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)

This review is concerned with qualitative and quantitative sectorial 201Tl-redistribution analysis of exercise myocardial scintigraphy (EMS). In 3092 cases the sensitivity (specificity) was on average 83 (90) %, the average CAD prevalence being 71%. Sensitivity (Se) for EMS (ExECG) increased from 73 (43) % in single vessel disease through 83 (69) % in double vessel to 90(77) % in triple vessel disease (n = 879); average Se was 77% for LAD-, 79% for RCA- and 65% for LCX-stenosis. Se for detection of the real extension of CAD conversely decreased from 59% in SVD through 41% in DVD down to 33% in TVD. Clinical recommendations for EMS and rest scans are outlined in CAD (atypical angina, follow-up after bypass-surgery, percutaneous transluminal angioplasty), in non-coronary artery disease (non-ischemic cardiomyopathies, right ventricular hypertrophy) and in pediatric cardiology.
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PMID:201Tl-myocardial scintigraphy: current status in coronary artery disease, results of sensitivity/specificity in 3092 patients and clinical recommendations. 645 85

This paper considers the literature on factors found to be associated with angina and pseudoangina, and attempts to delineate those psychosocial characteristics that might distinguish angina patients from either nonanginal CAD patients or from non-CAD normals. A cluster of characteristics emerges from both retrospective and prospective studies suggesting greater affective lability, "neuroticism," and perhaps physiologic reactivity than in either comparison group. The literature also suggests that learning and suggestion may play important roles in generating specific precipitants for anginal attacks. The literature on psychosocial intervention in anginal syndromes is almost entirely anecdotal, allowing few firm conclusions to be drawn, but suggesting the possible efficacy of certain behavioral, didactic, and supportive-psychodynamic interventions.
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PMID:Psychotherapeutic intervention in angina: I. A critical review. 648 43

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

We obtained myocardial imaging with Tl during pharmacologic interventions. Dipyridamole-loading myocardial imaging was performed in 38 patients with CAD. The diagnostic accuracy of this method was 66%. The combination of dipyridamole-loading and exercise stress myocardial imaging increased the diagnostic sensitivity of CAD from 71% (exercise stress imaging only) to 87%. In addition, dipyridamole-loading myocardial imaging was useful for the diagnosis of CAD in patients who could not perform exercise stress test. Chest pain and ST-segment depression were induced less often during dipyridamole administration than exercise stress test. Animal experiments showed that dipyridamole caused abnormalities in myocardial blood flow and myocardial Tl uptake distal to the critical coronary stenosis. And dipyridamole increased myocardial blood flow by 142% and myocardial Tl concentration by 62% in the normally perfused myocardial segments. Ergonovine-loading myocardial imaging was performed in 8 patients with resting angina and without significant coronary stenosis. And in all of them, ergonovine induced cold-spots on myocardial imaging with or without chest pain and ST-segment shift. Ergonovine-loading myocardial imaging was useful for the diagnosis of angina induced by coronary artery spasm. The combination of initial and delayed resting myocardial imaging was useful to differentiate the underperfused but viable myocardium from the scar. And by comparing with radionuclide angiography obtained before and after NTG administration, NTG-loading myocardial imaging and ECG findings in 20 patients with CAD, we demonstrated that the transient defective myocardial segments were underperfused but viable.
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PMID:Noninvasive detection of coronary artery disease by myocardial imaging with thallium-201--the significance of pharmacologic interventions. 677 29

