Anginal Chest Pain Research Articles

Cocaine-associated Chest Pain: Our Experience with Myocardial Markers and Stress Lexiscans

Abstract Background: Cocaine is a commonly abused recreational drug, leading to frequent emergency room visits. The aim of this study was to check the effect of cocaine on myocardial markers of injury and the stress myocardial imaging patterns. Materials and Methods: All patients with anginal chest pain or equivalents who tested positive for cocaine on urine drug screen with reversible myocardial ischemia on regadenoson stress myocardial perfusion imaging called lexiscans were included and their corresponding myocardial markers of injury and stress imaging were reviewed. Results: Thirty-four patients had tested positive for cocaine in urine, out of the 192 patients with reversible myocardial ischemia on stress testing. The percentage of cocaine-associated myocardial ischemia was up to 17.70% in our study. Creatine kinase-MB levels were above the normal reference value of 5 ng/mL in 72.7% of patients and the combined cardiac troponins by fourth-generation assays were above the detection levels (≥0.02 ng/mL for cardiac troponin I [cTnI] and ≥0.010 ng/mL for cardiac troponin T [cTnT]) in 50% of patients. None of our patients had severe reversible myocardial ischemia on lexicans, but rather minimal-to-mild reversible myocardial ischemia was seen in the majority (76.5%) of patients. cTnI elevation was significantly associated with minimal reversible myocardial ischemia on one-way analysis of variance (P < 0.05). Conclusion: Cocaine was associated with minimal-to-mild reversible myocardial ischemia on stress testing with significant elevation of cTnI.

Mechanisms affecting the neutrophil to lymphocyte ratio in heart failure: a prospective CMR study

Abstract Background The neutrophil-to-lymphocyte ratio (NLR) is a simple measure of inflammation defined as the ratio of the neutrophils to lymphocytes as measured in the full blood count. It is well known that patients with heart failure (HF) have elevated levels of pro-inflammatory cytokines. It has been demonstrated in a recent meta-analysis that elevated NLR in heart failure is significantly associated with worse outcomes including all-cause mortality, heart failure readmissions and cardiovascular death. Purpose Given this association between NLR and adverse prognosis in HF, we aim to identify which factors are associated with an elevated NLR. This may help to recognise patients at higher risk and guide management. Methods Patients with newly diagnosed HF and left ventricular ejection fraction <50% on referral echocardiogram were prospectively recruited at the time of referral for cardiovascular magnetic resonance (CMR). Exclusion criteria included prior revascularisation, myocardial infarction, anginal chest pain, congenital heart disease and suspected myocarditis. In one appointment patients (N=599) underwent clinical assessment, medication review, full blood count and CMR. The CMR protocol included quantitative assessment myocardial blood flow at stress and rest, assessment of ischaemic and non-ischaemic fibrosis by late gadolinium enhancement imaging and T1 and T2 mapping. Guideline directed medical therapy was determined by the referring physician. Baseline demographic data, medication and MRI results were recorded for all patients. NLR was calculated from full blood count and split into tertiles. Clinical and CMR parameters were compared between tertiles by analysis of variance and chi squared test. Results See Table 1 The factors which were found to be significantly associated with an elevated NLR were age, atrial fibrillation, NTproBNP, diuretic dose, inducible ischaemia and ischaemic fibrosis. Of note there was no significant difference between groups in terms of guideline directed medical therapy use or other CMR parameters. Conclusion NLR is increasingly recognised as a marker of adverse risk in patients with heart failure. This prospective study of 599 heart failure patients with reduced ejection fraction has identified that an elevated NLR is associated with: 1. Evidence of congestion as evidenced by NTproBNP results and increased diuretic doses. 2. Occult coronary artery disease as shown by greater levels of inducible ischaemia and ischaemic fibrosis. These findings suggest that the adverse prognosis associated with elevated NLR in heart failure may be mediated by worsening congestion and occult coronary artery disease. Importantly there was no association between myocardial inflammation or oedema (measured as native T1 and T2) and NLR. Whether NLR improves with medical therapy of heart failure remains to be established and our findings need to be validated in more varied cohorts of patients with heart failure.

