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ABSTRACT: To rationalize the efficient quenching of the fluorescence and the Z → E photoisomerization of m-ABDI, the meta-amino analogue of the green fluorescent protein (GFP) chromophore, in protic solvents, the femtosecond time-resolved fluorescence and transient infrared (TRIR) spectra of m-ABDI in CDCN, CHOH, and CDOD are determined. For solutions in CDCN, the fluorescence decay lifetime is ∼7.9 ns and IR absorption lines near 1513, 1531, 1557, and 1613 cm of m-ABDI in its electronically excited state were observed with a decay time >5 ns. For solutions in CHOH, the fluorescence decay is double exponential with time constants of ∼16 and 62 ps. In addition to IR absorption lines of m-ABDI in its electronically excited state with a decay time of ∼16 ps, new features near 1513, 1532, 1554, and 1592 cm were observed to have a rise time of ∼19 ps and a decay constant of ∼58 ps, indicating formation of an intermediate. The assignments for the IR spectra of the ground and excited states were assisted with DFT and TDDFT calculations, respectively. We conclude that the torsion of the exocyclic C═C bond (the τ torsion) is responsible for the nonradiative decay of electronically excited m-ABDI in CDCN. However, in CHOH and CDOD, the solute-solvent hydrogen bonding (SSHB) interactions diminish significantly the barrier of the τ torsion and induce a new pathway that competes successfully with the τ torsion, consistent with the efficient fluorescence quenching and the diminished yield for Z → E photoisomerization. The new pathway is likely associated with excited-state proton transfer (ESPT) from the solvent to m-ABDI, particularly the carbonyl group, and generates an intermediate (ESPT*) that is weakly fluorescent.
The Journal of Physical Chemistry B 03/2013; 117(9):2705-16. · 3.70 Impact Factor
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ABSTRACT: To understand the effects of solvent-solute hydrogen bonding (SSHB) on the excited-state dynamics of two GFP-like chromophores, p-ABDI and p-CFABDI, we have determined the quantum yields for fluorescence (Phi-f) and the isomerizations Z -> E (Phi-ZE) and the femtosecond fluorescence and transient infrared absorption in selected solvents. The behavior that Phi-ZE ~ 0.50 in aprotic solvents, such as CH3CN, indicates that the E-Z photoisomerizations adopt a one-bond-flip mechanism through the torsion of the exocyclic C=C bond (the tau torsion) to form a perpendicular species (tau ~ 90o) in the singlet excited state followed by internal conversion (IC) to the ground state and partition to form the E and Z isomers with equal probabilities. The observed Phi-ZE decreases from 0.50 to 0.15-0.28 when CH3CN was replaced with the protic solvents CH3OH and CF3CH2OH. In conjunction with the solvent-independent rapid (< 1 ps) kinetics for the fluorescence decay and the solvent-dependent slow (7-20 ps) kinetics for the ground-state recovery, we conclude that the SSHB modifies the potential energy surface for the tau torsion in a way that the IC occurs also for the twisted intermediates with a tau-torsion angle smaller than 90o, which favors the formation of the Z isomers.The possibility of IC induced by torsion of the exocyclic C-C bond (the phi torsion) is also considered but excluded.
The Journal of Physical Chemistry B 01/2013; · 3.70 Impact Factor
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ABSTRACT: A recent study showed that periostin (PN) induced reentry of differentiated cardiomyocytes into the cell cycle and improved heart function after acute myocardial infarction (AMI). This study sought to investigate whether PN levels increase after AMI and whether they provide prognostic value.
