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CORONARY ARTERY
DISEASES
Edited by Illya Chaikovsky
and Nataliia N. Sydorova
Coronary Artery Diseases
Edited by Illya Chaikovsky and Nataliia N. Sydorova
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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Publishing Process Manager Vedran Greblo
Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team
First published March, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechweb.org
Coronary Artery Diseases, Edited by Illya Chaikovsky and Nataliia N. Sydorova
p. cm.
ISBN 978-953-51-0238-0
Contents
Preface IX
Part 1 Coronary Artery Disease:
Pathophysiology and Epidemiology 1
Chapter 1 Coronary Artery Disease and Oxidative Stress 3
Mara S. Benfato, Tássia M. Medeiros and Tiago B. Salomon
Chapter 2 Prediction of Coronary Heart Disease Risk
in a South European Population: A Case-Control Study 25
Maria Isabel Mendonça, Roberto Palma Reis and António Brehm
Part 2 Coronary Artery Disease: Diagnostic Features 41
Chapter 3 Magnetocardiography in Unshielded Setting:
Heart Electrical Image Based on 2-D and 3-D Data
in Comparison with Perfusion Image
Based on PET Results – Clinical Cases 43
Illya Chaikovsky, Michael Primin,
Igor Nedayvoda and Mykola Budnyk
Chapter 4 Quantitative Functional Assessment
of Ischemic Patients by Cardiopulmonary
Exercise and Recovery Indices 59
Eliezer Klainman, Alex Yarmolovsky and Gershon Fink
Chapter 5 LBBB: The ECG Patterns and Cardiac Function
in Patients With and Without Coronary Artery Disease 83
Marwan Badri, William Kornberg, James F. Burke,
Peter R. Kowey and Li Zhang
Chapter 6 Characterization of Repolarization
Alternans in the Coronary Artery Disease 91
Laura Burattini and Roberto Burattini
VI Contents
Chapter 7 Relatioship Between Serum 7-Ketocholesterol
Concentrations and Coronary Artery Disease 111
Takashi Hitsumoto and Kohji Shirai
Chapter 8 Oxidized Low Density Lipoprotein,
Statin Therapy and Carotid Stenosis 125
Elias Skopelitis, Dimitrios Levisianou,
Theodore Gialernios and Sofoklis Kougialis
Part 3 Treatment for Coronary Artery Disease 149
Chapter 9 Evaluation of Anti-Ischemic Therapy
in Coronary Artery Disease: A Review 151
Marwan S.M. Al-Nimer
Chapter 10 Coronary Arterial Drug-Eluting Stent:
From Structure to Clinical 197
Tim Wu and Stephen McCarthy
Chapter 11 Pursuing Candidate Stem Cells
for Optimal Cardiac Regeneration in Patients
Suffered from Acute Coronary Syndrome 225
Mohaddeseh Behjati
Part 4 Coronary Artery Disease and Comorbidities 259
Chapter 12 Impact of Thyroid Dysfunction
on Natural Course of Coronary Artery Disease 261
Nataliia N. Sydorova
Chapter 13 Coronary Artery Disease and Systemic Vasculitis:
Case Report and Review 281
Damianos Eleftheriadis and Nikolaos Eleftheriadis
Chapter 14 Occupational Stress and Coronary Artery Disease 301
Sheng Wang and Dou Chang
Chapter 15 Specific Features of Target Organ Damage
in Patients with Arterial Hypertension
and Coronary Artery Disease 317
Corina Şerban, Ruxandra Christodorescu, Alexandru Caraba,
Germaine Săvoiu, Carmen Cristescu and Simona Drăgan
Preface
This book has "wide geography" both literally and figuratively. First of all, this book
brings together contributions from around the world, both from post-industrial
countries and developing world.
This is natural, because coronary artery disease is becoming pandemic worldwide.
CAD is the single most frequent cause of death in developed countries, causes about 1
in every 5 deaths.
Mortality from cardiovascular disease is predicted to reach 23.4 million in 2030.
