Free triiodothyronine in relation to coronary severity at different ages: Gensini score assessment in 4206 euthyroid patients

Background: Lipid disorder was one of the major risk factors for coronary artery disease (CAD), especially in postmenopausal women, whose lipid profile significantly changed during the transition period to menopause. The aim of the present study was to examine whether plasma lipoprotein(a) [Lp(a)] was a biomarker for predicting the presence and severity of CAD in postmenopausal women. Methods: A total of 783 postmenopausal women who had their first angina-like chest pain were enrolled and classified into two groups according to the results of coronary angiography: CAD group (n = 309) and age-matched non-CAD group (n = 309). Patients with CAD were further divided into the three groups based on Gensini score (GS). The relationships of plasma Lp(a) levels to the presence and severity of CAD were evaluated, and the predictive value of Lp(a) for CAD was also examined. Results: CAD group had higher Lp(a) levels when compared to non-CAD ones (p < 0.001). The multivariate logistic regression analysis suggested that Lp(a) was an independent predictor for the presence of CAD (p < 0.001). Plasma levels of Lp(a) were significantly related to GS (p < 0.001). In addition, plasma Lp(a) level was significantly elevated according to the tertiles of GS (p = 0.001) and was independently associated with high GS (p < 0.001). In receiver-operating characteristic analysis for predicting the presence of CAD in postmenopausal women, Lp(a) was found to have the area under the curve of 0.703, with an optimal cutoff value of 255.69 mg/L. Conclusions: Lp(a) is an independent risk factor for predicting the presence and the severity of new-onset CAD in postmenopausal women, suggesting that Lp(a) may be a lipid target for prevention and treatment in such patients.

The aim of this study is to investigate the relationship between serum thyroid hormone levels that are within the normal range and the presence and severity of coronary artery disease (CAD) in patients referred for coronary angiography. In this observational study, we enrolled 119 consecutive patients (77 men, mean age 60.7±13.8 years) who underwent coronary angiography. Blood samples were tested for thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) concentrations. Additionally, risk factors, clinical characteristics and angiographic results were obtained. The patients were separated into two groups according to the Gensini score as those with mild or severe atherosclerosis. Statistical analysis was performed using the Chi-square, Mann-Whitney U, correlation and logistic regression tests, and ROC analysis. FT3 levels were significantly lower in subjects with CAD (4.0±0.7 vs. 4.6±0.6 pmol/L; p<0.001). Moreover, lower FT3 levels were found in patients with severe atherosclerosis (3.9±0.7 vs. 4.5±0.6 pmol/L; p<0.001). Logistic regression analysis demonstrated that the lower FT3 levels were associated with the presence (OR =0.266, 95% CI: 0.097-0.731, p=0.01) and severity (OR=0.238, 95% CI:0.083-0.685, p=0.008) of CAD. In the ROC analysis, a level of FT3 ≤4.2 pmol/L was found to predict the presence of CAD with 69% sensitivity and 71% specificity (AUC:0.744, 95% CI:0.653-0.834, p<0.001); and the severity of CAD with 75% sensitivity and 67% specificity (AUC:0.733, 95% CI:0.642-0.824, p<0.001). FT3 levels within the normal range were inversely correlated with the presence and severity of CAD. Moreover, lower FT3 concentrations were correlated with the Gensini score and independently predicted the presence and severity of CAD. Thus, the FT3 levels may be used as the indicator of increased risk for CAD.