We recruited 123 patients: 45 with AMI, 45 with stable coronary artery disease (CAD), and 33 healthy controls (CON). Blood PN and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were measured. Echocardiography was repeated 3 months after AMI. In the AMI group, the PN levels 1.3 ± 1.2 days after AMI were significantly lower than those in the CAD and CON groups (175 ± 60, 245 ± 68, and 232 ± 63 ng/mL, respectively, P = 0.001). The NT-pro-BNP levels were significantly higher in the AMI group, compared to the CON and CAD groups (10.07 ± 28.2 [median, 0.70] vs 0.08 ± 0.06 [median, 0.05] and 1.1 ± 4.2 [median, 0.09] ng/mL, respectively; P = 0.02). The PN levels further decreased 8 ± 2 days after AMI (from 175 ± 60 to 143 ± 57 ng/mL; P = 0.003). However, NT-pro-BNP levels did not significantly change. With respect to the echocardiographic parameters 3 months after AMI, the PN levels measured before discharge were negatively associated with the left ventricular ejection fraction (rs = -0.50; P = 0.001), end diastolic (rs = 0.42; P = 0.009) and systolic (rs = 0.46; P = 0.004) diameters. The NT-pro-BNP levels were not significantly correlated with these parameters.
Acute myocardial infarction is associated with a decrease in blood PN levels, and PN concentrations predict cardiac function 3 months after AMI.
Journal of Investigative Medicine 02/2012; 60(2):523-8. · 1.96 Impact Factor
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ABSTRACT: Although inhibition of Rho-associated coiled-coil containing protein kinase (ROCK) has been shown to prevent coronary vasospastic angina (CVA), direct evidence linking ROCK activity and CVA is lacking. Accordingly, we investigated whether ROCK activity is an independent marker for CVA and is altered after treatment with antispastic medications.
We prospectively studied 31 Taiwanese patients who were diagnosed with CVA and 33 control subjects. Subject demographics were recorded, and blood samples were obtained at baseline in all participants and in CVA patients after 3 months of antispastic treatment. Compared with control subjects, leukocyte ROCK activity was greater in CVA patients (136% versus 91%, P<0.001). A cutoff value for leukocyte ROCK activity of 104% predicted the presence of CVA with specificity and sensitivity rates of 88% and 84%, respectively. ROCK activity increased with the severity of CVA (P for trend<0.001). Following 3-month treatment of antispastic agents, leukocyte ROCK activity, high-sensitivity C-reactive protein, and interleukin-6 levels were reduced by 43%, 42% and 27%, respectively (P<0.05 for all).
Increased levels of leukocyte ROCK activity independently predicted the presence of CVA and correlated with CVA severity. Treatment with antispastic agents substantially reduced the level of leukocyte ROCK activity.
Atherosclerosis 01/2012; 221(2):521-6. · 3.79 Impact Factor
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ABSTRACT: We report a case of essential thrombocythemia (ET) in a 30-year-old female who exhibited inferior wall ST-elevation acute myocardial infarction (AMI) without significant obstructive coronary artery disease. Right coronary vasospasm was observed after intra-coronary methylergonovine administration and she received verapamil 120 mg/dthereafter and hydroxyurea 1500 mg/d for thrombocythemia. After discontinuation of the hydroxyurea for 9 mo based on the impression of coronary spasm-related instead of coronary thrombosis-related AMI, her platelet count rose but no chest pain was observed. It is suggested that coronary spasm potentially plays a role in patients with ET, AMI and no significant coronary artery stenosis.
World journal of cardiology. 08/2011; 3(8):278-80.
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ABSTRACT: The aim of this study was to investigate the relations of left ventricular (LV) mass and geometry to LV function in patients with predialysis chronic kidney disease (CKD), by real-time 3-dimensional echocardiography (RT3-DE).
Echocardiography was performed on 76 consecutively enrolled patients (51 men) with different stages of CKD, including 26 patients with mild CKD (CKD stages 1-2) and 50 patients with moderate-to-severe CKD (CKD stages 3-5). LV mass and LV end-diastolic volume were measured by RT3-DE.
Greater prevalence of LV diastolic dysfunction and higher mitral E/myocardial velocities in early diastole (Em) values were noted in patients with moderate-to-severe CKD. In the moderate-to-severe CKD group, patients with increased LV mass had lower myocardial velocities in peak systole (Sm) and longer isovolumic relaxation time (IVRT). In the mild CKD group, patients with increased LV mass to volume ratios had lower Em. Moderate-to-severe CKD was associated with lower Sm and Em and higher mitral rapid filling to Em (E/Em) ratios by LV mass quartile stratification. Using LV mass/volume quartile stratification, moderate-to-severe CKD was associated with longer IVRT, lower Sm and higher mitral E/Em. Multivariable logistic regression analysis showed that CKD severity was the most independent predictor of elevated LV filling pressure (odds ratio = 2.96, p=0.019).
