Lack of Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography

Aim. Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. Methods. The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. Results. There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. Conclusion. The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.

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The Relationship between Inter-Arm Blood Pressure Difference and Coronary Artery Disease Severity Calculated by the SYNTAX Score

International Journal of Hypertension ◽

10.1155/2018/9370417 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Gündüz Durmuş ◽

Erdal Belen ◽

Akif Bayyigit ◽

Muhsin Kalyoncuoğlu ◽

Mehmet Mustafa Can

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Pressure Difference ◽

Syntax Score ◽

Pressure Measurements ◽

Blood Pressure Difference ◽

Artery Disease ◽

The Relationship

Objectives. The inter-arm systolic blood pressure difference (IASBPD) is closely related to cardiovascular mortality and morbidity. The SYNTAX score indicates the extent and complexity of coronary artery disease, which are determined by coronary angiography. The aim of our study is to examine the relationship between the IASBPD (which is easily calculated in routine practice) and the SYNTAX score. Methods. 104 patients were included in this cross-sectional study. The IASBPD was calculated by blood pressure measurements obtained simultaneously from both arms. The SYNTAX score was calculated by coronary angiography. Results. Patients were divided into two groups: those with a high SYNTAX score (≥20) and those with a low SYNTAX score (<20). The mean IASBPD values were significantly higher in the group with a high SYNTAX score (≥20) (p<0.001). The patients with IASBPD≥10 were more likely to have a high SYNTAX score compared to the patients with IASBPD<10 (p<0.001). Multiple logistic regression analysis revealed that only the IASBPD values were found to be independently associated with high SYNTAX score (OR: 1.717 (CI: 1.307-2.257), p<0.001). Conclusion. The IASBPD values obtained by only blood pressure measurements are closely related to the extent of coronary artery disease.

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Prognostic Significance of Targeted Magnetic Resonance Coronary Angiography to Predict Cardiac Events in Patients with Known or Suspected Coronary Artery Disease

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.10.13164 ◽

2021 ◽

Vol 104 (10) ◽

pp. 1711-1721

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Magnetic Resonance ◽

Coronary Angiography ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Cardiac Events ◽

Significant Coronary Artery Stenosis ◽

Magnetic Resonance Coronary Angiography ◽

Artery Disease

Background: Magnetic resonance coronary angiography (MRCA) is one of the most promising tools for noninvasive imaging of coronary arteries without radiation exposure or contrast media administration. However, knowledge about the prognostic value of MRCA is limited. Materials and Methods: The present study included 389 patients with known or suspected coronary artery disease (CAD) underwent clinical cardiac magnetic resonance (CMR) including MRCA imaging. The presence of a significant coronary artery stenosis was defined by visual estimation of ≥50% diameter reduction using targeted MRCA images. Patients were followed up for hard cardiac events (cardiac death or non-fatal myocardial infarction) and major adverse cardiac events (MACE) which also included hospitalization for heart failure and late revascularization (>180 days after the CMR study). Results: The average age was 68±11 years and 48% were male. One hundred and thirty-nine patients had significant stenosis on MRCA. During a median follow-up period of 53.9 months, 23 hard cardiac events and 52 MACE, occurred. Patients with significant coronary artery stenosis had higher rates of hard cardiac events (annual event rate 3.12% versus 0.56%, HR 5.52, 95% CI 2.17 to 14.01, p<0.001) and MACE (annual event rate 6.44% versus 1.83%, HR 3.49, 95% CI 1.98 to 6.14, p<0.001) than those without significant stenosis. Multivariable analyses identified significant coronary artery stenosis as an independent predictor of hard cardiac events (HR 3.35, 95% CI 1.13 to 9.96, p=0.03) and MACE (HR 2.00, 95% CI 1.02 to 3.90, p=0.04). MRCA presented an incremental prognostic value over clinical factors, left ventricular ejection fraction, and myocardial scarring to predict hard cardiac events (p=0.03). Conclusion: Targeted MRCA demonstrated independent and incremental prognostic values to predict future cardiac events in patients with known or suspected CAD. Keywords: Cardiac magnetic resonance imaging; Coronary artery disease; Magnetic resonance coronary angiography; Prognosis