Moreover, in the developing world, cardiovascular disease tends to affect people at a
younger age and thus could negatively affect the workforce and economic
productivity. The morbidity, mortality, and socioeconomic importance of CAD make
its diagnosis and management fundamental for all practicing physicians.
On another hand, the book widely represents "geography" of CAD itself, i.e. many
various aspects of its pathophysiology, epidemiology, diagnosis, treatment are
touched in this book.
Pathophysiologic mechanisms of CAD are well studied in general, but there are some
details to be clarified. Oxidative stress is considered as one of important pathogenetic
components of the atherosclerosis course, studies of its effect onto the atherosclerotic
plaque formation and progression are still lasted. Section "Coronary artery disease:
pathophysiology and epidemiology" includes the review “Coronary Artery Disease
and Oxidative Stress”concerning this problem.
Another chapter in this Section is an epidemiological research demonstrating
capabilities of the modern genetic risk factors in improvement of the ability to predict
incident CAD beyond that afforded by traditional non genetic risk factors.
Section "Coronary artery disease: diagnostic features" begins with the chapter
"Magnetocardiography in Unshielded Setting: Heart Electrical Image based on 2-D and
3-D Data in Comparison with Perfusion Image Based on PET Results", devoted to the
promising technique of investigation of the cardiac electrical generator –
magnetocardiography (MCG). Comparison is drawn of the cardiac imaging on the base
of current density distribution maps, obtained by MCG and PET images. Two other
articles of this Section are devoted to the different issues of the modern advanced resting
electrocardiography, demonstrating that capabilities of this oldest technique of
instrumental diagnosis in cardiology are far from completed. Exercise stress test is
sometimes figuratively called "workhorse" in diagnosis of CAD. Authors of the chapter
"Quantitative Functional Assessment of Ischemic Patients by Cardiopulmonary Exercise
and Recovery Indices" emphasize important contribution of the cardiopulmonary
indices for quantitative functional assessment of patients with CAD. Laboratory
diagnostics is represented by the chapters "Oxidized low density lipoprotein, statin
therapy and carotid stenosis", continuing the topic of oxidative stress impact onto the
course of CAD and “Relationship Between the Serum 7-ketocholesterol Concentrations
and Coronary Artery Disease” representing the measuring system for evaluation of the
serum 7-ketocholesterol concentrations. Also clinical significance of 7KCHO is discussed.
Treatment of the coronary artery disease is continuously improved and developed.
New evidences appear for effectiveness of modern therapeutic and surgical
approaches. Section "Treatment for coronary artery disease" begins with the chapter
"Evaluation of Anti-ischemic Therapy in Coronary Artery Disease" with detailed
description of the modern treatment of patients with this disease. No doubt, that
nowadays surgical revascularization – is one of the basic therapeutic interventions in
CAD patients. In chapter "Coronary Arterial Drug-Eluting Stent: From Its Structure to
Clinic" features and advantages of the drug-eluting stents available for clinical practice
are discussed, demonstrating their future prospects. The subject with growing
popularity of stem cells is covered in chapter "Pursuing Candidate Stem Cells for
Candidate Regeneration in Patients Suffered from Acute Coronary Syndrome".
This book also contains the Section "Coronary artery disease and comorbidities"
discussing such comorbidities as thyroid dysfunction ("Impact of Thyroid Dysfunction
on Natural Course of Coronary Artery Disease", systemic vasculitis ("Coronary Artery
Disease and Systemic Vasculitis: Case Report and Review"), professional stress
("Occupational Stress and Coronary Artery Disease"), migraine (“Endothelial Function
in Migraine”) and arterial hypertension (“Specific features of Target Organ Damage in
Patients with Arterial Hypertension and Coronary Artery Disease”) et al.
This book does not pretend on complete and integral description of the Coronary
artery disease. Rather, it contains selected issues of this complex multifactorial disease.
Nevertheless, we hope that readers will find Coronary Artery Disease useful for clinical
practice and further research.
