The Relationship of Metabolic Syndrome with Stress, Coronary Heart Disease and Pulmonary Function--An Occupational Cohort-Based Study.

BACKGROUND AND AIMS: Higher levels of stress impact the prevalence of metabolic syndrome (MetS) and coronary heart disease. The association between MetS, impaired pulmonary function and low level of physical activity is still pending assessment in the subjects exposed to stress. The study aimed to examine whether higher levels of stress might be related to MetS and the plaque presence, as well as whether MetS might affect pulmonary function. DESIGN AND METHODS: The study embraced 235 police officers (mean age 40.97 years) from the south of Poland. The anthropometrics and biochemical variables were measured; MetS was diagnosed using the International Diabetes Federation criteria. Computed tomography coronary angiography of coronary arteries, exercise ECG, measurements of brachial flow-mediated dilation, and carotid artery intima-media thickness were completed. In order to measure the self-perception of stress, 10-item Perceived Stress Scale (PSS-10) was applied. Pulmonary function and physical activity levels were also addressed. Multivariate logistic regression analyses were applied to determine the relationships between: 1/ incidence of coronary plaque and MetS per se, MetS components and the number of classical cardiovascular risk factors, 2/ perceived stress and MetS, 3/ MetS and pulmonary function parameters. RESULTS: Coronary artery atherosclerosis was less associated with MetS (OR = 2.62, 95%CI 1.24-5.52; p = 0.011) than with a co-existence of classical cardiovascular risk factors (OR = 5.67, 95% CI 1.07-29.85, p = 0.03; for 3 risk factors and OR = 9.05; 95% CI 1.24-66.23, p = 0.02; for 6 risk factors, respectively). Perceived stress increased MetS prevalence (OR = 1.07, 95% CI 1.03-1.13; p = 0.03), and impacted coronary plaque prevalence (OR = 1.05, 95% CI 1.001-1.10; p = 0.04). Leisure-time physical activity reduced the chances of developing MetS (OR = 0.98 95% CI 0.96-0.99; p = 0.02). MetS subjects had significantly lower values of certain pulmonary function parameters. CONCLUSIONS: Exposure to job-specific stress among police officers increased the prevalence of MetS and impacted coronary plaque presence. MetS subjects had worse pulmonary function parameters. Early-stage, comprehensive therapeutic intervention may reduce overall risk of cardiovascular events and prevent pulmonary function impairment in this specific occupational population.

Anomalous origin of the coronary artery from the wrong coronary sinus evaluated with computed tomography: "high-risk" anatomy and its clinical relevance.

OBJECTIVE: The aim of the study was to assess coronary arteries arising from the wrong coronary sinus, including CT-evaluated high-risk anatomic features, clinical symptoms and cardiac events during follow-up. METHODS: A total of 7,115 patients scheduled for 64-slice or dual-source cardiac CT were screened for the presence of isolated anomalous origin of the coronary artery from the wrong coronary sinus. RESULTS: Anomalous origin of the coronary artery was found in 54 (0.76 %) patients (29 men, 25 women, mean age 60.9 ± 11.6 years). Sixteen (30 %) patients with abnormal right coronary origin (ARCA) more commonly had a slit-like orifice (15 vs. 3; p < 0.001), intramural course (15 vs. 3; p < 0.001) and interarterial course (11 vs. 0; p < 0.001) than 22 (41 %) and 13 (24 %) individuals with abnormal circumflex artery (ALCx) and left coronary artery (ALCA) origin, respectively. Patients with ALCA presented less frequently with chest pain than subjects with ARCA and ALCx (25 vs. 3; p = 0.03). Patients with ARCA tended to show higher occurrence of cardiac events in the follow-up than individuals with ALCA and ALCx (5 vs. 4; p = NS). CONCLUSIONS: High-risk anatomy features are most common in patients with ARCA and these patients also have higher prevalence of chest pain and cardiac events in the follow-up than individuals with ALCA and ALCx. KEY POINTS: • Multislice computed tomography enables detection and evaluation of the coronary artery anomalies. • Anomalous anatomy of the coronary artery potentially influences the prevalence of adverse events. • Adverse events tend to be most common in anomalous right coronary arteries.

Computed tomography characteristics of coronary artery atherosclerosis in subjects with lower extremity peripheral artery disease and no cardiac symptoms.

INTRODUCTION:  Computed tomography coronary angiography (CTCA) enables noninvasive evaluation of coronary artery atherosclerosis. However, its value to assess coronary artery disease (CAD) in subjects with lower­extremity peripheral artery disease (PAD) and no cardiac symptoms is unknown. Moreover, the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in this group of patients was not sufficiently elucidated. OBJECTIVES:  The aim of the study was to determine the value of CTCA to assess coronary artery atherosclerosis and to evaluate the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in subjects with lower­extremity PAD and no cardiac symptoms. PATIENTS AND METHODS:  Sixty­five individuals (45 men, 20 women, mean age, 62.5 ±7.6 years) with lower­extremity PAD and no cardiac symptoms underwent CTCA. RESULTS:  CTCA revealed CAD in 56 subjects. Twenty­two had obstructive CAD. The mean ankle-brachial index (ABI) was 0.64 ±0.16. Twenty­six individuals demonstrated abnormal carotid artery intima-media thickness (IMT). ABI lower than median, if compared with ABI equal of higher than median, was associated with a higher proportion of obstructive multivessel to single vessel CAD (8:4 vs. 1:9; P = 0.01) and higher number of coronary artery segments with mixed plaques (2.3 ±2.2 vs. 1.2 ±1.3; P = 0.02). Comparing patients with abnormal and normal IMT, the former demonstrated higher proportion of obstructive multivessel to single-vessel CAD (7:3 vs. 2:10; P = 0.01) and higher number of coronary artery segments with noncalcified (1.9 ±3.2 vs. 0.6 ±1.4; P = 0.04) and mixed plaques (2.3 ±2.1 vs. 1.3 ±1.7; P = 0.049). CONCLUSIONS:  CTCA may be effective to detect CAD in subjects with lower­extremity PAD and no cardiac symptoms. The low ABI and abnormal IMT are associated with more extensive CAD and higher burden of high­risk coronary artery plaques.

