Angiographic definition of critical coronary artery stenosis

Temporal Relationship-Aware Treadmill Exercise Test Analysis Network for Coronary Artery Disease Diagnosis

The treadmill exercise test (TET) serves as a non-invasive method for the diagnosis of coronary artery disease (CAD). Despite its widespread use, TET reports are susceptible to external influences, heightening the risk of misdiagnosis and underdiagnosis. In this paper, we propose a novel automatic CAD diagnosis approach. The proposed approach introduces a customized preprocessing method to obtain clear electrocardiograms (ECGs) from individual TET reports. Additionally, it presents TETDiaNet, a novel neural network designed to explore the temporal relationships within TET ECGs. Central to TETDiaNet is the TETDia block, which mimics clinicians' diagnostic processes to extract essential diagnostic information. This block encompasses an intra-state contextual learning module and an inter-state contextual learning module, modeling the temporal relationships within a single state and between states, respectively. These two modules help the TETDia block to capture effective diagnosis information by exploring the temporal relationships within TET ECGs. Furthermore, we establish a new TET dataset named TET4CAD for CAD diagnosis. It contains simplified TET reports for 192 CAD patients and 224 non-CAD patients, and each patient undergoes coronary angiography for labeling. Experimental results on TET4CAD underscore the superior performance of the proposed approach, highlighting the discriminative value of the temporal relationships within TET ECGs for CAD diagnosis.

Incidence and clinical relevance of primary congenital anomalies of the coronary arteries in children and adults

OBJECTIVES

To describe our experience in the management of coronary artery anomalies both in an adult and in a paediatric population and to compare the two groups for finding out differences in terms of angiographic incidence and treatment.

PATIENTS AND METHODS

Databases at the Department of Cardiology of San Martino Adult's Hospital and of Gaslini Children's Hospital were searched for all patients with a diagnosis of coronary artery anomaly who underwent coronary angiography between 1994 and 2006.

RESULTS

Coronary anomalies were diagnosed in 76 (1%) adult patients. Anomalous left circumflex artery was the commonest coronary anomaly (25%). Anomalous left coronary artery from pulmonary artery and myocardial bridges were the only anomalies responsible for angina-like symptoms. No patients except the one with anomalous left coronary artery from pulmonary artery needed surgical intervention. In the paediatric population, we found 28 (0.9%) patients with coronary anomalies. Anomalous left coronary artery from pulmonary artery was the most common anomaly (48%) and always required emergency surgical treatment; in addition there were two patients with stenosis of the left main coronary artery.

CONCLUSION

Coronary artery anomalies may be associated with very acute, even life-threatening symptoms in children, whereas they are usually clinically silent and detected by accident on coronary angiography in adults. Recognition of coronary artery anomalies enables early treatment or close follow-up in children, whereas it could be useful in case of cardiac surgery in adults.

Effect of glyceryl trinitrate on coronary and systemic hemodynamics in man

The effects of sublingual and intracoronary nitrates on coronary artery diameter were evaluated in five separate experiments in man. The first three are concerned with sublingual nitrates and the last two with intracoronary nitrates. The data obtained indicate that (1) administration of a fixed dose sublingual nitrate results in an increase in percent coronary artery stenosis compared with control measurements; (2) small doses of sublingual nitrates can dilate coronary arteries without a significant reduction in systemic arterial pressure or increase in heart rate; (3) the magnitude of percent coronary artery dilation after a fixed dose of sublingual nitrate is inversely related to the size of the coronary artery, that is, the smaller the coronary artery diameter the greater the relative dilation after administration of sublingual nitrate; (4) fixed dose sublingual nitrate often dilated coronary stenoses, but the more narrow stenoses were less likely to dilate; (5) the optimal dose of intracoronary nitrate required to produce maximal or near maximal coronary dilation without clinically important systemic hemodynamic effects is in the range of 200 micrograms; (6) intracoronary nitrate is a more potent coronary artery dilator than sublingual nifedipine, when administered as a 10 mg dose.