Angiographic Coronary Artery Research Articles

Bioresorbable stent unloading during percutaneous coronary intervention: Early detection and management

In this letter, we comment on a recent case report by Sun et al in the World Journal of Cardiology . The report describes the successful management of a rare complication: The unloading or detachment of a bioresorbable stent (BRS) during percutaneous coronary intervention (PCI) in a male patient. The unloading of BRS was detected via angiography and intravascular ultrasound (IVUS) imaging of the left coronary artery and left anterior descending artery. Although this case is interesting, the authors’ report lacked crucial details. Specifically, insufficient information about the type of BRS used, potential causes of BRS unloading, or whether optical coherence tomography (OCT) imaging for coronary arteries was performed before, during, or after PCI. The OCT imaging of coronary arteries before PCI can potentially prevent BRS unloading due to its higher resolution compared to IVUS. In addition, despite detecting myocardial bridging during the PCI, the authors did not provide any details regarding this variation. Here we discuss the various types of BRS, the importance of OCT in PCI, and the clinical relevance of myocardial bridging.

Prevalence and Risk Factors of Renal Artery Stenosis in Patients Undergoing Simultaneous Coronary and Renal Artery Angiography: A Systematic Review and Meta-Analysis of 31,689 Patients from 31 Studies.

Background/Objectives: Renal artery stenosis (RAS) is associated with coronary artery disease (CAD), exacerbation of arterial hypertension, and progression to heart failure, but remains frequently unrecognized in clinical practice. Methods: We conducted a systematic review and meta-analysis of studies by pooling data of patients undergoing CAG due to suspected or stable CAD that received a bilateral renal artery angiography. Results: A total of 31 studies with 31,689 patients were included (mean age 63.2 ± 8.7 years, 20.9% were female). Overall, 13.4% (95%CI 10.5-16.7%) of patients undergoing coronary angiography had significant RAS, with 6.5% (95% CI 4.5-8.9%) and 3.7% (95%CI 2.5-5.2%) having severe and bilateral RAS. The mean weighted proportion of patients with three-vessel coronary disease (3VD) was 25.1 (95%CI 19.6-30.9%) while 4.2% (95%CI 2.6-6.2%) had left main (LM) coronary disease. Patients with RAS compared to those without RAS were significantly older (mean difference, MD 4.2 years (95%CI 3.8-4.6)). The relative risk of RAS was greater for the female sex (risk ratio, 95%CI; RR 1.3, 1.03-1.57), presence of diabetes (RR 1.2, 1.10-1.36), arterial hypertension (RR 1.3, 1.21-1.46), dyslipidemia (RR 1.1, 1.06-1.14), peripheral artery disease (PAD) (RR 2.1, 1.40-3.16), chronic kidney disease (CKD) (RR 2.6, 2.04-3.37), 3VD (RR 1.6, 1.30-1.87), and LM disease (RR 1.8, 1.28-2.47). Smoking had a neutral effect on the risk of RAS occurrence (RR 1.0, 0.94-1.06). Conclusions: RAS is common in patients undergoing coronary angiography. CKD, PAD, older age, and severe CAD were among the strongest predictors for the presence of significant RAS.

V-210.4: Empagliflozin effect in prevention of contrast nephropathy after coronary artery angiography or percutaneous coronary intervention.

V-210.4: Empagliflozin effect in prevention of contrast nephropathy after coronary artery angiography or percutaneous coronary intervention.

Imaging Challenge in Recurrent Spontaneous Coronary Artery Dissection (SCAD): A Case Report

Spontaneous Coronary Artery Dissection (SCAD) represents a significant cause of acute coronary syndrome (ACS) in patient populations with low-risk cardiovascular profiles and, therefore can be sometimes underdiagnosed. On the other hand, it often preserves the typical clinical presentation of ACS which makes coronary artery angiography (CAG) execution mandatory. A 62-year-old woman with a history of recurrent SCAD presented to the emergency department for a new episode of acute chest pain with troponin elevation. CAG revealed an ambiguous angiography image suggesting a sub-occlusive type 2 SCAD involving the distal segment of the left circumflex artery. The patient was managed conservatively due to the absence of ongoing ischemia or hemodynamic instability. At the seven-day follow-up, a computed tomography coronary angiography (CTCA) was performed to better assess SCAD and detect concomitant associated arteriopathies. Optimized medical therapy was prescribed at the discharge and at one-month follow-up, no recurrence of symptoms was referred.

