Narendran, A (2015) A study on usefulness of flow mediated vasodilatation of brachial artery in assessing the severity of coronary artery disease and its correlation with coronary angiogram. Masters thesis, Stanley Medical College, Chennai.
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Abstract
METHODOLOGY- Patients diagnosed with coronary artery disease within 1 month and have undergone coronary angiogram ;from the period January 2014 to September 2014 in ICCU/ cardiology wards are included in the study. Patients will be subjected to symptom analysis, clinical examination, laboratory investigations and flow mediated vasodilation studies of brachial artery. The final analysis will be made at the end of the study to achieve the fore mentioned goals using appropriate statistical methods. PATIENT SELECTION: INCLUSION CRITERIA 1. All patients who have been diagnosed having coronary artery disease which includes chronic stable angina, ST elevation MI, non ST elevation MI , unstable angina 2 within the last 1month and have undergone CAG. 2. All patients who have undergone primary/ facilitated PCI within the above mentioned time. 3. Patients between 20 and 60 years of age. EXCLUSION CRITERIA 1. Patients with any form of connective tissue disorder, chronic kidney disease, Chronic liver disease 2. Any patient < 20 and > 60 yrs of age. CONCLUSION OF THIS STUDY Our aim of this study was to determine if there is any correlation between severity of CAD and FMD of the brachial artery , as well as to observe the relationship with various other cardiovascular risk factors . A total of 75 patients were included in the study and following are conclusions from the statistical analysis. The subjects were divided into 4 four study groups as described above and subsequently analysed. The association between the study group and factors like age , gender , diet ,alcohol intake ,duration of hypertension was found to have no correlation There is a positive correlation between duration of smoking and severity of CAD Presence of diabetes had an meaningful correlation with the study groups and there is a increase in severity of CAD with increase in duration of diabetes BMI was found to have a positive correlation with the study groups and as the BMI of the patient increased more severe was the CAD observed in them Non HDL (LDL) was found to be the better marker for assessing the cardiovascular risk as there was a significant increase in CAD severity with increasing levels of LDL ,however no such positive correlation existed between study groups and HDL Left ventricular ejection fraction measured at the time of admission was significantly lower as the severity of CAD increased There was no positive correlation between brachial artery resting diameter and post occlusive diameter among the various CAD groups Interestingly percentage of increase in flow mediated vasodilatation correlated well with the severity of CAD , in which the more severe CAD patients had significantly lower percentage increase in FMD 3 There is also a meaningful correlation between % increase in FMD and modified GENSINI SCORE.As the severity of CAD as assessed by modified GENISINI score increased significantly lower was the % increase in FMD. Hence we conclude that apart from assessing the traditional cardiovascular risk factors , it is also important to assess the endothelial function of the patient by methods like FMD. It is very clear the physiological alteration(endothelial dysfunction) in the body due to atherosclerosis, diabetes and other risk factors occur much before the structurally evident changes like plaques. FMD could be used as a tool to determine the endothelial function of the patients very early in the course natural history of CAD . Its use could be widely employed as it is non invasive and very simple procedure . Interestingly even unstable angina patients with normal /non obstructive CAG had endothelial dysfunction and whether this could be the reason for angina is still debatable. Since it a direct reflection of the health status of coronary vessels this could be utilised in screening of even young healthy individuals with family history of CAD . This technique has great scope in the near future mainly because of its non invasive technique in assessing the severity of CAD. It however requires large sample studies to substantiate this and though not yet recommended for routine clinical use, non invasive endothelial function testing has provided valuable insights into vascular changes associated with early atherosclerosis and the potential reversibility of arterial disease.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Flow Mediated Vasodilatation; Coronary Artery Disease; Coronary Angiogram |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Punitha K |
| Date Deposited: | 17 Jan 2018 06:32 |
| Last Modified: | 17 Jan 2018 06:32 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5475 |
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