Toru Naganuma

Clinical impact of dyslipidemia for coronary plaque vulnerability in acute coronary syndrome without metabolic syndrome.

BACKGROUND Although the metabolic syndrome is associated with incident cardiovascular disease, low-density lipoprotein (LDL) cholesterol is a well-known risk factor for coronary atherosclerosis. The aim of this study was to clarify the clinical markers for coronary plaque vulnerability in acute coronary syndrome (ACS) patients (men) without the metabolic syndrome. METHODS Consecutive Japanese men with ACS (n=264) underwent emergent coronary angiography and B-mode carotid ultrasonography. Common carotid intima-media thickening and vascular dilatation were considered to indicate carotid artery remodeling. Patients were divided into two groups based on the number of complex plaques identified by coronary angiography. RESULTS Abdominal obesity and low high-density lipoprotein cholesterol levels were frequently observed in overall patients with multiple complex coronary lesions. Although the metabolic syndrome was a significant independent predictor of multiple complex coronary lesions in overall ACS patients, a high LDL cholesterol level was an independent predictor in ACS patients without the metabolic syndrome. Carotid artery remodeling was an independent predictor of multiple complex coronary lesions in both overall patients and patients without the metabolic syndrome. CONCLUSION In ACS patients without the metabolic syndrome, high LDL cholesterol levels and carotid artery remodeling are important indicators for assessing the efficacy of aggressive treatments for secondary prevention of ACS.

Left atrial appendage thrombi revealed by coronary angiography

A 77-year-old male patient was admitted to the hospital because of chest pain. Electrocardiography revealed atrial fibrillation with high voltage. Coronary angiography (CAG) revealed left atrial appendage (LAA) thrombi with abnormal neovascularization arising from the left atrial branch of the left circumflex artery in the right anterior oblique projection (arrows in Figure 1). There were no angiographical findings indicating severe stenosis or embolic occlusion. Transesophageal echocardiography also showed severe spontaneous echocardiography contrast and hypoisoechoic thrombi in the LAA without mitral stenosis (arrows in Figure 2). Although previous studies (1–3) have reported that CAG is useful for the diagnosis of LAA thrombi in patients with mitral stenosis, it is rare that both CAG and transesophageal echocardiography clearly reveal the thrombi without mitral stenosis. Figure 1 Figure 2