Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: EC:4.1.1.6 (CAD)
4,420 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiac transplantation for the treatment of end-stage congestive heart failure has been shown to be of benefit regardless of the etiology. With few exceptions, the evaluation of patients with end-stage heart failure is the same, regardless of the etiology. In those with cardiomyopathy not as a result of CAD, special attention must be given to exclude secondary causes of cardiomyopathy such as amyloidosis, hemochromatosis, and sarcoidosis, as well as generalized systemic illnesses that may also involve the heart, either secondary or hereditary, because special consideration must be given to these patients on a case-by-case basis to determine that there is no general systemic involvement of the illness that would preclude satisfactory rehabilitation after transplantation. Before cardiac transplantation becomes widely available, there must be a greater number of donor hearts, the lack of which now severely limits the number of transplants performed in comparison with the estimated need.66 Additionally, more effective and specific immunosuppressive agents must be identified in order to reduce the incidence of rejection, infection, and accelerated atherosclerosis that now limits the longevity of transplant recipients. Furthermore, the ideal immunosuppressive agent should be associated with fewer side effects than those currently available. The emotional and economic burdens placed on the patient, the family, and society must be balanced against the benefits generated by the procedure. Despite these limitations, cardiac transplantation continues to offer hope for the terminally ill patient, which must be tempered by an understanding of the real limitations of transplantation.
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PMID:Patient selection and results of cardiac transplantation in patients with cardiomyopathy. 304 84

The evidence suggests that digitalis glycosides do indeed improve ventricular performance through a sustained but moderate positive inotropic effect. This effect is more marked in failing than in nonfailing myocardium. The clinical studies suggest a moderate salutary effect in patients with chronic CHF who are in sinus rhythm. The drug can be given safely to patients with CAD and in combination with other medications when the physician is aware of those factors leading to increased sensitivity to digitalis.
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PMID:How effective is digitalis in the treatment of congestive heart failure? 305 82

Estimates of the prevalence of atrial fibrillation (AF) in patients with coronary artery disease have varied from "frequent" to less than 2%. Data on 18,343 patients with angiographically demonstrated CAD in the Coronary Artery Surgery Study (CASS) registry were reviewed and AF was found to be present in 116 (0.6%) patients. The presence of AF was positively associated with the following clinical and angiographic variables: older age, sex (male), mitral regurgitation and functional impairment due to congestive heart failure. The number of diseased coronary arteries was negatively related to the presence of AF. Atrial fibrillation was an independent predictor of survival and its presence doubled the estimated risk over those patients without AF.
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PMID:Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry). 325 67

The interpretation and selection of exercise tests depends on the pretest probability of CAD. Imperfect tests (like exercise tests) provide probability estimates, not definite statements (such as "the patient has CAD" or "the patient does not have CAD"). In patients with a low pretest probability of CAD (asymptomatic persons or men and women with nonanginal chest pain), abnormal exercise test results provide probability estimates that are much too low to conclude that the patient has CAD. In patients with anginal pain and normal exercise tests, the probability of CAD is too high to conclude that the patient has a normal coronary circulation. Exercise tests are not useful for trying to rule out CAD in patients with anginal pain. In patients with an intermediate pretest probability of CAD (men and women with atypical angina and women with typical angina), abnormal exercise tests (particularly the myocardial scintiscan) provide probability estimates that are high enough to justify starting treatment for CAD. Exercise tests are most useful in this group, a conclusion that has been reached by other methods of analysis. The myocardial scintiscan is much more useful than the exercise ECG in women. When CAD is strongly suspected, exercise tests have relatively little diagnostic value but may be useful for prognosis. However, clinical evidence of poor ventricular function may alone suffice to select patients with angina pectoris for coronary arteriography. Conversely, when clinical indicators of congestive heart failure are absent, the prognosis in chronic stable angina is so favorable that any further testing may be unnecessary. Screening asymptomatic persons for CAD is a very low yield practice. Patients who have no cardiac risk factors (hypercholesterolemia, family history of CAD, cigarette smoking, and hypertension) are at especially low risk of a primary cardiac event. Older men with stable typical angina are particularly likely to have left main coronary artery stenosis or three-vessel disease with poor ventricular function. The exercise ECG can identify groups of older men with a relatively high risk of having left main coronary artery stenosis. Physicians should be cautious when applying these recommendations to a primary care practice. The foregoing analysis is based on data obtained from patients who had been selected for coronary arteriography. There are two principal effects of biased selection of study patients: The pretest probability of CAD in clinical subgroups is probably lower than as shown here.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Exercise testing in suspected coronary artery disease. 385 11