Hyperpolarized Water for Coronary Artery Angiography and Whole-Heart Myocardial Perfusion Quantification.

Purpose: Water freely diffuses across cell membranes, making it suitable for measuring absolute tissue perfusion. In this study, we introduce an imaging method for conducting coronary artery angiography and quantifying myocardial perfusion across the entire heart using hyperpolarized water. Methods:1H was hyperpolarized using dissolution dynamic nuclear polarization (dDNP) with UV-generated radicals. Submillimeter resolution coronary artery images were acquired as 2D projections using a spoiled GRE (SPGRE) sequence gated on diastole. Dynamic perfusion images were obtained with a multi-slice SPGRE with diastole gating, covering the entire heart. Perfusion values were analyzed through histograms, and the most frequent estimated perfusion value (the mode of the distribution), was compared with the average values for 15O water PET from the literature. Results: A liquid state polarization of 10% at the time of the injection and a 30 s T1 in D2O TRIS buffer were measured. Both coronary artery and dynamic perfusion images exhibited good quality. The main and small coronary artery branches were well resolved. The most frequent estimated perfusion value is around 0.6 mL/g/min, which is lower than the average values obtained from the literature for 15O-water PET (around 1.1 and 1.5 mL/g/min). Conclusions: The study successfully demonstrated the feasibility of achieving high-resolution, motion-free coronary artery angiography and 3D whole-heart quantitative myocardial perfusion using hyperpolarized water.

Atropine sulfate may be effective to recover the unstable hemodynamics in coronary artery spasms related to atrial fibrillation ablation procedures.

Coronary artery spasms related to atrial fibrillation ablation procedures could cause lethal ventricular fibrillation or cardiopulmonary arrest. It may be useful to try intravenous atropine sulfate while preparing urgent coronary artery angiography in hemodynamically unstable coronary artery spasms cases to prevent development of the lethal arrhythmias.

Repeated acute coronary syndrome caused by a mind-bending mural thrombus in ascending aorta: a case report and review of the literature

BackgroundAcute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired).Case presentationWe report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward.ConclusionsAcute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus.

Dual-energy Computed Tomography in Coronary Artery Calcium Scoring

Computed tomographic (CT) coronary artery angiography with calcium scoring is crucial in suspecting coronary artery disease (CAD). The routine protocol for CAD radiological investigation involves a precontrast series for calcium scoring and a postcontrast series for investigating structural changes in coronary arteries. This review intends to investigate the feasibility of virtual noncontrast images to replace the true noncontrast (TNC) images in coronary artery calcium scoring to decrease the radiation dose. The current review included articles found in the PubMed database. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the further evaluation of the articles for inclusion criteria, 25 articles were finally shortlisted for the final review. It is found that the calcium score of coronary arteries estimated by virtual unenhanced images generated by dual-energy CT (DECT) is comparable with that of TNC images. The virtual unehncanced images has the potential to eliminate the need for the TNC series acquisition, thereby reducing the radiation dose. Especially, photon-counting detector-based DECT has excellent potential in the estimation of calcium scores and the reduction in radiation dose. In addition, contrast dose also can be significantly reduced, which is crucial in patients with renal insufficiency. In conclusion, using DECT for CAD investigations significantly reduces both radiation and contrast doses compared to conventional CT scans. This reduction is particularly crucial for patients who require repeated follow-up scans, as it enhances their safety and minimizes potential risks.