BackgroundThe relationship between galectin-3 (Gal-3) and coronary artery disease (CAD) has not been fully elucidated.AimThis study aimed to determine the relationship between the presence and severity of CAD and serum Gal-3 levels.Patients and MethodsThree-hundred thirty-one consecutive CAD patients were enrolled as the study group. An additional 62 patients without CAD were enrolled as the control group. Serum Gal-3 levels were separately compared between the non-CAD and CAD groups, among the stable CAD and Acute coronary syndrome (ACS) groups, and between CAD patients with low and high SYNTAX scores (SSs). The 1-year cumulative rate of major adverse cardiac events (MACEs) was also compared among ACS patients by Gal-3 levels.ResultsSerum Gal-3 was significantly higher in the CAD group than in the non-CAD group 3.89 (0.16–63.67) vs. 2.07 (0.23–9.38) ng/ml, P < 0.001. Furthermore, serum Gal-3 was significantly higher in the non-ST-segment elevation ACS (NSTE-ACS) group than that in the stable CAD group, 4.72 (1.0–16.14) vs. 2.23 (0.65–23.8) ng/ml, P = 0.04 and higher in the ST-segment elevation myocardial infarction (STEMI) group than that in the stable CAD group 7.87 (0.59–63.67) vs. 2.23 (0.65–23.8) ng/ml, P < 0.001. Serum Gal-3 level was an independent predictor of ACS compared with stable CAD group (OR = 1.131, 95% CI: 1.051–1.217, P = 0.001) as well as high SS (OR = 1.030, 95% CI: 1.021–1.047, P = 0.038) after adjust other confounding risk factors. Acute coronary syndrome patients with Gal-3 levels above the median (gal-3 = 4.78 ng/ml) showed a higher cumulative MACE rate than those with Gal-3 levels below the median. After adjusting other confounding risk factors, Gal-3 remained an independent risk factor for the cumulative rate of MACEs in ACS patients (6% higher rate of MACEs incidence per 1 ng/ml increment of Gal-3).ConclusionGalectin-3 correlated with the presence of CAD as well as coronary stability and complexity. Galectin-3 may be valuable in predicting mid-term prognosis in ACS patients.

The associations between the presence or severity of coronary artery disease (CAD) and measurements of various kinds of fat as assessed by multidetector row computed tomography (MDCT) are unclear. We enrolled 300 patients who were clinically suspected to have CAD or who had at least one cardiac risk factor and had undergone MDCT. The number of significantly stenosed coronary vessels (VD), and measurements of pericardial fat index, paracardial fat index, epicardial fat index, visceral fat index, and subcutaneous fat index were quantified using MDCT. Plasma levels of adiponectin, pentaxin-3, and high-sensitivity C-reactive protein factors were also measured. Pericardial fat index, paracardial fat index, and visceral fat index in a CAD group were significantly greater than those in a non-CAD group. In addition, the levels of these fat indices tended to increase as the number of VD increased and were positively correlated with the Gensini score. The area-under-the-curve for paracardial fat index was significantly greater than those for the other parameters of fat index measured by a receiver-operating characteristic curve analysis. The cut-off level of paracardial fat index that gave the greatest sensitivity and specificity for the diagnosis of CAD was 54.9 cm3/m2 (sensitivity 0.710, specificity 0.552). The presence of CAD was independently associated with paracardial fat index, in addition to age and diabetes mellitus, by a multiple logistic regression analysis. In conclusion, paracardial fat index may be a marker for evaluating the presence or severity of CAD.

Circulating FAM19A5 level is associated with the presence and severity of coronary artery disease

Epicardial adipose tissue (EAT) is presumed to play an important role in the development of coronary artery disease (CAD). The purpose of our study was to examine the influence of EAT volume measured by cardiac CT on the severity and presence of CAD. A total of 209 subjects (114 normal subjects and 95 patients with CAD) underwent cardiac and abdominal computed tomography (CT) scan before diagnostic coronary angiography. Pixels with a threshold range of -190 to -30 Hounsfield units were identified as EAT. CAGE ≥ 20, CAGE ≥ 50, and modified Gensini index were used to define the extent and severity of CAD. While there was no significant difference in BMI and WC between the two groups, the mean EAT volume was higher in the CAD group than in the normal subjects (102.4 ± 41.87 cm(3) versus 125.36 ± 47.64 cm(3), P < 0.001). EAT was significantly associated with CAGE ≥ 20, CAGE ≥ 50, and Gensini score by linear regression analyses after adjusting for age, gender, smoking, and alcohol use. The severity of CAD increased linearly with each tertile increase in EAT volume (P for trend < 0.05). Similarly, the coronary artery calcium (CAC) score was also increased with each increase in EAT tertile (P = 0.002). In multivariate logistic regression models, EAT and VAT were significantly associated with the presence of CAD and CAC in age, gender, smoking, alcohol use, and BMI adjusted models. In conclusion, EAT volume measured by CT is associated with the presence and severity of CAD. EAT may give important information for risk evaluation in CAD.