In a series of 531 CENDX, preoperative cardiac risk was categorized by clinical criteria. Patients with CAD (history of previous MI, angina, congestive heart failure, and/or electrocardiographic evidence of CAD were selected for more invasive studies based on clinical criteria. The overall incidence of postoperative myocardial infarction was 2.5% and increased slightly to 4% in patients with symptomatic cardiac disease. More importantly, the overall mortality was 0.9% and only 3 of 13 (23%) postoperative myocardial infarctions were fatal. Neurologic complications averaged 1.4% and approximately 70% were related to preceding cardiac events. Twenty-two patients or 4% of the entire series underwent carotid endarterectomy combined with coronary artery bypass graft and this approach was associated with one death and one stroke. Therefore, we conclude that a selective approach to coronary arteriography and subsequent CABG based on clinical criteria is associated with an acceptably low mortality and cardiac morbidity.
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PMID:The impact of coronary artery disease on carotid endarterectomy. 660 29

Between January, 1968, and January, 1993, 790 patients underwent cardiac operations that were either complex or performed in the presence of a life threatening disease of other vital organs. There were 73 (9.2%) operative deaths (d; < thirty days). A substantial number (n) of the operations (30 or more) and associated operative deaths included left ventricular (LV) aneurysmectomy or plication (LVA-P) with coronary artery bypass (CAB) grafts with, or, without other cardiac procedures (OCP; n = 261; d = 11.1%), cardiac reoperations (n = 65; d = 4.6%), CAB grafts plus mitral or aortic valve replacement (n = 59; d = 1.7%), combined mitral and aortic valve replacement (MAVR) with, or without tricuspid valve (TV) replacement and CAB grafts (n = 52; d = 7.7%), CAB grafting for an end-stage coronary artery disease (CAD; n = 40; d = none), emergency CAB grafts for an acute myocardial infarction (MI) with cardiogenic shock (n = 37; d = 24.3%), complex internal thoracic artery (ITA) grafting (n = 30; d = none), and miscellaneous (n = 43; d = 2.3%). The best results were achieved in CAB grafts for an end-stage CAD, complex ITA grafting, CAB grafts plus mitral or aortic valve replacement, cardiac reoperations, MAVR, and miscellaneous. This is probably related to an intensive treatment of congestive heart failure (CHF) before the operation, pretreatment with the oxygen free radical inhibitor (allopurinol), selective use of an intraaortic balloon assist (IABA) device, routine use of hemoconcentrator (ultrafiltration, UF) during cardiopulmonary bypass (CPB) in those with CHF, thorough myocardial protection, and a complete left-sided plus right-sided coronary revascularization.
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PMID:Complex cases in cardiac surgery. 832 91

In this study a correlation was sought between the NYHA class, the results of cardiopulmonary exercise testing (CPX) and the ejection fraction (EF) measured by echocardiography and scintigraphy. Of 36 patients enrolled, CHF in 20 patients was due to CAD and in 16 patients due to DCM. The NYHA class was determined independently by two cardiologists who were blinded to the CPX, echocardiography or scintigraphy results. Sixteen patients were classified as class II and 20 as class III. As a control, 23 patients without cardiopulmonary disease were examined. The CPX was done according to a ramp protocol with continuous measurement of respiratory gases, maximal oxygen consumption (VO2-max) and oxygen consumption at the anaerobic threshold (VO2-AT). A correlation (p = 0.0425) between the NYHA classification and the Weber classification for VO2-AT was found. There was no correlation for VO2-max. VO2-AT was significantly higher in NYHA II patients as compared to NYHA III patients. No significant difference was seen in relation to the VO2-max. In comparison to the normal group, the VO2-AT and VO2-max were significantly lower in NYHA II and III patients. There was no significant correlation between VO2-AT and EF, VO2-max and EF, or between NYHA class and EF. During a 16-month follow-up period lethality was 8/14 patients with VO2-AT < 10 ml/kg/min. Although the NYHA classification provides a valid method for determining the prognosis of CHF patients, if feasible, the CPX examinations should be used to provide updates of the disease progress.
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PMID:[Comparison of NYHA classification with cardiopulmonary function in patients with chronic heart failure]. 876 67

