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John A Spertus - One of the best experts on this subject based on the ideXlab platform.
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low diastolic blood pressure is associated with angina in patients with chronic coronary artery disease
Journal of the American College of Cardiology, 2018Co-Authors: Poghni A Periokonny, John A Spertus, Krishna Patel, Philip G Jones, Tracie Breeding, Kensey Gosch, Suzanne V ArnoldAbstract:Abstract Background In patients with coronary artery disease (CAD), low diastolic blood pressure (DBP) is associated with increased risk of myocardial infarction, but its association with angina is unknown. Objectives The goal of this study was to examine the association of low DBP and angina in patients with CAD. Methods The study assessed the frequency of angina (measured by using the Seattle Angina Questionnaire–Angina Frequency score) according to DBP in patients with known CAD from 25 U.S. cardiology clinics. Hierarchical logistic regression was used to test the association between DBP and angina, with a spline term for DBP to assess nonlinearity. Results Among 1,259 outpatients with CAD, 411 (33%) reported angina in the prior month, with higher rates in the lowest DBP quartile (40 to 64 mm Hg: 37%). In the unadjusted model, DBP was associated with angina with a J-shaped relationship (p = 0.017, p for nonlinearity = 0.027), with a progressive increase in odds of angina as DBP decreased below ∼70 to 80 mm Hg. This association remained significant after sequential adjustment for demographic characteristics (p = 0.002), comorbidities (p = 0.002), heart rate (p = 0.002), systolic blood pressure (p = 0.046), and antihypertensive antianginal medications (p = 0.045). Conclusions In patients with chronic CAD, there seemed to be an association between lower DBP and increased odds of angina. If validated, these findings suggest that clinicians should consider less aggressive blood pressure control in patients with CAD and angina.
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change in angina symptom status after acute myocardial infarction and its association with readmission risk an analysis of the translational research investigating underlying disparities in acute myocardial infarction patients health status triumph r
Journal of the American Heart Association, 2016Co-Authors: Jacob A Doll, Fengming Tang, Sharon Cresci, Thomas M Maddox, John A Spertus, Tracy Y WangAbstract:Background Angina is common both before and after myocardial infarction (MI). Whether the change in angina status within the first 30 days after MI is associated with subsequent readmission and angina persistence is unknown. Methods and Results We studied 2915 MI patients enrolled at 24 hospitals in the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status (TRIUMPH) registry. Angina before and 30 days after MI was assessed with the Seattle Angina Questionnaire. Patients were divided into angina‐free pre‐ and post‐MI (−/−), resolved angina (+/−), new angina (−/+), and persistent angina (+/+) groups. Multivariable proportional hazards and hierarchical modified Poisson models were performed to assess the association of each group with all‐cause readmission, readmission for MI or unplanned revascularization, and angina persistence at 1 year. Overall, 1293 patients (44%) had angina before their MI and 849 (29%) reported angina within 30 days of discharge. Patients with post‐MI angina were more likely to be younger, nonwhite, and uninsured. Compared with patients who were angina‐free pre‐ and post‐MI, 1‐year all‐cause readmission risks were significantly higher for patients with persistent angina (hazard ratio [HR], 1.35; 95% CI 1.06–1.71) or new angina (HR, 1.40; 95% CI, 1.08–1.82). At 1 year, angina was present in 22% of patients and was more likely if angina was persistent (HR, 3.55; 95% CI, 3.05–4.13) or new (HR, 3.38; 95% CI, 2.59–4.42) at 30 days compared with patients who were angina‐free pre‐ and post‐MI. Conclusions Post‐MI angina, whether new or persistent, is associated with higher likelihood of readmission. Prioritizing post‐MI angina management is a potential means of improving 1‐year outcomes.