Increased LV mass impaired LV contraction and relaxation in patients with moderate-to-severe CKD. Concentric remodeling impaired LV diastolic function in patients with mild CKD. CKD severity was positively associated with elevated LV filling pressure.
Journal of nephrology 05/2011; 25(1):96-106. · 1.65 Impact Factor
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ABSTRACT: Coronary vasospasm (CVsp) has been reported to be an inflammatory disease, reflected by elevated high-sensitivity C-reactive protein (hs-CRP). We investigated the interactions among gender, age, hypertension and hs-CRP in patients with CVsp.
We retrospectively examined 722 Taiwanese patients with or without CVsp during an 8-year period. None of the patients had obstructive coronary artery disease. Serum hs-CRP levels were examined in a subset of 375 patients to evaluate the interactions of hs-CRP with gender, age, smoking and hypertension in the development of CVsp.
In women, only the highest hs-CRP tertile (> 3 mg L⁻¹) was independently associated with CVsp. In men, age > 58 years and the highest hs-CRP tertile were independently associated with CVsp. In women, elevated risk was only demonstrated in patients ≤ 58 years of age with hs-CRP levels in the highest tertile. In men, a positively monotonic trend was demonstrated between hs-CRP levels and CVsp in those > 58 years of age. The odds ratios of CVsp in both women and men with hs-CRP in the highest tertile reduced from 6·01 to 1·48 and 6·35-2·69 respectively, if they had hypertension.
The relationship between hs-CRP and CVsp differed between men and women. Our findings that there is a non-threshold model in men and a threshold model in women provide evidence that more smokers in men (life-style) and age (induction time) contribute to the natural history of CVsp development. The negative effect of hypertension on CVsp suggests that the pathogenesis of CVsp differs from that of coronary atherosclerosis.
European Journal of Clinical Investigation 12/2010; 40(12):1094-103. · 3.02 Impact Factor
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ABSTRACT: Accurate multireference configuration interaction and time-dependent density functional calculations have been performed to interpret the experimental UV-vis spectrum of the CS(2)/Cl complex in the spectral region 320-550 nm. The molecular structure of the complex responsible for the previously observed UV-vis spectrum is recognized as ClSCS, not ClCS(2). Two low-lying excited states of ClSCS, responsible for its optical absorption, have been identified and analyzed. Optical excitation of ClSCS leads to the excitation-specific bond elongation that may lead to photofragmentation of the molecule. In addition, experimental conditions for verifying the presence of ClCS(2) are identified and detailed characterization of its optically active excited states with possible photofragmentation pathways is given.
The Journal of Physical Chemistry A 10/2010; 114(41):11008-16. · 2.95 Impact Factor
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ABSTRACT: Novel heteroleptic ruthenium complexes--RD1, RD5, RD10 and RD11--with ligands based on benzimidazole were synthesized and characterized for application to dye-sensitized solar cells (DSSC); the remarkable performance of RD5-based DSSC is understood for its superior light-harvesting ability and slower charge-recombination kinetics.
Chemical Communications 10/2010; 46(47):8992-4. · 6.17 Impact Factor
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ABSTRACT: Accurate multireference configuration interaction and time-dependent density functional calculations have been performed to interpret the experimental UV−vis spectrum of the CS2/Cl complex in the spectral region 320−550 nm. The molecular structure of the complex responsible for the previously observed UV−vis spectrum is recognized as ClSCS, not ClCS2. Two low-lying excited states of ClSCS, responsible for its optical absorption, have been identified and analyzed. Optical excitation of ClSCS leads to the excitation-specific bond elongation that may lead to photofragmentation of the molecule. In addition, experimental conditions for verifying the presence of ClCS2 are identified and detailed characterization of its optically active excited states with possible photofragmentation pathways is given.