Annexins are a unique family of membrane-associated, Ca2+ and phospholipid-binding proteins found in various tissues. Among the 12 isoforms, Annexin II, V and VI exist in heart tissue in the highest amounts. Annexin VI has been shown to affect intracellular Ca2+ cycling and contractility in isolated cardiomyocytes. Annexin V is present in both cardiomyocytes and non-myocyte cell types in the heart and may play a role in the regulation of cellular ion fluxes, organization and secretion, while the cardiac effects of annexin II are unclear. To identify changes in annexin II, V and VI isoforms that might occur in human heart failure, we measured mRNA and protein levels of these three annexins in transplanted left ventricular tissue of 12 patients with end-stage congestive heart failure due to coronary artery disease (CAD, n=6) or idiopathic dilated cardiomyopathy (DCM, n=6) who underwent cardiac transplantation. Normal heart tissue (C, n=6) was used as a control. Northern blot analyses showed a significant decrease (61%) in annexin VI mRNA levels in heart failure patients compared with controls (1.08+/-0.16 v 2.79+/-0.20 A.U.C. unit, determined by laser densitometry, mean+/-s.e.). In contrast, we found a 67% increase (2. 32+/-0.27 v 3.88+/-0.29) in annexin II mRNA levels and a two-fold increase (1.00+/-0.24 v 2.21+/-0.29) in annexin V mRNA levels in cardiomyopathic hearts as compared to normal hearts. Western blot analyses demonstrated a corresponding decrease (46.1%) in annexin VI protein levels in the heart failure group as compared to controls (2. 63+/-0.22 v 4.88+/-0.52), while annexin II protein levels showed a significant 40.7% increase in patients with heart failure compared to those in normal hearts (5.08+/-0.67 v 3.61+/-0.32). Annexin V protein levels were also significantly increased (45%) in heart failure patients compared with normal (2.14+/-0.19 v 1.48+/-0.11). No difference in either annexins II, V or VI mRNA and protein levels were found between CAD and DCM patients. We conclude that human end-stage heart failure is associated with a down regulation of annexin VI and up regulation of annexin II and V proteins. Coordinate changes were observed in steady-state mRNA levels. These results suggest that these annexin isoforms may contribute to the regulation of intracellular Ca2+ homeostasis in the cardiomyopathic heart.
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PMID:Altered cardiac annexin mRNA and protein levels in the left ventricle of patients with end-stage heart failure. 951 22

Preventing the progression of established heart failure can be difficult, as multiple factors contribute to the continual decline of cardiac function. Blunting the activated neurohormonal response to a decreased systolic function is a proven means of slowing progression of CHF. Preventing further CAD and cardiac ischemia may also prove to be an effective mechanism. Two trials with HMGCoA reductase inhibitors lend support to this hypothesis. Studies using ACE inhibitors may also support this notion. Since a major portion of heart failure in the USA is caused by CAD, preventing CHF progression may be related to the prevention of CAD. Using ACE inhibitors and lipid-lowering agents, in addition to standard measures of CAD risk factor modification, may prove useful in future trials to retard the progression of heart failure. Further research and clinical trials involving this method of CHF prevention are warranted.
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PMID:Role of secondary prevention in congestive heart failure due to coronary artery disease. 989 17

CAD is the most common cause of death in older men and was present in 44% of 664 men, mean age 80 years. Independent risk factors for new coronary events in older men include increasing age, prior CAD, cigarette smoking, hypertension, diabetes mellitus, high serum total cholesterol, and low serum HDL cholesterol. In older men with hypertension, echocardiographic LVH is a powerful independent predictor of new coronary events, atherothrombotic brain infarction, and CHF. In 554 older men with a mean age of 80 years, two-dimensional and Doppler echocardiography demonstrated that the prevalence of aortic stenosis was 14%, 1 + aortic regurgitation or greater was 31%, rheumatic mitral stenosis was 0.4, 1 mitral regurgitation or greater was 32%, mitral annular calcium was 35%, hypertrophic cardiomyopathy was 3%, idiopathic dilated cardiomyopathy was 1%, left atrial enlargement was 29%, LVH was 41%, and abnormal LVEF was 29%. The prevalence and incidence of CHF increase with age in older persons. The prevalence of a normal LVEF associated with CHF as a result of prior myocardial infarction or hypertension was 22% in men aged 60 to 69 years, 33% in men aged 70 to 79 years, 41% in men aged 80 to 89 years, and 47% in men aged 90 years or older.
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PMID:The older man's heart and heart disease. 1050 66


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