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abstract 17489 large variability of patient reported angina frequency within provider assigned canadian cardiovascular society angina class
Circulation, 2012Co-Authors: Edward Mcnulty, Paul S Chan, P D Jones, Megan Coylewright, John A SpertusAbstract:Background: Whereas the Canadian Cardiovascular Society (CCS) classification grades angina severity from providers’ perspectives, the Seattle Angina Questionnaire (SAQ) Angina Frequency scale does ...
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angina frequency after myocardial infarction and quality of life in older versus younger adults the prospective registry evaluating myocardial infarction event and recovery study
American Heart Journal, 2011Co-Authors: Ryan B Longmore, John A Spertus, Karen P Alexander, Kensey Gosch, Kimberly J Reid, Frederick A Masoudi, Harlan M Krumholz, Michael W RichAbstract:Background Residual angina is known to be strongly associated with health-related quality of life (HRQL) in patients with chronic coronary artery disease. As the age of myocardial infarction (MI) survivors increases, better insights into the relationship between angina frequency and HRQL in older as compared to younger patients are needed to efficiently target medical resources. Methods We evaluated angina frequency and HRQL at 1 and 6 months after MI in 1,795 post-MI survivors using the Seattle Angina Questionnaire (SAQ). We compared changes in HRQL between older (age ≥70 years, n=464) and younger (age Results After adjusting for baseline HRQL and 26 other covariates, older patients with similar or improved angina control at 6 months had significantly greater improvements in HRQL than younger patients (difference in SAQ quality-of-life scale 8.77 points [CI 4.00-13.54, P = .0003] and 2.56 points [CI 0.66-4.47, P = .0084], respectively). However, older patients with increased angina experienced similar declines in HRQL as compared to younger patients. Conclusion In stable patients with coronary artery disease after a recent MI, changes in angina control were correlated with HRQL in both older and younger patients. However, improved angina control was associated with greater HRQL improvements in older than in younger adults, underscoring the importance of aggressive angina control in older patients.
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comparison of three quality of life instruments in stable angina pectoris seattle angina questionnaire short form health survey sf 36 and quality of life index cardiac version iii
Journal of Clinical Epidemiology, 1998Co-Authors: Cynthia M Dougherty, Tim A Dewhurst, Paul W Nichol, John A SpertusAbstract:Three instruments for the assessment of quality of life, the Seattle Angina Questionnaire (SAQ), the Short Form Health Survey (SF-36), and the Quality of Life Index-Cardiac Version III (QLI) were administered to 107 patients with stable angina pectoris in a longitudinal randomized trial comparing the use of alternative anginal medications in the management of chronic stable angina pectoris. This study demonstrated that differences in angina severity as measured by the Canadian Cardiovascular Society Classification (CCSC) were related to each of the SAQ subscales, to selected subscales of the SF-36, but not to the QLI. All quality of life (QOL) instruments demonstrated acceptable test-retest reliability when administered over a 2-week interval. Neither the SF-36 nor the QLI were discriminative of angina severity or sensitive to changes in CCSC angina classification. Both the SAQ and QLI detected changes in heart disease related QOL over time.
Valentin Fuster - One of the best experts on this subject based on the ideXlab platform.