Abstract P514: Association Between Glycemic Disorder and Acute Coronary Syndrome Among Patients With Stable Coronary Artery Disease: A Propensity Score Matching Analysis

Background: Type 2 diabetes mellitus is known as a major risk factor of acute coronary syndrome (ACS) as previous studies reported. However, the association between prediabetes and ACS is not fully investigated among patients with stable coronary artery disease (CAD). Furthermore, no study has examined whether there’s effect modification by sex, age and BMI in the association between glycemic disorder and ACS. Our study aimed to evaluate the role of glycemic disorder in ACS occurrence among patients CAD. Methods: In this cross-sectional study based on electronic medical records (EMR), participants with CAD after elective coronary artery angiography (CAG) during 2016-2020 were enrolled. Diagnosis of prediabetes was based on patients’ HbA1c level ranging from 5.7% to 6.4% or fasting plasma glucose (FPG) level between 5.6 - 6.9 mmol/L. The diabetes diagnosis was defined as HbA1c ≥6.5% or fasting plasma glucose (FPG) ≥7.0 mmol/L. Multivariable logistic regression models were built to evaluate the association between prediabetes, diabetes and ACS, adjusting for age, body mass index (BMI), hypertension, low density lipoprotein, triglyceride level, statin and anti-platelet medication use. Subjects with prediabetes were matched 1:1 to healthy controls using propensity score matching to test the robustness of the result. In the subgroup analysis, we examined the heterogeneity of age, sex and BMI in the association between glycemic disorders and ACS. Results: Among 1525 participants, 1158 were male and 367 were female. Compared to participants with no diabetes, those with prediabetic were not significantly associated ACS, after adjusting for potential confounders. The result persisted after 1:1 propensity score matching. There was effect modification by sex in the association between glycemic disorders and ACS (P glycemic disorder*sex = 0.012). Female participants with diabetes, compared to those without diabetes, were positively associated with ACS (OR 2.00, 95% CI 1.00 - 3.98). The association between glycemic disorders and ACS remained stable among those with severe coronary stenosis. Conclusions: Our finding suggested that the association between prediabetes and ACS did not differ from those with normal glycemic status and CAD. The association remained consistent among those with severe coronary stenosis. Besides, sex modifies the association, and female participants with diabetes should be paid attention to their higher risk of ACS.

Correlation of High Sensitive C-Reactive Protein with the Extent of Coronary Atherosclerotic Disease

Background and objectives: The inflammatory process of the intima of coronary vessels is significant in the atherosclerotic process. We aimed to evaluate the role of high sensitive C-reactive protein in diagnosing and prognosis of ischemic heart disease and atherosclerosis. Methods: From 2021-2022, we randomly enrolled 100 patients referred to surgical specialty hospital/ cardiac center in Erbil City (Jan 2021- Jan 2022) for angiography complaining of a chronic coronary syndrome. Blood sampling was taken to measure (high sensitive C-reactive protein). Coronary artery angiography was done, and the extent of atherosclerosis was measured using the Syntax score and clinical syntax score using the calculator from internet site www.syntaxscore.org. Results: We enrolled 58 males and 42 females; 39% of patients had Diabetes mellitus, 49% had hypertension, 41% were smoker, 18% with peripheral arterial disease, 8% had chronic obstructive disease, and 3% with left primary illness. The study showed a highly significant linear correlation between high sensitive C-reactive protein and syntax score of 15±10.52 and clinical syntax score 26.68±12.17. Conclusion: The study concluded that a high sensitive C-reactive protein level is a reliable method to independently predict coronary artery disease in ischemic heart disease patients and the extent of severity; these results were not affected by sex category and other risk factors like diabetes mellitus, hypertension, or smoking.

Influence of COVID-19 pandemic in India on coronary artery disease clinical presentation, angiography, interventions and in-hospital outcomes: a single centre prospective registry-based observational study

ObjectiveThe study examined the influence of the COVID-19 pandemic in India on variation in clinical features, management and in-hospital outcomes in patients undergoing percutaneous coronary intervention (PCI).DesignProspective registry-based observational study.SettingA...