Prediction model for recommending coronary artery calcium score screening (CAC-prob) in cardiology outpatient units: A development study.

Despite the well-established significance of the CAC score as a cardiovascular risk marker, the timing of using CAC score in routine clinical practice remains unclear. We aim to develop a prediction model for patients visiting outpatient cardiology units, which can recommend whether CAC score screening is necessary. A prediction model using retrospective cross-sectional design was conducted. Patients who underwent CAC score screening were included. Eight candidate predictors were preselected, including age, gender, DM or primary hypertension, angina chest pain, LDL-C (≥130 mg/dl), presence of low HDL-C, triglyceride (≥150 mg/dl), and eGFR. The outcome of interest was the level of CAC score (CAC score 0, CAC score 1-99, CAC score ≥100). The model was developed using ordinal logistic regression, and model performance was evaluated in terms of discriminative ability and calibration. A total of 360 patients were recruited for analysis, comprising 136 with CAC score 0, 133 with CAC score 1-99, and 111 with CAC score ≥100. The final predictors identified were age, male gender, presence of hypertension or DM, and low HDL-C. The model demonstrated excellent discriminative ability (Ordinal C-statistics of 0.81) with visually good agreement on calibration plots. The implementation of this model (CAC-prob) has the potential to enhance precision in recommending CAC screening. However, external validation is necessary to assess its robustness in new patient cohorts.

Analysis of patient data to explore cardiovascular risk factors

According to the World Health Organisation, cardiovascular diseases claim over 17.9 million lives yearly on a global scale. Hence, cardiovascular diseases are responsible for 32 percent of global deaths yearly. Furthermore, it is estimated that more than 50 percent of heart disease cases are only discovered after they have reached the critical stage of heart failure and stroke. However, early detection of these heart diseases can reduce the mortality rates of cardiovascular diseases. Scientists have suggested using machine learning algorithms to identify the risk factors. However, the unavailability of data has hindered the significant success of this approach. In this study, machine learning algorithms are used to identify the important features that should be monitored to prevent heart diseases by considering a dataset obtained from 1000 patients. The six machine learning algorithms used for this study are Logistic Regression, Support Vector Machine, k-nearest Neighbour, Decision Tree, Random Forest and Multi-layer Perception Classifier. The dataset consists of twelve features that are considered to be associated with heart disease and a target variable. The results from this study show that patients suffering from typical and atypical angina chest pain are prone to heart disease. Patients who exercise up the slope have a higher likelihood of living without heart disease. Among the six algorithms used, the MLP Multi-layer Perception Classifier outperforms all others by achieving a 99 percent accuracy. Moreover, the Random Forest algorithm follows with an accuracy of 98 percent.

Blast from the past. It is possible to diagnose a myocardial infarction without testing from serum troponin

The diagnosis of acute myocardium infection is typically that of anginal type chest pain accompanied by ECG changes and an increase in serum troponin levels. However, there are often atypical presentations, especially in women. We present a case of a middle-aged woman with severe prolonged vomiting in whom the diagnosis of myocardial function was not made at the initial presentation.

Coronary myocardial bridge imaging by stress-echocardiography and coronary adipose tissue attenuation on computed tomography angiography

Myocardial bridging is a congenital defect characterized by the course of a segment of the coronary arteries within the heart muscle most frequently affecting the left anterior descending coronary artery (LAD). Patients with myocardial bridging may present with episodes of exertional anginal chest pain. The gold standard for non-invasive diagnosis of myocardial bridge is coronary computed tomography angiography (CCTA), which allows anatomical characterization. Coronary flow velocity reserve (CFVR) of the LAD on stress echocardiography (SE) can play an important role in the diagnosis of myocardial bridging of the LAD; a relationship between CVFR-LAD and coronary inflammation by estimating the attenuation of peri-coronary adipose tissue at CCTA has been demonstrated in patients without obstructive ischaemic heart disease. Therefore, coronary inflammation localized to the LAD has been assessed in patients diagnosed with myocardial bridging of the LAD and previous SE with CFVR-LAD in a case series.

