diagnosed with CAD, of which 62% (49 pts) were hypertensive, 37.97% (30 pts) had diabetes and 117.72% (14 pts) had CKD III or more. A total of 12.66% (10 pts) were known to have prolonged QTc while 6.33% (5 pts) were newly diagnosed with it. The 13.9% (11 pts) were found to have an improvement in ejection fraction while the 11.4% (9 pts) got worse. Two of these patients had myocardial infarction. (Table 3). Follow up echocardiograms showed that the ejection fraction did not get worse in 90 out of 116 patients. Overall only 1.93% (4 pts) had cardiac arrest of which 3 pts had prior history of CAD and none of them had prolonged QTc. Conclusion: This study has exposed the possibility of the positive effect of methadone in the cardiac pump function. There appears to be a progression of CAD in our patients who underwent to cardiac catheterization as a follow up, but due to the size of the sample of patient we cannot establish this relation as the definitive risk for the progression of the disease. Based on the literature review and our results, there is no doubt in the possible potential positive effect that long term use of opioids could have or maybe the negative cardiovascular effect, from the cardiac point of view. The incidence of fatal events did not represent a higher risk (Arrhythmias, myocardial infarction, or cardiac arrest) than the potential benefit (Improvement of heart function or mitigation of CAD).

scholarly journals Exercise duration as apredictor ofcardiovascular disease in arterial hypertension. Data from a 6-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Leontsinis ◽  
A Kasiakogias ◽  
M Mantzouranis ◽  
F Fragoulis ◽  
I Andrikou ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Exercise Capacity ◽  
Cardiovascular Events ◽  
Exercise Duration ◽  
Cox Regression Analysis ◽  
Artery Disease

Abstract Background Current hypertension guidelines necessitate an individualized cardiovascular risk assessment through a process that includes several parameters and remains challenging. Exercise capacity has been strongly associated with prognosis in cardiovascular disease and can be easily assessed by the exercise treadmill test (ETT). Purpose The aim of the present study was to investigate theprognostic role of exercise capacity for future cardiovascular events in a cohort of essential hypertensive subjects. Methods We followed up 1037 hypertensive adults (mean age 56 years, 53% males) with no previous history of cardiovascular disease, for a mean period of 6±3 years. During the baseline visit all subjects underwent a complete echocardiographic study, office blood pressure measurements, ECG, routine blood testing and an ETT with a Bruce protocol.During follow-up, all subjects were reviewed at least annually. Exercise capacity was expressedwithexercise duration the distribution of which was split by the median (9min). Accordingly, the subjects were classified into those with high (51%) and low exercise capacity (49%). The cardiovascular endpoint of interest was the composite of coronary artery disease and stroke. Results The incidence of cardiovascular eventsduring the follow-up period was 4.1% (35 cases of coronary artery disease and 10 cases of stroke).Cox regression analysis revealed that high exercise capacity was associated with a lower risk for future cardiovascular events (HR = 0.35 (95% CI 0.172–0.741, p=0.006). In multivariate models adjusting for standard clinical and laboratory cardiovascular risk factors this association was sustained. Conclusion Exercise duration shows a significant prognostic value for future CV events among hypertensivepatients. Exercise capacity assessment by means of TTE could enhance the identification of asymptomatic hypertensives at higher risk. Funding Acknowledgement Type of funding source: None

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