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Diagnostic Value of C-Reactive Protein in Patients with Angiographically Documented Coronary Heart Disease

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2019.73 ◽

2002 ◽

Vol 45 (4) ◽

pp. 155-160 ◽

Cited By ~ 1

Author(s):

Esin Eren ◽

Necat Yılmaz ◽

Sadrettin Pençe ◽

Hasan Koçoğlu ◽

Sıtkı Göksu ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Artery Stenosis ◽

Diagnostic Value ◽

Artery Stenosis ◽

Control Group ◽

C Reactive Protein ◽

Reactive Protein ◽

Artery Disease

Aim: The aim of this study was to evaluate the diagnostic value of serum C-reactive protein (CRP) level measurement in predicting coronary artery disease (CAD) that can be shown angiographically. Methods: CRP levels were determined in the blood of 198 patients (patients group, PG) with angiographically documented coronary artery disease and compared with that of 85 patients (control group, CG) who had a clinical indication for coronary angiography but have no angiographically determined coronary artery stenosis, as well as with that of 41 healthy volunteers as a healthy control group (HG) who did not have any complaint and did not have coronary angiography. CRP levels were measured 24 hours prior to angiography in PG and CG patients, and in the morning after not having eaten for same time. Any coronary artery stenosis or plaque formation was defined as CAD. Severity of the disease was assessed by both the number of diseased vessels (0 to 3) and the degree of stenosis (<50 % mild, 50–70 % moderate and >70 % severe). Results: Receiver Operating Characteristics (ROC) curves of CRP in angiographically documented CAD group showed a diagnostic value of 0.659 in female patients, followed by 0.542 in male patients, in predicting CAD. CRP levels were found to be significantly different between groups, higher in PG (6.2 ± 0.86 mg/L) than those of CG (3.7 ± 0.92 mg/L) and HG (0.854 ± 0.2 mg/L) (p<0.05). CRP levels were not associated with the number of diseased vessels, neither with the degree of the occlusion (p>0.05). Multiple logistic regression analysis after adjustment for the established coronary risk factors showed CRP as an independent discriminating risk factor for CAD. Conclusion: It is concluded that CRP measurement has a value in predicting the presence of angiographically documented CAD. However, CRP levels were not associated with the degree or severity of CAD.

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Elevated Interarm Systolic Blood Pressure Difference Is Positively Associated with Increased Likelihood of Coronary Artery Disease

International Journal of Hypertension ◽

10.1155/2021/5577957 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Min Li ◽

Fangfang Fan ◽

Yan Zhang ◽

Wei Ma ◽

Yong Huo

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Systolic Blood Pressure ◽

Pressure Difference ◽

Normal Group ◽

High Group ◽

Blood Pressure Difference ◽

Artery Disease

Background. Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We investigated the relationship between interarm systolic blood pressure difference and coronary artery disease. Methods. We retrospectively analyzed data for patients undergoing coronary angiography and brachial-ankle pulse wave velocity examination during hospitalization from 2013 to 2018. Patients underwent simultaneous upper arm blood pressure measurement. Interarm systolic blood pressure difference (IASBPD) was defined as the absolute value of the difference between the right and left upper limb systolic blood pressure. Patients with IASBPD ≥10 mmHg constituted the high group, and those with IASBPD <10 mmHg constituted the normal group. We also recorded data for cardiovascular risk factors. Coronary artery disease was defined as ≥50% vessel stenosis or having undergone interventional therapy according to coronary angiography results. Results. Compared with the normal group, the number of patients with coronary artery disease was higher in the high group (86.1% vs. 74.6%, P = 0.029 ). Multiple logistic regression showed that IASBPD ≥10 mmHg were positively correlated with coronary artery disease (odds ratio, 2.313; 95% confidence interval, 1.086–4.509; P = 0.029 ), and as the IASBPD value increased, the correlation also gradually increased. Conclusions. IASBPD ≥10 mmHg was positively related to coronary artery disease and increased IASBPD values were correlated with coronary artery disease severity.