Cardiac Thyrotoxicosis Mimicking an Acute Coronary Syndrome

This case report details the clinical presentation, diagnosis, and multidisciplinary management of a 68-year-old man with cardiac thyrotoxicosis mimicking an acute coronary syndrome (ACS). The patient presented with persistent anginal chest pain, systemic symptoms, and electrocardiographic abnormalities suggestive of ACS. Despite presenting with persistent chest pain and ACS-like symptoms, a thorough examination, including the calculation of the thyrotoxicosis storm (StPRM) score, revealed thyrotoxicosis-induced dilated cardiomyopathy, challenging the initial diagnosis. This specific scoring for thyrotoxicosis severity played a crucial role in accurately identifying the thyrotoxic crisis. The case highlights the intricate relationship between thyroid dysfunction and cardiovascular manifestations, emphasizing the need for a multidisciplinary approach. Management included standard ACS protocols, careful titration of antithyroid medications, and the transition from intravenous to oral heart failure medications. Follow-up assessments demonstrated the success of personalized treatment strategies, with the normalization of thyroid function and complete resolution of the patient's symptoms. Nevertheless, the enduring impairment of left ventricular function following treatment prompts intriguing inquiries into the lasting impact of cardiac thyrotoxicosis on myocardial recovery. However, the persistence of impaired left ventricular function post-treatment raises intriguing questions about the lingering effects of cardiac thyrotoxicosis on myocardial recovery. This case underscores the importance of considering diverse cardiac presentations in hyperthyroid patients and the effectiveness of individualized management approaches in navigating the complexities of thyroid-cardiac interactions.

Management of anterior ST-elevation myocardial infarction presenting more than 48 hours from symptom onset without reperfusion therapy in the cardiac care unit

ST-elevation myocardial infarction is a form of acute coronary syndrome that is the leading cause of death worldwide. Treatment with reperfusion therapy in the form of primary percutaneous intervention is the main treatment to reduce morbidity and mortality. However, reperfusion therapy is not recommended for patients presenting with symptoms onset of more than 48 hours. A 62-year-old male patient was diagnosed with anterior STEMI with symptoms onset of more than 48 hours based on complaints of anginal chest pain and shortness of breath. ST-segment elevation in V1-V4 and pathological Q in V1-V3 on ECG and increased hs-Troponin I was reported. The patient was not treated with reperfusion therapy based on treatment recommendations. The patient was given vasodilators, beta-blockers, statins, heparinization, and comorbid infection control in the cardiac care ward. Clinical improvement was obtained, and the patient was discharged after seven days of hospitalization and then was planned for Dobutamine Stress Echo during the follow-up visit. Conservative management and viability testing are the main options for patient management in STEMI with symptom onset of more than 48 hours without any complaints of chest pain, stable hemodynamics, and no life-threatening arrhythmia.

Case Report: Multiple atherosclerotic plaques at its extreme in synchrony

Peripheral artery (PAD) disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral artery disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.

Performance evaluation of Machine Learning models to predict heart attack

Coronary Artery Disease is the type of cardiovascular disease (CVD) that happens when the blood vessels which stream the blood toward the heart, either become tapered or blocked. Of this, the heart is incapable to push sufficient blood to encounter its requirements. This would lead to angina (chest pain). CVDs are the leading cause of mortality worldwide. According to WHO, in the year 2019 17.9 million people deceased from CVD. Machine Learning is a type of artificial intelligence that uses algorithms to help analyse large datasets more efficiently. It can be used in medical research to help process large amounts of data quickly, such as patient records or medical images. By using Machine Learning techniques and methods, scientists can automate the analysis of complex and large datasets to gain deeper insights into the data. Machine Learning is a type of technology that helps with gathering data and understanding patterns. Recently, researchers in the healthcare industry have been using Machine Learning techniques to assist with diagnosing heart-related diseases. This means that the professionals involved in the diagnosis process can use Machine Learning to help them figure out what is wrong with a patient and provide appropriate treatment. This paper evaluates different machine learning models performances. The Supervised Learning algorithms are used commonly in Machine Learning which means that the training is done using labelled data, belonging to a particular classification. Such classification methods like Random Forest, Decision Tree, K-Nearest Neighbour, XGBoost algorithm, Naive Bayes, and Support Vector Machine will be used to assess the cardiovascular disease by Machine Learning.