Illya Chaikovsky, MD PhD multiple, Senior research fellow, Assoc Prof,
International Research and Training Center for Informational Technologies and
Systems of National Academy of Science, Kyiv,
Ukraine
Nataliia Sydorova, MD PhD, Assoc Prof,
Ukrainian Military Medical Academy, Kyiv,
Ukraine
[...]... monocytes and macrophages, and lymphocytes HDL can also be oxidized by endothelial cells and by chemical means Oxidation of these lipoproteins can be blocked by antioxidants Ox-LDL also has potentially atherogenic affects, inhibits the mobility of tissue macrophages, enhances production of chemotatic factors and adhesion molecules, induces smooth muscle cells’ migration and both proliferation and apoptosis... ferritin and AHI (r = 0.398, P = 0.002), prohepcidin and ferritin (r = 0.432, P = 0.001) and iron and ferritin (r = 0.346; P = 0.009); between AHI and prohepicidin was r= -0.15 (P = 0.3) (figure 2) How hypoxia could be affecting the ferritin and hepcidin levels is not known In a multivariate regression, however, controlling for age, sex, body mass index and coronary heart disease, the AHI and ferritin... produced by all vascular types of cells and can be formed by numerous enzymes, such as xanthine oxidase, uncoupled endothelial NO synthase and NAD(P)H oxidase, that are the most relevant in vascular disease and hypertension It is worth keeping in mind the function of this enzymes, the Coronary Artery Disease and Oxidative Stress 19 xanthine oxidase catalyses the oxidation of hypoxanthine and xanthine... Part 1 Coronary Artery Disease: Pathophysiology and Epidemiology 1 Coronary Artery Disease and Oxidative Stress Mara S Benfato, Tássia M Medeiros and Tiago B Salomon LEO, Depto de Biofísica, IBIO, Programa de Pós-Graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul, Brazil 1 Introduction O2 arose on Earth in about... ferrous to ferric iron for uptake by plasma transferrin and regulated by hepcidin, an inhibitor of iron absorption and releases from macrophages and other cell types The hepcidin causes ferroportin internalization and degradation, decreasing the transfer of iron to the body Extracellular iron is bound with high affinity by the serum iron-transport protein transferrin and taken into the circulation (the... and iron overload Iron can be recycled or stored as needed Human erythrocytes undergo Coronary Artery Disease and Oxidative Stress 9 surface alterations that mark them to be phagocyted and digested by macrophages in the spleen and the liver In macrophages, iron is recovered from heme by the action of heme oxygenase and stored in ferritin, but the major site of iron storage is the liver, into hepatocytes... vascular function and structure, in part, by stimulating production of NO• and ROS Summarizing, the biomechanical forces increase activation and expression of endothelial NOS and stimulate production of O2•- and H2O2 (Paravicini & Touyz, 2006) Again, remembering that O2•- and NO• can form ONOO-; increased vascular pressure in hypertension is associated with stretch of endothelial and vascular smooth... proinflammatory forms It is assumed to be pathogenic and contribute to the etiology of various diseases (Niki, 2009) 12 Coronary Artery Diseases Carbon radicals often stabilize by molecular rearrangement to form conjugated dienes, but if two radicals collide within a membrane they cross-link the fatty acid side-chain When the formation of peroxy radical (by O2 action) occurs, this can abstract a hydrogen... large and medium-sized elastic and muscular arteries and can lead to ischemia of heart, brain or extremities, resulting in infarction 2.1 Formation and progression The initiation of atherosclerosis begins with endothelial injury or dysfunction that is characterized by enhanced endothelial permeability and LDL deposition in the intima LDL is accumulated in the preferred sites for lesion formation and. .. atherosclerosis include elevated and modified LDL; free radicals caused by cigarette smoking, hypertension and diabetes mellitus; genetic alterations; elevated plasma homocysteine concentrations (toxic to endothelium and prothrombotic); infections microorganisms; and combinations of these or other factors The process of atherosclerosis occurs primarily in certain arteries, such as coronary and carotid arteries . CORONARY ARTERY
DISEASES
Edited by Illya Chaikovsky
and Nataliia N. Sydorova
Coronary Artery Diseases
Edited by Illya Chaikovsky. species (RNS), and are divided into radicals and non-
radicals. Radicals have at least one unpaired electron in an open shell configuration and
non-radicals
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