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acute coronary syndromes unstable angina and non q wave myocardial infarction
Circulation, 1998Co-Authors: Pierre Theroux, Valentin FusterAbstract:Ischemic heart disease includes a wide spectrum of conditions, ranging from silent ischemia and exertion-induced angina, through unstable angina, to acute MI. Unstable angina occupies the center of this spectrum, causing disability and risk greater than that of chronic stable angina but less than that of acute MI1 (Fig 1⇓). Although non–Q-wave MI for many years was considered prognostically similar to unstable angina, recent longitudinal studies indicate that it is similar to Q-wave infarction2 3 (Fig 2⇓). Figure 1. Cumulative 6-month mortality from ischemic heart disease. Diagnosis on admission to hospital (n=21 761; 1985 to 1992). From Duke Cardiovascular Database. Reproduced with permission from Reference 1. Figure 2. Top, Cumulative 1-year combined death or MI among patients with Q-wave and non–Q-wave MI treated with fibrinolysis. Reproduced with permission from Reference 2. Bottom, Risk of subsequent cardiac events in stable convalescing patients after first non–Q-wave and Q-wave MI. Reproduced with permission from Reference 3. The concept of unstable angina has emerged from observations of frequent symptoms preceding acute MI, followed by prospective documentation that unstable symptoms frequently culminated in acute MI. The syndrome was rapidly accepted as a well-defined clinical entity as specific clinical manifestations, pathophysiological mechanisms, laboratory findings, and treatment became better characterized. Unstable angina is currently one of the leading causes of hospital admission for CAD, and non–Q-wave MI accounts for >30% of admissions for acute MI.1 4 Yet, the diagnosis of unstable angina remains clinical, based on symptom recognition. The physician caring for patients with unstable angina is in a privileged position of recognizing rapidly evolving CAD and being able to intervene to prevent irreversible left ventricular damage and progression of CAD. Unstable angina is classically described as a heterogeneous disease, referring to a wide spectrum of clinical manifestations from stable angina to MI, of disease …
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macrophages smooth muscle cells and tissue factor in unstable angina implications for cell mediated thrombogenicity in acute coronary syndromes
Circulation, 1996Co-Authors: Pedro R Moreno, Victor Bernardi, Julio Lopezcuellar, Alvaro M Murcia, Igor F Palacios, Herman K Gold, Roxana Mehran, Samin K Sharma, Yale Nemerson, Valentin FusterAbstract:Background Macrophage expression of tissue factor may be responsible for coronary thrombogenicity in patients with plaque rupture. In patients without plaque rupture, smooth muscle cells may be the thrombogenic substrate. This study was designed to identify the cellular correlations of tissue factor in patients with unstable angina. Methods and Results Tissue from 50 coronary specimens (1560 pieces) from patients with unstable angina and 15 specimens from patients with stable angina were analyzed. Total and segmental areas (in square millimeters) were identified with trichrome staining. Macrophages, smooth muscle cells, and tissue factor were identified by immunostaining. Tissue factor content was larger in unstable angina (42±3%) than in stable angina (18±4%) (P=.0001). Macrophage content was also larger in unstable angina (16±2%) than in stable angina (5±2%) (P=.002). The percentage of tissue factor located in cellular areas was larger in coronary samples from patients with unstable angina (67±8%) than ...
Juan Carlos Kaski - One of the best experts on this subject based on the ideXlab platform.
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effects of neuropeptide y on coronary artery vasomotion in patients with microvascular angina
