Physiological flow analysis in significant human coronary artery stenoses

To evaluate the local hemodynamics in flow limiting coronary lesions, computational hemodynamics was applied to a group of patients previously reported by Wilson et al. (1988) with representative pre-angioplasty stenosis geometry (minimal lesion size d(m)=0.95 mm; 68% mean diameter stenosis) and with measured values of coronary flow reserve (CFR) in the abnormal range (2.3+/-0.1). The computations were at mean flow rates (Q) of 50, 75 and 100 ml/min (the limit of our converged calculations). Computed mean pressure drops Deltap were approximately 9 mmHg for basal flow (50 ml/min), approximately 27 mmHg for elevated flow (100 ml/min) and increased to an extrapolated value of approximately 34 mmHg for hyperemic flow (115 ml/min), which led to a distal mean coronary pressure p(rh) of approximately 55 mmHg, a level known to cause ischemia in the subendocardium (Brown et al., 1984), and consistent with the occurrence of angina in the patients. Relatively high levels of wall shear stress were computed in the narrow throat region and ranged from about 600 to 1500 dyn/cm(2), with periodic (phase shifted) peak systolic values of about 3500 dyn/cm(2). In the distal vessel, the interaction between the separated shear layer wave, convected downstream by the core flow, and the wall shear layer flow, led to the formation of vortical flow cells along the distal vessel wall during the systolic phase where Reynolds numbers Re(e)(t) were higher. During the phasic vortical mode observed at both basal and elevated mean flow rates, wide variations in distal wall shear stress occurred, distal transmural pressures were depressed below throat levels, and pressure recovery was larger farther along the distal vessel. Along the constriction (convergent) and throat segments of the lesion the pulsatile flow field was principally quasi-steady before flow separation occurred. The flow regimes were complex in the narrow mean flow Reynolds number range Re(e)=100-230 and a frequency parameter of alphae=2.25. The shear layer flow disturbances diminished in strength due to viscous damping along the distal vessel at these relatively low values of Re(e), typical of flow through diseased epicardial coronary vessels. The distal hyperemic flow field was likely to be in an early stage of turbulent flow development during the peak systolic phase.     

Proteomic analysis of circulating human monocytes in coronary artery disease

Monocytes play an important role in inflammation and atherosclerosis; however, the molecular details underlying these diverse functions are not completely understood. Proteomic analysis of monocytes can provide new insights into their biological role in coronary artery disease (CAD). Twenty angiographically confirmed male, CAD patients (≥50% stenosis) attending cardiology clinic of Nehru Hospital, PGIMER, Chandigarh, and who were not receiving any lipid lowering therapy and 20 TMT negative subjects who served as controls were enrolled in the study. Circulating monocytes isolated from overnight fasting blood samples were analyzed by 2D gel electrophoresis (pH 4-7), and differentially expressed protein spots were subjected to mass spectrometry and identification of proteins. We observed 333 ± 40 protein spots in monocytes from patients and 312 ± 20 in controls; out of which 63 protein spots showed altered intensity in CAD patients. Thirteen spots showed fivefold increased and two protein spots showed fivefold decreased expression in CAD group as compared to control group, respectively. Two proteins showing decreased expression in monocytes from CAD patients were identified as: (i) glutathione transferase and (ii) heat shock protein 70 KDa. Proteins showing increased expression in CAD patients were identified as: (i) vimentin, (ii) mannose binding lectin receptor protein, and (iii) S100A8 calcium-binding protein. The results of our study offer identification of several proteins in monocytes which can provide new perspectives in role of monocytes in pathogenesis of atherosclerosis.     

Quantitative analysis of feedforward sympathetic coronary vasodilation in exercising dogs.

Recent experiments demonstrate that feedforward sympathetic beta-adrenoceptor coronary vasodilation occurs during exercise. The present study quantitatively examined the contributions of epinephrine and norepinephrine to exercise coronary hyperemia and tested the hypothesis that circulating epinephrine causes feedforward beta-receptor-mediated coronary dilation. Dogs (n = 10) were chronically instrumented with a circumflex coronary artery flow transducer and catheters in the aorta and coronary sinus. During strenuous treadmill exercise, myocardial oxygen consumption increased by approximately 3.9-fold, coronary blood flow increased by approximately 3.6-fold, and arterial plasma epinephrine concentration increased by approximately 2.4-fold over resting levels. At arterial concentrations matching those during strenuous exercise, epinephrine infused at rest (n = 6) produced modest increases (18%) in flow and myocardial oxygen consumption but no evidence of direct beta-adrenoceptor-mediated coronary vasodilation. Arterial norepinephrine concentration increased by approximately 5. 4-fold during exercise, and coronary venous norepinephrine was always higher than arterial, indicating norepinephrine release from cardiac sympathetic nerves. With the use of a mathematical model of cardiac capillary norepinephrine transport, these norepinephrine concentrations predict an average interstitial norepinephrine concentration of approximately 12 nM during strenuous exercise. Published dose-response data indicate that this norepinephrine concentration increases isolated coronary arteriolar conductance by approximately 67%, which can account for approximately 25% of the increase in flow observed during exercise. It is concluded that a significant portion of coronary exercise hyperemia ( approximately 25%) can be accounted for by direct feedforward beta-adrenoceptor coronary vascular effects of norepinephrine, with little effect from circulating epinephrine.     