Patients with metabolic syndrome are at high-risk for development of atherosclerosis and cardiovascular events. Serum soluble lectin-like oxidized low-density lipoprotein receptor-1(sLOX-1) is associated with coronary artery disease (CAD) and metabolic disorders. We sought to assess whether serum sLOX-1 levels are correlated with the presence and severity of CAD in patients with metabolic syndrome (MetS) undergoing coronary angiography. Serum sLOX-1 levels were measured in 112 consecutive patients with MetS, undergoing coronary angiography for the evaluation of CAD. The severity of CAD was assessed by angiographic Gensini score system. Serum sLOX-1 levels were significantly higher in MetS patients with CAD (n=69) than in those without CAD (n=43) (0.925 [range 0.137 to 1.432] ng/ml vs. 0.207 [range 0.063 to 0.774] ng/ml, P < 0.01). Multivariate logistic regression analysis revealed that serum sLOX-1 level was independently associated with the presence of CAD (odds ratio 2.489, 95% confidence interval 1.290-4.802; P < 0.01). Serum sLOX-1 levels were positively correlated with the Gensini score (ρ: 0.394, P < 0.01) after adjusting for other clinical characteristics. High sLOX-1 levels are associated with the presence and severity of CAD in patients with MetS. The measurement of serum sLOX-1may be potentially useful in predicting the presence and severity of CAD in patients with MetS.

BackgroundObesity is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). Estimation of visceral adipose tissue is important and several methods are available as its surrogate. Although correlation of epicardial adipose tissue (EAT) with visceral adipose tissue as estimated by magnetic resonance imaging (MRI) and/or CT is excellent, it is costlier and cumbersome. EAT can be accurately measured by two-dimensional (2D) echocardiography. It tends to be higher in patients with acute coronary syndrome than in subjects without coronary artery disease (CAD) and in those with stable angina. It also carries advantage as index of high cardiometabolic risk as it is a direct measure of visceral fat rather than anthropometric measurements. The present study evaluated the relationship of EAT to the presence and severity of CAD in clinical setting.MethodsIn this prospective, single-center study conducted in the Department of Cardiology, LPS Institute of Cardiology, Kanpur, India, 549 consecutive patients with acute coronary syndrome or chronic stable angina were enrolled. Sensitivity, specificity, and receiver operating characteristic (ROC) curve were estimated to find cut-off value of EAT thickness for diagnosing CAD using coronary angiographic findings as gold standard.ResultsPatients were diagnosed as CAD group (n = 464, 60.30 ± 8.36 years) and non-CAD group (n = 85, 54.42 ± 11.93 years) after assessing coronary angiograms. The EAT was measured at end-systole from the PLAX views of three cardiac cycles on the free wall of the right ventricle. Lesion was significant if > 50% in left main and > 70% in other coronary arteries. The mean EAT thickness in CAD group was 5.10 ± 1.06 and in non-CAD group was 4.36 ± 1.01 which was significant (P = 0.003). Significant correlation was demonstrated between EAT thickness and presence of CAD (P < 0.003). Higher EAT was associated with severe CAD and presence of multivessel disease. By ROC analysis, EAT > 4.65 mm predicated the presence of significant coronary stenosis by 71.6% sensitivity and 73.1% specificity.ConclusionEAT thickness measured using transthoracic echocardiography (TTE) significantly correlates with the presence and severity of CAD. It is sensitive, easily available, and cost-effective and assists in the risk stratification and may be an additional marker on classical risk factors for CAD.

Background:The existing evidence suggests that plasma adiponectin concentrations can be indicative of the presence and severity of coronary artery disease (CAD). However, the results of the studies conducted hitherto on this subject are inconsistent. We sought to investigate the possible correlation between plasma adiponectin levels and the presence and severity of CAD in patients undergoing non-urgent coronary angiography.Methods:In 399 consecutive patients undergoing non-urgent coronary angiography for CAD survey, plasma adiponectin, triglyceride, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, and fasting blood sugar levels were measured and demographic characteristics such as age, sex, Body Mass Index, diabetes mellitus history, systemic hypertension history, and family history of CAD were collected. According to the angiography results, the patients were divided into two groups of CAD and non-CAD. The severity of coronary atherosclerosis in the CAD group was defined using the Gensini score system.Results:Average age was 61.4 ± 9.94 years in the CAD group and 57.9 ± 10.75 years in the non-CAD group. Also, 73.7% of the CAD group and 55.4% of the non-CAD group were male. Totally, 278 (69.7%) patients were found to have CAD. Patients without CAD did not have higher mean plasma adiponectin concentrations than did those with CAD (13.38 ± 11.96 vs. 14.95 ± 14.11 mcg/ml; p value = 0. 896). After adjustment for CAD conventional risk factors, plasma adiponectin levels still were not associated with CAD. No association was found between plasma adiponectin levels and the Gensini score. Furthermore, in contrast to the fairly strong correlation previously reported, there was no correlation between adiponectin levels and conventional CAD risk factors.Conclusion:We could not observe any relationship between plasma adiponectin concentrations and the presence or severity of CAD in patients undergoing coronary angiography.