Nitroglycerin to Ameliorate Coronary Artery Spasm During Focal Pulsed-Field Ablation for Atrial Fibrillation

BackgroundIn treating atrial fibrillation, pulsed-field ablation (PFA) has comparable efficacy to conventional thermal ablation, but with important safety advantages: no esophageal injury or pulmonary vein stenosis, and rare phrenic nerve injury. However, when PFA is delivered in proximity to coronary arteries using a pentaspline catheter, which generates a broad electrical field, severe vasospasm can be provoked. ObjectivesThe authors sought to study the vasospastic potential of a focal PFA catheter with a narrower electrical field and develop a preventive strategy with nitroglycerin. MethodsDuring atrial fibrillation ablation, a focal PFA catheter was used for cavotricuspid isthmus ablation. Angiography of the right coronary artery (some with fractional flow reserve measurement) was performed before, during, and after PFA. Beyond no nitroglycerin (n = 5), and a few testing strategies (n = 8), 2 primary nitroglycerin administration strategies were studied: 1) multiple boluses (3-2 mg every 2 min) into the right atrium (n = 10), and 2) a bolus (3 mg) into the right atrium with continuous peripheral intravenous infusion (1 mg/min; n = 10). ResultsWithout nitroglycerin, cavotricuspid isthmus ablation provoked moderate-severe vasospasm in 4 of 5 (80%) patients (fractional flow reserve 0.71 ± 0.08). With repetitive nitroglycerin boluses, severe spasm did not occur, and mild-moderate vasospasm occurred in only 2 of 10 (20%). Using the bolus + infusion strategy, severe and mild-moderate spasm occurred in 1 and 3 of 10 patients (aggregate 40%). No patient had ST-segment changes. ConclusionsAblation of the cavotricuspid isthmus using a focal PFA catheter routinely provokes right coronary vasospasm. Pretreatment with high doses of parenteral nitroglycerin prevents severe spasm.

Correlation of serum ferredoxin 1 and lipoic acid levels with severity of coronary artery disease

To analyze the correlation of copper death inducer ferredoxin 1 (FDX1) and lipoic acid (LA) with the occurrence and severity of coronary atherosclerosis and explore their roles in coronary heart disease (CHD). We analyzed the data of 226 patients undergoing coronary artery angiography (CAG) in our hospital between October, 2021 and October, 2022, including 47 patients with normal CAG findings (control group) and 179 patients with mild, moderate or severe coronary artery stenosis (CHD group). Serum FDX1 and LA levels were determined with ELISA for all the patients. We also examined pathological changes in the aorta of normal and ApoE-/- mice using HE staining and observed collagen fiber deposition with Sirius red staining. Immunohistochemistry was used to detect the expression and distribution of FDX1 and LA in the aorta, and RT-PCR was performed to detect the expressions of FDX1, LIAS and ACO2 mRNAs in the myocardial tissues. Compared with the control patients, CHD patients had significantly lower serum FDX1 and LA levels, which decreased progressively as coronary artery stenosis worsened (P < 0.01) and as the number of involved coronary artery branches increased (P < 0.05). Serum FDX1 and LA levels were positively correlated (r=0.451, P < 0.01) and they both negatively correlated with the Gensini score (r=-0.241 and -0.273, respectively; P < 0.01). Compared with normal mice, ApoE-/- mice showed significantly increased lipid levels (P < 0.01) and atherosclerosis index, obvious thickening, lipid aggregation, and collagen fiber hyperplasia in the aorta, and significantly reduced expressions of FDX1, LA, LIAS, and ACO2 (P < 0.05). Serum FDX1 and LA levels decrease with worsening of coronary artery lesions, and theirs expressions are correlated with coronary artery lesions induced by hyperlipidemia.

