Coronary Artery Disease prognosis

Di Carli MF, Davidson M, Little R, Khanna S, Mody FV, Brunken RC et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol 1994 73 527-533... 

Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction a meta-analysis. J Am Coll Cardiol 2002 39 1151-1158... 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

The diagnosis of depression still rests primarily on the clinical interview. Major depressive disorder (MDD) is characterized by depressed mood most of the time for at least 2 weeks and/or loss of interest or pleasure in most activities. In addition, depression is characterized by disturbances in sleep and appetite as well as deficits in cognition and energy. Thoughts of guilt, worthlessness, and suicide are common. Coronary artery disease, diabetes, and stroke appear to be more common in depressed patients, and depression may considerably worsen the prognosis for patients with a variety of comorbid medical conditions. 

The primary indication for antidepressant agents is the treatment of MDD. Major depression, with a lifetime prevalence of around 17% in the USA and a point prevalence of 5%, is associated with substantial morbidity and mortality. MDD represents one of the most common causes of disability in the developed world. In addition, major depression is commonly associated with a variety of medical conditions—from chronic pain to coronary artery disease. When depression coexists with other medical conditions, the patient s disease burden increases, and the quality of life—and often the prognosis for effective treatment—decreases significantly. 

In 2275 diabetic patients aged 45-74 years compared with 9047 non-diabetics with proven coronary artery disease, 32% of those taking metformin and 44% of those taking combined metformin and glibenclamide died during 7.7 years (112). After 4 years the risks of death with metformin alone and combined therapy were equal, but after 7 years combined therapy had a worse prognosis. 

O Rourke RA, Brundage BH, Froelicher VF et al. American College of Cardiology/American Heart Association Expert Consensus Document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol 2000 36(1) 326-40. Review. 

Beller GA, Zaret BL. Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation 2000 101 1465-1478. 

Diabetes is highly prevalent in the heart failure population, with current estimates indicating that it is present in approximately one-third of heart failure patients. Diabetes may contribute directly to systolic or diastolic dysfunction, as well as indirectly by contributing to the development of coronary artery disease. Diabetes is an independent risk factor for developing heart failure, and its presence is associated with a hastened progression of heart failure and worse prognosis. 

Mark DB, Hlatky MA, Harrell FE Jr, et al.Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med 1987 106(6) 793-800. 

Ghali JK, Liao Y, Cooper RS. Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease. J Am Coll Cardiol 1998 31(7) 1635-40. 

Marcovitz PA, Shayna V, Horn RA, et al. Value of dobu-tamine stress echocardiography in determining the prognosis of patients with known or suspected coronary artery disease. Am J Caridol 1996 78(4) 404-8. 

Gilard M, Le Gal G, Cornily JC, Vinsonneau U, Joret C, Pen-nec PY, Mansourati J, Boschat J (2007) Midterm prognosis of patients with suspected coronary artery disease and normal multislice computed tomographic findings a prospective management outcome study. Arch Intern Med 167 1686-1689... 

The surface electrocardiography (ECG) in both acute and chronic phase of ischaemic heart disease (IHD) may give crucial information about the coronary artery involved and which is the area of myocardium that is at risk or already infarcted. This information jointly with the ECG-clinical correlation is very important for prognosis and risk stratification, as will be demonstrated in this book. Therefore, we will give in the following pages an overview of the anatomy of the heart, especially the heart walls and coronary tree, and emphasise the best techniques currently used for its study. 

Cardiovascniar In 95 patients with coronary heart disease and depression, who were randomized to sertraline (mean dosage 70 mg/day) or placebo over 20 weeks, sertraline significantly improved flow-dependent, endothelium-mediated dilatation of the brachial artery, while reducing the concentrations of C-reactive protein and interleukin-6 [17 ]. This suggests that sertraline has beneficial effects on the endothehum and immunological system, which could improve the prognosis of patients with depression and coronary heart disease. 

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