Introduction: Secreted frizzled-related protein 5 (SFRP5), an anti-inflammatory adipokine, is excreted by adipose tissue and may have protective effects on cardiovascular system. In the present study, the relationships of serum level of SFRP5 with the presence and severity of coronary artery disease (CAD) was investigated. Materials and methods: In the current study, 40 control subjects, 40 stable and 40 unstable CAD patients were included. Serum level of SFRP5 in all subjects in the study was determined by immunoassay method. The severity of CAD (based on Gensini score) was assigned by angiography examination. The status of conventional risk factors was also determined. Then, the association of SFRP5 with CAD severity and traditional CAD risk factors was explored. Results: Serum level of SFRP5 was lowest in unstable CAD, followed by stable CAD patients and then control subjects (P < 0.001). The correlation of SFRP5 with Gensini score was significant only in unstable CAD patients (P < 0.01). However, the correlation of SFRP5 with the traditional CAD risk factors was relatively significant and negative in all patients (P<0.05). SFRP5 had a reverse association with the presence of CAD. Conclusions: Decreased level of serum SFRP5 is associated with the presence and severity of CAD, highlighting its usefulness as a potential clinical biomarker.

AIM:This study was conducted to investigate the correlation between waist/hip ratio (WHR) as a measurement of obesity and severity of coronary artery disease (CAD) assessed by angiography in Kosovo.METHODS:The study included 82 patients with suspected or known CAD who were referred for coronary angiography. All patients were subjected to full individual medical history, clinical examination including measurement of arterial blood pressure, body weight, height, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, and waist/height ratio. Coronary angiography was performed using standard techniques to determine the presence and severity of coronary artery lesions with the Gensini score.RESULTS:Among the 82 patients in the study, the mean age in the CAD group was 66.76 ± 9.12 years and the mean age in the non-CAD group was 64.80 ± 8.30 years. Patients in the CAD group had a mean BMI of 28.17 ± 3.32 kg/m2 and those in the non-CAD group had a mean BMI of 28.76 ± 4.68 kg/m2. Patients in the CAD group had a mean waist/height ratio of 1.76 ± 7.56 and those in the non-CAD group had a mean waist/height ratio of 0.57 ± 0.08. Patient in the CAD group had a mean waist/hip ratio of 0.93 ± 0.06 and those in the non-CAD group had a mean waist/hip ratio of 0.88 ± 0.07. Thirty-seven patients (45.1%) had no coronary artery disease (Gensini score = 0), 15 (18.3%) had mild disease (Gensini score = 1-32), 14 (17.1%) had moderate disease (Gensini score = 32-58), and 16 (19.5%) had severe disease (Gensini score ≥ 58).CONCLUSION:There was a significant positive correlation between waist/hip ratio and presence of CAD in Kosovar patients.

Objective To explore the correlation between thyroxine hormone and the severity of coronary artery disease (CAD).Methods 158 patients with coronary adisease were entered consecutively into the study.They were separated into control group (absence of CAD,n=98)and CAD group (presence of CAD,n=60).Based on the number of vessel disease,CAD group was further divided into three sub-groups:single-vessel CAD subgroup (n=30),bi-vessel CAD subgroup (n=15) and multi-vessel CAD subgroup (n=15).Serum free triiodothyronine (fT3),free thyroxine (fT4),thyroid stimulating hormone (TSH) were tested by electrochemiluminescence; high density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) weremeasured by cholesterol oxidase method; and Gensini scoring system was used to evaluate the degree of coronary artery stenosis.Results The levels of fT3 in both bi-vessel CAD and multi-vessel subgroups were higher than those in control group (t=1.947,6.415,both P＜0.05).And the level of fT4 in multi-vessel subgroup was also higher than that in control group (t=3.026,P＜0.05).fT3 was an independent risk factor of CAD using Logistic regression model.In addition,fT3 was negatively correlated with Gensini scoring inmultiple linear regressions.Gensini scores would increase by 1 as long as the level oft fT3 decreases 0.234 pmol/L.Conclusions fT3 level decreased in patients with CAD,and correlated with the severity of CAD.Gensiniscores would increase 1 as long as fT3 decreases 0.234 pmol/L,which could be supposed as a sensitive predictor of CAD. Key words: Thyroid hormones; Coronary artery disease; Gensini scoring