International Journal of Cardiology, 2017Co-Authors: Giuseppe M C Rosano, Dimitris Tousoulis, Eugene Mcfadden, J Clarke, Graham Davies, Juan Carlos KaskiAbstract:Abstract Background Patients with microvascular angina (exertional angina, positive exercise tests and normal coronary arteriograms) usually have a reduced coronary blood flow reserve. Neuropeptide Y (NPY) is a potent endogenous vasoconstrictor involved in modulation of coronary vasomotor tone and may play a role in microvascular angina. Methods We compared the effects of NPY (0.2–1.0pmol/kg, intracoronary) on the vasomotor response of proximal and distal segments of the coronary arteries in 7 patients with microvascular angina, 9 with chronic stable angina, and 9 control individuals. The coronary response to the administration of ergonovine was also assessed in 9 other patients with microvascular angina. Computerized coronary artery diameter measurements were carried out before (baseline) and after the administration of the vasoactive agents. Results Mean baseline coronary lumen diameters were similar in control, microvascular angina, and coronary artery disease patients. NPY constricted proximal coronary segments by 8±2%, 5±2% and 6±3% and distal segments by 14±2%, 11±2% and 10±2% in control, microvascular angina, and coronary artery disease patients, respectively ( p =NS between groups). In patients with microvascular angina, ergonovine constricted proximal coronary segments by 7±1.5% and distal segments by 12.5±3% ( p =NS vs. NPY). During NPY administration four microvascular angina patients developed chest pain, ST segment depression, and a marked lengthening of the contrast medium run off, in the absence of epicardial coronary artery spasm. Control individuals and coronary artery disease patients did not experience chest pain, ST segment shifts, or lengthening of the run off during NPY administration. Ergonovine administration caused chest pain and lengthening of the contrast run-off, in the absence of epicardial coronary artery spasm, in one microvascular angina patient. Conclusions Exogenous NPY causes mild epicardial coronary artery constriction which is similar in patients with non-cardiac chest pain, microvascular angina and coronary artery disease. Myocardial ischemia and marked lengthening of the contrast run off in response to NPY occurred in microvascular angina patients but not in control or coronary artery disease patients. An abnormal constrictor response to NPY at the microcirculation level could be the mechanism underlying the ischemic manifestations observed in patients with microvascular angina. Condensed abstract (table of contents) The vasomotor response of proximal and distal coronary artery segments was studied in twenty five patients: 7 microvascular angina, 9 chronic stable angina, and 9 control subjects. Computerized measurements of coronary diameters were carried out before and after the intracoronary administration of neuropeptide Y (NPY) and ergonovine. Constriction of epicardial arteries in response to NPY was mild and not significantly different in control, microvascular angina and coronary artery disease patients. Ergonovine-induced epicardial coronary artery constriction was similar to that of NPY. However, NPY caused transient myocardial ischemia in patients with microvascular angina (probably through constriction of the small intramyocardial vessels), but not in control subjects or coronary artery disease patients.
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serum levels of the antiinflammatory cytokine interleukin 10 are decreased in patients with unstable angina
Circulation, 2001Co-Authors: D A S Smith, Della Cole, Sandra D Irving, Joanna Sheldon, Juan Carlos KaskiAbstract:Background Proinflammatory cytokines play a role in acute coronary events. However, the potential role of antiinflammatory cytokines in the modulation of the atherosclerotic process remains unknown. Interleukin (IL)-10, which is expressed in human atherosclerotic plaques, has potent deactivating properties in macrophages and T cells. The aim of this study was to assess whether serum concentrations of IL-10 differed between patients with unstable and stable angina pectoris. Methods and Results A total of 95 patients with angina pectoris and angiographically documented coronary artery disease were studied. Of these, 50 patients had chronic stable angina (with stable symptoms over 3 months), and 45 patients had Braunwald class IIIB unstable angina with ST-segment changes. Serum IL-10 and IL-6 concentrations were measured on admission using commercially available immunoassays. Serum IL-10 concentrations were lower in unstable angina patients compared with those who had chronic stable angina (28.4 versus 14.0 ...