09/2010;
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ABSTRACT: Cardiac remodeling has been demonstrated in patients on hemodialysis and in predialysis patients with chronic kidney disease (CKD). Using functional echocardiographic parameters to study the association of hemodynamic status and predialysis CKD has not yet been established.
From November 2007 to September 2008, ninety-six patients (50 men and 46 women) with different stages of CKD were enrolled consecutively to undergo echocardiography. Group 1 consisted of 27 patients with mild CKD (CKD stages 1 and 2) and group 2 consisted of 69 patients with moderate/severe CKD (CKD stages 3-5).
Higher values were observed for the products of serum calcium and phosphorus, serum phosphorus, and intact parathyroid hormone; lower values were observed for hematocrit and serum albumin in group 2 patients. Higher mitral E and A velocities, longer isovolumic relaxation time, more prevalence of moderate-to-severe left ventricular (LV) diastolic dysfunction and higher mitral E/Em value were noted in group 2 patients. Eccentric left ventricular hypertrophy (LVH) had effects on systolic contraction disturbance in group 2 patients. CKD severity without LVH had effects on LV filling pressure elevation and relaxation impairment. Among biochemical and echocardiographic parameters, mitral E/Em was most independently associated with a diagnosis of moderate/severe CKD (odds ratio = 1.29, P = 0.023) and it was the most predictive variable with sensitivity and specificity values for a cutoff value of > or =13 of 64% and 74%, respectively.
CKD severity without LVH increased LV filling pressure and impaired LV relaxation. Mitral E/Em was significantly associated with moderate/severe CKD.
Echocardiography 04/2010; 27(6):621-9. · 1.24 Impact Factor
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ABSTRACT: Interaction between 2 major risk factors, cigarette smoking and high-sensitivity C-reactive protein (hs-CRP), has not been evaluated in patients with coronary vasospasm (CV) without hemodynamically significant coronary artery disease.
From 1999 to 2005, patients undergoing diagnostic coronary angiography with or without proven CV and without coronary stenosis >50% were evaluated. A total of 621 subjects (335 and 286 with and without CV, respectively) were enrolled in the study. The levels of hs-CRP, measured immediately before coronary angiography, were examined in a subset of 314 patients.
Subjects with CV were likely to be older, men, current smokers, and have high hs-CRP levels. The most significant factors for CV were smoking and hs-CRP. In the nonsmoker group, elevated risk of developing CV was only demonstrated in patients with the highest hs-CRP tertile (>5.01 mg/L, P = 0.012). In the smoker group, however, a positively monotonic trend of association was demonstrated between hs-CRP tertile and CV risk, with multivariate-adjusted odds ratios of 1.11, 3.09 (P = 0.012), and 4.12 by the hs-CRP tertiles, suggesting that smokers developed CV at a lower hs-CRP level than nonsmokers and there was a positive interaction between smoking and hs-CRP.
The smokers developed CV at a lower hs-CRP level compared with the nonsmokers. A positive interaction between smoking and hs-CRP was demonstrated for this disease in our study population.
The American Journal of the Medical Sciences 12/2009; 338(6):440-6. · 1.39 Impact Factor
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ABSTRACT: Real-time three-dimensional echocardiography (RT3DE) has emerged as a more accurate and effective tool for assessing left ventricular (LV) function, compared to traditional two-dimensional (2D) methods. In this study, we used this new tool to revise the controversial relationship between LV function and intra-dialytic hypotension.
This study enrolled 29 intra-dialytic hypotensive patients (the IDH group) and 34 controls (the CON group) on regular maintenance haemodialysis. The RT3DE- and 2D-derived ejection fraction (EF), stroke volume index (SVI) and ratio of early transmitral inflow velocity to diastolic early tissue velocity were assessed at pre-dialysis and mid-dialysis. The intravascular volume was assessed by the inferior vena cava collapsibility index.