In this study, 87 consecutive patients with angiographically proven coronary artery disease (CAD, stenosis greater than 75%) underwent 24-h Holter monitoring, 76 of them having had transmural myocardial infarction, a mean of five months before evaluation. Of the total, 51 patients showed single-vessel disease, in 31 (61%) of them with involvement of the left anterior descending (LAD) artery. In 26 patients with proximal LAD stenosis or occlusion and usually large aneurysms and subsequently impaired left ventricular function relatively low prevalence of significant ventricular premature contraction (VPC, Lown greater than or equal to III) was seen. On the contrary in 19 patients with multivessel disease and proximal LAD stenosis advanced forms of VPCs were present in 63% (p less than 0.01). Further both groups differed significantly in the frequency of postinfarction angina (30% vs. 100%; p less than 0.001) and their incidence in positive exercise stress tests (15% vs. 84%; p less than 0.001). Ejection fractions were comparable in both groups (mean 45% vs. 52%). Finally 17 patients with multivessel disease but without proximal LAD lesion did not differ in any of the above mentioned parameters, when compared to the patients with single-vessel disease and proximal LAD stenosis. We conclude that impaired left ventricular function does not sufficiently explain the high risk of sudden death in postmyocardial infarction patients. The coronary and functional status of the surviving myocardium has to be taken into consideration as well.
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PMID:Proximal left anterior descending coronary heart disease and complex ventricular arrhythmias. 683 88

To evaluate the duration of favourable effects of coronary artery bypass (CAB) on exercise-induced angina (A), 58 patients: 13 with single 21 with double and 24 with triple vessel disease, were studied. All patients underwent CAB for stable angina on effort. Patients underwent exercise testing (ET) before surgery at one, two and three years. Heart rate peak (HR), HR x systolic blood pressure peak (DP), work load (W), exercise-induced ST segment depression (ST) and incidence of A were evaluated; the results of ET before surgery were compared with those found after CAB. Our findings show that HR, DP, W and ST were significantly improved by surgery for at least 3 years. The lowest incidence of A was found at one year ET (20.6%), while it increased at two years (27,5%) and three years ET (37.9%). Most patients with A had angiographic evidence of left ventricular abnormal wall motion and ec-graphic signs of previous myocardial infarction. Our data indicate that serial exercise testing can objectively monitor the results of CAB. Most patients show an improved exercise tolerance for up to 3 years after CAB. Some patients, with more extensive CAD, showed a progressive deterioration of the clinical pattern and a decrease of the exercise tolerance.
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PMID:[Serial evaluation by effort test of the effects of coronary artery bypass on effort angina (author's transl)]. 698 Aug

Visualization of the lumen of the coronary arteries by angiography has greatly expanded the ability of the physician to evaluate the extent of disease in patients suspected of having an ischaemic cardiac disorder. Criteria for coronary angiography have been developed in part by reviewing the experience in the Coronary Artery Surgery Study, CASS. During a five year period at 15 participating sites 24959 consecutive patients undergoing angiography for suspicion of coronary artery disease were enrolled. Chest pain was the dominant symptom in more than 80%. Unstable angina occurred in more than 1/3 of patients classified as definite or probably angina pectoris. The majority of patients were in Canadian Class 2,3. In a study previous reported by CASS a mortality of 002 and a morbidity (myocardial infarction) of 003 was found; presence of left main disease increased mortality 6.8 times. In males, 79% had significant and 12% no CAD; left main disease occurred in 9%. In females 45% had significant and 40% no CAD; left main disease occurred in 4%. The distribution of 1,2 and 3 vessel disease will be presented. From these data and a survey of clinical experience during the past several years, 10 indications for visualization of the coronary artery anatomy by angiography have been developed. These indications are presented for discussion.
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PMID:[Indications for coronary arteriography]. 706 86

In view of the fact that stable echocardiograms are easily obtained during atrial pacing, pacing echocardiography was performed to evaluate the usefulness for detecting regional wall motion abnormalities during pacing-induced ischemia and to investigate the relationship between changes in the R wave and left ventricular dimension. The patients were 12 cases of angina pectoris (10 of coronary artery disease; CAD, and 2 of coronary patent aortic valvular disease; AVD) and 6 control cases. Simultaneous recording of two-dimensional and M-mode echocardiograms and electrocardiograms was done before, during and after the atrial pacing at increasing heart rate until angina appeared or the heart rate of at least 140/min was reached. In 12 angina cases, angina and ST depression were induced in 10 and 11, respectively. Excursion of the interventricular septum (IVS) decreased during pacing-induced ischemia in 6 of 7 CAD cases, in which the left anterior descending coronary artery was significantly stenosed (more than 75%). Excursion of the left ventricular posterior wall (LVPW) decreased during pacing-induced ischemia in 4 of 7 CAD cases, in which the vessels giving rise to posterior descending coronary artery were significantly stenosed (more than 75%). In 2 AVD cases, excursion of both IVS and LVPW decreased during ischemia. Left ventricular end-diastolic dimension (LVEDD) increased in only 2 angina cases, although R wave amplitude increased in 6 angina cases.
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PMID:Pacing echocardiography: regional wall motion, left ventricular dimension and R wave amplitude in patients with angina pectoris. 708 87