Fasting serum total bile acid level is associated with coronary artery disease, myocardial infarction and severity of coronary lesions

The aim of our study was to investigate the relationship between age, sex, obesity, nonalcoholic fatty liver disease (NAFLD), carotid intima-media thickness (CIMT), and both the presence and severity of coronary artery disease (CAD) and their predictive value for the presence and severity of CAD. Our study population consisted of 136 patients who underwent coronary angiography for various reasons. Gensini scoring was used to determine the severity of coronary atherosclerosis. Carotid intima-media thickness was estimated by carotid duplex ultrasound. Nonalcoholic fatty liver disease was diagnosed by abdominal ultrasonography. Body mass index (BMI) was calculated as kilograms divided by meters squared. Coronary artery disease was detected in 74 patients (54%). In the whole group, patients with CAD had significantly higher CIMT measurements compared with those without CAD (0.93 [SD, 0.14] and 0.72 [SD, 0.12] mm, respectively, P < 0.001). Carotid intima-media thickness was correlated with BMI (P < 0.001, r = 0.453), age (P = 0.001, r = 0.389), and grade 2-3 NAFLD (P < 0.001, r = 0.356). In the multiple logistic regression model, CIMT (odds ratio, 1.189; 95% confidence interval, 1.122-1.261; P < 0.001) was the only independent predictor of the presence of CAD. In receiver operating characteristic curve analysis, optimal cutoff value of CIMT to predict the presence of CAD was found as greater than 0.75 mm with 93.2% sensitivity and 71% specificity. In CAD group patients, Gensini score was correlated with CIMT (P < 0.001, r = 0.604), grade 2-3 NAFLD (P < 0.001, r = 0.534), BMI (P < 0.001, r = 0.498), and age (P = 0.001, r = 0.385). In the multiple stepwise linear regression model, CIMT (β = 0.444, P < 0.001) and grade 2-3 NAFLD (β = 0.353, P < 0.001) were associated with severity of CAD. Our data suggest that CIMT is a strong independent predictor for the presence and severity of CAD. Furthermore, moderate to severe hepatosteatosis is also significantly associated with the severity of CAD. Therefore, detection of CIMT and NAFLD by ultrasonography, which is a very cheap, safe, and noninvasive radiological modality, can be used to improve CAD risk prediction.

Background:Recent studies have shown EAT to be an indicator of cardiovascular risk and atherosclerotic plaque development. However, such data is sparse from Indian sub-continent. The present study evaluated the relationship of EAT as determined by echocardiography to the presence and severity of coronary artery disease (CAD).Materials and Methods:This was a cross-sectional observational study constituting 500 patients including 250 with angiographically normal coronary arteries (non-CAD group), and 250 patients with significant CAD on coronary angiogram (CAD group). CAD severity was assessed by Gensini and SYNTAX scores.Results:The mean systolic and diastolic EAT thickness in the CAD group (5.7 ± 1.5 mm and 4.3 ± 1.1 mm) were significantly higher than the non-CAD group (4.2 ± 1.2 mm and 3.2 ± 1.2 mm), both P < 0.001. EAT thickness showed a significant positive correlation with waist circumference, LDL-C levels, Gensini score, and SYNTAX score. On multivariate logistic regression analysis, both systolic and diastolic EAT thickness were found to be independent predictor of CAD in addition traditional risk factors. Receiver operating characteristics (ROC) analysis showed that systolic EAT thickness of 5 mm and diastolic EAT thickness of 4 mm had similar sensitivity (85% vs 83%, respectively) and specificity (70% vs 72%, respectively) to detect presence of CAD.Conclusion:Systolic and diastolic EAT thicknesses are increased in CAD patients and related to both presence and severity of CAD. EAT, being modifiable, may be an attractive target for future interventions to reduce CV risk and has potential to monitor the response to life-style modification and therapy. However, larger and prospective studies required to validate these findings.