Pre-dialysis evaluation showed no difference in RT3DE- and 2D-derived parameters between the two groups. At mid-dialysis, the IDH group had a lower 2D EF (54 +/- 9.1 versus 62 +/- 6.8% in the CON group, P < 0.001), RT3DE EF (53 +/- 6 versus 60 +/- 7% in the CON group, P < 0.001) and SVI (24.3 +/- 8 versus 30.6 +/- 12.2 mL in the CON group, P = 0.02). From pre-dialysis to mid-dialysis, the IDH group had greater decrease in the change in 2D EF (-4.8% +/- 12.6% versus 5% +/- 13.7% in the CON group, P = 0.004), RT3DE EF (-11.8 +/- 10.3 versus -3.4 +/- 11.5% in the CON group, P = 0.003) and SVI (-17.3 +/- 18.5 versus -9.2 +/- 19.8% in the CON group, P = 0.004). The calculated cardiac index change also showed a greater decrease in the IDH group (-17.8 +/- 20.2 versus -5.7 +/- 18.5% in the CON group, P = 0.02). No significant difference in the ratio of early transmitral inflow velocity to diastolic early tissue velocity, heart rate, systemic vascular resistance index or inferior vena cava collapsibility index was found between the two groups at the baseline or mid-dialysis. A lack of an increase in heart rate and the systemic vascular resistance index in the IDH group during the hypotensive episodes implies that these patients have autonomic dysfunction. Multivariate analysis showed that the RT3DE EF change of < -9.5% (odds ratio = 6, P = 0.003) and the presence of diabetes (odds ratio = 4.4, P = 0.013) had significant and independent associations with intra-dialytic hypotension.
By adopting RT3DE to assess LV performance, our data demonstrated that an inadequate compensation in the LV systolic function is the main mechanism mediating the occurrence of intra-dialytic hypotension in patients with autonomic dysfunction.
Nephrology Dialysis Transplantation 09/2009; 25(1):249-54. · 3.40 Impact Factor
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ABSTRACT: After acute myocardial infarction (AMI), reopening of a totally occluded infarct-related artery (IRA) at a subacute stage is still controversial in symptom-free patients. However, in patients with persistent ischemic symptoms and inadequate collaterals to the infarct area, recanalization is thought to provide beneficial effects. In addition to augmenting myocardial perfusion, we hypothesized that the benefit of recanalization involves the manipulation of circulating stem cell-mobilizing cytokines. This study included 30 patients with a totally occluded IRA and ongoing ischemic symptoms (the study group) and 30 patients with a partially occluded IRA (the control group). All patients underwent successful angioplasty and/or stenting. Before and immediately after the coronary intervention, blood granulocyte-colony-stimulating factor (G-CSF), stem-cell factor (SCF), vascular endothelial growth factor (VEGF), and stroma-derived factor-1 (SDF-1alpha) were measured. After recanalization, G-CSF levels significantly increased in the study group compared to the control group (P=0.03). SDF-1alpha levels in the study group decreased relative to the controls (P=0.02). However, no significant changes in VEGF or SCF levels between the two groups were found. In the multivariate analysis, reopening of a totally occluded IRA was independently and significantly associated with changes in G-CSF and SDF-1alpha levels after recanalization. In conclusion, our data suggest that the benefits of late reperfusion of a totally occluded IRA in patients with ongoing myocardial ischemia may involve mechanisms associated with stem cell-mobilizing and plaque-stabilizing cytokines. This study provides the rationale to investigate serial changes in cytokines and the numbers of circulating progenitors after reperfusion in the future.