Coronary artery angiography image vessel segmentation method based on feature pyramid network

Coronary artery angiography image vessel segmentation method based on feature pyramid network

Comparative study of treadmill test positive patients with coronary artery profile on coronary angiography in patient presenting with chest pain in BPKIHS, Dharan, Nepal

BACKGROUND Diagnosis of Coronary artery disease by Coronary artery angiography is limited by its availability, cost and as an invasive procedure. Treadmill test is a noninvasive and easily available test for diagnosing as well as prognosis of coronary artery disease and is most commonly performed stress test for diagnosis of coronary artery disease. Treadmill test is often used as an initial assessment of patient with suspected coronary artery disease serving as a poor man’s angiogram METHODS This was a cross sectional observational study carried out over a period from 25th August 2023 to 25th November 2023 in Department of Cardiology. A total of 100 patients with positive Treadmill test underwent CAG and subsequently analyzed for the presence of CAD were enrolled in the study. TMT test was done using Bruce Protocol and results were classified as positive and negative upon ECG changes. Data about Socio demographic profiles, clinical data, major comorbidity, the presumed risk factor for CAD were entered in MS Excel and analyzed through SPSS 25. RESULTS A total of 100 patients were enrolled in the study. Males were 45(45%) and females were 55(55%). The mean age of the patient was 53.38±16.7 years and 44.27±13.8 years in male and female group respectively. Smoking (82%) was the number one risk factor in male group and Hypertension (52%) in female group.. Significant CAD was seen in 33% of cases ad normal coronaries in 45%. The most common coronary artery involved having significant disease during coronary angiogram was LAD in 25% of cases CONCLUSIONS There was a significant correlation between positive TMT Results and coronary artery disease in coronary angiography.

Angiografía coronaria normal. Una forma de evaluar el uso apropiado de la indicación de este estudio.

Coronary angiography remains the gold standard when studying coronary artery disease. Currently, there are guidelines on how to do this diagnostic procedure and the diseases that require its application, however, a significant proportion of inappropriate exams are reported, with increased risk to patients and overall healthcare costs. This has not been evaluated in our country. In this study the last 500 normal consecutive coronary artery angiographies on patients with suspected coronary artery disease and 50 with severe 3 vessel disease. Three cardiologist with different experience, blinded to the coronariography results, were asked to review the clinical data of the 550 patients and decide if they would perform or not a coronary angiography. Then data were analyzed to identify potential causes for normal coronary angiographies. The results showed that in 100% of severe three vessel disease patients, cardiologist would perform coronary angiography and in normal exams, 60% would be performed, with 40% of them would have been inappropriate, similar to literature. We can conclude that normal coronary angiographies with a good indication exist and a significant proportion of exams should not have been done, suggesting a more careful application of guidelines and improved non invasive testing before invasive exams.

Clinical and Prognostic Value of Non-Fasting Lipoproteins and Apolipoproteins in Chinese Patients with Coronary Heart Disease.

Lipid profiles differ naturally between individuals and between populations. So far, the data relating to non-fasting lipid profiles has been derived predominantly from studies on Western population. The characteristics and clinical significance of non-fasting lipids in Chinese patients with coronary heart disease (CHD) in response to traditional Chinese diets remain poorly understood. A total of 1022 Chinese CHD patients with coronary artery luminal stenosis 40% as diagnosed by coronary artery angiography were enrolled in the study. All patients received standard treatment for CHD, including statins. They were divided into an intermediate stenosis group (luminal stenosis 40-70%, n = 486) or a severe stenosis group (luminal stenosis 70%, n = 536). Their blood lipid profiles were measured in the fasting state, and 4 hours after normal breakfast. All participants were followed up for five years. Major adverse cardiovascular events (MACE) including all-cause death, cardiac death, myocardial infarction, unscheduled coronary revascularization and stroke were recorded. After normal breakfast intake, patients with intermediate or severe stenosis showed an apparent increase in the levels of triglyceride (TG), remnant cholesterol (RC) and Apo (apolipoprotein) A1 compared to the fasting state, but a significant reduction in the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), Apo B and Apo E. In addition to the traditional risk factors (older age, male, diabetes and smoking) and coronary artery stenosis, the fasting levels of LDL-C and Apo B, as well as non-fasting levels of HDL-C and Apo A1, were identified as independent predictors of 5-year MACE occurrence by multivariate Cox proportional hazards analysis. Patients in the 1st tertile of the non-fasting HDL-C group ( 0.86 mmol/L) showed a significantly higher risk of MACE than 3rd tertile ( 1.07 mmol/L) (1st tertile: 2.786, 95% CI (confidence intervals) [1.808, 4.293], p 0.001). This prospective observational study found that lipid profiles in either the fasting or non-fasting states were associated with the long-term risk of MACE in Chinese CHD patients. In addition to the fasting LDL-C level, a low non-fasting HDL-C level may also be an independent risk factors for cardiovascular events. Measurement of lipid profiles during the non-fasting state may be feasible for the management of CHD patients in routine clinical practice in China.