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The Correlation between Polymorphism of β Fibrinogen Gene -455 G/A and Serum Fibrinogen Level with The Severity of Coronary Artery Stenosis In Coronary Artery Disease Patient

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v18i2.40711 ◽

2019 ◽

Vol 18 (2) ◽

pp. 379-384

Author(s):

Taufik Indrajaya ◽

Yudhi Fadilah ◽

Mediarty Yuwono ◽

Ali Ghanie

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Stenosis ◽

Fibrinogen Level ◽

Coronary Artery Stenosis ◽

Disease Patient ◽

Artery Stenosis ◽

Gensini Score ◽

Artery Disease

Background: Now a days coronary artery disease (CAD) becomes major cause of death. One among 7 deaths in America caused by CAD. CAD is an atherosclerosis process, which progresively develops into plaque that will lead to stenosis of coronary artery lumen. Several studies found that high serum fibrinogen level is an independent and significant to the severity of artery coronary stenosis. Serum fibrinogen level determined by genetic factor. Polymorphism of fibrinogen gene β -455 G/A seem plays an important role in plasma fibrinogen level. Although some studies showed a significant correlation between polymorphism and cardiovascular diseases, but some other studies report inversely. Aim. To evaluate the correlation between the polymorphism of fibrinogen gene β -455 G/A and serum fibrinogen level with the severity of artery coronary stenosis. Method: This is an analytic correlative study with prospective approach without comparison. Coronary angiography was performed in catheterization labor in the department of internal medicine, while DNA analysis and PCR done in the department of microbiology in General Hospital dr Muhammad Husin Palembang- Indonesioa, since July 2015 until Agustus 2016. Samples are CAD patient who undergo for coronary angiography and fulfield the criterias. The severity of stenosis in coronary artery determined by Gensini score. This study included 31 patient. Results. Among 31 CAD patients, this study found severe stenosis of coronary artery in 17 patients (53,1%), moderate in 5 patients (15,6%) and mild in 10 patients (31,2%). Genetic analysis showed that serum fibrinogen level was controlled by polymorphism of fibrinogen gene β -455 G/A, concecutively by genotipe AA in 15 patients (48,4%), genotipe GA in 12 patient (38,7%) and by genotipe GG in 4 patients (12,9%). Chi Square test showed a significant correlation between polymorphism gene fibrinogen β -455 G/A and serum fibrinogen level (p=0,039). Spearman’s rho test found no significant correlation between serum fibrinogen level and severity of coronary artery stenosis based on Gensini score (r=0,142; p=0,447). And also this study found no significant correlation between polymorphism gene fibrinogen β -455 G/A with the severity of stenosis in coronary artery (p=0,512). Conclusion. Although this study succeded to prove that serum fibrinogen level was determined by polymorphism fibrinogen gene β -455 G/A, but there are no significant correlations between polymorphism fibrinogen gene β -455 G/A and serum fibrinogen level with severity of coronary artery stenosis in CAD patients. This study suggest to study other candidate gene to look for other cardiac risk beside this fibrinogen. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.379-384

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Abstract 4508: Endothelial Dysfunction is Associated with Coronary Lesion Complexity in Patients with Coronary Artery Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_903-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Yasushi Matsuzawa ◽

Seigo Sugiyama ◽

Hitoshi Sumida ◽

Koichi Sugamura ◽

Toshimitsu Nozaki ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Endothelial Dysfunction ◽