Formulation and Evaluation of Buccoadhesive Tablet of Verapamil Hydrochloride for the Treatment of Hypertension

The creation and assessment of buccoadhesive tablets of verapamil hydrochloride were the study's primary goals. Blood pushing excessively hard against the arterial wall is referred to as hypertension. Typically, hypertension is characterized by blood pressure readings over 140/90; readings over 180/120 are regarded as severe hypertension. Verapamil is used to manage angina (chest pain) and treat excessive blood pressure. Verapamil belongs to the category of drugs known as calcium channel blockers. In order to save the heart from having to pump as hard, it relaxes the blood artery. Additionally, it enhances the heart's blood and oxygen flow while decreasing electrical activity to regulate heart rate. Five formulations that demonstrated satisfactory physicochemical characteristics and drug release were chosen for the investigation. Physical examination, weight fluctuation, uniformity of content, thickness, friability, hardness, and in vitro drug release were used to characterize the formulation. In terms of physical examination, weight variation, uniformity of content, thickness, friability, hardness, and in vitro drug release, all formulations produce satisfactory results. The buccoadhesive tablet formulation (F2 Batch) had the best in vitro drug release of 87% in 8 hours. Verapamil hydrochloride's UV spectrum was examined, and it was discovered that the drug's highest absorbance occurs at 227nm, increasing its bioavailability.
 Keywords: Verapamil Hydrochloride, Hypertension, Bioavailability, Buccoadhesive Tablet, Calcium channel blocker.

Case Report: Multiple atherosclerotic plaques at its extreme in synchrony

Peripheral vascular disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral vascular disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.

Coronary Spasm: Ethnic and Sex Differences.

Coronary spasm (CS), which may occur at the epicardial (focal or diffuse spasm) and/or microvascular (microvascular spasm) level, is a well-established cause of myocardial ischaemia, in particular in patients with anginal chest pain despite unobstructed coronary arteries. The diagnosis of CS can be confirmed during coronary angiography by an additional provocation test with vasoactive substances such as acetylcholine. Due to partially inconsistent data from large clinical studies, especially between Asian and white CS patients, ethnic differences concerning the prevalence and angiographic patterns of CS seem to exist. Furthermore, several studies in patients with coronary vasomotor disorders pointed towards differences among male and female CS patients. This article gives an overview of ethnic- and sex-related differences in patients with CS.

First Experience of Measuring Index of Microcirculatory Resistance at Auckland City Hospital

Patients with angina and non-obstructive coronary artery disease (NOCAD) present an important diagnostic and management challenge. Measurement of the index of microcirculatory resistance (IMR) with a coronary pressure wire at the time of invasive coronary angiography can help distinguish between microvascular angina and non-cardiac chest pain. A retrospective audit was undertaken of consecutive patients with NOCAD and measurement of microvascular indices from the Northern region between March 2020 and January 2023 at Auckland City Hospital (ACH). Coronary flow reserve, IMR, and fractional flow reserve were measured, as shown in the Table. Sixty-two patients had IMR measured and seven were excluded as they were out of area; 75% were male and the mean age was 65 (SD 8.6) years. An elevated IMR was found in 24 (43%); 47% had history of smoking, 24% previous myocardial infarction, 7% previous stroke, and 51% diabetes; 52% presented with stable angina, 24% with unstable angina, and 22% with non-ST elevation myocardial infarction; and 70% were on aspirin, 44% on beta blockers, 18% on calcium channel blockers, 31% nitrates, 38% statins, and 2% nicorandil.TableMedianInterquartile rangeHeart rate (per minute)75.9(64.6, 87.2)Coronary flow reserve (CFR)3.51(2.18, 4.79)Index of microcirculatory resistance (IMR)22.8(14.8, 39.8)Fractional flow reserve (FFR)0.85(0.81, 0.90)Gensini score7.5(2.6, 18.6) Open table in a new tab This study describes initial experience in measuring IMR amongst patients with NOCAD at ACH. This cohort had a low burden of coronary disease. IMR provides useful diagnostic information that informs management.