Prognostic role of extracardiac incidentalomas detected with computed tomography in patients with severe aortic stenosis candidates for transcatheter aortic valve replacement

Abstract Background Aortic stenosis is one of the most common valvular heart diseases worldwide, especially among older individuals. According to the latest guidelines for the management of valvular heart disease, in patient with high surgical risk and aged 75 years and older, transcatheter aortic valve replacement (TAVR) is the first therapeutic option to be considered (1). Every patient undergoing TAVR should perform a computed tomography (CT) scan before percutaneous procedure. An incidentaloma is defined as an unexpected finding on a CT scan performed for another clinical reason. Purpose The purpose of this study is to determine the prognostic role of incidentalomas found on CT scan performed pre-TAVR procedure in elderly patients with severe aortic stenosis. Methods We performed a monocentric retrospective observational study of 284 patients with severe aortic stenosis evaluated for TAVR from January 2016 to December 2022. All data were collected retrospectively and processed anonymously. Patients' clinical data (past medical history, cardiovascular risk factors, comorbidities, echocardiogram and coronary artery angiography findings) were collected, and all CT scans were reviewed for the presence of incidentalomas. An incidentaloma was considered clinically relevant only if further investigations were required following its diagnosis. Statistical analyses were performed using Mann-Whitney test, uni- and multivariate Cox regression models. Only variables with p&amp;lt;0,05 on univariate analysis were included in multivariate models. The primary endpoint of the study was delay in TAVR implantation. The secondary endpoint was death. Results We analyzed 284 patients’ data with a median age of 87 (83-90) years. The median follow-up was 713 (464-1130) days in which 165 (58%) patients underwent TAVR and 83 (29%) deceased. Among the patients, 43 incidentalomas were diagnosed (Table 1). About primary endpoint, within patients who underwent TAVR, median delay to the procedure was 217 (160-284) days and there was not statically difference in delay between patients with or without incidentalomas (Mann-Whitney test p=0,08) (Figure 1). Furthermore, about the secondary endpoint, incidentalomas were not associated with death on univariate analysis (p=0,38) (Figure 2). Atrial fibrillation, chronic kidney disease (CKD), dilatation of left ventricle, left ventricular ejection fraction (LVEF) and TAVR were statistically significant among patients survived or not. LVEF was not associated with outcome (p=0,06) on univariate Cox regression analysis. In multivariate model (Table 2) TAVR reduced risk of death, instead CKD and dilated left ventricle increased risk. Conclusion Between patients with severe aortic stenosis candidates for TAVR presence of clinically relevant incidentalomas on CT scan was not associated with significant delay in procedure or death. Further studies are needed to prospectively confirm these results on a larger cohort of patients.Table 1 and Table 2Figure 1 and Figure 2

Simultaneous, free-breathing, non-contrast 3D whole-heart coronary magnetic resonance angiography and vulnerable plaque imaging in patients with suspected acute coronary syndrome