International Heart Journal 08/2009; 50(4):433-44. · 1.16 Impact Factor
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ABSTRACT: We recorded several rovibronic bands of C(6)H(5)O and C(6)D(5)O in their A (2)B(2)<--X (2)B(1) transitions in the range 1.14-1.31 microm with the cavity ringdown technique. While the electronic transition is forbidden, several vibronic bands are observed. By comparison of rovibronic contours of observed and simulated bands to determine their types of transition, and by consideration of vibrational wavenumbers of the upper state based on quantum-chemical calculations, we were able to provide vibronic assignments of observed bands and derive several experimental vibrational wavenumbers (given as nu in unit of cm(-1) in this paper) for the A (2)B(2) state, namely, nu(12)=947, nu(13)=793, nu(14)=417, nu(15)=964, nu(16)=866, nu(17)=723, nu(18)=680, and nu(19)=499 for C(6)H(5)O, and nu(12)=772, nu(13)=626, nu(14)=365, nu(15)=812, nu(17)=599, nu(18)=532, and nu(19)=436 for C(6)D(5)O. Transitions involving vibrationally excited levels of nu(20) were also observed; nu(20) of the A state is greater by 50 cm(-1) than the X state of C(6)H(5)O. A weak origin at 7681 cm(-1) for the A<--X transition of C(6)H(5)O (7661 cm(-1) for C(6)D(5)O) with a c-type contour was observed. Observed isotopic ratios of vibrational wavenumbers for the A state of C(6)H(5)O to those of C(6)D(5)O are in good agreement with the predictions from quantum-chemical calculations at the B3LYP/aug-cc-pVTZ level.
The Journal of chemical physics 11/2008; 129(15):154307. · 3.09 Impact Factor
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ABSTRACT: Accurate ab initio study of the lowest excited state (A (2)B(2)) of the thiophenoxyl radical is presented. The calculated equilibrium geometries, excitation energies, and harmonic vibrational frequencies show that the A (2)B(2) <-- X (2)B(1) excitation in C(6)H(5)S has different characteristics than the analogous transition in the phenoxyl radical. Vertical excitation energies for other low-lying (<4.5 eV) excited states of the thiophenoxyl radical are also presented and compared with available experimental data.
The Journal of Physical Chemistry A 10/2008; 112(47):11998-2006. · 2.95 Impact Factor
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ABSTRACT: A positive noninvasive stress test result is often considered as a false-positive indicator of coronary artery disease (CAD) when coronary angiography reveals no hemodynamically significant CAD.
From January 2001 through December 2004, 5474 patients scheduled to undergo exercise electrocardiogram (ECG) [exercise ECG without imaging or exercise ECG with thallium-201 (201Tl) single photon emission tomography (SPECT)] or dipyridamole 201Tl tomography at our outpatient clinic because of chest oppressive sensation were included in this prospective study. Coronary angiography was performed when a noninvasive test result was positive for ischemia or when ischemic chest pain was suspected. Intracoronary methylergonovine testing was performed when spastic angina was suspected and coronary angiography showed no hemodynamically significant CAD.
Noninvasive stress testing was positive in 113 (67%) patients with coronary spasm. Of the 53 patients who had positive exercise ECG (exercise ECG with or without imaging), ST depression was found in 50 patients and ST elevationin in 3 patients. Multivessel spasm was found in 6 (15%), 6 (15%), and 7 (21%) of the patients with a positive result on exercise ECG without imaging, exercise ECG with 201Tl SPECT, and dipyridamole 201Tl SPECT, respectively. There was no significant difference in the results of noninvasive stress testing and the number of vessels with coronary spasm (1-vessel spasm versus multivessel spasm) among these 3 noninvasive stress testing groups.
Intracoronary ergonovine testing induced coronary spasm in over 50% of patients who had suspected ischemic chest pain, a positive noninvasive stress test, and no hemodynamically significant CAD.
The American Journal of the Medical Sciences 06/2008; 335(5):354-62. · 1.39 Impact Factor
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ABSTRACT: Little information is available regarding the relationship between three-dimensional (3-D) echocardiographic parameters in acute stage of acute myocardial infarction (AMI) and subsequent left ventricular (LV) remodeling after AMI.
Consecutive patients with AMI were analyzed for echocardiographic predictors of subsequent LV remodeling after AMI using two-dimensional (2-D) echocardiography and real-time 3-D echocardiography at baseline and month 3 of follow-up. LV adverse and favorable remodeling were defined as a >10% and <or=10% increase in 3-D derived LV end diastolic volume index (LVEDVI) at 3 months' follow-up compared with baseline, respectively.
