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 All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. 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