Abstract Background Coronary artery high-risk plaque identified on cardiovascular magnetic resonance (CMR) is associated with future coronary events, independent of coronary artery luminal stenosis. We have recently developed a 3-dimensional whole-heart free-breathing non-contrast CMR sequence that allows for simultaneous high-resolution visualisation of the coronary arteries and vulnerable plaque on co-registered bright and black blood images (iT2prep-BOOST) with 100% respiratory scan efficiency. Objectives To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI) against the reference standard imaging modalities of invasive X-ray coronary angiography and intravascular imaging [optical coherence tomography (OCT)/intravascular ultrasound (IVUS)]. Methods 41 consecutive patients with suspected NSTEMI, based upon clinical history, electrocardiographic changes and positive high-sensitivity troponin assays, were recruited into the study. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque rupture and thrombus). The highest plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analysed on iT2prep-BOOST. Results The mean iT2prep-BOOST acquisition time was 10.8 ± 1.3 minutes. The mean ± standard error of mean (SEM) PMR of culprit segments was significantly higher than non-culprit segments, which was significantly higher than normal segments (1.01 ± 0.05 vs. 0.67 ± 0.01 vs. 0.35 ± 0.01, P&amp;lt;0.001). Coronary segments with lipid, calcium and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P&amp;lt;0.001) but lower than segments with TCFA, plaque rupture and thrombus (P&amp;lt;0.001). There was a progressive increase in PMR with increasing degree of coronary stenosis (P&amp;lt;0.001). Patients with type 2 diabetes, hypertension, hyperlipidaemia and family history of coronary artery disease had a significantly higher PMR on iT2prep-BOOST (P&amp;lt;0.001, P=0.02, P=0.04 and P=0.02 respectively). Finally, PMR was positively correlated with HbA1c, total cholesterol, non-HDL cholesterol, LDL cholesterol and triglyceride levels (P&amp;lt;0.001, P=0.02, P=0.02, P=0.05 and P=0.05 respectively). Conclusions In summary, the proposed iT2prep-BOOST framework has the potential to simultaneously acquire coronary artery angiography and to differentiate normal segments from non-culprit and culprit plaque segments. Furthermore, PMR is associated with both biochemical and patient related risk factors for coronary artery disease (CAD). The long-term prognostic value of PMR needs to be investigated in a longitudinal multi-centre study of patients with suspected CAD.Figure 1Figures 2 and 3

Abstract 13492: Optimal Fluoroscopy Views and Catheter Selection for Coronary Angiography in Porcine Models

Coronary angiography is the gold standard for the diagnosis and treatment of epicardial coronary artery disease. Further, it is an essential tool for conduction of translational cardiac research on large animal models, in the development of novel cardiac therapies. While in humans coronary angiography has an exceedingly low mortality rate; in pigs, procedural mortality has been reported as high as 15%, likely due to unsuitable variations in angiographic techniques. Porcine models are used due to the resemblance of cardiac function and anatomy to humans. However, procedural guidelines delineating proper equipment to be used for angiography in this model has yet to be systematically assessed. Aims: To evaluate clinically common catheters for their utility in the safe engagement of the coronary vessels in pigs. Establish optimal workflow and fluoroscopy views for safe coronary artery engagement and angiography. Method/Results: Percutaneous superficial femoral artery access was acquired via ultrasound guidance and subsequent cardiac catheterization was performed in sus domesticus weighing 35-50 kg. Catheters that were tested included the JL 2.5, JL3.0, JR 3.0, AR1, AL1, MPA1, Champ1, 3DRC, hockey stick and RCB (5-7 french) operated over a standard .035 J tip wire. AP views were optimum to engage both the left and right coronary vessels. Only AR1, 3DRC, and hockey stick catheters successfully engaged the RCA, while all catheters tested could successfully engage the LCA. AR1 was noted to be the best for RCA engagement and AL1 for Left system engagement. AR1 was also the most succesful in engagement of both LM and RCA in same pig. AL1 provided the most stable engagement for Left coronary system. AR1/JL were better for LAD intervensions. AL1 is best for LCX intervensions Conclusion: We present a systematic description of percutaneous coronary angiographic procedures highlighting that AL for the LCA and AR for the RCA are the best choice of catheters for fastest and safest engagement of the coronary arteries limiting both radiation time and contrast use. While variations in anatomy can mandate changes in angiographic angles and catheter techniques, AP visualization and use of AL and AR catheters provided the most consistent and effective approach for porcine angiography.