P63 THE EQUIVOCAL AND DANGEROUS CLASSIFICATION OF STABLE CHEST PAIN

Abstract Background The classification of suspected anginal stable chest pain into typical, atypical, and non anginal is equivocal and may lead to patient perceptions and physician decisions that do not match the importance of the clinical picture. The study compares the clinical and ischemic burden with that of the cardiovascular risk. Methods Over 15 years, 3588 outpatients, >35 years old (mean 64±9, female 55%) were evaluated for stable chest pain. 290 patients with findings indicative of ischemic heart disease, heart failure, cardiomyopathy, valvular disease were excluded. In the others we applied the classification of typical, atypical and nonanginal pain (Table 1). All were evaluated for the presence of HEART score risk factors (smoking, obesity, family history of cardiovascular events, hypertension, diabetes, hypercholesterolemia) as well as age. All patients with typical or atypical angina and those with non–anginal pain according to the doctor‘s judgment performed functional tests to search for ischemia. Results In Table 2 we find the results of the classification of chest pain and the positivity of the functional test. In Table 3 we have the major events at follow–up stratified according to the initial assessment of chest pain. Table 4 stratifies events according to risk factors and age. Prognosis and event rate differ significantly only when stratified by risk factors and age. Approximately 1% presented a clinical event regardless of the type of pain and the presence of ischemia and 87% of the events involved patients with ≥ 3 risk factors or heavy smokers. 9% of heavy smokers aged <65 years had a major event and are the highest risk group with a peak of 12.5% ​​in those with atypical pain. Conclusions The traditional classification of stable chest pain is dangerous and misleading, both for the identification of ischemia and prognosis, which appears to be linked to the burden of cardiovascular risk and above all to cigarette smoking in patients aged <65 years, rather than the clinical and ischemic burden. It will be necessary to evaluate whether the anatomical burden for the search for high–risk coronary lesions improves the prognosis with an added value with respect to the treatment of lifestyles and risk factors.

P304 ACUTE ST–ELEVATION MYOCARDIAL INFARCTION DUE TO AORTIC DISSECTION: HISTORY OF A LATE DIAGNOSIS AFTER PRIMARY ANGIOPLASTY

Abstract Introduction We report a case of aortic type A dissection, involving the right coronary ostium, presented as an inferior STEMI. The aortic dissection diagnosis was formulated only after the coronary angioplasty on the right coronary was successfully done, leading to chest pain resolution. Dual antiplatelet therapy was administered. We want to underline how sometimes, mostly in emergencies, can be difficult to do the right diagnosis at the right time, even if some angiographic findings could help us to avoid life–threatening mistakes. Case presentation: 60 years–old man with typical angina chest pain started after an effort. The electrocardiogram showed ST elevation in inferior leads, while the echocardiogram akinesia of the inferior wall, a preserved EF, a normal diameter of the aortic root, no dissection signs, no pericardial effusion. The coronary angiography showed ostial RCA occlusion, critical stenosis in mid–distal LAD. Angioplasty on the RCA ostium with one drug–eluting stent (DES 3.5 x 18 mm) achieving reperfusion with TIMI 3 flow, complete resolution of ECG alteration and symptoms. Then PCI of LAD with DES was performed. During hospitalization in ICU recurrence of mild chest pain without ECG alterations. Routine echocardiogram performed the following day showed signs of aortic root dissection and moderate aortic valve regurgitation; an angio–CT scan was immediately performed confirming the aortic dissection, and cardiac surgery was immediately performed with good result. Reanalysis of the angiographic images showed some signs that should have made us think right away of an aortic dissection: abnormal convexity of the right coronary sinus, extravascular stagnation of contrast medium, and ostial RCA stent create a communication between the real and the false lumen, visible at the final injection. Conclusion Aortic root dissection, involving coronary ostium, could be a sneaky diagnosis since signs and symptoms could be very similar to myocardial infarction ones. A correct diagnosis is very important, leading to the right surgery treatment, the PCI and the dual antiplatelet therapy could lead to worsening outcomes. It is mandatory to pay attention to the signs that could help us doing the right diagnosis when we are performing coronary angiography. Always check the patient accurately during the ICU stay in order not to lose signs that can let us change the wrong to the correct diagnosis.