A clinical evaluation of the dipyridamole in the myocardial perfusional scintigraphy (MPS) was carried out in a series of patients, comprehensive of cases of unstable angina, aiming to assess the feasibility and diagnostic validity of the test and to state its possible role in comparison with exercise stress test. On the whole, 107 subjects were examined (34 with stable angina, 23 with unstable angina, 19 with recent myocardial infarction, 15 with atypical angina, 10 with chest pain of uncertain origin and 6 healthy volunteers), performing 108 scintigraphic studies (48 after dipyridamole infusion and 37 after bicycle exercise). In the studies with physical or pharmacologic stress a redistribution scintigraphy was also performed (4 hour after the injection). The dipyridamole stress test was well tolerated by patients with unstable angina too and showed a diagnostic sensitivity equivalent to that with exercise stress, although the latter appears better as regards image quality and can give an increase of sensitivity provided electrocardiographic findings are evaluated. Post-stress redistribution of 201 Tl in delayed scans was shown either after dipyridamole or after exercise in patients with typical angina without prior infarction. The computation, by the Bayes's theorem, of the predictive value of the two tests leads the Authors to the following conclusions: in atypical angina (prevalence of CAD: about 40%) the association MPS + exercise ECG is preferable; in patients with chest pain of uncertain origin or with asymptomatic electrocardiographic alterations (prevalence of CAD: about 15%) it is better to take into account only the scintigraphic findings obtained after exercise or pharmacologic stress, to avoid an excess of false positive results.
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PMID:[Clinical usefulness of thallium-201 myocardial scintigraphy with dipyridamole pharmacodynamic test in ischemic heart disease (author's transl)]. 723 8

The literature about pathological septal motion in coronary artery disease is contradictory. Purpose of this study was to reveal the sensitivity and specificity of the echocardiography for diagnosis of stenoses and occlusions (S/O) of the left anterior descending artery (LAD). 50 patients with CAD were studied using coronary angiography and echocardiography. In 32 of the cases a critical stenosis (over 70% narrowing) of the LAD was present. History of old infarction was found in 80% of the patients. Angina pectoris was absent at the time of the investigation. It was proven that the sensitivity of the echocardiography for the diagnosis of coronary stenoses and for proximal and peripheral LAD-S/O is not high (44%-61%). 50 percent of all LAD-S/O and 61% of the proximal LAD-S/O have a pathological septal movement. In presence of a pathological septal motion, however, it may be concluded that there is a critical stenosis in one or more of the three main coronary arteries (predictive value 91%). The diagnosis of the localization of the occlusion by echocardiography is not possible. 1/3 of peripheral LAD-S/O also lead to a dyscinetic septum which mostly is found in proximal LAD-S/O. The number of false positive (pathological) echocardiographic septal dyscinetic motion is low (12%). The sensitivity of echocardiographic method for diagnose of coronary alteration is increased when using the differentiation between stenosis and occlusion of LAD. By that it can be revealed that full occlusions of the LAD lead in 80% to septal dyscinetic motion, whereas stenoses are only rarely combined with pathological septum (36%). It is concluded that not only the localization but predominantly the degree of the vessel-narrowing influences the septal movement. Perhaps these findings may help to declare the contradictory results in literature.
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PMID:[Echocardiographic septal motion in 50 patients with coronary artery disease. A correlative study with coronary angiographic findings (author's transl)]. 726 24


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