Coronary Angiography ◽

Coronary Artery Stenosis ◽

Coronary Plaque ◽

Artery Stenosis ◽

Control Group ◽

Coronary Lesions ◽

Artery Disease

Endothelial dysfunction is an important step in the atherosclerosis progression, and associates with future cardiovascular events. Reactive hyperemia peripheral arterial tonometry (RH-PAT) is a noninvasive, automatic, and objective tool to evaluate endothelial dysfunction. Angiographic complex coronary lesions are involved in plaque vulnerability. We investigated whether finger values of RH-PAT could correlate with angiographic coronary plaque complexity in patients with coronary artery disease (CAD). RH-PAT was measured using Endo-PAT2000 in 171 patients who were referred to Kumamoto University Hospital for cardiac catheterization. We defined the two group as below, Control group; coronary artery stenosis > 25% (n = 36, age 63 ± 11, male 25 %), and CAD group; coronary artery stenosis > 25 % (n = 135, age 68 ± 11, male 74 %). Coronary lesions (single-vessel; n = 29, multi-vessel disease; n = 106) were classified as of simple appearance (n = 43) or complex appearance (n = 92) by coronary angiography. Values of RH-PAT were significantly lower in patients with CAD than Control (1.65 [1.50 – 1.86] versus 1.92 [1.80 – 2.28], P < 0.01), and were significantly lower in CAD patients with complex coronary appearance than patients with simple coronary appearance (1.55 [1.45 – 1.76] versus 1.81 [1.66 – 1.95], P < 0.01). All patients underwent selective coronary angiography, and the extent of coronary stenosis was assessed using the scoring system. RH-PAT was significantly correlated with coronary plaque Extent Score (Rs = −0.33, P < 0.01). Single logistic regression analysis demonstrated that high-density lipoprotein cholesterol, triglycerides, and RH-PAT value significantly associated with the presence of complex coronary lesions, and multivariable analysis including cardiovascular risk factors identified that lower RH-PAT value was the only factor associated with the complex coronary lesions (odds ratio 1.45, 95% confidence interval 1.14 – 1.84; P < 0.01). Endothelial dysfunction was significantly associated with angiographic complex appearance of coronary plaques in patients with CAD. CAD patients with lower RH-PAT values might be vulnerable patients with vulnerable plaques and vulnerable endothelium.

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Inter Arm Blood Pressure Difference in Patients Undergoing Coronary Angiography and Its Relationship to Coronary Artery Disease Complexity

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/607 ◽

2020 ◽

Vol 7 (49) ◽

pp. 2968-2973

Author(s):

Cibu Mathew ◽

Shilpa Kannamkumarath ◽

Sajna Mathumkunnath Vijayan ◽

Karunadas Prabhakaran Chakkalakal

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Pressure Difference ◽

Lower Score ◽

Syntax Score ◽

Chi Square ◽

Blood Pressure Difference ◽

Artery Disease

BACKGROUND Blood pressure (BP) in the right and left arms can be different. This inter arm difference (IAD) in BP can be systolic (IAD - SBP) and / or diastolic (IAD - DBP). IAD of ≥ 10 mm of Hg is considered significant. SYNTAX score is used to assess the complexity of coronary artery lesions. Prevalence of IAD in patients undergoing coronary angiography (CAG) and its relationship to complexity of coronary artery disease is unclear. METHODS In 100 patients taken up for CAG, BP was recorded in both the arms simultaneously with automated devices using oscillometric method. Significant IAD was defined as ≥ 10 mm of Hg. Using SYNTAX score, patients were divided into two groups; those with a lower score < 22 and those with a higher score ≥ 22. Data was analysed using SPSS version 16. Mean difference of the variables was analysed using Independent t test. Association of interarm BP difference and high SYNTAX score was analysed using Chi Square test. RESULTS Significant IAD of ≥ 10 mm of Hg was noted in 16 out of 100 patients. SYNTAX score of ≥ 22 was seen in 30 patients. IAD - SBP ≥ 10 was noted in 23.3 % in patients with higher SYNTAX score as against 2.9 % in those with lower score (p 0.001). IAD - DBP ≥ 10 was seen in 20 % of patients with higher SYNTAX score as against 1.4 % in those with lower SYNTAX score (p 0.001). CONCLUSIONS Interarm blood pressure difference of ≥ 10 mm of Hg is seen in 16 % of cases taken up for coronary angiogram. Patients with IAD ≥ 10 mm of Hg had higher SYNTAX score of ≥ 22 suggesting more complex coronary artery disease. KEYWORDS Interarm Blood Pressure Difference, SYNTAX Score

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