Quantitative,three-dimensional analysis of alfalfa egg cells in two genotypes: Implications for biparental plastid inheritance

In alfalfa (Medicago sativa L.), plastids are inherited biparentally. Patterns of plastid transmission vary according to the genotypes involved, but there is a strong bias in favor of male plastid transmission. Previous cytological studies on the male gametophyte of this species have not provided an adequate explanation for the differences in plastid transmission frequencies among genotypes. In the present study, we compared egg cells from genotypes classified as strong or weak plastid transmitters to determine whether plastid transmission strength is correlated with egg cell structure before fertilization. We found that plastids in the mature egg cells of the strong female (genotype 6–4) are significantly larger than in mature eggs of the weak female (genotype CUF-B), and that significantly more plastids are positioned in the apical portion of the mature egg cell of genotype 6–4 than in CUF-B. Immature eggs in the two genotypes show the same pattern as mature eggs with regard to plastid number and polarization. Since only the apical portion of the egg cell/zygote gives rise to the functional embryo, these results indicate that the potential input of female plastids, in terms of plastid size and number, may be an important factor in determining the inheritance patterns of these organelles in alfalfa.Support for this work by the United States Department of Agriculture under grant 88-37234-3876, the National Science Foundation under grant DCB-9103658, the Organized Research Fund of Northern Arizona University, and the Arizona Agricultural Experiment Station is gratefully acknowledged. We are indebted to Dr. Craig Caldwell, Northern Arizona University Computer Visualization Laboratory, for his expert help with the computer graphics.     

Preliminary analysis of inheritance of scoliosis

90 pedigrees (283 individuals) were used for statistical and segregation analysis of scoliosis inheritance. It was shown that inheritance of scoliosis may be described by the monogenic model with incomplete penetrance of heterozygotes, the latter being lower in men than in women. The monogenic model allows to perform correct predictions, the probability of incorrect prediction being about 0.1.     

Large-scale gene-centric analysis identifies novel variants for coronary artery disease

Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. We examined 49,094 genetic variants in ∼2,100 genes of cardiovascular relevance, using a customised gene array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin). We attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. Potential mechanisms through which the novel variants could affect CAD risk were explored through association tests with vascular risk factors and gene expression. We confirmed associations of several previously known CAD susceptibility loci (eg, 9p21.3:p<10⁻³³; LPA:p<10⁻¹⁹; 1p13.3:p<10⁻¹⁷) as well as three recently discovered loci (COL4A1/COL4A2, ZC3HC1, CYP17A1:p<5×10⁻⁷). However, we found essentially null results for most previously suggested CAD candidate genes. In our replication study of 24 promising common variants, we identified novel associations of variants in or near LIPA, IL5, TRIB1, and ABCG5/ABCG8, with per-allele odds ratios for CAD risk with each of the novel variants ranging from 1.06–1.09. Associations with variants at LIPA, TRIB1, and ABCG5/ABCG8 were supported by gene expression data or effects on lipid levels. Apart from the previously reported variants in LPA, none of the other ∼4,500 low frequency and functional variants showed a strong effect. Associations in South Asians did not differ appreciably from those in Europeans, except for 9p21.3 (per-allele odds ratio: 1.14 versus 1.27 respectively; P for heterogeneity = 0.003). This large-scale gene-centric analysis has identified several novel genes for CAD that relate to diverse biochemical and cellular functions and clarified the literature with regard to many previously suggested genes.     

Identification of patients with coronary artery disease using magnetocardiographic signal analysis.

INTRODUCTION: Magnetocardiography (MCG), which measures the magnetic component of the heart's electrical activity, offers an alternative approach for analyzing changes induced by coronary artery disease (CAD). This study examines several parameters that quantify spatial and temporal aspects of cardiac magnetic signals in CAD. MATERIALS AND METHODS: MCGs were registered at rest in 144 subjects, aged 58.3 +/- 9.8 years: 50 healthy subjects, 43 CAD patients without myocardial infarction (MI), 36 with MI, and 15 with spontaneous episodes of ventricular tachycardia (VT). Spatial characteristics of magnetic field maps (MFM), quantified using their centers of gravity, included MFM orientation and trajectory plots. Spatio-temporal analysis was performed by determining the spatial distribution of the QT interval. RESULTS: In CAD patients, MFM orientation during the QT interval deviated from normal in 67% of patients without MI and in 85% of patients with MI. Trajectory plots deviated from those of the normal group, with deviation increasing with disease severity. Quantifying the distribution of QT interval duration using a smoothness index demonstrated a significant difference between the values for healthy subjects and non-MI patients, as well as MI patients with and without VT (p < 0.001). CONCLUSION: The results reported demonstrate that disturbances in cardiac electrogenesis resulting from CAD may be assessed using MCG signal analysis.     