STUDY THE IN HOSPITAL MORTALITY AND MORBIDITY IN PATIENTS OF ACUTE MYOCARDIAL INFARCTION WITH RESPECT TO SERUM MAGNESIUM LEVELS

Magnesium improves myocardial metabolism, reduces platelet aggregation, decreases systemic vascular resistance, dilates coronary arteries, guards against catecholamine induced myocardial necrosis, and stabilizes cell membranes. Ventricular tachyarrhythmia, sudden cardiac death and re-infarction are frequently results of hypomagnesaemia in the early post-acute myocardial infarction (AMI) period. In this prospective observational study, all patients presenting in the emergency with Acute onset anginal chest pain and associated symptoms were screened for AMI by obtaining an Electrocardiogram and Biochemical Markers. For those diagnosed to have ST elevation myocardial Infarction were subjected to detailed clinical history and examination. Serum Magnesium levels and Electrolyte would be obtained within 6 hours of the admission. Patients were treated as per the standard line of management on the advice of the treating physician/ cardiologist. In the present study there is Summary: signicant association seen between serum magnesium level and arrhythmia, morbidity of the study subjects, need of ventilator support, mortality, history of alcoholics, serum potassium level and serum troponin. I level in the study subjects. On the basis of present study, it is concluded that Magnesium plays a cardinal role in management and prevention of complications related to cardio-vascular event and its estimation in acute myocardial infarction serves as a tool for assessment of severity of the disease and envisage possible adverse outcomes including prevention of morbidities and mortality associated with hypomagnesemia in acute myocardial infarction patients

Acute Coronary Syndrome Treated with Percutaneous Coronary Intervention in Hutchinson–Gilford Progeria

Hutchinson-Gilford progeria syndrome is an extremely rare genetic disease caused by a de novo mutation in the LMNA gene, leading to an accumulation of a form of Lamin A, called Progerin, which results in a typical phenotype and a marked decrease in life expectancy, due to early atherosclerosis and cardiovascular disease. We report the case of a fourteen-year-old Chinese boy with Hutchinson-Gilford progeria syndrome admitted to the emergency room because of precordial pain. Physical examination showed tachycardia 130 beats/min and arterial hypertension: 170/120 mmHg, normal respiratory rate, no neurological impairment; ECG evidenced sinus tachycardia, left ventricular hypertrophy, horizontal ST-segment depression in I, aVL, II, III, aVF leads, and V4-V6 and ST-segment elevation in aVR and V1 leads. Echocardiography highlighted preserved global left ventricular function with concentric hypertrophy, altered diastolic flow pattern, mitral valve insufficiency, and minimal aortic regurgitation. Blood tests evidenced an increase in high-sensitivity troponin T level (335 pg/mL). NSTEMI diagnosis was performed, and the patient was admitted to the intensive care unit. A coronary CT angiography showed a severe obstruction of the common trunk of the left coronary artery, for which an urgent percutaneous coronary intervention (PCI) was proposed. A selective coronary angiography imaged complete chronic occlusion of the left main coronary artery as well as severe stenosis at the origin of a very enlarged right coronary artery that vascularized the left coronary artery through collaterals. Afterwards, the right coronary artery was probed using an Amplatz right (AR1) guiding catheter, through which a large 3.5 mm drug-eluting coronary stent (Xience Sierra, Abbott, Abbott Park, IL, USA) was implanted. At the end of the procedure, no residual stenosis was imaged and improved vascularization of the left coronary artery distribution segments was observed. Dual antiplatelet therapy (DAPT) consisting of aspirin (75 mg daily) and clopidogrel (37.5 mg daily) and anti-hypertensive therapy were started. At the one-year follow-up, the patient had not reported any occurrence of anginal chest pain.

Cardiovascular risk factors and pericardial fat volume as predictors of coronary atherosclerosis burden in postmenopausal women: A retrospective, single center study.