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increased serum neopterin a marker of coronary artery disease activity in women
Heart, 2000Co-Authors: Xavier Garciamoll, Della Cole, Emmanouil Zouridakis, Juan Carlos KaskiAbstract:OBJECTIVE—To assess whether neopterin concentrations in women with unstable angina differ from those in women with chronic stable angina. DESIGN—Prospective cohort study. SETTING—University hospital in south west London. PATIENTS—114 consecutive women with angina were studied: 82 had chronic stable angina (typical exertional chest pain, positive exercise ECG testing, and/or abnormal myocardial scintigraphy; symptoms stable for at least three months), and 32 had unstable angina (Braunwald class III). All patients with chronic stable angina (100%) and 18 with unstable angina (56.3%) underwent digital coronary angiography; neopterin concentrations were determined using a commercially available immunoassay. MAIN OUTCOME MEASURES—Major clinical events during one year follow up were readmission with Braunwald's class IIIb unstable angina, non-fatal myocardial infarction, and cardiac death. RESULTS—Major events occurred in 12 women with chronic stable angina (14.6%) and nine women with unstable angina (28.1%). Mean (range) neopterin concentrations were significantly higher in women with unstable angina than in those with chronic stable angina (7.6 (5.1-11.5) nmol/l v 5.9 (4.4-7.5) nmol/l; p = 0.003), even after adjustment for variables which were significantly different on univariate analysis. In women with chronic stable angina, baseline neopterin concentrations were higher in those with cardiac events than in those without events (7.1 (5.9-9.1) nmol/l v 5.7 (3.9-7.3 nmol/l); p = 0.010), even after adjustment for variables with significant differences between both groups on univariate analysis. CONCLUSIONS—On average, women with unstable angina had significantly higher neopterin concentrations than women with chronic stable angina. Women with chronic stable angina with events during follow up had higher neopterin concentrations than those without events. Neopterin concentrations were similar in patients with unstable angina and women with chronic stable angina who developed events. Neopterin concentrations may therefore be a marker of risk in women with coronary artery disease. Keywords: neopterin; women; coronary artery disease
Andrea M. Skantar - One of the best experts on this subject based on the ideXlab platform.
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Real-Time PCR for Detection and Identification of Anguina funesta, A. agrostis, A. tritici, and A. pacificae.
Plant Disease, 2015Co-Authors: Zonghe Yan, Mark K. Nakhla, Andrea M. SkantarAbstract:A number of seed, leaf, and stem gall nematodes are of significance to the forage and landscape grass and livestock industries. In North America, the bentgrass nematode, Anguina agrostis, reduces seed production on Agrostis tenuis and several other grass species. Anguina funesta is a seed-gall nematode that is most significant for its association with the toxigenic bacteria Rathayibacter toxicus. The wheat seed gall nematode A. tritici causes significant damage to wheat and other cereals; although it has been found in many countries worldwide, it has not been detected in the United States since 1975. Molecular methods based upon sequence variation in the ribosomal internal spacer region are useful for accurate identification of Anguina spp. Described herein are new species-specific primers and TaqMan probes for real-time polymerase chain reaction (PCR) identification of A. agrostis, A. funesta, A. tritici, and A. pacificae. Primer and probe combinations were each specific for the intended species and were sensitive enough to detect as few as 1.25 copies of nematode ribosomal DNA. PCR was also specific and sensitive in duplex assays that included genus-specific internal control primers as well as species-specific primers and probes. These standardized real-time PCR protocols should facilitate fast and accurate identification of Anguina spp. by diagnostic laboratories.
Karen P Alexander - One of the best experts on this subject based on the ideXlab platform.
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ranolazine after incomplete percutaneous coronary revascularization in patients with versus without diabetes mellitus river pci trial
Journal of the American College of Cardiology, 2017Co-Authors: Alexander C Fanaroff, Ori Benyehuda, Stefan James, Giora Weisz, Kristi Prather, Kevin J Anstrom, Daniel B Mark, Karen P Alexander, Gregg W Stone, Magnus E OhmanAbstract:Abstract Background Chronic angina is more common in patients with diabetes mellitus (DM) with poor glucose control. Ranolazine both treats chronic angina and improves glucose control. Objectives This study sought to examine ranolazine’s antianginal effect in relation to glucose control. Methods The authors performed a secondary analysis of the RIVER-PCI (Ranolazine in Patients with Incomplete Revascularization after Percutaneous Coronary Intervention) trial, a clinical trial in which 2,604 patients with chronic angina and incomplete revascularization following percutaneous coronary intervention were randomized to ranolazine versus placebo. Mixed-effects models were used to compare the effects of ranolazine versus placebo on glycosylated hemoglobin (HbA1c) at 6- and 12-month follow-up. Interaction between baseline HbA1c and ranolazine’s effect on Seattle Angina Questionnaire angina frequency at 6 and 12 months was tested. Results Overall, 961 patients (36.9%) had DM at baseline. Compared with placebo, ranolazine significantly decreased HbA1c by 0.42 ± 0.08% (adjusted mean difference ± SE) and 0.44 ± 0.08% from baseline to 6 and 12 months, respectively, in DM patients, and by 0.19 ± 0.02% and 0.20 ± 0.02% at 6 and 12 months, respectively, in non-DM patients. Compared with placebo, ranolazine significantly reduced Seattle Angina Questionnaire angina frequency at 6 months among DM patients but not at 12 months. The reductions in angina frequency were numerically greater among patients with baseline HbA1c ≥7.5% than those with HbA1c Conclusions In patients with DM and chronic angina with incomplete revascularization after percutaneous coronary intervention, ranolazine’s effect on glucose control and angina at 6 months was proportionate to baseline HbA1c, but the effect on angina dissipated by 12 months.