Quantitative inheritance and barriers to crossability in Cicer arietinum L.

Summary Three different diallel crosses were studied in Cicer arietinum; two of size 6×6, one within each of the two botanical groups macrosperma and microsperma of the cultivated subspecies, and one of 9×9 involving lines covering most of the morphological variation of chickpea. Barriers to crossability present neither a botanical nor a geographical pattern, being probably a direct consequence of interactions between genotypes. The genetic systems of twelve quantitative characters were analysed. Full dominance in a negative sense (small values dominant) is shown by leaflet length, width and shape index, rachis length, leaflet density on the rachis and pod length. Full dominance in a positive sense is shown by seeds per pod. Overdominance (in a positive sense) is evident for pods, seeds and yield per plant. Weak reciprocal differences were manifested by pod length, and pods, seeds and yield per plant. The system controlling number of leaflets per leaf is not clear. Dominance of primitive over selected characters seems to be the rule. As far as the environmental effects have permitted the analysis, no differences in genetic systems were observed between botanical groups.     

Simulation of coronary artery revascularization

Simulation of the commonly constructed geometries of aorto-coronary bypass anastomoses was carried out using especially fabricated distensible tubes and a pulsatile pump. The system pressure was maintained between 80 and 120 mmHg. The total mean flow was set at 250 ml min-1 (Reynolds number of 200) and the pulsatile frequency was varied from 0 to 2 Hz. A water-glycerine mixture having a density and viscosity similar to that of blood was used throughout. A 16 mm film of the front of black dye injected proximal to the anastomosis was made as the dye approached and passed through the anastomosis. Anastomotic geometries consisted of: end to side, parallel, 45 degree angle, and 90 degree angle. Stenoses, located in the tube representing the coronary artery, were simulated using a bevelled insert which represented an 80-85% area reduction. Flow visualization revealed that distensible tubes gave more realistic flow patterns than rigid tubes, a result particularly evident when a stenosis was present. Pulsatile flow demonstrated considerably more mixing than steady flow. The use of pulsatile flow in distensible tubing with a partial stenosis showed retrograde flow through the stenosis which was not evident for either steady flow or for flow in rigid tubing. The flow at the anastomatic site of the graft having an angle of 0 degrees showed a jetting action with a zone of recirculating fluid being present whereas for a 90 degree graft a distinct helical flow was formed distal to the anastomosis.     

Multilevel selection 1: Quantitative genetics of inheritance and response to selection

Interaction among individuals is universal, both in animals and in plants, and substantially affects evolution of natural populations and responses to artificial selection in agriculture. Although quantitative genetics has successfully been applied to many traits, it does not provide a general theory accounting for interaction among individuals and selection acting on multiple levels. Consequently, current quantitative genetic theory fails to explain why some traits do not respond to selection among individuals, but respond greatly to selection among groups. Understanding the full impacts of heritable interactions on the outcomes of selection requires a quantitative genetic framework including all levels of selection and relatedness. Here we present such a framework and provide expressions for the response to selection. Results show that interaction among individuals may create substantial heritable variation, which is hidden to classical analyses. Selection acting on higher levels of organization captures this hidden variation and therefore always yields positive response, whereas individual selection may yield response in the opposite direction. Our work provides testable predictions of response to multilevel selection and reduces to classical theory in the absence of interaction. Statistical methodology provided elsewhere enables empirical application of our work to both natural and domestic populations.     

Proton NMR analysis of plasma is a weak predictor of coronary artery disease

Multivariate analysis of 1H-NMR spectra of blood sera was reported previously to predict angiographically defined advanced coronary artery disease (CAD) with >90% accuracy and specificity. The analysis depended mainly on the major lipid regions of the spectra, but many variables, including gender and drug treatment, affect lipid composition and are potential confounders. We have determined the predictive power of the same methodology for angiographically defined CAD using plasma samples from groups of male patients, classified by statin treatment, who had normal coronary arteries (NCAs) or CAD. Predictions for NCA and CAD groups were only 80.3% correct for patients not treated with statins and 61.3% for treated patients, compared with random correct predictions of 50%. A confidence limit of >99% was achieved for 36.2% of predictions for untreated groups and 6.2% for treated groups. Detection of CAD by 1H-NMR with >99% confidence was therefore very weak compared with angiography.