19 AMI patients underwent real-time 3-D echocardiography at baseline and at 3 months after AMI. In patients with favorable remodeling (n = 12), baseline, LVEDVI, LV end-systolic volume index (LVESVI) and LV stroke volume index (LVSVI) were significantly increased compared with patients with adverse remodeling. At 3 months of follow-up, patients with favorable remodeling had significant 3-D LVEDVI, LVESVI, and systolic sphericity index reductions compared to patients with adverse remodeling in which these variables were increased. Baseline clinical and echocardiographic variables were analyzed for the identification of favorable LV remodeling. Of these, LVESVI was the most predictive variable with sensitivity, specificity, and positive and negative predictive values for a cutoff value of >42 mL/m(2) of 75%, 71%, 75%, and 71%, respectively.
LVESVI assessed by 3-D echocardiography was the most predictive parameter indicating favorable LV remodeling after AMI. LV shape on contraction changed from elliptical shape to more globular in the adverse remodeling process after AMI.
Angiology 05/2008; 59(6):688-94. · 1.51 Impact Factor
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ABSTRACT: A theoretical study of molecular, electronic, and vibrational properties of the first excited state of the phenoxyl radical, A 2B2, is presented. The calculated molecular geometries, vertical and adiabatic excitation energies, and harmonic vibrational frequencies are compared with analogous results obtained for the ground state. The calculated excitation energies correspond well to experimental data. The harmonic vibrational frequencies of the A 2B2 and the ground state are similar except for modes involving the vibrations of the CO bond.
The Journal of Physical Chemistry A 04/2008; 112(12):2648-57. · 2.95 Impact Factor
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ABSTRACT: Limited information is available comparing the clinical characteristics and prognosis for patients with coronary vasospastic angina in the absence of hemodynamically significant coronary artery disease (CAD) (defined as >50% stenosis) versus patients with significant fixed CAD presenting with either stable angina pectoris (SAP) or acute coronary syndromes (ACS).
Patients who underwent cardiac catheterization for suspected ischemic heart disease between August 1999 and February 2003 were followed clinically. For patients without hemodynamically significant CAD, a provocation test for coronary vasospasm was undertaken using a step-wise dose of intracoronary ergonovine administration.
A total of 1134 patients were enrolled in the final analysis and stratified into 4 diagnostically distinct groups: control group (n = 239; mild CAD without coronary vasospasm); vasospasm group (n = 284; coronary vasospastic angina pectoris without hemodynamically significant CAD); SAP group (n = 110; hemodynamically significant CAD with SAP); ACS group (n = 501; hemodynamically significant CAD with ACS). Comparison of these 4 groups revealed that the ACS patients were more likely to be male, current smokers, and have hypercholesterolemia. In addition, this group had a significantly higher incidence of typical angina pectoris, 3-vessel CAD, and lower left ventricular ejection fraction. Between-group comparison revealed that vasospasm patients had a significantly higher incidence of early morning angina pectoris. Multivariate analysis showed that current smoking was the most independent risk factor associated with the diagnosis of coronary vasospastic angina pectoris in patients without hemodynamically significant CAD. During a median follow-up period of 49 months, recurrent angina pectoris was noted in patients from the control (n = 6; 3%), SAP (n = 9; 8%), vasospasm (n = 30, 11%), and ACS groups (n = 92; 18%); with nonfatal myocardial infarction identified during follow-up in the SAP (n = 5; 5%), vasospasm (n = 3; 1%), and ACS groups (n = 37; 7%). In addition, 29 and 3 cardiac deaths occurred in the ACS and SAP groups, respectively, whereas there were no such mortalities in the control and vasospasm groups.
Early morning angina pectoris and cigarette smoking were the most common clinical characteristics in patients with coronary vasospasm. These patients had an excellent prognosis despite the possibility of recurrences of vasospastic angina pectoris.
The American Journal of the Medical Sciences 09/2007; 334(3):160-7. · 1.39 Impact Factor