Little is known about the clinical relevance of pericardial fat volume (PFV), compared to other conventional cardiovascular risk factors, as predictors of coronary atherosclerosis severity among postmenopausal women. Our main aim was to assess the association of PFV and cardiovascular risk factors with coronary atherosclerosis burden, including occlusive coronary artery disease (CAD) (luminal stenosis >50%), coronary artery calcium score (CAC)>100, and plaque types in postmenopausal women. Patients who had chest pain of angina and referred for 64-slice multi-detector CT (MDCT) angiography examination to exclude occlusive CAD presence were enrolled in this retrospective study. A total of 241 women with absence of menses for more than 2 consecutive years and not taking hormone replacement therapy were enrolled in the present study. Increased PFV(OR[CI] = 1.1 [1-1.3],p = 0.004), age (OR [CI] = 1.1 [1-1.4],p = 0.002), and diabetes mellitus (OR [CI] = 2 [1-4],p = 0.025)were significant predictors of occlusive CAD presence. Increased PFV(OR [CI] = 1.1 [1-1.4],p = 0.017)and increased age (OR [CI] = 1.2 [1.1-1.4],p < 0.001)were better predictors of CAC>100 than other cardiovascular risk factors. Regarding coronary plaque types, increased age (OR [CI] = 1.1 [1.1-1.3],p = 0.001)showed a significant association with coronary calcified plaque presence while increased body mass index(OR [CI] = 1.2 [1-1.4],p = 0.018)showed a significant association with coronary non-calcified plaque presence. Higher PFV values showed an independent association with occlusive CAD and significant coronary calcification. This may imply that increased PFV is likely associated with the development of advanced and severe phenotype of coronary atherosclerosis among postmenopausal women with suspected CAD.

The Prevalence of Frank’s Sign and the Diagnostic Accuracy in Coronary Artery Disease Among Chest Pain Patients at Lampang Hospital, Thailand

Background: One of the leading cause of death in Thailand is coronary artery disease (CAD). There are several studies that demonstrated a significant correlation between diagonal earlobe creases (DELC) or Frank’s sign and CAD, but data in Thai populations still remains unclear. Because of Frank’s sign is easily to observe by health-care professional including medical students, so it was very interesting to use to identify risk of atherosclerosis of the patients in hospital which has limitation of resources. The purpose of the study was to assess the prevalence of Frank’s sign and evaluate the diagnostic accuracy in CAD among the angina chest pain patients at Lampang Hospital. Methods: This study was a cross-sectional, observational, study. Three hundred and nine patients with angina chest pain who underwent coronary angiography (CAG) and followed up at the coronary clinic at Lampang Hospital were enrolled in the study. Both ears of the patients were inspected for Frank’s sign. The accuracy of Frank’s sign was confirmed by three cardiologists and clinical data was collected in medical record form. We excluded the patients whose earlobe could not be clearly observed, including those with keloid/ulcer on the earlobe or those with no earlobe. The correlation of Frank’s sign and CAD were analyzed by using logistic regression and receiving operative curve (ROC) curve. Results: 64.4% of the angina chest pain patients (N=199) have demonstrated for Frank’s sign, unilateral Frank’s sign in 12.3% (N=38) and bilateral Frank’s sign in 52.1% (N=161). Twenty-one patients (6.8%) were normal CAG and 288 patients (93.2%) were significant CAD, single vessel disease CAD (N=86), double vessel disease CAD (N=83) and triple vessel disease CAD (N=119). The diagnostic accuracy of the Frank’s sign revealed that 64.6% for the sensitivity and 38.1% for the specificity. Besides, the positive predictive value (PPV) was 0.935 and for negative predictive value (NPV) showed 0.073. Nevertheless, the positive likelihood ratio (LR+) was 1.032 and 0.947 for the negative likelihood ratio (LR-). Moreover, the area under the curve (AuROC) of Frank’s sign with respect to detection of CAD was 0.513 (95% Confidence Interval was 0.385-0.642, P= 0.838). Conclusion: Frank’s sign was observed in two-third of angina chest pain patients at Lampang Hospital and mostly of the patients with Frank’s sign were significant CAD. The results of this study showed that Frank’s sign was a simple, non-expensive and non-invasive method for medical student and health-care professional to identify risk of CAD.