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effects of ranolazine on angina and quality of life after percutaneous coronary intervention with incomplete revascularization results from the ranolazine for incomplete vessel revascularization river pci trial
Circulation, 2016Co-Authors: Karen P Alexander, Stefan James, Giora Weisz, Kristi Prather, Kevin J Anstrom, Daniel B Mark, Linda Davidsonray, Adam Witkowski, Angel J Mulkay, Anna OsmukhinaAbstract:Background—Angina often persists or returns in populations following percutaneous coronary intervention (PCI). We hypothesized that ranolazine would be effective in reducing angina and improving quality of life (QOL) in incomplete revascularization (ICR) post-PCI patients. Methods and Results—In RIVER-PCI, 2604 patients with a history of chronic angina who had ICR post-PCI were randomized 1:1 to oral ranolazine versus placebo; QOL analyses included 2389 randomized subjects. Angina and QOL questionnaires were collected at baseline and months 1, 6, and 12. Ranolazine patients were more likely than placebo to discontinue study drug by month 6 (20.4% versus 14.1%, P<0.001) and 12 (27.2% versus 21.3%, P<0.001). Following qualifying index PCI, the primary QOL outcome (Seattle Angina Questionnaire [SAQ] angina frequency score) improved markedly, but similarly, in the ranolazine and placebo groups, respectively, from baseline (67.3±24.5 versus 69.7±24.0, P=0.01) to month 1 (86.6±18.1 versus 85.8±18.5, P=0.27) and...
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angina frequency after myocardial infarction and quality of life in older versus younger adults the prospective registry evaluating myocardial infarction event and recovery study
American Heart Journal, 2011Co-Authors: Ryan B Longmore, John A Spertus, Karen P Alexander, Kensey Gosch, Kimberly J Reid, Frederick A Masoudi, Harlan M Krumholz, Michael W RichAbstract:Background Residual angina is known to be strongly associated with health-related quality of life (HRQL) in patients with chronic coronary artery disease. As the age of myocardial infarction (MI) survivors increases, better insights into the relationship between angina frequency and HRQL in older as compared to younger patients are needed to efficiently target medical resources. Methods We evaluated angina frequency and HRQL at 1 and 6 months after MI in 1,795 post-MI survivors using the Seattle Angina Questionnaire (SAQ). We compared changes in HRQL between older (age ≥70 years, n=464) and younger (age Results After adjusting for baseline HRQL and 26 other covariates, older patients with similar or improved angina control at 6 months had significantly greater improvements in HRQL than younger patients (difference in SAQ quality-of-life scale 8.77 points [CI 4.00-13.54, P = .0003] and 2.56 points [CI 0.66-4.47, P = .0084], respectively). However, older patients with increased angina experienced similar declines in HRQL as compared to younger patients. Conclusion In stable patients with coronary artery disease after a recent MI, changes in angina control were correlated with HRQL in both older and younger patients. However, improved angina control was associated with greater HRQL improvements in older than in younger adults, underscoring the importance of aggressive angina control in older patients.