[Cystic lesion in the topography of occluded aortocoronary saphenous vein bypass]. / Zmiana torbielowata w topografii niedroinego, zylnego pomostu aortalno-wiencowego.

Article presents a case of a 66-year old manwith a pericardial cyst, localized in tlhe topography of an occluded aorto-ccoronary saphenous vein graft. The lesion was revealed in computed tomogrnaphy and also evaluated in the subsequently performed magnetic resonance.

[Anomalous right upper pulmonary venous drainage into the superior vena cava with coexistence sinus venosus atrial septal defect (ASD)]. / Nieprawidlowy splyw zyly plucnej górnej prawej do zyly glównej górnej wraz ze wspólistniejacym ubytkiem w przegrodzie miedzyprzedsionkowej o typie zatoki zylnej (ASD).

Article presents a case of a 71-year old woman with pulmonary right upper venous drainage into the superior vena cava and with coexistence sinus venous type Atrial Septal Defect (ASD) which was revealed as interesting finding in multislices computed tomography angiography during estimation of coronary arteries.

[Physical activity and subclinical coronary atherosclerosis in asymptomatic middle-aged men]. / Aktywnosc fizyczna a subkliniczna miazdzyca tetnic wiencowych u bezobjawowych mezczyzn w wieku srednim.

INTRODUCTION: Few studies have examined the effect of physical activity (PA) on subclinical atherosclerosis. Those that have been conducted were not based on longitudinal observation of lifestyle and objective measures of cardiorespiratory fitness. AIM: The aim of the study was to assess the influence of PA level on subclinical atherosclerosis in a long-term prospective observation (mean 17.9 +/- 4.21 years) of asymptomatic middle aged-men. METHODS: We studied 27 men with stable high PA level (mean age 57.1 +/- 6.6 years) and 27 pair matched controls with sedentary lifestyle (mean age 56.1 +/- 6.6 years). PA level was assessed by detailed questionnaire based on the CINDI Health Monitor Questionnaire. Objective measurements of aerobic capacity was evaluated by exercise tests. Subclinical atherosclerosis was measured by assessing coronary calcification score (CCS) according to Agatston's method by means of the multi-slice computed tomography. RESULTS: Mean CCS was significantly lower among highly active men than among sedentary controls (28.3 +/- 70.6 vs 211.4 +/- 344.9; respectively, p<0.02). Active men had also more often CCS=0 (15 vs 7 persons). Not even one case of advanced calcification (CCS > 400) was noted among active men. Additional analysis of the active men group revealed that persons with CCS=0 had significantly higher energy expenditure, PA volume and better aerobic capacity as compared to other active men, but with CCS>0. CONCLUSIONS: Long-term high PA may be associated with a lower risk of developing subclinical atherosclerosis in asymptomatic middle-aged men.

The use of a novel type of distal protection system (FiberNet®) in the percutaneous management of saphenous vein graft disease.

Percutaneous intervention in saphenous vein grafts is associated with a high risk of distal embolisation by plaque material, 'no flow' phenomenon and clinical complications such as myocardial infarction or death. According to randomised trial evidence, intervention in a degenerated vein graft should be performed using an embolic protection device (EPD), since this strategy significantly reduces periprocedural and 30 day adverse event rate. FiberNet® is a novel distal protection system with unique characteristics of a low crossing profile (0.031'' for vessel size 3.5-5 mm), 'cotton wool'-like three dimensional design and a small pore size (40 µm). The FiberNet® does not require a separate delivery sheath and self-achieves its optimal apposition to the vessel wall; the EPD system also contains a dedicated aspiration catheter. We present the use of FiberNet® in a 77 year-old patient who had undergone coronary artery bypass grafting 20 years ago and currently presented with CCS class III angina due to a significant stenosis of the saphenous vein graft to the marginal branch. The procedure involved the use of a novel mesh-covered stent (MGuard®) designed to 'trap' the plaque material between the stent and the vessel wall. It was technically successful and clinically uncomplicated, and the patient remains well six months later.

[Assessment of coronary artery stents in computed tomography: state of the art]. / Ocena stentów tetnic wiencowych w tomografii komputerowej: stan obecny.

Percutaneous coronary interventions (PCI) with stent implantation play an important role in the revascularization therapy of coronary artery disease. Introduction of drug eluting stents (DES) diminished problem of restenosis but brought several new major problems like i.e. late stent thrombosis. This makes bare metal stents (BMS) still popular choice for some patients. Coronary-artery-computed-tomography becomes useful device in the noninvasive diagnostics measure of restenosis after PCI. Development of 64-slice computed tomography (CT) enables the noninvasive imaging and evaluation of stents with diameter higher than 3,0 mm and detection of significant restenosis with a low number of false positive results. CT allows with high accuracy to exclude in-stent restenosis among patients with atypical angina, especially those localized in proximal segments of coronary arteries. Future development of CT is needful since evaluation of significant number of examinations remains difficult or impossible due to presence of artifacts.